In this module, you will learn about the many symptoms of gastrointestinal imbalances, including skin problems like psoriasis and eczema, gallbladder problems, seasonal allergies, food sensitivities, and mood disorders. You will learn how to assess your own gastrointestinal function using functional medicine tests as well as through assessment of “reflex” points known as Chapman’s reflexes in chiropractic and Front Mu points in Chinese Medicine.
Gastrointestinal Assessment & Evaluation
Signs and Symptoms of GI Dysfunction
Physical Signs of Nutritional Deficiencies of the GI System
Abdominal Examination: Standard and Functional
Somatovisceral Reflexes (Chapman’s Reflexes).
Blood Test Interpretation of Gastrointestinal Dysfunction from a Functional Medicine Perspective
References
Appendix
JAOA: Presence of Chapman Reflex Points in Hospitalized Patients with Pneumonia
Signs and Symptoms of GI Dysfunction
Hypochlorhydria and/or Pancreatic-Insufficiency
Bloating shortly after a meal
Poor appetite (loss of taste for meat)
Supplements cause upset stomach
Food allergies
Burping/belching
Anemia (Iron/B12) unresponsive to supplementation
o Diseases Associated with Hypochlorhydria
Psoriasis
Acne Rosacea
Urticaria
Thyroid dysfunction
Eczema
Osteoporosis
Autoimmune disease
Gastric Irritation (gastritis, ulcer, H.pylori)
Heartburn
Acid reflux
Sour taste in mouth
Stomach pain/cramps
Increased stomach pain with HCI and/or digestive enzyme supplementation
Pancreatic/Small Intestine Dysfunction
Belching 1 hours after a meal
Undigested food in stool
Food allergies
Gluten sensitivity
Liver/Gallbladder
Greasy foods upset stomach
Sour taste in mouth
Nausea
Dry skin
Chemical sensitivity (smoke perfume/diesel fumes
Pain in the right upper quadrant of the abdomen
Light colored stools
Signs and Symptoms of GI Dysfunction (con’t)
Bowel Dysbiosis/Intestinal Hyperpermeability
Sinus congestion
Alternating constipation
Mood swings, mental confusion (yeast?)
Coating on tongue (also noted in liver dysfunction)
Foul smelling stool
Bad breath
Anal itching
Bloody stools, mucus in stools
Strong body odor
Dark circles under the eyes
Diseases Associated with Intestinal Hyperpermeability
Acne
Autism
Celiac disease
CFIDS
Childhood hyperactivity
Eczema
IBS/IBD
Pancreatic insufficiency
Psoriasis
Urticaria
Stool Characteristics
Pale (yellow or white)
o Malabsorption
o Celiac
o Bile acid synthesis defect
o Cholestasis (biliary disorders)
o Hepatitis (liver disorders
o Jaundice
o Steatorrhea
o Pancreatic dysfunction
Green
o Antibiotic use
o Gastroenteritis
Salmonella
Giardia
Signs and Symptoms of GI Dysfunction
Stool Characteristics
Dark/Black
o Internal bleeding
o Intestinal polyp
o Cancer
o Iron supplementation
o Licorice
o Beets
o Ulcers
Bloody (rectal/GI Bleeding)
o IBD
o Gastroenteritis
o Polyps
o Hemorrhoids
o Anal fissure
o Cancer
Mucus (inflammation of intestines)
o Colitis
o Pancreatitis
o Bowel dysbiosis
o Food allergies
o IBS/IBD
o Celiac disease
o Parasites
Foul Smelling
o [sticky, increased fat (steatorrated, floats)]
o Pancreatic insufficiency
o Dysbiosis
o Pancreatitis
o Bile duct obstruction
(Note: Steatorrhea can be caused by infections, medications, IBD, and celiac disease)
Physical Signs of Nutritional Deficiencies of the GI System
Abdominal Examination: Standard and Functional
B2, B3, B6, B12, Folic Acid, zinc, iron, biotin
Angular Stomatitis
Cheilosis
B2, B3, biotin, B6, iron
Esophagitis
Proctitis
Niacin
Hepatomegaly
Protein, fat
Ascites
Protein
The Functional Physical Exam
In the 1930’s, Dr. Frank Chapman, an osteopathic physician identified neurolymphatic reflex points that corresponded to specific organs and glands. He observed discrete tissue texture changes at specific anatomic locations for specific organ/gland pathology. Most resources indicate the possibility of an autonomic nervous system connection. The tissue changes have been described as small, smooth and firm, usually about 2-3 mm in diameter when found alone, while the pattern may be irregular if the points are found in groups. Tissue biopsy studies have been unable to demonstrate the reflex change, however, a research article published in the Journal of the American Osteopathic Association in October, 2003 concluded that there was a statistically significant relationship between the presence of Chapman reflex points classified for lung and the potential diagnosis of pneumonia.
These points, known as Chapman’s Reflexes, can be used as diagnostic indicators of the potential for organ/gland dysfunction. The points have also been used for treatment. I recommend obtaining the book “An Endocrine Interpretation of Chapman Reflexes” for a more in depth discussion.
Blood Test Interpretation of Gastrointestinal Dysfunction from a Functional Medicine Perspective
The following is a compilation of patterns and changes that suggest GI dysfunction. They are not absolute and are often empirical. If you observe these patterns, further investigation is required. Remember to integrate all lab test results with the patient history and physical examination.
Hypochlorhydria
Increased Decreased
MCV >90.0 Phosphorus < 3.0
MCH >31.9 Total Protein (or normal)
Anion Gap CO2
Total globulin >2.8 Alk phos
BUN >16
Note:
1. Decreased alk phos indicates zinc deficiency
2. Increased anion gap indicates a need for B1
3. Confirm Hypochlorhydria with subjective complaints (gas, bloating, etc)
4. Total globulin may decrease with an inflammatory process
[Zinc and B1 are needed for the production of HCI]
[Heidelberg pH capsule test can be used to assess for Hypochlorhydria, Hyperchlorhydria, Achlorhydria, Pyloric insufficiency]
Pancreatitis
Increased Decreased
ALT/AST Calcium
Lipase
Amylase
MCV
Triglycerides
1. Serum amylase is also increased in acute cholecystitis
2. Serum lipase levels are increased in pancreatic and biliary diseases
o Often 5 to 10 times normal values in pancreatitis
Common causes: alcoholism, gallstones, smoking, cystic fibrosis, high triglycerides, infection, hyperparathyroidism
Pancreatic Insufficiency
Inability of the exocrine pancreas to produce enough digestive enzymes to break down food in the intestine.
Malabsorption, malnutrition, steatorrhea
Caused by pancreatitis, cystic fibrosis, AA
Stool analysis may be the best test to evaluate for pancreatic insufficiency
Elastase
Produced and secreted by the pancreas
Hydrolyses amides an esters
Low levels are observed in pancreatic insufficiency
o Trysin (low levels)
o Fecal fat (high levels)
Cirrhosis of the Liver
Increased Decreased
ALT Albumin
AST Cholesterol
Alk Phos RBC magnesium
Amylase
Total bilirubin
LDH
Liver Dysfunction
Increased Decreased
ALT/AST Cholesterol
LDH Triglycerides
Bilirubin Protein
Ferritin BUN
Gilbert’s Syndrome
Increased
Unconjugated (indirect) Bilirubin
Symptoms: Usually none; possible: jaundice, fatigue, abdominal pain
Cause: inherited gene abnormality of phase II liver detoxification pathway.
More side effects with medications
Fatty Liver (>10% of liver weight)
Can cause inflammation (steatohepatitis)
Causes: obesity, diabetes, medications, viruses, toxins
Increased
ALT
LDH
Alk Phos
Biliary Insufficiency/Stasis (decreased production of bile/bile too thick)
Possible causes: Hypochlorhydria, hormone imbalances (high estrogen levels), diet, liver dysfunction
Increased
GGTP
Alk Phos
Cholesterol
Note: Labs may be normal. Check subjective indications – gas, bloating, pain between the shoulder blades, pain over the
eyes, light colored stools.
Biliary Obstruction
Increased
GGTP
Alk Phos
Total Bilirubin
ALT
AST
Note: If GGTP is >150 u/l and total serum bilirubin is >2.8 mg/dL refer to qualified physician.
Chronic Renal Dysfunction
Increased
BUN
Alk phos
Creatinine
CRP
Phosphorus
Uric Acid
Triglycerides
Digestive Inflammation (Leaky Gut Syndrome, gastritis, IBD/IBS)
Increased Decreased
Globulin Albumin
ALP isoenzyme Phosphorous
MCV/MCH HCT
HGB
Potassium
Intestinal Parasites
Increased
IgE
Basophils
Monocytes
Eosinophils
Note: If you observe these increased levels a [comprehensive stool analysis] is recommended. This will be discussed in
detail in future modules.
References
1. Balancing Body Chemistry with Nutrition, Dr. Harry Eidenier, Jr., referenced and reprinted with permission
2. Osteopathic Medicine Recall, Andrew D. Mosier, Dai Kohara
3. Digestive Wellness, 3rd ed, Elizabeth Lipski, Ph.D., CCN
4. Journal of the American Osteopathic Association; JAOA, Vol 103, No 10, October 2003
