My last three columns have discussed the Reticuloendothelial or Macrophage System. This month, the discussion concludes with an examination of the role of the Peyer's patches of the small intestine.

My purpose in talking about this system has been to bring to your attention the role that poor digestion plays in producing repeated -- and eventually chronic -- subluxation patterns (regional spinal dysfunctions). Such as the loss of a normal thoracic kyphosis and the appearance of Pottenger's saucer.

From this viewpoint, the most frequently cited components of this system are:

*** Macrophages distributed throughout loose connective tissues, which are especially numerous in mucous membranes of the digestive tract and in association with small blood vessels and lymphatics of subserous connective tissue of the peritoneum;

*** Monocytes in the blood stream;

*** Macrophages lining the blood sinuses of the liver (Kupffer cells) and bone marrow; and

*** Macrophages lining the sinuses of lymph nodes and the spleen.

Peyer's patches were named by a Swiss anatomist sometime around the year 1700. Today, they are known as aggregated lymphatic follicles. They are similar to the tonsils and are found throughout the body, especially in the mucous linings of the digestive and respiratory tracts.

Composed of reticular (network) tissue, they are not easily distinguished from the surrounding connective tissue. Of course, they contain white blood cells. An incredibly important -- and almost completely overlooked -- function of these cells is to defend the body against inadequately digested food particles crossing the gut wall and entering the blood.

Inadequately digested food molecules, not digested well enough to be absorbed across the gut wall, are acted upon by "unfriendly" bacterial growth in the bowel. When this happens, toxic chemicals, known collectively as "Indican," are formed. Most of these compounds can be excreted in the feces. However, since they are toxic, they cause a number of problems, not the least of which is inflammation of the bowel.

Unfortunately, the patient is usually only aware of increased lower bowel gas and constipation. These symptoms of putrefaction are usually dismissed and only if they continue are over-the-counter remedies purchased. Seldom is a doctor consulted.

This process has been widely underestimated as a stressor of the immune system. It is the function of the phagocytic cells found in Peyer's patches and other lymphatic aggregate follicles, to attack these foreign invaders while they are still in the bowel.

When the intestinal mucosa becomes inflamed it becomes more permeable. When the functioning of any aspect of the gut mucosal barrier is sufficiently compromised, the integrity of the bowel itself becomes compromised, resulting in increased permeability to foreign or gut-derived antigens, allowing them to "leak" through the gut into the lymphatics and the systemic circulation.

Obviously, once they have entered the blood they are no longer subjected to the action of the digestive tract and must be eliminated by the immune system. Acting as foreign invaders, they can target specific organs, produce pain, and an inflammatory immune response. This process is enhanced by the deposition of immune complexes in the tissues.

The union between these remnants and the phagocytic cells have been referred to as circulating immune complexes. This can lead to the symptoms of fibromyalgia as well as symptoms of infection, even without an infectious agent, because immune responses to foreign invaders are identical, be they infectious or not.

Circulating immune complexes (systemic foreign antigens) are the leading cause of fibromyalgia and can retard healing, promote and prolong pain from inflammatory processes and reduce the competency of the immune system. Only an intact intestinal mucosal barrier protects the body from entry by foreign antigens and their systemic effects.

Therapy with prostaglandin inhibitors such as Nsaids or aspirin, and steroids such as prednisone and cortisone are the major factors that compromise the mucosal barrier. Prostaglandin inhibitors suppress repair and have been shown to increase gut permeability with moderate use. Long-term steroid use can cause stomach and duodenal ulcers and immune suppression contributing significantly to gut hyperpermeability and its complications.

Antacids decrease the acidity of the stomach, reduce the activity of pepsin and limit the stomach's ability to adequately digest proteins. This compromise increases the number of undigested, large molecules entering the bowel and systemic circulation. By decreasing stomach acidity, antacids can also impair the absorption of minerals.

Antibiotics disrupt the normal balance of bacterial microflora in the gut, as well as the mouth, skin and vagina. This often leads to serious overgrowth of pathogenic microflora in these areas resulting in infection and inflammation. Proliferation and overgrowth of Candida and other yeasts in the gastrointestinal tract can result in a complex of symptoms from gas, bloating and gastrointestinal distress to unexplained chronic fatigue, depression and various systemic inflammatory disorders.