M.Tech. / Irritable bowel syndrome (IBS) is a multifactoral disorder of the gastrointestinal tract causing disturbances in gastric motility, resulting in abdominal pain, bloating and abnormal bowel movements. It is defined as a 'disorder of gut function in the absence of structural pathology' (Palmer et a!, 2002). It is the most commonly encountered functional gastrointestinal disorder in the primary and secondary health care system with a prevalence in the general population of five to twenty percent (Bellini et a!, 2005). No definite aetiological factor has been isolated, but factors such as psychological stress, anxiety and depression, certain dietary intolerances, increase in abnormal sensitivity to visceral distension, and hormonal changes in women have been implicated in compounding the symptoms of IBS (Ohman & Simren, 2007). Current treatment regimes include dietary changes and symptomatic relief using allopathic medications, which come with the risk of side-effects and may lead to dependency (University of Maryland Medical Center, 2007). Homoeopathic studies which have addressed the physical symptoms as well as the psychological contributing factors associated with IBS, have recorded favourable results when treating this syndrome (Mathie & Robinson, 2006).The aim of this research was to determine the efficacy of Homoeopathic Similimum treatment in IBS. In order to recruit volunteers, this study was advertised in local newspapers, pharmacies and at the University of Johannesburg's Doornfontein Campus. Volunteers completed the Rome III Criteria evaluation to determine their suitability for this study, with the likelihood of any other bowel pathology having been excluded. Ten suitable female volunteers, ranging in age from twenty to thirty five, were selected having met the inclusion criteria. Over a period of three months, each participant partook in four homoeopathic consultations. The initial consultation involved the completion of the information and consent form, an explanation of the research procedures, general well-being and general symptom rating questionnaires were completed, a full homoeopathic case history was taken, and a physical examination was performed. A baseline of four weeks without treatment followed. Participants were requested to complete daily symptom rating scales and keep a daily food diary in the four weeks between consultations. This was continued throughout the study period. The subsequent follow-ups, of which there were three, consisted of a follow-up on the initial consultation, completion of general well-being and symptom rating questionnaire, and a physical examination. A homoeopathic similimum remedy was chosen based on each participant's unique symptoms. Using physical, mental, and emotional symptoms in accordance with classical homoeopathic principles, a single remedy that most suited the individual was chosen and prescribed. It was predicted that the study would provide an alternative and safe treatment option to relieve the symptoms ofiBS. The results of the study showed that the homoeopathic similimum remedy does not provide a statistically significant improvement in the symptoms of IBS. Clinically, however, most participants experienced a general trend of improvement in physical symptoms and general well-being .

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Background: Inflammatory Bowel Disease (IBD) is a group of chronic gastrointestinal diseases with a relapsing nature. The two main types are Crohn’s disease (CD) and ulcerative colitis (UC). Both CD and UC patients experience very similar and distressing symptoms: acute abdominal pain, vomiting, malnutrition, fever, fatigue, diarrhoea and rectal bleeding. These symptoms are disabling and have a severe impact on physical and psychosocial wellbeing. Around 30% of patients suffer from moderate to severe psychological distress and have difficulties coping with the illness even in remission. However, it appears that mental health is overlooked by clinicians who often focus on physical gastrointestinal symptoms only. Mindfulness-Based Cognitive Therapy (MBCT) is evidence based, group psychological intervention that has been successful in reducing depression and anxiety scores in patients with depression while improving overall quality of life. However, MBCT has never been tested in the IBD population before. PhD question: Can MBCT be used as an adjunct therapy to IBD symptom management, for improving IBD patients' general well-being and quality of life? Aims and objectives: The overall aim of the thesis was to develop and collate the evidence for a definitive randomised controlled trial (RCT) testing the effectiveness of MBCT for patients with inflammatory bowel disease (IBD). The thesis brings together six publications. The six publications were integrated into four objectives that collectively contributed in answering the overall PhD question. Results: The findings from the first three publications highlighted the disease-related concerns and psychological needs for patients with IBD. The findings from the last three publications highlighted how feasible it is to use MBCT in IBD and emphasised the IBD patients’ perspectives about MBCT. Conclusion: The thesis concluded that a definitive RCT of MBCT for IBD patients is both feasible and acceptable.

M.A. / Irritable bowel syndrome [IBS] has been described as a chronic relapsing condition, characterised by a change in bowel habit and abdominal pain, that cannot be explained by an organic disease. Some research indicates that IBS may be psychogenic in origin, however, the aetiology of this complex syndrome is still unclear. Some researchers have postulated that IBS is primarily a motility disorder of the gut, while others have indicated that the symptoms of IBS are mediated by the central nervous system. Thus it is not surprising that the care of patients with IBS poses a particular challenge to physicians, especially because of its biologic and symptomatic heterogeneity and, particularly for patients with refractory symptoms, its association with psychological disturbances. The literature study indicates that there that there may be a possible connection between the ingestive disorders, the menstrual cycle fluctuations associated with premenstrual dysphoric disorder and IBS. All three of these disorders also appear to be mediated, to some extent, by the neurotransmitter serotonin. In terms of these suggested correlations one of the aims of this study was to determine whether blood-serotonin levels significantly influence the symptomatology of IBS. Extensive literature exists documenting the potential role that serotonin plays in gastrointestinal functioning. However, none of the existing studies refer specifically to blood-serotonin levels. Thus the present study attempted to address this problem. A second aim of the present study was to determine the possible serotonergic connection in the ingestive disorders and premenstrual dysphoric disorder in women with IBS. All the subjects were required to go for a blood test in order to determine whether their serotonin levels were low, normal, or high. In addition, three self-report questionnaires were used in this investigation. The Irritable Bowel Syndrome Client Questionnaire; The Eating Disorder Inventory -2, of which four subscales out of 11 subscales were included, namely the Drive for Thinness, Bulimia, Body Dissatisfaction and Introceptive Awareness subscales; and the Premenstrual Assessment Form, of which six subscales out of 18 were included, namely Endogenous Depressive Features, Atypical Depressive Features, Signs of water Retention, General Physical Discomfort, Autonomic Physical Changes and Miscellaneous Physical Changes. In order to address the above mentioned aims, research was conducted at the Research and Counselling Centre for Psychogastroenterology at the Rand Afrikaans University. The Research and Counselling Centre for Psychogastroenterology is a facility developed to investigate the psychological constituents of IBS. Researchers at the centre are aiming to explore the multidimensional components of IBS with the purpose of gaining some understanding into the development and maintenance of this syndrome. A variety of topics are being investigated at the Research and Counselling Centre for Psychogastroenterology, including the role that stress, depression and coping styles play in IBS. Initially a sample group of (N = 60) women with IBS were selected for this research from a population of South Africans who were referred from gastroenterologists and general practitioners to the Centre for Gastroenterology at the Rand Afrikaans University. A number of women (N = 40) without IBS, from the north eastern suburbs of Johannesburg, were also asked to participate in this study in order to compile the comparison group.

The present study sought to determine whether a dietary and multi-element psychological treatment (DMPT) approach in combination with standard medical treatment would offer a more efficacious therapeutic package to irritable bowel syndrome (IBS) patients than would standard medical treatment (SMT) employed alone. The DMPT group (N = 19) received a stress management training package for a 2 week period consisting of relaxation training, imagery, and bowel sound biofeedback training via a stethoscope, in addition to instructions to increase their daily consumption of dietary fiber. They also were to continue the implementation of whatever standard medical treatment they were currently receiving, be it a bulking agent, or anti-anxiety, anti-cholinergic, or anti-depressant medications, etc. The SMT group (N = 19) simply received whatever conventional medical treatment they had been prescribed.