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Introduction: Inflammatory bowel disease (IBD) is a chronic, remitting and relapsing disease of the gastrointestinal tract, the aetiology of which remains elusive. Diagnosis of IBD requires complex and invasive procedures. Endoscopy and histology of biopsy specimens remain the current "gold standard" for detecting and quantifying bowel inflammation. Due to similarity of symptoms of IBD and irritable bowel syndrome (IBS), invasive procedures are used excessively to differentiate the two conditions which have significant safety and economical implications. Currently available non-invasive serological markers (such as CRP and ESR) are unreliable due to their poor correlation with clinical and endoscopic findings. Volatile organic compounds (VOCs) are chemicals, which may be emitted from faeces, and other bodily fluids, and are responsible for their characteristic odours. Historically, changes in the smell of human excreta may be assigned to various illnesses; so understanding these changes in the smell by identifying its volatile signature can be of diagnostic value. Objective: To evaluate the faecal VOCs in the diagnosis of IBD and compare them with those from the patients with I BS and healthy controls Method: We studied samples from 356 individuals, 30 with diarrhoea predominant IBS, 217 with IBD (Crohn's disease=117, ulcerative colitis=100), and 109 healthy individuals. Faecal volatile were extracted using SPME (solid phase micro-extraction) technique and were analysed by GC-MS (gas chromatography-mass spectrometery). VOCs were identified using the NIST (National Institute of Science and Technology) library and manual visualization using the fragmentation pattern when appropriate. Results: From the 350 VOCs identified in these experiments, univariate analysis was used to identify those VOCs, which were statistically significant (p< 0.05) in discriminating between the groups. A forward stepwise discriminant function analysis was used to develop a predictive model, which showed significant value in separating active IBD cases from those with disease in remission, IBS and healthy controls (p<0.05). The model was able to differentiate active CD from inactive CD and from healthy controls. Similarly the model was able to differentiate active UC from inactive UC and healthy controls. The model also showed statistically significant value in discriminating IBS from active IBD and healthy controls. On cross-validation, the model remained stable: 90% of patients were correctly diagnosed. This model has overall sensitivity of 90% and specificity 80%. Conclusion: These results show that VOCs analysis has the potential to provide a non- invasive means of diagnosing IBD, monitoring the disease activity and to differentiate it from IBS. This technique is fast and convenient and opens up a promising area for use as a non- invasive diagnostic tool with advantages of providing a much-needed, reliable, real-time and point of care diagnosis and monitoring of various gastrointestinal disorders.

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Although there is growing interest in the support needs of disabled parents, little is known about the experiences and needs of families when a parent has a chronic illness. This thesis represents the first investigation into the support needs of parents with inflammatory bowel disease (lBD) and their children. IBD is a chronic illness that can cause a range of debilitating symptoms, including some which are associated with considerable social stigma. The theoretical frameworks underpinning the research are the transactional model of stress and coping, the family-systems illness model, and the resource-based approach to intervention. The research began with a qualitative phase, in which two exploratory studies were carried out, one involving parents with IBD, the other their children aged 6-20 years. Findings from this research led to a quantitative phase, which included a postal survey of 178 parents with IBD and 74 of their children, aged 11-16 years. The research found that parents' greatest difficulties in relation to parenting were with household chores, providing for financial needs, and social activities. In addition, rates of anxiety and depression amongst parents were significantly higher than reported in a UK community sample. Through regression analysis it was possible to account for 65% of the variance in depression. Significant predictors of depression were perceived IBD-related health status, parenting difficulty, and an interaction between family support and parenting difficulty. Anxiety was not well explained by regression analysis. Parents reported that their greatest need was for psychological support, including stress-management and counselling. Despite the difficulties parents experienced, their children, at least in the adolescent years, appeared to be largely unaffected in terms of their social life with peers, domestic responsibilities, school attendance, and relationships with parents. However, they did experience significantly more emotional and behavioural difficulties than expected for their age range. Preliminary research suggests these difficulties are associated with the child's age, whether the child has an illness or disability, parenting difficulties, and the child's relationship with their parents. A substantial proportion of parents and young people reported a need for age-appropriate information for children on IBD and its treatment. It is concluded that families can best be supported by interventions targeted at the parent, though information for children on the condition and its treatment would also be valued.

Irritable Bowel Syndrome (IBS) is a common gastroenterological disorder characterised by recurrent abdominal pain and a change in bowel habit. Diagnosis is made with reference to clinical symptomatology and the exclusion of other competing disorders. As such there is no reliable biomarker in the clinical field to prove or disprove the diagnosis. This has obvious implications for the treatment of the syndrome. Recent research has targeted the immunology of IBS to see if changes in cytokine expression support the concept of a chronic low-level inflammatory state. IBS has a strong association with psychological comorbidity. Visceral hypersensitivity is also a hallmark of the disease. This study was constructed to compare the psychological profiles of patients with IBS against a control group; to use cortical evoked potentials to observe the cortical representation of an electrical rectal stimulus to see if changes in amplitude or latency might be suggestive of enhanced afferent nerve transmission; and to use cytokine analysis of stimulated and un-stimulated peripheral blood mononuclear cells to study the inflammatory response.

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