Bloating and distension remain important and intrusive manifestations of Irritable Bowel Syndrome. Although much of previous literature has used the the terms bloating and distension interchangeably, epidemiological data suggest that (i) distension is seen more commonly in IBS with constipation (IBS-C) compared with IBS with diarrhoea (JBS-D) patients (ii) bloating and distension seem to "correlate predominantly but not exclusively in IBS-C.

The initial lesions observed in Crohn's disease typically occur over lymphoid aggregates in tne large bowel and Heyers patches in the small bowel where M-cells are present. An increased presence of Adherent and Invasive Escherichia coli (AlEC) has been reported in Crohn's disease mucosa. Crohn's disease is common in westernised countries where low levels of soluble fibre are eaten and where the use of emulsifiers in processed food is common. It is possible that dietary factors may be implicated in the pathogenesis of the disease. The aims of this work were to establish if AIEC interact with intestinal M-cells, and to establish the effect that dietary factors have on these interactions.

The project concerns the development of a drug delivery system for the treatment of inflammatory bowel disease. This condition, which affects more than 2 million people in Europe alone, is characterised by inflammatory lesions which may be confined to the large bowel (ulcerative colitis) or extend through the intestinal tract (Crohn's disease). The components of disease activation lend themselves to treatment with immunomodulators such as the folate analogue methotrexate; although systemic sideeffects are significant. :. To o overcome this limitation, a local delivery system was investigated. In this thesis, folate has been used as a safer surrogate in the development of a silicone ribbon-based oral dosage form.

Inflammatory Bowel Disease (IBD) refers to a group of diseases which share the common representation of chronic inflammation of the gastrointestinal tract, of which Crohn's disease and ulcerative colitis belong to. In recent years several genome wide association studies (GWA) have identified mutations in the human autophagy gene ATG16L1 (T300A) to be associated with susceptibility to Crohn's disease. This finding prompted further studies on the possible role(s) that ATG16Ll, which is one of the main components of the autophagy pathway, might have on the development of IBD. Specific mouse models were generated and in one, mice hypomorphic for Atg1611, show Paneth cell granule abnormalities and increased IL-l~ production by macrophages when infected with the Mouse Norovirus (MNV) and increased susceptibility to DSS induced colitis. ATG16Ll has also recently been shown to interact with NOD2 at the plasma membrane and this interaction is impaired in NOD2 frame shift mutations associated with Crohn's disease. Taken together these results indicate a link between Crohn's disease, autophagy, infection and innate immune function. In this Thesis the aim has been to generate three different mouse models. In one mouse model Atg1611 will be specifically knocked-out in the intestinal epithelium, the second mouse model includes the Atg1611 T300A mutation found to be associated with IBD in humans and the third mouse model lacks the WO-repeat domain of Atg1611, the function of which remains unknown. We anticipate that these mouse models will be key to understanding the role played by autophagy in inflammatory responses of the intestinal mucosa in Crohn's disease.

Background: Hypnotherapy improves the symptoms of approximately two thirds of IBS sufferers but is very expensive to provide. Therefore, a way of predicting those most likely to respond could lead to the more efficient use of this form of treatment.

Background: The past forty years have seen an increase in the number of people with chronic illness and a struggle for biomedicine to provide effective treatments. The lack of effective biomedical treatments for conditions such as IBS creates opportunities for Chinese medicine; however, in its growing popularity, Chinese medicine has had to adapt to biomedicine’s dominant influence on research and practice. Purpose: The purpose of this thesis is to explore Chinese medicine’s adaptations to biomedicine regarding diagnosis differentiation and treatment individualisation through a study that places Chinese medicine in the context of IBS. Methods: Methods were selected based on a pragmatic mixed methodological underpinning that allowed for the research questions to dictate appropriateness. As such, a mixture of qualitative and quantitative methods were used to assess acupuncturists’ contextualisation and treatment of IBS; patient’ experiences with acupuncture and perceptions of outcome; and patients’, GPs’, and acupuncturists’ understanding of how acupuncture works and the impact of that understanding on outcome and acceptance of acupuncture. Findings: Acupuncturists contextualise IBS according to symptoms they perceive to be relevant, and do not perceive IBS to be a useful diagnosis. Acupuncture treatment of IBS incorporated three over-lapping approaches including: disease-specific, pragmatic, and individualised. The proportional influences of the approaches were different for different treatment aspects. Regarding how acupuncture works, patients, acupuncturists, and GPs used a variety of traditional, scientific, and physical explanations. Patients and acupuncturists perceived that the explanation may affect treatment outcome. Conclusions: Collective interpretation of the findings suggest that TCM diagnosis differentiation is fundamental to TCM treatment and plays a role similar to biomedical diagnoses in that it may validate patients’ symptoms and identify conditions that are treated effectively. Additionally, the use of combined treatment approaches notes an over-emphasis on individualisation that may be a by-product of TCM’s adaptation to biomedicine.

Few studies exist on sufferers‟ perspectives of living with Inflammatory Bowel Disease (IBD) and on cultural influences of choices of alternative health practices, including Traditional, Complementary and/or Alternative Medicine (TCAM). This research explores how and why cultural influences affect how IBD sufferers look after themselves with particular healing practices, including TCAM. The research was underpinned by a conceptual framework of the cultural construction of illness and healing, developed by drawing on existing literature from medical anthropology and sociology. The empirical phase of the study utilised a qualitative approach, involving eight participants. Two interviews were conducted with each participant; each was asked to complete a written diary for at least a month. Data was analysed using an inductive method guided by the conceptual framework and its four components: cultural influences; perspectives of Self; perspectives of illness and healing; and, healing practice pluralism. Half of the participants (5 female, 3 male, aged between 23 and 72 years) were medically diagnosed with Ulcerative Colitis (UC) and the others with Crohn‟s Disease (CD). Insight is provided into the diverse approaches of how sufferers live with IBD and two key treatment decision points. The cross-case analysis identified eight key factors directly or indirectly guiding participants towards choosing non-medical healing practices, and enumerated a range of preventive and curative healing practices that participants used in relation to different parts of the Self. Throughout their living with IBD, there is an on-going re-evaluation of the Self (personal preferences) in relation to self-management of illness. The research demonstrates the diverse ways of living with IBD, use of multiple preventive and curative healing practices and reinforces the value and strength of the conceptual framework. This study may prove useful in providing an explanatory model for other long-standing illness research as well as the combining of various healing practices in the context of healing practice pluralism.

No description available.

No description available.

No description available.