IAH AC Gastrointestinal Disease

Gastrointestinal Disease 

IAH AC Gastrointestinal Disease 

© IAH 2007 

1

Body surfaces 

• Skin = 

2 square metres 

• Respiratory tract = 

80-100 square metres 

• Urogenital tract = 

60-80 square metres 

• GIT = 300-600 square metres 


2 

The gastrointestinal tract is one of the most specialized organs in the body. 

It is the largest surface of the body in contact with the outside world, and through 

evolution has become very specialized in order to assure optimal absorbtion of 

nutrients, yet to keep invaders and toxins on the outside. 

It has a surface of 300-600 square metres, and through the luminal surface will 

be in direct contact with toxins, gases and of course the nutrients that is needed. 

2

The intestinal mucosa 

• Has the paradoxical function of: 

• Barrier 

• Filter 

• The barrier function of the mucosa is demonstrated in the 

following two slides: 

• Graphic 

• Pictorial 


3 

For this purpose, the gastrointestinal mucosa has a paradoxical function, that of 

a very specialized filter, but at the same time also a very selective barrier. 

As a filter it needs to allow the passage of nutrients, but at the same time act as a 

barrier to toxins and other undesired substances. 

It is thus clear that this will need a very specialized arrangement. 

This will be viewed on the next slides 

3

5 

liver 

blood 

4 

receptor for e.g. 

corticotrophic hormone 

immune system 

tight junction 

3 

food particles 

bacteria 

gut lumen 

1. 2 

mucous and 

unstirred water layer 

the intestinal barriers 


4 

The intestinal tract and the liver comprise of 5 barriers which will keep undesired 

particles out of the body. 

These are: 

1. The mucous and water layer covering the mucosa on the luminal side 

2. The symbiotic bacteria, which through their numbers form a passive barrier on 

the luminal side, so that toxins do not come into contact with the gut lining, but 

also will use certain toxins in their metabolism, and therefore will render them 

harmless before they even come into contact with the mucosa. 

3. The tight junction. This is the most important barrier, and is not an anatomical 

barrier, but rather a channel, which closed integrity is kept up by active action 

of the adjacent mucocytes. This means that the cells need energy and fuel to 

be able to keep up this physiological function. Should the energy in the 

epithelial cell fall, or there are not enough nutrients, this barrier will be 

impaired. Infections, stress and toxins, like alcohol can all affect this important 

function. 

4. The gut immune system or GALT form the 4th barrier (see later) 

5. The liver is the last barrier, as all the blood from the gut drains to the liver via 

the portal vein, and toxins can be finally metabolised and made harmless 

here, or made water soluble for excretion. 

4

The mucosal barrier 

• From the gastrointestinal 

brochure 

Heel Inc., USA, October 2004: 

Text: Alta Smit 

Graphics: Andrew Mingione 


5 

The Gut associated lymphoid tissue (GALT) is the largest aggregation of immune 

competent cells in the body. 

The loosely aggregated lymphoid tissue in the lamnia propria,and the so called 

Peyers patches, as well as the tonsillar rings of Waldeyer forms the GALT. All 

antigens which get into the post mucosal location will be processed by the GALT. 

A deeper barrier is formed by the mesenteric lymph nodes, which are the biggest 

in the body. 

The immune reaction will differ due to the frequency of contact and the 

concentration of the antigen. Small concentrations of antigens which has a short 

exposure will induce tolerance, whereas high concentrations of antigens with 

longer exposure will tend to induce inflammation. 

This is important when we look at the effect of low concentration antigens later in 

the lecture. 

The gut lining is further a small PNEI (Psycho –neuro- endocrine-immune) 

system in its own right. 

For instance, the mucocytes have got receptors for Cortico Releasing Hormone 

(CRH) and will respond to stress with increased permeability. 

The gut brain axis, has been well researched, and plays a major role in the gut 

diseases associated with a psychosomatic component, like Irritable Bowel 

Syndrome and Inflammatory Bowel Disease (see later) 

5

• Antigen presenting cells 

• Intraepithelial cells 

• Dendritic cells 

• Neutrophils 

• Macrophages 

recognition 

Antigen is presented mostly 

via the MCH II. 

In some patients this is 

aberrant and leads to IBD 

activation 

T cell response, non-specific 

local immune response, with 

mast cell as transducer 

response 


6 

Determination of which immune reaction will be induced, will depend on the 

antigen presenting cell taking up the antigen. 

In the gut a special class of APC’s (antigen presenting cells) namely certain 

dendritic cells will respond differently to different antigens. This will start the 

differentiation into a tolerant reaction or an inflammatory reaction. 

Dendritic cells will respond to the antigens presented by a special class of cells, 

the M cells in the epithelium, or directly to antigens getting through the tight 

junction. 

Some patients will be genetically predisposed to generate an inflammatory 

response, rather than the normal tolerant response in the gut. 

This will predispose then to diseases like Crohn’s disease. 

A large body of research is now available in these individual differences in the 

immune response in the gut. 

6

The function of the mucosal lining 

as an immune organ 

• Permeability 

• MHC secretion 

• Antigen presentation 

• Secretory component 

• Adhesion molecule 

• Presentation 

• Immunocyte chemo 

• Attractants 

• Antimicrobial activity 


7 

The epithelium itself plays a very important role in immunity. 

Through the integrity of the Tight Junction, the size of antigens is controlled, so 

that under normal physiological conditions, only small amounts of antigen is 

processed by the GALT. This leads to natural tolerance. 

The gut further secretes Major Histocompatibilty proteins, especially Type II 

which play a role in antigen presentation. 

The M cells interspersed between the epithelial cells are specialized Antigen 

Presenting cells. 

IgA is the major antibody active in the gut, but needs a secretory component to 

function. 

This is provided by the mucosal cells. 

The mucosa will also secrete chemokines which under special conditions will 

attract immune cells to the gut by virtue of chemotaxis. 

Lastly the gut lining will secrete several antimicrobial peptides, which plays a role 

in host defense. 

7

The antigenic response in the gut 

• Is always geared towards tolerance and anti-inflammation 

• Mediated by the Th2, Th3 helper cells and the T suppressor 

cells 

• The activation of this is dependent on the 

• Concentration of the antigen 

• Type of antigen presenting cell 

• Specific antigen presenting cells will take up homeopathic 

dilutions in D1-14 dilution, which will induce TH3 cells and 

secrete TGF-beta 


8 

By nature, and for obvious reasons the immune reaction in the gut is geared towards a TH2 type 

response, thus a tolerant response. 

Furthermore, the gut has the most of the inducible type T reg cells, namely TH3 cells. 

These cells are stimulated in the gut lining when the concentration and the frequency of the 

antigen exposure is very short and very low concentration. 

This has been seen by Heine and his co workers to be the case with low diluted plant material, 

such as Traumeel and certain suis organ extracts. 

Schmolz, Manfred; Heine, Hartmut 

Homöopathische Substanzen aus der Antihomotoxischen Medizin modulieren die 

Synthese von TGF-ß1 in menschlichen Vollblutkulturen. Biologische Medizin 2001; 

nr 2 61-65 

This natural reaction towards tolerance ensures that we do not make an inflammatory response to 

the food we eat, which contains substances which we do not necessarily use. 

However when the integrity of the gut lining is disturbed, the amount of antigen that could enter 

into the body is so high that it can cause an inflammatory response. 

Some patients will be genetically predisposed to generate an inflammatory response, rather than 

the normal tolerant response in the gut. 

This will predispose then to diseases like Crohn’s disease. 

A large body of research is now available regarding these individual differences in the immune 

response in the gut, and forms the part in the quest to find the aetiology of inflammatory bowel 

disease as well as to design new treatment strategies. 

8

Breast is best!! 

Photos: WHO Ethiopia 


9 

The gut lining in an infant is wide open to allow for the absorption of vital factors 

in breast milk, such as transfer factors amongst others. 

It closes at about 20 months when intestinal permeability is fully established 

under physiological conditions. 

Till then, breast milk will also gear the gut immune response towards tolerance, 

so that breast fed babies are known to have fewer allergies in later life. 

If a baby is fed foreign protein, like the casein in cows milk, for instance, too early 

allergy will ensue. 

9

Vaccination 


10 

Due to the fact that the immune system is so well balanced in the gut, orally given 

immunizations such as polio, is much more tolerable, as they are processed with 

the T reg cells on stand by if the response will overshoot. 

Polio is such a vaccine. 

10

Environment 


11 

The gut is at onslaught of the environment in the form of drugs like 

chemotherapies, lifestyle toxins such as alcohol and what is in food, as well as 

the scourge of our modern times, the stress factor. 

From the above it should be clear that psychological stress has a devastated 

effect on the gut lining and will contribute significantly to systemic disease. 

Heavy metals, from amalgams and food also damage the gut lining, and can 

cause dysbiosis. 

Chemo and radiation have a special devastating effect on the gut lining, as it will 

in fact affect the fast turnover tissue, of which the GIT mucosa is one together 

with the gonadal cells and the hair follicle. 

In all patients who has received chemotherapy, the gut needs to be seen to be 

damaged. 

11

Mucosal distress (1) 

• Term refers to the breakdown in the integrity of the mucosal 

surface so that one or more of the above mentioned functions 

cannot be carried out 

• It seems that when one mucosa is affected in one organ, all the 

mucosae are affected 

(Rosales 2004) 

• The result is not only local disease, but also systemic disease 


12 

From modern investigation, it is becoming clearer that patients having disease in 

one mucosa, is probably affected in all mucosae. 

This comprise the so called mucosal stress syndrome, and was examined by 

Rosales in 2004, where he could show for instance that patients presenting with 

a disease process in one mucosa, such as the respiratory mucosa is also likely to 

suffer from GIT and vaginal symptoms. 

Rosales-Estrada M: Mucosal inflammation syndrome in allergic disease. 

Journal of Biomedical Therapy Winter 2007 : 3-5 

Due to the fact that the gut mucosa is so large, and relatively easily affected 

orally, this can form the point of entry to restore mucosal integrity in other 

locations as well. 

In many cases of immune modulation, the mucosal membrane is thus the 

preferable point of entry into the body. 

12

Mucosal distress (2) 

• Examples, where mucosal breakdown is implicated in disease: 

• Inflammatory bowel disease 

• Arthritis (sero-negative and rheumatoid arthritis) 

• Septicemia following extensive burns 

• Allergy 

• Skin disease e.g. psoriasis 


13 

Many systemic diseases are now linked to mucosal distress, such as IBD, where 

it is for instance known that patients suffering from Crohn’s disease will have a 

higher incidence of leaky gut just before a relapse, and that a high percentage of 

their siblings will have a leaky gut,even without having Crohn’s disease. 

Rheumatoid arthritis is closely linked with bacterial endotoxins in the gut, to the 

point that tetracycline is a common treatment for RA. If the gut is leaky, more of 

these endotoxins can enter the body and cause disease. 

The mucosa also leans itself to manipulation of the immune system in these type 

of diseases. 

A large number of researches are currently looking at the effect of oral tolerance 

on disease. For e.g., in Crohn’s disease: 

Margalit M, Israeli E et al. 

A double-blind clinical trial for treatment of Crohn's disease by oral 

administration of Alequel, a mixture of autologous colon-extracted 

proteins: a patient-tailored approach. Am J Gastroenterol. 2006 

Mar;101(3): 

13


14 

Increased permeability( so called leaky gut ) plays a tremendous role in the 

development of disease. 

Like the Austrian Physician FX Mayr already said so dramatically, ‘The death 

lurks in the gut.’ 

Above are the factors which will increase the physiological opening in the 

diameter of the tight junction. 

The mechanism will vary in the different cases. NSAIDs can both damage the 

mucosa, but also interfere with the energy production of the cell, so that the 

mucocyte cannot ensure the integrity of the tight junction. 

Especially infestations, like worms and parasites can cause a ‘leaky gut’ 

Even after a normal viral infection, like a rota virus, a child will have a leaky gut 

for a few weeks. 

Burns patients and multi trauma patients often die of overwhelming infection, not 

from the wounds, but from the endotoxins absorbed through the gut lining which 

opens under this stressful conditions. 

The role of the stress hormones have already been mentioned. Psychological 

stress affects the gut brain axis, which in turn will cause an increase in the 

permeability of the gut, and predispose to disease. 

14

Vicious cycles of changed permeability 

• Immune activation or suppression 

• Food intolerance 

• Hepatic overload 

• Bacterial dysbiosis 

• Low grade pancreatitis (partially digested foods) 


15 

Increased permeability will led to a couple of vicious cycles: 

The first is an increase in food intolerance and also changes in the immunity. 

The immunity goes down when the symbiotic bacteria are not stimulating the 

immune system enough, whereas if the food and toxic particles get into the gut 

lining in too high quantities,it will set off an inflammatory process. (see the next 

slides) 

The liver, being the last barrier, will bear the brunt of chemicals and 

environmental toxins leaking through the gut lining, and all patients with a leaky 

gut should be considered to have liver overload. 

The symbiotic bacteria and the gut lining have a very special relationship. 

The gut lining, if healthy, will maintain a milieu for the bacteria, and conversely, 

the bacteria will in their metabolism secrete substances such as propionic acid, 

which will act as a fuel source for the gut cells. New evidence even suggest this 

symbiotic relationship to exist to the point where there is cell to cell 

communication between the bacteria and the gut lining. If the permeability is 

disturbed this is lost, and dysbiosis will ensue. 

Lastly we see a low grade malapsorbtion, as the exocrine pancreas is affected. 

15

I. Allergy and inflammation 

• Locally in gut 

• Neutrophils(frustrated neutrophil) 

• Lymphocytes 

• Chemical mediators 

• Mast cells, histamine 

• Bradykinin 

• Serotonin 


16 

Inflammation in the gut locally can cause a lot of tissue damage. This is mediated 

by the neutrophils part from the process outlined in the previous slide. If the food 

particles are too big for the neutrophil to engulf it totally the peroxides etc. which 

the neutrophil secreted to inactivate the toxins, will leak out of the cell, causing 

damage to the adjacent tissue. 

This is the concept of the so called ‘frustrated neutrophil’ 

Furthermore, a paracrine reaction will also take place and serotonin and 

bradykinin will be secreted. 

Last but not least is the role of the mast cell. The mast cell is a type of 6th sense 

in the gut, and respond very quickly to set off a whole chain of events. 

TH 1 cells are also activated in the view of large amount of antigens, and TNF 

alpha, the major cytokine secreted by TH1 cells is responsible for a lot of the 

phenomena we see in diseases like Crohn’s. 

This will set of another vicious cycle of inflammation and tissue damage. 

In diseases such as Crohn’s , we see for instance a deficiency in TGF beta, so 

that repair of the gut is also impaired. 

Immunomodulation as a pillar is a very important part of the treatment of patients 

with increased intestinal permeability. 

16

Lactose intolerance, not immune-regulated 

• Often from birth (familial) 

- Germany 10% 

- Asia and Africa 90% 

Therapy by substitution of lactase (Lactizyme, Digestizyme) 

• Diagnosis through the Hydrogen Breath Test 

• Secondary after parasitic, viral, bacterial infections, reversible 

after cure 


17 

Several conditions can cause problems in the gut lining, such as lactose 

intolerance as well as celiac disease. 

Both of these have a genetic component, but gets worse when the permeability 

goes up. 

Lactose intolerance is due to a inborn absence,or an acquired absence of the 

enzyme lactase, which will digest the milk sugar in diary products. 

A high incidence exist in Africa and Asia where it is mostly genetic, but it can also 

be caused by for instance temporary damage to the gut mucosa, such as can 

occur after infection. 

The test to diagnose this comprise blowing exhaled air into a machine, which will 

measure hydrogen. 

If too high, lactose intolerance is diagnosed. 

It can be treated by replacing the missing enzyme, or in the case of acquired 

lactose intolerance, by treating the underlying cause as well. 

The role of intestinal permeability in celiac disease is depicted in the next slide. 

17


18 

The above slide depict the importance of increased intestinal permeability in the 

development of celiac disease. 

The gliadin from gluten together with the tight junction proteins are taken up by 

the dendritic cells and will stimulate both a TH1 and TH2 response, both which 

has damaging effects. 

Apart from the local inflammation which is caused by this, we also see the 

systemic manifestations which can be the result of such a leaking of gliadin 

through the open gut lining. 

This forms the basis of many auto immune diseases which are increasingly seen 

to be associated with increased intestinal permeability. 

18

Food allergies 

Positive skin test 

Positive test meal 

Peanut 

26 

12 

Chicken egg 

19 

10 

Cow’s milk 

17 

7 

Soy 

10 

2 


19 

There is a lot of confusion between food intolerance and food allergies. 

Food allergy always means a immune reaction involving IGE, whereas food 

intolerance are often mediated by neutrophils and can give a rise in IgG or even 

IgM. 

True food allergy can become a medical emergency. 

Above are examples of food allergy and their incidences in the German 

population 

19

Cross allergies 

• Birch pollen 

• Apple, peach, apricot, celery (raw), 

• Hazelnut, cherry, almonds, kiwi fruit, fennel 

• Wormwood pollen 

• Celery, fennel, dill, aniseed, carrot, caraway, 

• Pepper, paprika, mango, melon, cucumber, chilli 

• Grass pollen 

• Tomato, pulses, grains 

• Natural latex 

• Bananas, avocado, grains 


20 

It is also important to note that a number of cross allergies exist, where a patient 

may have an allergy to pollen, and then have a cross allergy to food. 

The reverse is also true. 

For instance, a patient who develop a allergy to bananas may suddenly react to 

latex gloves. 

20

II. Liver overload 

• All the blood from the gut drains through the liver, this will cause 

an overload of toxic material if the gut is too permeable 


21 

Liver overload is the second vicious cycle of the leaky gut, as all the blood of the 

gut drains through this organ via the portal vein. 

It is important to keep in mind that all patients with increased intestinal 

permeability will have a liver overload, and by inference a systemic toxicity. 

Detoxification and drainage as a pillar is thus of high importance when treating 

patients with a leaky gut. 

21

III. Bacterial dysbiosis 

• Bios = Life, sym = with 

• Dys symbiosis: outcome not good 

• Yeasts: problem for systemic immunity 

• Parasites more often seen e.g. Blastocystis hominis 

• E. coli and other pathogens can be the main culprit 


22 

We live in harmony with some bacteria in the gut and have developed a good 

relationship with them. 

There is even cross talk between the proteins of these bacteria and the cells of 

the body. 

When this balance is disturbed, we see a condition of dysbiosis, which can be 

quite dangerous. 

Friendly bacteria belong to the Lactobaccilus group, etc. 

Dysbiosis can be caused by protozoan parasites (Entamoeba histolytica, 

Entamoeba coli, other Entamoeba, Dientamoeba fragilis, Endolimax nana, 

Giardia lamblia, Blastocystis hominis, Chilomastix mesnili, and others); yeast 

(Candida albicans, other Candida species, Torulopsis glabrata, and others); or 

bacteria (Salmonella, Shigella, Campylobacter jejuni, Yersinia enterocolitica, 

Klebsiella pneumoniae, Citrobacter freundii, Citrobacter diversus, Proteus 

mirabilis, Pseudomonas aeruginosa, some strains of Escherichia coli, 

Staphylococcus aureus, some strains of Bacteriodes, Clostridium difficile, and 

others). 

22

Gut milieu 

luminal contents and pH 

bacteria 

immunity: 

strains important 

e.g. Acidophilus DDS, Rhamnosus 

barriers see 

before 


23 

Symbiotic bacteria is vital for our health. The important role has been seen in 

animal experimentation, when the gut is sterilized, these animals will die of 

infection. 

The relative non pathogenic antigens of these friendly bacteria will stimulate the 

immune system of the GALT and keep it ready for infection. 

Symbiotic bacteria have a host of other actions, such as metabolizing certain 

toxins in the gut, such as heavy metals. 

Some of the metabolites of symbiotic bacteria, such as propionic acid serves as 

fuel for the enterocytes. 

The bacteria contribute to the good milieu in the lumen of the gut and keep the 

pH in the optimal range. 

They also give competition to invaders by competing for resources. 

Lastly, they for part of the passive barrier, so that toxins will not even come into 

contact with the gut lining. 

It is clear from the above that the inoculated bacteria should be live in order to 

recolonize the gut. For immune stimulation the proteins in the cells walls are 

sufficient, but for tall the other functions, live bacteria is needed. 

A cold chain for the transport of the bacteria is thus of utmost importance. 

This can be difficult, in a practical way, but is of such importance that it should be 

the ideal situation 

23

Some symbiotic bacteria 

Ingredient 

Function 

Lactobacilli: main species: 

lactobacillus acidophilus 

Bifidobacteria: main species: 

bifidobacterium longum 

Most important in aerobic milieu; assist 

apart from other functions formation of 

dextro-rotatory lactic acid 

The most common in the anaerobic 

milieu, and apart from other functions 

degrade harmful substances 

Dextro-rotatory lactic acids 

Energy source for the mucosal cells 

Ballast or roughage 

Stimulate the peristalsis 


24 

This give an overview of the main functions of the two main species of symbiotic 

bacteria 

The role of the dextrorotatory lactic acids such as propionic acid has been 

mentioned above. 

24

IV. Low grade pancreatitis 

liver 

Toxic bile 

Common bile duct 

pancreas 

Toxic bile leaks unto head of exocrine pancreas: 

end result is maldigestion 


25 

Due to the retrograde leaking of toxic bile into the pancreatic duct, a low grade 

exocrine pancreatitis is seen over time. 

This will impair the ability of the pancreas to secrete digestive juices, and a 

maldigestion will ensue. 

In some patients the pancreatitis is severe enough to cause a rise in the amylase 

level, but this is rare. 

If one does special tests, though, such as a CDSA (Comprehensive Diagnostic 

Stool Analysis), a number of undigested food fibers are seen in in the stool of 

these patients. 

25

Mucosal support 

• Four “R” Regime of mucosal support 

• Remove all noxious factors 

• Food 

• Homotoxins 

• Replace all factors mucosa need 

• Nutrients 

• ENERGY (Catalysts) 

• Repair the gut lining 

• Reinoculate good bacteria 


26 

The way to approach the leaky gut is through a 4 R regime, that of 

remove, replace, repair and reinnoculate. 

This regime will aim to remove all noxious toxins and pathogenic bacteria, as well 

as to replace all the nutrients which are needed for the body to regulate and 

especially for the enterocytes to ensure health of the gut lining. 

The repair need to be supported with specific antihomotoxic medicine. 

Lastly the inoculation of live bacteria should complete the regime. 

26

Homotoxicology approach 


27 

This antihomotoxic regime is used for patients who are seen to have a leaky gut. 

When one treats diseases which are accompanied by a leaky gut, we see that 

the three pillars will go a long way to treat this component as well, as the basic 

organ support of Mucosa compositum and catalysts are included in most of the 

advanced three pillar therapy schemes. 

Nux vomica-Homaccord is a very good functiotropic remedy in the case of any 

gut syndrome, and Hepar compositum has a colonic and pancreatic extract in it, 

which will support the gut and pancreas further. 

If there are symptoms of moderate to severe pancreatitis one can add Momordica 

compositum, but in most cases Hepar compositum will be sufficient. As the 

pancrestitis is low grade. 

Traumeel and organ extracts are used to induce the T reg cells in the gut lining, 

and restore tolerance in this way, as well as reduce the inflammation. 

27

The Induction of Immune Tolerance 

over the Gut Lining 


This section is of utmost importance, as most of the immunomodulation we do 

can be explained according to this working mechanism. 

The mucosal surfaces lean themselves very well to the manipulation of the local 

and systemic immune system. 

The GALT is part of the MALT, (Mucosa Associated Lymph Tissue) , and it is well 

known that cells migrate between the different surfaces. 

This means that the cells which are primed in the gut lining can also have a 

primary effect on the Nasal associated lymphoid tissue, or NALT, the BALT or 

bronchial associated lymphoid tissue as well as the VALT(vaginal associated 

lymphoid tissue) 

Furthermore migrate these cells also to other areas of the body, which implies 

that the whole immune system can be regulated over the gut lining. 

The gut immune system is peculiar in that it responds differently to different 

concentrations of antigens, 

TH 3 cells, which are a type of regulatory T cell which can be induced by external 

antigens, are especially abundant in the mucosal surfaces, therefore driving 

responses towards tolerance in the mucosae and elsewhere in the body. 

This can be used successfully in therapeutic applications. 

28

Oral tolerance and 

immunological bystander reaction I 


29 

The plants, organs, venoms and suis organs are contained as a low dose antigen 

in the various antihomotoxic medicine. 

It is well known from the work of Weiner, Heine and others, that low doses of 

antigens stimulate a different kind of immune response (maybe through the 

different dendritic cells which process these antigens) . The immune response is 

different to the exposure which is short lived and also with a low dose of antigen. 

The first step is of course the ingesting of the amino acid containing substances. 

The body will see this as foreign and it will be engulfed by a antigen presenting 

cell, (APC) either a dendritic cell, or a macrophage. 

In the APC, the protein is then processed into small chains of amino acids 

(mainly 5-15) 

29


immunological bystander reaction II 


30 

The chains of amino acids are now bound to the major histocompatibility 

complex, the MCH, and is presented on the outside of the cell 

This is called the epitope. (That part of an antigenic molecule to which the t-cell 

receptor responds,) Together with the MCH complex it forms a motif (literally a 

recurring sequence) which is recognized by the T cell receptor. 

The T cells normally circulate as naïve TH0 cells. These cells will scan the 

environment for these presented epitopes. Due to the concentration and the type 

of APC’s active, the naïve T cells will be transformed into TH3 cells. 

These are regulatory type of cells, and will down regulate the TH1 secreted Pro 

inflammatory cytokines (see lecture on immune modulation) 

These TH3 cells will now migrate into the lymph nodes and be cloned to millions 

of copies of TH3 cells. 

A different TH3 cell will be created for each different motif. 

This TH3 cells primed by Arnica, TH3 cells primed by Chamomile…. Etc. 

30


immunological bystander reaction III 


31 

If there is a site of inflammation in the body, say an inflamed joint, the TH 3 cells 

will be attracted to the site of inflammation through chemotaxis. 

31


immunological bystander reaction IV 


32 

Once at the site of inflammation, TGF beta, the primary cytokine of the TH3 cell will be secreted, 

and this will effect down regulation of the TH1 cytokines, as well as it will start tissue repair. 

According to the homeopathic simile principle, it is postulated that each primed TH3 cell for the 

different plants or organs, will be specific in down regulating the TH1 cell which were induced by a 

corresponding toxin, 

This principle is also applied in so called Oral Tolerance Therapy, where a tissue is fed over the 

gut lining in order to down regulate inflammation at a distant part of the body. 

For instance, in hepatitis B, the viral envelope protein is fed over the gut lining in order to prevent 

the damage by the hepatitis B virus. 

In Multiple sclerosis, scientists have fed patients myelin basic protein over the gut lining to induce 

tolerance to the MBP in the brain of these patients. 

In the case of the substances in homotoxicology, which are used to induce the tolerance, we can 

talk of a bystander reaction. 

The plant is not the toxin which has start the disease, yet the substance can induce TH3 cells 

which are capable of reducing inflammation. 

The substance is thus a bystander which will induce a meaningful immune response. 

We thus use this principle in basic immune modulation by inducing TH3 cells which down regulate 

inflammation, but also by giving organ preparations over the gut lining, which will then induce 

tolerance in that organ (in case of autoimmunity) or tolerance in the case of allergy. 

32

Systemic Gastroenterology 

Antihomotoxic Pharmacy 


Now to the practical application of the above 

33

Treatment plan on the DET 

Detoxification 

Cellular activation 

Organ regulation and 

immunomodulation 

plants minerals catalysts nosodes 

venoms 

sarcodes 

plants minerals 


34 

As general rule, we apply the three pillars also in disease of the gut. 

See the lecture on formulating a treatment plan and the Three pillars 

34

Aphthous ulceration 

• Painful ulcers in the mouth and the gums 

• Often a sign of Epstein Barr Virus or Cytomegalovirus 

reactivation 

• Homotoxicological treatment 

• Gastricumeel (not Traumeel in this case) 

inflammation 

orodermal 


35 

Aphthous ulceration is often seen in ‘run down’ patients, but also can be a sign of 

reactivation of one of the deeper herpes viruses, such as Epstein Barr or 

Cytolomegalovirus. In the latter case, the disease is in the impregnation phase, 

but the ulceration is in the inflammation phase. 

The treatment is thus a simple mixed preparation for the ulceration,namely 

Gastricumeel. 

Traumeel is used in the case of stomatitis induced by chemotherapy. The mouth 

is rinsed 5x a day with one ampoule of Traumeel in a bit of water. 

35

Gastroesophageal reflux disease (GERD) 

• Reflux very common 

• 25 million Americans 

• Lower esophageal sphincter weakened: acid reflux into alkaline 

esophagus 


36 

Gastroesophageal (GERD) reflux is very common nowadays. 

One just has to look at the amount of advertisement which is done for over the 

counter products done for this on the television, and it is clear that this is a 

common problem. 

This is also one of the diseases which illustrate the theory of disease progression 

very well, as postulated by Reckeweg.(see below) 

36

Gastroesophageal reflux disease (GERD) 

• Chemical burn 

• Develop a problem with the mucosa 

• Cancerous change 

• Barrett’s esophagus (pre-cancerous state) 


37 

The lower esophageal sphincter is really only a high pressure area where the 

esophagus is crossing through the diaphragm. 

Many substances, like peppermint and coffee, will relax this area, with the 

subsequent effect that acid and gastric contents will leak into the esophagus. 

A high pressure in the abdomen, or a change in the alignment of the stomach , in 

for instance in pregnancy, can also cause a reflux of acid into the esophagus. 

In severe cases the chronic inflammation of the lower esophagus will cause a 

change in the mucosal lining of the esophagus, which eventually lead to the so 

called Barrett’s esophagus. 

37

The Disease Evolution Table 

Excretion 

Phase 

Inflammation 

Phase 

Deposition 

Phase 

Impregnation 

Phase 

Degeneration 

Phase 

Dedifferentiation 

Phase 

Acute 

inflammation 

Chronic 

inflammation 

Barrett’s 

esophagus 


38 

With chronic GERD, we see a progression from first the acute inflammatory state 

in the esophageal mucosal membrane, to a state of chronic inflammation. 

If the homotoxins is not removed as in this case the toxin is the acid in an alkaline 

environment, the so called Barretts esophagus will ensue. 

Barrett’s esophagus is a pre cancerous state. 

This is an illustration of disease progression as we see on the DET. 

Therefore patients with GERD should be followed very closely with regular 

gastroscopies. 

This fact should not be forgotten if patients are treated with biological therapy 

alone. 

It is commonly done when patients are on therapies such as H2 blockers. 

38

Treatment of gastroesophageal 

reflux disease (GERD) 

• Gastricumeel 

• Nux vomica-Homaccord 

• Mucosa compositum 

• Pulsatilla compositum 


39 

The treatment of GERD can be single or adjuvant to conventional treatment, depending on the 

severity of the case. 

In the case of Barrettts esophagus, a dual therapy is almost mandatory, as the biological therapy 

will afford the support of the immune system and support the mucosa, whereas the H2 blockers 

will mostly reduce the acid, till the regulation is such that the H2 blocker can be stopped. 

The so called Nissens operation, which is done to increase the pressure of the gastro esophageal 

junction only has limited success and a number of complications. 

It is thus only done in selected patients today, mostly as a endocsopic procedure. 

The biological therpy consist of a basic preparation, Gastricumeel (see next slide) 

Nux vomica-Homaccord, and Mucosa compositum affords the support of the tissues, and Mucosa 

compositum, due to the suis organs in there is at the same time an immunomodulator. 

Lastly, Pulstatilla will work both as a symptomatic preparation, but also as a catalyst, as 

Reckeweg postulated that all hormones in dilution (as is Cortisone here in a D28), will act as a 

catalyst. 

Apart from this, Pulstailla will also support the connective tissue, and activate the matrix. In more 

severe cases this can replace the Gastricumeel as a basic preparation as well. 

39

The composition of Gastricumeel 

1. Argentum nitricum (Silver nitrate) 

Meteorism, gastritis, gastrocardial 

symptom complex, ulcus ventriculi 

2. Acidum arsenicosum (Arsenicum album) 

Burning abdominal pain, gastritis, diarrhea 

3. Pulsatilla (wind flower) 

Meteorism, dyspepsia, for mucodermal reaction phases 


40 

The next two slides depict the so called materia medica for the ingredients of 

Gastricumeel. 

As depicted, this is very suited to treat symptoms of GERD, but also of peptic 

ulceration. 

40

The composition of Gastricumeel 

4. Nux vomica (vomit nut) 

Gastrointestinal and liver preparation, spasm after the 

indulgence of stimulants (coffee, alcohol, nicotine) 

5. Carbo vegetabilis (wood charcoal) 

Dyspepsia, flatulence, burning abdominal pain, homotoxin 

absorption 

6. Antimonium crudum (black antimony) 

Sensation of fullness, abdominal pain, intolerance to alcohol 


41 

41

Treatment of gastroesophageal 

reflux disease (GERD) 

• Passive measures 

• No tight clothes 

• Avoid heavy lifting 

• Lift head of the bed at night 

• Last meal about four hours before bed 


42 

The passive measures, which are aimed at reducing the mecahnical pressure in 

the abdomen, should not be forgotten. 

These simple measures often offers a lot of relief on their own. 

42

Peptic ulcer disease 

• Gastric ulceration 

• Acid often low or normal 

• Associated with higher incidence of cancer 

• Often part of Pernicous Anemia (PA) 

• These patients also have Vitamin B12 deficiency 


43 

Peptic ulceration is another disease which is ubiquitous today. 

The gut brain axis also will play a role here , and toxins like cigarette smoke, but 

also a number of conventional drugs, like NSAID’s and cortisol as well as 

chemotherapy contribute towards this. 

A difference should be made between gastric ulceration and duodenal ulceration 

In the case of gastric ulceration there is often a low gastric acid, and anti acids 

are not effective. 

Gastric ulceration should be treated with more caution, as there is a high 

incidence of cancerous change associated with this. 

It can also be part of Pernicious Anaemia (PA), where there are antibodies to the 

parietal cells in the stomach lining. 

This is an autoimmune disease and can be associated with vitiligo, but also with 

Vit B deficiency, as the parietal cells will secrete the intrinsic factor needed for the 

absorption of Vit B12 orally. 

Atrophic gastritis also is part of this disease picture. 

43

Peptic ulcer disease 

• Duodenal ulceration 

• Related to hyperacidity 

• Helicobacter pylori infection often present 

• Both can be caused by NSAIDs like aspirin, ibuprofen, 

diclofenac (mostly Cox-1-inhibitors, more than Cox-2) 


44 

Duodenal ulceration on the other hand, is almost always associated with a high 

acid secretion and also with a high incidence of Helicobacter Pylori. 

Both the gastric as well as the duodenal ulceration can contributed to by the use 

of NSAIDS. 

These, as we mentioned above regarding the leaky gut, can in fact directly 

damage the mucosa, but also interfere with the metabolism of the mucosal cells, 

and therefore can cause tissue breakdown, and subsequently ulceration. 

44

Treatment 

• Often an adjuvant treatment 

• Mild to moderate forms can be treated with antihomotoxics alone 

• (Regular follow ups) 

• Helps to heal ulcer quicker and relapses are longer apart 

• H. pylori can also be treated without antibiotics 

• Chronic association connected with cancer 


45 

Care should be taken not to treat patients with progressive disease with only 

biological therapy. 

Often a combination therapy can go a long way to promote tissue healing and to 

keep the patient in remission for longer periods of time, or even eradicate the 

disease earlier. 

Mild to moderate forms deserve a trial of antihomotoxic therapy alone, but there 

should be regular follow ups in these patients with endoscopy, especially in 

gastric ulceration the disease progression towards cancer should be a constant 

concern. 

With duodenal ulceration other complications, such as perforation, etc must also 

be kept in mind. 

Even H. Pylori can be treated with biological therapy alone, as was seen on a 

study by Karl Heinz Ricken. 

45

Treatment 

• H. pylori can also be treated without antibiotics 

• Study by Karl-Heinz Ricken with Nux vomica-Homaccord, 

Lymphomyosot and Gastricumeel 

• Ricken K-H. The antihomotoxic treatment of dyspepsia and 

Helicobacter pylori. Biological therapy 1997; No.3: 56-71 


46 

If the patient has mild to moderate disease, or is intolerant to triple therapy, a trial 

of therapy with antihomotxic treatment can be started. 

The efficacy of this was documented by Karl Heinz Ricken in 1996 (see reference 

above), where he used a combination of Nux vomica-Homaccord, 

Lymphomyosot, as well as Gastricumeel, and could show an eradication of H. 

Pylori after several weeks. 

46

Peptic ulceration 

Symptomatic 

Basic medication 

Gastricumeel or 

Duodenoheel 

+ 

Support 

regulation 

Three pillars 

Detox-Kit advanced 

first basic 

after the acute stage 

Mucosa compositum 

Organ strengthening 

and cellular activation 


47 

The treatment for peptic ulceration follows the three pillar approach. 

This condition is in the degenerative phase of the DET, or in the impregnation 

phase if it is still in the phase where there is only a leaky gut. 

The approach is thus to use all three pillars of homotoxicology. 

Gastricumeel we already encountered in the treatment of aphtous ulceration. 

It was originally designed to treat conditions of the gastric mucosa and stomach. 

A simple basic combination, it displays the Burgi effect. 

Duodenoheel on the other hand, is used for conditions lower in the upper GIT, 

however, in experience, many patients in this region will also respond to 

Gastricumeel. 

It is thus worth switching if the desired results are not seen in a few visits. 

The three pillars classically include the advanced and basic detox and drainage. 

Especially the Nux vomica homoaccord in the detox Kit has a functiotropic effect 

on the liver and the gut, and therefore not only functions to support the detox and 

drainage, but the gut itself. 

Mucosa compositum is a mandatory compositum if it is available, and so aqre the 

catalysts. 

However, in countries where the above is not available, Pulsatilla compsoitum is 

a valuable alternative, although this will take longer. 

47

Antihomotxic medication for liver 

and gall bladder support 

Nux vomica-Homaccord 

Injeel-Chol 

Chelidonium-Homaccord 

Hepar compositum 

Hepeel 


48 

Various medications are available to fit into the three pillar concept for treatment. 

Nux vomica-Homaccord is the universal functiotropic medication in potency chord 

for the treatment of liver and gut disorders. 

Although classically used after overindulgence of alcohol and coffee, Nux vomica- 

Homaccord has been conceived to be functiotropic for the liver and the gut. This 

means that the ingredients will support the function of the liver and the gut. 

This is in difference to the composita, which classically contain tissue extracts as 

well as catalysts, and form part of tissue support. 

Hepeel on the other hand, being a basic combination, also has been shown in in 

vitro experiments, as having anti oxidant and anti proliferative actions. It showed 

that even combinations with plants and minerals can also be used for organ 

support. 

Chelidonium-Homaccord, and Injeel-Chol are used when the gall bladder or bile 

flow has to be supported. 

48

Cholecystitis and gall stones 

• Injeel-Chol 

• Chelidonium-Homaccord 

• Do not use these drainage preparations if there is obstruction of 

the bile duct 


49 

As mentioned in the previous slide, these products are specially used for gall 

baldder problems. 

Chelidonium-Homaccord is used for gall stones, but can also be used in 

cholecystitis. 

Injeel-Chol not only supports the gall bladder and bile flow, but also has an effect 

on the liver and thus works deeper than Chelidonium-Homaccord. 

However, these should not be used if there is an obstruction to the bile flow, like 

is seen when a large stone gets lodged in the bile duct. 

When there are only small stones, or sludge, the products can be used safely. 

Chelidonium-Homaccord is often used for longer periods of time, up to three or 

four months, and the progress can be followed with ultrasound. 

49

Cholecystitis 

• Spascupreel 

• New cohort study comparing it to butyl scopolamine bromide 

(Buscopan) 

• 70 % of these patients were suffering with acute spasms 

• Comparable/superior to Buscopan 

• Müller-Krampe B et al. Behandlung von Spasmen bei Kindern. 

Jatros Päd. 2004;25(4) 20-2. 


50 

In acute cholecystitis, Spascupreel can be of tremendous value. 

It has a fast onset of action, and can be repeated every 15 minutes for up to 8 

doses. 

In a study done by Mueller Krampe, a paediatrician, it was shown that 

Spascupreel is comparable, and even in some cases superior to scopolamine 

bromide in children suffering from abdominal spasm. 

If injectables are available and allowed, Spascupreel can be injected i.v. in acute 

cholecystitis for a faster relief. 

50

Spascupreel 

tablets - injection solution 

D6 

D4 

D3 

D2 

Atropinum 

Colocynthis 

sulfuricum 

Ammonium 

bromatum 

Chamomilla Cuprum 

sulfuricum 

Veratrum 

Gelsemium Agaricus 

Magnesium 

phosphoricum 

Passiflora 

incarnata 

Aconitum 


51 

Through the composition of plants and minerals, we have a combination therapy 

which contains classsic homeopathic constituents for spasm, such as cuprum, 

aconitum and magnesium phosphate. 

Atropinum is the basis of atropine, which is also used in conventional medicine 

for spasm of the smooth muscle. 

Colocynthis is effective for spasm which cause the patient to bend double. 

Chamomilla is one of the mainstays of analgesic treatment in homotoxicology. 

This medication can also be used for spasm of the striated muscle. 

51

Hepatitis 

• Viral 

• Toxic 

• Environmental 

• Alcoholic 

• Drug-induced 

• Autoimmune 


52 

Hepatitis can have many aetiologies. 

Hepatitis is an inflammation and we also here see a disease progression along 

the six phase table, namely that of fatty infiltration of the liver going on to fibrosis 

and eventually cancer. 

It is thus quite important that the liver is supported during these disease 

processes, as oxidative damage as well s inflammation will cause the above 

disease progression. 

In some cases there is no conventional treatment available, and the biological 

therapy may be the single intervention, in others, the intervention may be 

adjuvant. 

52

Viral hepatitis 

• Hepatitis viruses 

• Oral-fecal transmitted: 

• A, E, enterically transmitted non-A, non-B 

• Blood and sexually transmitted: 

• B, C, D (Also called delta virus), G 


53 

Many types of viruses can cause hepatitis, some of them oral faecal borne, some 

of them blood and sexually transmitted. 

For this reason the viruses transmitted through the latter route are also seen in 

drug addicts, for instance, and is transmitted by sharing needles. 

Many of these viruses can cause persistent infections, like for chronic active 

hepatitis and will go on to dedifferentiation and liver cancer. 

On the DET these diseases are always past the regulation division, in the 

impregnation phase( see lecture on viral infections) and will need the full three 

pillar treatment 

53

Aims of antihomotoxic treatment of hepatitis 

• Treat symptoms 

• Support the liver function 

• Prevent damage from toxins and viral activity 

• In case of viral infection: increase cellular immunity 


54 

The aims of treatment will be to treat symptoms, like nausea, fatigue, urticaria , 

arthralgia etc, but also to support the liver function, to prevent damage or even try 

and reverse tissue damage through organ support, and in case of viral infection, 

to support the cellular immunity in order to give the body a chance to eliminate 

the virus. 

54

Hepatitis 

Symptomatic 

Basic medication 

Vomitusheel 

Engystol (Viral protection) 

+ 

Support 

regulation 

Three pillars 

Detox-Kit advanced 

first basic 

after the acute stage 

Hepar compositum 

(part of advanced detox) 

Hepeel 

Coenzyme compositum 

Ubichinon compositum 


55 

With viral hepatitis, we often see symptoms long before the patient becomes 

icteric or jaundiced. 

A high index of suspicion should be present, when there severe vomiting, myalgia 

and arthralgia as well as severe headache in a patient. 

Although three pillars are used in these patients, the order of doing them is 

reversed. 

The detoxification should be a later event in these patients, as the liver gets 

overloaded during the detoxification process. 

In these cases, Engystol is added early as well as Hepeel together with the 

advanced detox which is more supportive. It contains the product Hepar 

compositum, which will support the liver tissue. 

Hepeel is especially important in these patients with long standing chronic 

hepatitis, as it has been shown to have antiproliferative action as well as 

antioxidant action, and as such can prevent disease progression. 

Drainage is always done as a late event in these patients, and only should be 

attempted when the liver functions have stabilized and the viral counts came 

down. 

55

Functional disturbances of motility 

• Irritable bowel syndrome 

• 10-20% of people 

• Starts in adolescence and symptoms are not constant 

• New evidence suggests a major influence of stress 

• This is mediated via the brain-gut axis 


56 

Irritable bowel syndrome (IBS) is very common nowadays, and whereas before 

thought to be a psychosomatic disease, is now well recognized as including 

disturbances of the gut brain axis. 

This is compounded by stress, and we saw above, the stress have an influence 

on the gut lining. 

In IBS though there is also a disturbed communication between the gut and the 

brain, and there is a heightened sensory experience of pain in these patients. 

It is thus important to add medication which works on the emotions and the brain. 

56

Functional disturbances of motility 

• Irritable bowel syndrome 

• Medication 


• (Colocynthis) 

• Hepeel (if Nux vomica-Homaccord is not enough) 


• Nervoheel 

• Tonico-Injeel 


57 

The mainstay of the treatment here is the functiotropic Nux vomica-Homaccord, 

which will treat colic, bloating as well as constipation. 

Hepeel can be added if there is a lot of bloating, and Nux vomica is not enough. 

Spascupreel can be added on demand when there is a component of spasm, 

and can be given in the acute dose of one tablet every 15 minutes for up to two 

hours. 

To treat the brain gut axis, Nervoheel can be added in the case of milder anxiety 

syndromes, whereas Tonico Injeel is better added in patients who are 

overworked and on the brink of collapse or burn out. 

57

Constipation 

• Discourage laxative abuse 

• Fiber and fruit and vegetables 

• Antihomotoxic medications 

• Graphites-Homaccord 


• Due to the longer contact time with the mucosa, more toxins can 

be absorbed 

• Hepar compositum (contains colon suis) 


58 

Constipation is not a disease as such, but has a high level of discomfort for the 

patients suffering from this condition. 

It can be temporary in patients who for instance travel, and change their diet, or 

can be chronic in some patients. 

Laxative abuse should be discouraged, as it tends to cause a rebound 

constipation. 

The diet should be adjusted accordingly to contain fresh fruit and vegetables and 

natural fibre. 

The antihomotoxic medications, such as Graphites-Homaccord and Nux vomica 

can be very helpful. 

Nux vomica-Homaccord is often used in patients with severe persistent 

constipation and is also useful in children suffering from constipation. 

It is normally given for a couple of weeks. 

In cases with long standing or stubborn constipation, a tissue support in the form 

of Hepar compositum is added. 

This also contains and extract of colon tissue, and can thus support the large 

bowel. 

58

Diarrhea 

• Increase secretion of chloride ions into the lumen through the 

tight junction 

• Water follows, with loose stools 

• Protective mechanism 

• If too long or mixed with blood and mucous, it should be 

investigated 

• Most common cause are viruses, enteroviruses 

• (Coxsackie) or also Rota viruses (change of season) 


59 

Diarrhea is seen in homotoxicology as part of the excretion phase, and therefore 

as a purposeful defense against toxins, which could be foul food, bacterial or viral 

infections etc. 

The infective diarrhea called gastroenteritis, is one of the most common diseases 

and still a major cause of mortality in poorer countries. 

However, when it is persistent, or mixed with mucous and blood it can be part of 

a more severe disease picture, such as Inflammatory Bowel Disease. 

59

Treatment of simple diarrhea 

• Diarrheel 

• Veratrum-Homaccord 



60 

Simple diarrhoa is treated with supportive measures, like dehydration and 

replacement of electrolytes. This is mandatory and can save many lives in the 

incidence of gastroenteritis in small infants. 

Diarrheel is a basic combination, which will gently reduce the diarrhoa, without 

suppressing it as seen with the commercial products available. 

It will thus allow the body to excrete the offender, but still reduce all the 

symptoms concomitantly. Its combination is depicted in the next slide. 

Veratrum album is a plant which classically is used when there is severe 

coldness , clammy sweat and collapse associated with the diarrhoa. 

Veratrum-Homaccord can thus be added if this is a feature of the illness in the 

patient. 

Spascupreel can be added when there is severe cramping. 

60

Actions of Diarrheel 

Mucosal 

action 

Gastro 

enteritis 

Colic 

Diarrhea 

Arg nit 

Veratrum 

(weak) 

Arsen 

alb (cold) 

Colchicum 

Colocynthis 

Tormentilla 

Merc corr 

Podophyllum 

Ars alb 


61 

This slide depicts the actions of Diarrheel S. 

61

Inflammatory bowel disease 

• IBD 

• Crohn’s disease 

• Ulcerative colitis 


62 

These diseases, which needs to be distinguished from the simple diarrhoa, are 

treated with advanced treatment, which will be discussed in more advanced 

courses. 

62

IAH AC Gastrointestinal Disease

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