Abdominal pain of non-visceral origin has been recognised as a clinical entity for many years. In many gastroenterology clinics up to 50 per cent of patients attending have no pathological cause to their symptoms and such patients often become chronic attenders and suffer repeated investigation without resolution of their problem. They are often left with a label' of Irritable Bowel Syndrome (lBS) without a precise diagnosis being made. This is both unsatisfactory for the patient and physician. This study set out to determine the incidence of musculoskeletal causes of abdominal pain and to determine what diagnostic tools will help identify this group of patients and thus allow the physicians to refer the appropriate patients at an early stage. The aims were to identify questions that act as predictors of the presence of abdominal pain of musculoskeletal origin, patterns of pain presented in this group of patients and the ability of physiotherapists to detect cases of abdominal pain of musculoskeletal origin. The incidence of abdominal pain of musculoskeletal origin in this study was 14 per cent. Questions that act as predictors include an affirmative response to pain being aggravated by movements such as bending, twisting and turning, and coughing and sneezing, and a negative response to change in bowel habit, symptoms being aggravated by food and no weight change. The ability of the physiotherapist to detect cases was 88.3 per cent. No particular pattern of pain areas emerged to differentiate patients with abdominal pain of visceral and musculoskeletal causes. Early assessment of the musculoskeletal system by a trained physiotherapist is recommended. An early referral will lead to prompt and appropriate treatment and, consequently, to a reduction in costs for the NHS. For patients where the cause of their abdominal pain is not obvious it is unacceptable that they are left with the diagnosis of IBS without the musculoskeletal system being assessed. This study shows that such an assessment is vital to detect cases where the pain has a musculoskeletal origin.

Irritable Bowel Syndrome (IBS) är en kronisk mag- och tarmsjukdom. Av de som lever med mag- och tamproblematik har 10% IBS som grund till sina besvär. Utgångspunkt vid diagnostisering är patientens anamnes och uteslutande av andra potentiella sjukdomar. IBS underskattas ofta av vårdpersonal och patienter blir felaktigt bemötta. Detta har en stor inverkan på de drabbades redan svåra vardag då det inte finns något botemedel mot sjukdomen. Det råder en kunskapsbrist kring denna sjukdom. Därför känns det väsentligt att belysa patienters erfarenheter av att leva med IBS. Med hjälp av befintliga studier och tidigare forskning gjordes en litteraturstudie där tio kvalitativa artiklar ingick. Efter att ha läst våra utvalda studier framkom fyra teman med åtta subteman där erfarenheter skildras om hur det är att leva med IBS och hur patienternas livskvalité påverkas. I resultatet framkommer hur deltagarna upplever skam, skuld och rädsla i att deras omgivning och/eller sjukvården inte ska ta deras besvär på allvar. Det framkom även att det fanns ett kunskapsbehov hos patienterna där egenvård kunde minska risken för insjuknande och ge symtomlindring. Då patienternas besvär inte tas på allvar så utsätts de för ett vårdlidande av sjukvården. Ökad kunskap hos både vårdpersonal och patienter har en betydande roll för att minska ohälsa. Genom en större öppenhet och kunskap kunde patienter hitta nya lösningar på sina problem och en lättnad över att känna sig förstådda.

Bakgrund En stor del av befolkningen upplever idag stora smärtor från magregionen. Många lider av diagnosen irritabel tarm, men diagnosen påverkar alla olika. Utöver att symtomen kan lindras med medicin och justeringar i vardagen, är det intressant att undersöka evidens för komplementär alternativmedicin för att lindra lidande och minska symptom vid irritabel tarm. Syfte Syftet med arbetet är att belysa evidens av komplementär alternativmedicin som ett användningsområde till sjuksköterskans kompetensområde informatik för att lindra symtom hos vuxna patienter som lider av irritabel tarm. Metod Studien är en icke- systematisk litteraturöversikt. Med hjälp av PubMed och CINAHL har relevanta artiklar tagits fram. Resultat Resultatet av denna studie visar att det finns stöd för komplementär alternativmedicin som behandling mot symtom hos patienter med irritabel tarm. Vidare visar denna studie att komplementär alternativ medicin bör tas upp som alternativ till farmakologisk behandling. Slutsats Slutsatsen visar att komplementär alternativmedicin kan minska symtom hos patienter med irritabel tarm. Vidare visar studien att även andra symtom som ångest och depression som påverkar det vardagliga livet kan med hjälp av komplementära alternativa medicinska åtgärder minska och öka livskvaliteten hos patienter med IBS.Nyckelord: Alternativmedicin, IBS, Irritable Bowel Syndrome, Komplementär alternativmedicin. / Background A big part of the population today experiences great pain from the abdominal region. Many people suffer from the diagnosis of irritable bowel syndrome, but the diagnosis affects everyone differently. In addition to the fact that the symptoms can be relieved with medication and adjustments in everyday life, it is interesting to examine the evidence for complementary alternative medicine to relieve suffering and reduce symptoms of irritable bowel syndrome. Aim The aim is to highlight the evidence of complementary alternative medicine as a nursing action to alleviate typical symptoms in adult patients suffering from Irritable Bowel Syndrome. Method The study is a non- systematic literature review. With the help of the databases PubMed and CINAHL, relevant articles will be used. Results The results of this study show that there is support for complementary alternative medicine as a treatment for symptoms in patients with IBS. Furthermore, this study shows that complementary alternative medicine should be included as an alternative to pharmacological treatment. Conclusions The conclusion shows that complementary alternative medicine can reduce symptoms in patients with IBS. Furthermore, the study shows that other symptoms such as anxiety and depression that affect everyday life can with the help of complementary alternative medical measures, reduce and increase the quality of life in patients with IBS.

No description available.

Introduction: Irritable bowel syndrome (IBS) is characterized by gastrointestinal (GI) symptoms, and as a consequence of dysregulated communication via the gut-brain axis, is highly comorbid with mental illnesses such as anxiety and depression. With no known cure, IBS patients must manage their symptoms through lifestyle factors. Physical activity is one such lifestyle factor that reduces GI symptoms and improves mental health; however, it remains unclear whether physical activity buffers against the acute worsening of IBS symptoms following a stressor. Method: To investigate this, we evaluated the stress reactivity and recovery of 9 IBS patients and 13 healthy controls following exposure to acute stress. We exposed participants to an electronic Trier Social Stress Test (e-TSST) and measured changes in psychological stress (state anxiety), physiological stress (sympathovagal balance, where higher LF/HF ratio indicates greater stress system activation), and GI symptom severity before, during and every 20 minutes for one hour after. Physical activity was measured using the Stanford Seven-Day Physical Activity Recall questionnaire and quantified as weekly energy expenditure. Results: IBS patients had higher state anxiety (p = .05), LF/HF ratio (p = .01) and GI symptom severity (p = .01) than healthy controls. Although the e-TSST did not exacerbate these group differences, higher state anxiety at baseline (p = .03) and higher LF/HF ratio in response to an acute stressor (p < .001) were associated with more severe GI symptoms within the first 20 minutes following the e-TSST. Importantly, IBS patients who were more physically active experienced less severe GI symptoms during that same timeframe (p = .03). Conclusion: Physical activity may be a promising lifestyle factor for lessening GI symptom severity in response to an acute stressor. / Thesis / Master of Science in Kinesiology

Background: Irritable Bowel Syndrome (IBS) is a common disorder in which the main symptoms are abdominal pain or discomfort combined with diarrhoea and/or constipation. Personal petitionary prayer – asking God for help and support when facing problems in life – is among the most common forms of prayer and can be viewed as a coping strategy when managing health problems. Previous research on the effects of personal petitionary prayer has showed conflicting findings and there are indications that prayer can be associated with more problems when facing stressful somatic problems such as chronic pain in Swedish settings rather than the opposite and expected benefits from praying. The present master-thesis was informed by the coping theory by Lazarus and Folkman (1984) and a theoretical perspective of prayer as a religious coping strategy. Aims: The aim was to investigate associations between personal petitionary prayer as a coping strategy and IBS symptoms, quality of life and anxiety. A second aim was to investigate if use of prayer would change 10 weeks later and if IBS symptoms at baseline could predict prayer assessed 10 weeks later.   Methods: The data in this master-thesis were collected in association with a treatment trial on internet-delivered cognitive behaviour therapy for IBS (Ljótsson et al., 2010). Data were derived from all 85 self-selected participants who had been included in the treatment trial. The three-item self-report measure of prayer which is  part of  the Coping Strategies Questionnaire for pain was used. I also included data on self-report measures of IBS symptoms and IBS-related quality of life and anxiety, and finally a measure of symptoms of depression. The sample included were mainly women (85%), with some form of higher education (64%) and finally fairly young (Mean age 34.6 years). Data on prayer have not been published before. 10 week follow-up data were available for 37 participants.  Results: Statistically significant cross-sectional correlations were found between the prayer scale score and IBS-related quality of life (r =-.44, p&lt;.01) and with gastrointestinal symptom-specific anxiety (r=.42, p&lt;.01), which indicates that more use of prayer is associated with  lower quality of life and more anxiety symptoms. Regression analyses entering prayer in competition with the other variables as predictors showed that prayer was more consistently associated with IBS-related quality of life which also predicted prayer. Use of prayer did not change over the 10-week period and prayer at 10 weeks could not be predicted. Interpretation: In line with some previous research personal petitionary prayer can be associated with more rather than less problems with health. It is important to note that personal prayer is one form of prayer and that long term effects may show different results. Finally, the role of religious affiliation and cultural aspects need to be considered in future research.

No description available.

The gluten-free diet is the only treatment available for gluten-related disorders, such as celiac disease, an autoimmune reaction to gluten, or non-celiac gluten or wheat sensitivity, a symptomatic reaction to wheat or gluten. However, gluten may not be the only culprit, and patients on a gluten-free diet have been suggested to symptomatically improve through the placebo effect, alterations in immune activity, and alterations in gut microbiota composition. It is unclear which of these mechanisms underlie symptoms in gluten-related disorders and well-designed clinical studies are needed to better understand them. This thesis aims to understand the mechanisms and symptomatic responses by which wheat and gluten affect individuals with gluten-related disorders. I hypothesize that patients with gluten-related disorders have increased psychological symptoms and immune reactivity which may be modulated by the gut microbiota. To test this, I conducted a clinical crossover trial to investigate whether whole wheat or gluten triggered symptoms versus gluten-free control, or nocebo, in irritable bowel syndrome patients adopting a gluten-free diet. Participants reacted similarly to each intervention, suggesting a strong 'nocebo effect' to be the main trigger of their symptoms. However, several participants did not comply to the protocol, muddying the results. Subsequent follow-up visits after disclosing personalized study results found no changes in participant beliefs, behaviours, and symptoms, and most remained on a gluten-free diet. Next, a systematic review of 65 observational studies found an elevated risk of IBD in celiac disease and vice versa. Finally, a systematic review of 6 RCTs found limited evidence that probiotics are safe and possibly therapeutic for ameliorating symptoms in celiac disease. Overall, the work presented in this thesis critically assesses the mechanisms by which gluten and wheat trigger symptoms in gluten-related disorders and highlights the importance of rigorous clinical trial design to control for psychological factors and patient compliance. / Thesis / Doctor of Philosophy (PhD) / Gluten, a wheat protein, is commonly associated with the autoimmune condition celiac disease, symptomatic worsening from gluten or wheat in non-celiac gluten/wheat sensitivity, and irritable bowel syndrome. This thesis strove to understand how gluten and other wheat proteins impact symptoms via psychological, immune, and/or bacteria-mediated pathways in gluten-related disorders. A clinical trial tested the effects of whole wheat, gluten, and gluten-free control on symptoms in irritable bowel syndrome patients on a gluten-free diet. We found no differences between interventions but discovered widespread diet non-compliance and that patient fears triggered symptoms. Informing patients of whether wheat, gluten, or gluten-free control triggered their symptoms did not change their dietary beliefs or behaviours. Additionally, two systematic reviews found a relationship between celiac disease and inflammatory bowel disease, and a possible therapeutic effect of probiotics in celiac patients. Our findings provided insights into the content and quality of the clinical evidence for gluten-related disorders.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Irritable Bowel Syndrome är en vanlig kronisk mag-tarmsjukdom som medför konsekvenser i det vardagliga livet för den som lever med sjukdomen. Än idag är orsaken till sjukdomen okänd, likväl finns inga tydliga riktlinjer för hur den ska behandlas. Syfte: Att belysa upplevelsen av att leva med Irritable Bowel Syndrome. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio kvalitativa vetenskapliga artiklar. Utifrån meningsenheter framkom tre huvudkategorier; Ett begränsat liv, Emotionell påverkan och Behov av förståelse och stöd med tillhörande sex underkategorier; Social isolering, Brist på energi, Rädsla och oro, Frustration, Att inte bli tagen på allvar av hälso- och sjukvårdspersonal och Att förstå och acceptera sin sjukdom. Slutsats: Att leva med Irritable Bowel Syndrome medförde begränsningar i det vardagliga livet. Det handlade både om professionella och privata områden. Att leva med den kroniska sjukdomen påverkade de drabbade individerna emotionellt eftersom de uttryckte att de inte kunde leva ett ”normalt” liv på grund av de oförutsägbara och genanta symtomen. I möten med hälso- och sjukvårdspersonal var det viktigt att ett personcentrerat förhållningssätt användes. Resultatet visade att individer med IBS uttryckte frustration över att inte få information och kunskap om deras sjukdom samt brist på evidensbaserad behandling. Därför behöver forskning bedrivas inom området. / Irritable Bowel Syndrome is a common chronic gastroinestinal disease that has consequenses in the everyday life for persons living with the condition. Still the cause of the disease is unknown, yet there is no clear guidelines how to treat it. Aim: To highlight the experience of living with Irritable Bowel Syndrome. Method: The study was conducted as a systematic literature study with inductive approach. Result: The result was based on nine qualitative scientific articles. Based on meaningful extracts three main categories were formed; A limited life, Emotional impact and The need for understanding and support. Six related subcategories were formed; Social isolation, Lack of energy, Fear and worry, Frustration, Not to be taken seriously by healthcare professionals and To understand and accept the disease. Conclusion: Living with Irritable Bowel Syndrome caused limitations in everyday life. It limited both the professional life and the private life. To live with a chronic disease affected the individuals emotionally because they expressed that they could not live a ”normal” life because of the unpredicable and embarrassing symptoms. In the meeting with healthcare it was important that a person-centered approach was used. The results showed that individuals living with IBS expressed frustration about not getting information and knowledge about their disease and treatment options. Because of this research needs to be conducted about the chronic condition and potential treatments.