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Ileocecal Valve Dysfunction

LET’S START AT THE BEGINNING:

How Does Digestion Work?

In short, when we eat and drink, everything is broken down in stages into what is known as chyme (or chymus). Chyme refers to the semi-fluid mass of partly digested food expelled by a person’s stomach through the pyloric valve into the duodenum of the small intestine. Chyme results from a bolus’s mechanical and chemical breakdown in the digestive tract; a bolus is a small, rounded mass of chewed food when swallowing and comprises partially digested food, water, hydrochloric acid, and various digestive enzymes.

Functions of the Small and Large Intestines:

The small intestine is similar to the kitchen area of our bowel. Its primary role is to absorb all the nutrients and fluids from our food. Ordinarily, chyme moves through the small intestine (via peristalsis) while this process occurs. After food material has been processed and absorbed in the small intestine, all leftover waste should then move into the large intestine (or colon), where it is expelled from the body.

What Is The Ileocecal Valve, And What Does It Do?

The last portion of the small intestine is known as the ileum. It joins onto the first portion of the large intestine, called the cecum. Between these two sections of the bowel is the ileocecal valve (ICV)—a small sphincter (two circular muscles) located in the same area as the appendix in the lower right quadrant of the abdomen. Specifically, the ICV is located approximately halfway between the belly button and the Anterior Superior Iliac Spine (ASIS) or hip bone (See Figure 1). After food material has been processed and absorbed in the small intestine, all leftover waste product should move through the ICV into the large intestine, where it is expelled from the body. The ICV, when functioning normally, allows for this forward movement while preventing any waste product from flowing back into the small intestine.

Ileocecal Valve Dysfunction
Figure 1: Location of the Ileocecal Valve (ICV)

LET’S GET TO THE PROBLEM:

Ileocecal Valve (ICV) Dysfunction or Syndrome:

The ICV can become stuck in an open or closed position for many reasons we will cover below. Theoretically, an open ICV is likely to present predominantly with loose stools or diarrhoea; a closed ICV, with constipation. However, it is important to clarify that one may experience neither or both. Often, what is initially thought to be an appendix problem is an issue with the ICV. ICV dysfunction is found frequently in the general population— possibly up to 90% of people and often goes undiagnosed.

In normal circumstances, the ICV: 

  • is closed most of the time
  • opens briefly to let the contents of the small intestine move into the large intestine. 
  • closes again quickly to prevent any materials in the large intestine from moving back into the ileum of the small intestine. 

Problems occur if the valve stays open too long or not long enough. 

An Open Valve:

When the ICV becomes stuck in an open position, chyme is likely to move through the gut too rapidly (i.e. diarrhoea), thus compromising the small intestine’s ability to absorb fluids and nutrients effectively. In addition, if the valve remains open or doesn’t close quickly enough, waste products and bacteria in the large intestine may back up into the small intestine and be reabsorbed, leading to irritation of the intestinal lining and an increased risk of systemic toxicity and inflammation (overburdening of the liver), reduced immunity, and the development or onset of degenerative or autoimmune conditions. In addition, the resulting overcrowding of the wrong kind of bacteria in the small intestine can lead to severe gas and bloating.

A Closed Valve:

In contrast, when the ICV becomes stuck in a closed position or doesn’t remain open for long enough, faeces cannot efficiently move past the small intestine, i.e. constipation. In this case, due to the slow transit time, the small intestine may continue to absorb the waste products and toxins before they reach the large intestine for expulsion—again leading to irritation of the intestinal lining and an increased risk of systemic toxicity and inflammation (overburdening of the liver), reduced immunity, and the development or onset of degenerative or autoimmune conditions. In addition, with the ICV stuck in a closed position and chyme backing up, one may become constipated and be more prone to bloating in the upper and lower abdomen, and acid reflux (heartburn).


SO WHAT CAUSES ILEOCECAL VALVE (ICV) PROBLEMS?

There are several reasons why the valve may not work correctly:

  • Digestion: overeating; eating too frequently or too quickly; under-chewing your food; not enough stomach acid (hypochlorhydria) or digestive enzymes (congenital sucrase-isomaltase deficiency, exocrine pancreatic insufficiency (EPI), lactose intolerance).
  • Diet: consuming excessive spicy or roughage-type foods; food sensitivities; excessive cooked food; not enough raw food; a high carbohydrate/low protein diet; not eating enough healthy high fibre foods including whole food nutrition (fresh fruits and vegetables); a diet high in processed foods, inflammatory grains and refined sugars (chocolate, popcorn, non-foods, junk foods etc.); excessive alcohol, caffeine or carbonated drinks; excessive white flour, chemical food additives and artificial colourings.
  • Chronic dehydration.
  • Stress or emotional trauma: think about the gut and the vagus nerve connecting to the brain—the gut-brain axis (GBA). Thoughts affect our gut health and vice versa; for example, a gut reaction, grief, resentment, and an inability to let go.
  • Appendicectomy: having had your appendix removed. Some researchers believe that the appendix, located right next to the ICV, acts like an overflow for toxins and holds these until the body can work them out slowly so as not to interrupt the workings of the ICV.
  • Prolonged courses of antibiotics or other drugs may lead to an imbalance of the gut microbiome—known as dysbiosis.
  • Imbalances or deficiencies of digestive enzymes—specifically from the pancreas, stomach and small intestine. 
  • Imbalances or deficiencies of nutrients.
  • Constitutional or familial factors.
  • Physical weakness—too little or too much exercise disturbing the digestive system.
  • Energy drains—phones, too much screen time, electromagnetic pollution, overwork. 
  • Postural misalignment—especially from hip issues, jaw problems and upper thigh muscle wastage.
  • SIBO (Small Intestine Bacterial Overgrowth).

The Bowel Hormone Storm:

In addition, ICV dysfunction may be the result of a hormonal imbalance:

  • Eating a diet high in carbohydrates, containing inflammatory grains or highly processed foods will imbalance our blood sugars.
  • This may cause a knock-on effect on digestive hormones such as motilin—a hormone released in the upper small intestine, which stimulates gastric and small intestine motility, thereby causing undigested food to move into the large intestine.
  • Imbalanced blood sugars facilitate the production of adrenaline and cortisol, which can cause the oesophagus to go into spasm, increase the production of stomach acid, and reduce pancreatic enzyme output.
  • With heightened stress, muscle tension can occur; most notably, the leg muscles can rotate in the legs, which can misalign the pelvis. In turn, this can misalign the ICV and cause digestive disturbances and pain.
  • With high insulin, high cortisol and impaired motilin and serotonin, we will likely see an increase in stress and oestrogen and a reduction in sex hormones like progesterone—this can significantly impact fertility and compromise the early stages of pregnancy. Also, remember that 95% of the body’s serotonin is produced in the gut. Changes in serotonin levels will affect the gut, brain and one’s mental and emotional health.
  • High oestrogen and gut disturbances contribute to elevated histamine levels, increased inflammation and a heightened immune response, which can present as allergies or food sensitivities/intolerances. Remember, oestrogen and other hormone receptors exist in the gut.
  • Several gut hormones are found to be the critical signals involved in the gut-brain crosstalk and human energy metabolism, such as ghrelin, PYY, GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and CCK, all of which are released in response to the ingestion of food and act to modulate different functions of the central nervous system (CNS), which in turn governs metabolic control.

If the body cannot process and balance hormones effectively, one stays on the blood sugar rollercoaster with an increased desire to eat erratically (See Figure 2). 

In relation to the hormonal aspect of ICV dysfunction, treatment aims to balance digestion, identify and avoid food intolerances, balance blood sugars and reduce stress.

Ileocecal Valve Dysfunction: The Bowel Hormone Storm
Figure 2: The Bowel Hormone Storm

THE GREAT MIMICKER:

ICV dysfunction is responsible for a myriad of symptoms and is sometimes called “the great mimicker” due to the wide range of symptoms that can manifest as a result of its dysfunction. An individual can have any of the following symptoms. However, when treated appropriately, it can make a big difference in how a person feels.

Ileocecal Valve (ICV) Syndrome Symptoms:

  • Digestion: chronic diarrhoea or loose stools; chronic constipation; abdominal pain; gas; borborygmus (gurgling); right-sided groin pain; bloating; distended belly; burping or belching; indigestion; general non-specific lower GI discomfort; right-sided lower abdominal pain (ICV); left-sided lower abdominal pain (the valves of Houston).
  • Digestive Disorders: Inflammatory Bowel Disease (IBD) (i.e. Ulcerative Colitis or Crohn’s Disease); Irritable Bowel Syndrome (IBS); Diverticulitis; Spastic Colon; Celiac Disease; Small Intestinal Bacterial Overgrowth (SIBO).
  • Headache or Migraine; sharp, pinpoint headaches (especially on the left side at the base of the skull); dull frontal headaches.
  • Joint pain; arthritis; shoulder or neck pain; frozen shoulder; bursitis-like pain in the shoulders and hip joints; right-sided hip or groin pain; carpal tunnel syndrome; right-sided shoulder pain at night.
  • Lower back pain: Ideopathic lower back (pain for no reason); sudden, stabbing or sharp lower back pain; pseudo-sacroiliac strain.
  • Leg pain—particularly right-sided; burning leg pain (that feels like a nerve) radiating into the front of the left thigh.
  • Nerve Impingement.
  • Muscular aches and pains.
  • Chest pain; palpitations; pain around the heart.
  • Dizziness; lightheadedness; faintness; vertigo; blurred vision.
  • Flu symptoms; feverishness.
  • Chronic fatigue; post-viral fatigue; general lethargy.
  • Pseudo-hypochlorhydria (deficiency of stomach acid).
  • Sudden or chronic thirst.
  • Nausea.
  • Tinnitus (ringing in the ears); fullness/pressure in the ears.
  • Recurrent or chronic sinus infections; sinusitis.
  • Post nasal drip.
  • Allergies; asthma-like symptoms; food or environmental sensitivities; hay fever.
  • Bad breath; body odour.
  • Depression; low mood; anxiety.
  • Skin conditions: eczema; psoriasis; acne, pallor (pale complexion); dark circles under the eyes; hives (urticaria); puffy cheeks.
  • Women’s health and fertility: painful periods (dysmenorrhoea), endometriosis, Polycystic Ovary Syndrome (PCOS).
  • Oedema: fluid retention or swelling.
  • Candida or fungal overgrowth. 
  • Symptoms that improve after getting out of bed and moving around.
  • Symptoms that intensify while lying down or at night.

LET’S GET TO THE SOLUTION:

How To Treat The Ileocecal Valve (ICV):

There are several steps necessary to return the ICV to normal function.

Physical Manipulation of the Valve:

The ICV functions under nerve control—specifically the vagus nerve. Physical manipulation or massage can correct improper nerve control in the short term. However, unless procedures are implemented to reduce irritation to the already inflamed and irritated bowel, ICV dysfunction will likely return. Your practitioner can provide lifestyle and dietary advice, and recommend nutritional supplements to aid digestion and reduce inflammation. For four weeks, therefore, one should follow the additional recommendations below.

Open vs. Closed Valve:

Our approach to treatment of the ICV will depend on whether we are looking at an open or closed valve.

Treating an Open Valve:

Low blood volume may cause the valve to lose its tension and “stick”—usually in an open position.

We should look at several things to treat an open valve problem. These are as follows:

  • Firstly, one can massage or hold the valve shut by adhering to the following steps:
    • Place both thumbs over the ICV.
    • Making sure to keep your thumbs flat, press straight down into the abdomen towards the back.
    • While continuing to press deeply, push upwards towards the left shoulder for 20-30 seconds—bearing in mind that this can be particularly uncomfortable. Pain may be localised or refer superiorly into the chest or stomach area, posteriorly into the back or distally into the groin or down the right leg. If you feel acute pain when pressing on this spot, it is likely to be an open ICV problem, which can feel more or less tender depending on the individual and the severity of ICV dysfunction. Locating the tender spot(s) while lying down may be easier.
  • Secondly, one can place a cold pack over the valve for approximately 15 to 20 minutes. A cold pack can be particularly valuable with a long-standing, difficult-to-treat ICV dysfunction. This should comprise cold tap water, not ice.

Both steps above should be repeated as necessary. 

In addition, one may do the following:

  • Add lactic acid yeast wafers to one’s diet. These can be sourced at any health food store or online.
  • Eliminate roughage-type foods; if the problem is an open valve and diarrhoea is a primary symptom, one should eliminate all roughage-type foods for four weeks; for example, whole grains, nuts, seeds, legumes, raw fruits and raw vegetables.
  • Chlorophyll may help to heal an open ICV. Also, chlorophyll complex perles contain fat-soluble vitamins, including vitamin K, and can be helpful for pain relief.

Treating a Closed Valve:

  • A closed valve is often caused by a hypertonic or spastic intestinal muscle, which can be the result of a deficiency of magnesium, usable calcium, low stomach acid (hypochlorhydria) and/or digestive enzymes.

We should look at several things to treat a closed valve problem. These are as follows:

  • Calcium, Magnesium, Vitamin D: add calcium (or silicon when calcium can’t be absorbed), magnesium and vitamin D to one’s diet.
  • Digestive Enzyme Supplementation: consider whether digestive enzyme supplementation may be required. Foods rich in natural digestive enzymes include kiwifruit, fig, papaya and pineapple, which contain proteases to help break down proteins, and mango and avocado, which have amylases to help break down carbohydrates and starches.

Treatment of both Open and Closed Valve Types:

What to do:

In addition to the above instructions specifically related to treating an open or closed ICV, the following advice applies to the treatment of both open and closed ICV types:

  • Eat your food slowly. 
  • Chew your food properly before swallowing.
  • Firstly, take garlic oil soft gels, two with each meal, for two or three days—expediting the elimination of any harmful toxins and pathogens in the small and large intestines. Alternatively, one may take raw garlic—beginning with half a small clove of raw, crushed garlic and working up to one small clove per meal for two to three days. Liquid chlorophyll works just as well, but garlic may be more readily available.
  • Drink 6 to 8 glasses of water per day.
  • Resolve Dysbiosis (Imbalance of the Gut Microbiome) by taking a high-strength probiotic:
    • Vivomixx or VSL#3: At Acupuncture West London, we recommend and stock Vivomixx and VSL#3.
    • Acidophilus (maximum dosage): you can request this at any pharmacy.
    • Kefir: alternatively, one can take 5fl. oz. of Kefir per day. However, If you are prone to constipation, we recommend acidophilus or other probiotics instead of kefir.
  •  Oils: add flaxseed, hemp or olive oil to your diet.
  •  Increase your fibre intake with steamed/soft cooked vegetables.
  •  Increase your fibre intake with steamed/soft-cooked fruit.
  • Resolve imbalances or deficiencies of nutrients:
    • Zinc and Vitamin B6 are necessary to produce hydrochloric acid and maintain the integrity of the intestinal wall.
    • Vitamin A is necessary to build a healthy mucosal and intestinal lining.
    • L-glutamine, an amino acid and key building block of protein, is essential to intestinal repair.

What not to do:

The following foods should be eliminated from one’s diet for four weeks:

  • Refined sugars: cakes, biscuits, sweets, chocolate, cocoa, etc. However, you may use the following natural and plant-based sugar substitutes:
    •   inulin—also a great prebiotic.
    •   stevia
    •   erythritol
    •   date sugar
    •   organic coconut sugar
    •   yacon syrup or palmyra blossom nectar
    •   honey or maple syrup (as a last resort and strictly in moderation)
  • Caffeine, green tea and black tea.
  • Alcohol and liquors.
  • Spicy foods and peppers: black pepper, cayenne pepper, chilli powder, cinnamon, cloves, hot peppers, paprika, salsas and tacos.
  • All roughage: chunky peanut butter, crackers, corn chips, nuts, popcorn, crisps (potato chips), pretzels, seeds, whole grains. 
  • All raw fruits and vegetables: salads, celery, cabbage, lettuce, carrots, apples, oranges, pickles, tomatoes, etc. Most fruits and vegetables may be consumed when cooked, as the cooking process breaks down the roughage. However, fruit or vegetables with a rough exterior, for example, potatoes, should be peeled before cooking.
  • Cruciferous vegetables: cabbage, broccoli and any food that creates gas.
  • Pulses and legumes: lentils, beans, sweet corn, chickpeas, etc.
  • Fermented foods: beans, miso paste, tempeh, soy sauce, vinegar, etc. 
  • Bran, granary bread or croissants. 
  • Millet. 
  • Seeds, buckwheat, oats.
  • Dried fruit (prunes, apricots, etc). 
  • Sun-dried tomatoes. 
  • Mushrooms (including powdered forms), marmite, blue cheese or fungae. 

Below is a non-exhaustive list of foods one may eat during these four weeks:

  • White rice, white pasta and white bread (including ciabatta, baguettes, white sourdough, white wheat, and white gluten-free). 
  • Meat and fish. 
  • All vegetables—as long as they’re peeled and cooked. 
  • All fruit—as long as they’re peeled and cooked. 
  • Bananas.
  • Avocado. 
  • Quinoa.
  • Smooth peanut butter. 
  • All dairy.
  • Chickpea flour. 
  • Tinned tomatoes. 
  • Fresh tomatoes—as long as they’re cooked. 
  • Tofu. 
  • Eggs. 
  • Potatoes. 
  • Rice cakes. 
  • Hummus. 
  • Oat and almond milk. 
  • Coconut (milk, flour, cream, flakes). 
  • Tahini. 
  • Vinegar (balsamic, apple cider). 
  • Mustard. 
  • Tamari/soya. 
  • Ham/salami. 
  • Smoked salmon. 
  • Polenta. 
  • Tapioca. 
  • Goats cheese/butter/yoghurt/milk. 
  • Lemon/lime juice. 

ADDITIONAL ADVICE:

Dietary and Lifestyle Advice:

  • The soluble fibre pectin can help an inflamed and sensitive large intestine and provide a temporary protective coating for the gut; one example is apple pectin. Apple sauce or a peeled, cored apple pureed in a blender every few hours is an easy way to get pectin. Under-ripe Granny Smith apples typically contain the most pectin, and bananas are also a good source.
  • Test for typical food allergies, intolerances and sensitivities to ensure you consume the best foods for you; for example, our AWL Certified Sensitivity Test.
  • Take digestive enzymes 10 minutes before meals and/or look at supplements that improve enzyme production, reduce cortisol levels (the stress hormone), balance excess oestrogen, and regulate bowel movements. At Acupuncture West London, we recommend and stock Digestive Enzymes Ultra 90’s (Pure Encapsulations).
  • Assess and realign one’s posture.
  • In the case of bacterial or fungal infections (candida), one should seek advice on taking anti-bacterial and anti-fungal herbs: for example, andrographis, oregano oil, allicin-releasing garlic supplements, and bitter herbs like dandelion, milk thistle and artichoke.
  • For bloating, one can take activated charcoal—2 to be consumed 2/3 hours away from food, as it may otherwise absorb nutrients from food.
  • Drink warm, soothing, anti-inflammatory chamomile, meadowsweet or marshmallow root tea throughout the day.
  • Manage stress levels with lemon balm, ashwagandha (or Shui Qie), passionflower, etc. At Acupuncture West London, we recommend and stock Shui Qie (Ashwagandha) 60’s (Pure Encapsulations).
  • Please avoid using your microwave, as it kills active food enzymes and compromises food’s nutritional value.

Detoxification and The Lymphatic Drainage System:

Most importantly, we can use acupressure to manipulate specific points and reflex areas to stimulate the lymphatic drainage system and detoxify the body (see Figure 3). After manipulating these points, one may often hear a “gurgling” sound near the ICV.  

In some instances of long-standing ICV problems, it may be valuable for the individual to stimulate specific nerve areas at home. Your practitioner will guide you to this effect. One can work on each indicated area for 15 to 20 seconds several times a day until the bowel “gurgles” or symptoms subside.

Ileocecal Valve Dysfunction: Detoxification and The Lymphatic Drainage System
Figure 3: Detoxification and The Lymphatic Drainage System

Acupuncture for Ileocecal Valve Dysfunction:

Finally, in addition to the guidelines above, acupuncture in conjunction with massage of the ICV is vital in treating ICV dysfunction. Weekly acupuncture sessions for four to five weeks will help to support and expedite the detoxification process, reduce systemic inflammation, calm the immune system, alleviate symptoms and balance the gut.


MAINTAINING THE ILEOCECAL VALVE (ICV) MOVING FORWARD:

Raw fruits and vegetables are not recommended for a malfunctioning ICV. However, maintenance is key once the ICV has been reset and the protocol above has been completed. One should now eat a fibre-rich diet that includes whole food nutrition; for example, fresh organic or locally sourced fruits and vegetables, superfoods and digestive supplements.


 OTHER FACTS ABOUT THE ILEOCECAL VALVE (ICV):

  • The broad spectrum of problems is usually related to toxicity and intestinal dysfunction. 
  • Colon cleanses, or colonics, are not recommended for ICV dysfunction. 
  • Certain medications may compound the problem: for example, antidepressants, antacids, antihistamines, diuretics, etc.
  • The use of laxatives may lead to dehydration and the loss of electrolytes, irritation of the intestinal lining, cramping and urgency.
  • The ICV is the only site in the GI tract that facilitates the absorption of vitamin B12 and bile acid. 
  • Approximately two litres of fluids enter the large intestine daily through the ICV.
  • Tumours of the ICV are rare but have been reported.
  • The ICV is sometimes known as Tulp’s valve after Dutch physician Nicolaes Tulp (1593-1674).
  • If the ICV isn’t functioning correctly, it will struggle with raw foods.
  • If fruit causes bloating or worsens symptoms, the ICV could be the cause.
  • The Valves of Houston or Houston folds are a set of semi-lunar transverse folds of the rectal wall that protrude into the rectum. They are located on the opposite side of the abdomen to the ICV on the left lower quadrant and can have similar problems to the ICV. When the Houston folds are out of balance, haemorrhoids may develop. Both Houston and Ileocecal valves can be out of balance concurrently.
  • A hiatal hernia will often cause frequent gas and bloating and may be caused by improperly digested proteins that accumulate in the intestinal tract and contribute to inflammation. 
  • A high percentage of people with a hiatal hernia may also have an open ICV 

You may only have a few of the symptoms caused by the ICV, but if you don’t take action to stop and correct these issues, you risk the onset of diseases that can reduce your quality of life.


Disclaimer:

Remember that these dietary recommendations are general guidelines, and individual needs may vary. It’s essential to listen to your body and consult with a healthcare professional or registered dietitian if you have specific dietary concerns or restrictions.


WHAT DO OUR PATIENTS THINK?

“Ben’s acupuncture is absolutely incredible! It was my first time experiencing acupuncture and Ben made the whole experience incredibly rewarding with his calm energy and professionalism. I would highly recommend going if you have any pains or migraines, but also if you just want an overall boost in energy and mood. I would definitely recommend to anyone. 10/10 service!”

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“I went to Ben for daily headaches and anxiety disorder. Other health issues I have: Digestive issues (15 years +) Psoriasis PCOS Dry Eyes. I have had 5 sessions and am still currently receiving treatment but the progress so far is: Anxiety – immediate significant improvement. Headaches – improvement. Dry eyes – CURED. Generally i feel so much better in myself, i have more energy and theres so much more space and movement in my body, i am over the moon with the results…”

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REFERENCES

  • Stoddart A. Conversations at The New Southfields Clinic (2019-2023).
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  • Murray, N. (2021) Ileocecal valve syndrome: Symptoms and treatmentBotanica Health. Available at: https://botanicahealth.co.uk/the-great-mimicker-ileocecal-valve-syndrome/ (Accessed: 30 November 2023).
  • Ileocecal valve syndrome (no date) Duben Holistic Chiropractic. Available at: https://www.docduben.com/ileocecal-valve-syndrome (Accessed: 30 November 2023).
  • Ileocecal valve syndrome (no date a) Specialized Physical Therapy. Available at: https://www.specializedptms.com/faq/ileocecal-valve-syndrome (Accessed: 30 November 2023). 
  • The ileocecal valve (2023) Functional Kinesiology. Available at: https://www.functionalkinesiology.co.uk/ileocecal-valve/ (Accessed: 30 November 2023).
  • Manipulating ileocecal valve syndrome for Better Health. Available at: https://www.healthydirections.com/articles/digestive-health/how-to-manipulate-your-ileocecal-valve-for-better-health (Accessed: 30 November 2023).
  • Ileocecal valve in Ventura, CA (2019) Gerckens Chiropractic & Wellness Center. Available at: https://gerckenschiropractic.com/services/the-total-person-concept-of-health/ileocecal-valve/ (Accessed: 30 November 2023).
  • Germani, P., Zucca, A., Giudici, F. et al. Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study. Updates Surg 73, 569–580 (2021). https://doi.org/10.1007/s13304-020-00845-z
  • ShafikAA AIA, Shafik A, Wahdan M, Asaad S, El Neizamy E (2011) Ileocecal junction: anatomic, histologic, radiologic and endoscopic studies with special reference to its antireflux mechanism. Surg Radiol Anat 33(3):249–256
  • Shafik A, El-Sibai O, Shafik AA (2002) Physiological assessment of the function of the ileocecal junction with evidence of ileocecal junction reflexes. Med Sci Monit 8(9):CR629–CR635
  • Malbert CH (2005) The ileocolonic sphincter. Neurogastroenterol Motil 17(Suppl. 1):41–49
  • Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, Vorisek V, Kopacova M (2010) Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 16(24):2978–2990
  • Grace E, Shaw C, Whelan K, Andreyev HJ (2013) Review article: small intestinal bacterial overgrowth—prevalence, clinical features, current and developing diagnostic tests, and treatment. Aliment Pharmacol Ther 38(7):674–688
  • Roland BC, Ciarleglio MM, Clarke JO, Semler JR, Tomakin E, Mullin GE, Pasricha PJ (2015) Small intestinal transit time is delayed in small intestinal bacterial overgrowth. Clin Gastroenterol 49:571–576
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  • Roland BC, Ciarleglio MM, Clarke JO, Semler JR, Tomakin E, Mullin GE, Pasricha PJ (2014) Low ileocecal valve pressure is significantly associated with small intestinal bacterial overgrowth (SIBO). Dig Dis Sci 59:1269–1277
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  • Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

 

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Comment ( 1 )

  • Suzy

    Wow, very comprehensive. Thanks for the info. I’ve had a chiropractor share that I likely have ICV challenges. Thus definitely confirmed my current struggle and I learned SO MUCH!! Thanks again.

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