Okay, next question that was submitted by Jamie. Jamie says, “Temporomandibular disorder is listed as a potential cause of IBS. Can you explain why or how this is a cause or how this is associated with IBS?”
Amy Nett: Temporomandibular disorder is actually correlated with irritable bowel syndrome, not causative. Lyndsey and I are going to try to get a paper in here for you guys that was published January 2017, two years ago, and it looks at the association of temporomandibular disorders in patients with irritable bowel syndrome, and overall what they found is that IBS patients had more than three times greater risk of temporomandibular disorder when compared with healthy controls and that the risk of having temporomandibular disorder was similar in the different IBS subtypes, again IBS-C, IBS-D.
There have been many other studies that have shown that patients who have IBS and temporomandibular disorder are often more pain sensitive. This is another thing to think about in those patients, that they may have a different pain response. It’s interesting because there have been numerous studies that have shown IBS overlaps or coexists with a number of different medical conditions that don’t have a really logical connection with the gut. One of the really common ones is fibromyalgia. Again, I know that diagnostic term is only semi-useful, but again, fibromyalgia, temporomandibular disorder, as you mentioned, chronic pelvic pain, these are all correlated with IBS. I don’t know that it’s well understood why that’s the case, but there is interesting research on those correlations.