Denna uppsats behandlar den dolda folksjukdomen IBS och dess konsekvenser för individens sociala delaktighet. Syftet med studien är att studera individens upplevelse av delaktighet och erfarenhet av att leva med sjukdomen. IBS är en så kallad funktionell mag- och tarmsjukdom och står för Irritable Bowel Syndrome (Colon/Kolon irritabile), Irriterad tarm i svenskt tal och kännetecknas av återkommande eller kroniska symtom från mag- tarmkanalen. Medicinskt sett anses IBS vara en godartad sjukdom, men den kan vara besvärlig att leva med och ibland ge nästintill handlingsförlamande konsekvenser för individen och dennes sociala livsvärld. Forskarna vet inte orsaken bakom IBS och det finns inget medicinskt test som visar att det är IBS som en patient lider av, men man vet att individens sjukdomshistoria ofta är typisk och att sjukdomen är vanligast bland kvinnor. Av världens alla invånare lever det många människor med sjukdomen IBS, som kommit att bli en ny folksjukdom, då man beräknar att närmare 10-20 procent av den vuxna befolkningen har IBS. Individens upplevelse av vad som är normalt kontra avvikande när det gäller det friska och det sjuka visar en bild av hur samhället tycks vara skapat. Individens hälsotillstånd påverkar livskvaliteten och diagnosen bidrar till en förändrad identitet, och för varje individ som lever med IBS har begreppet delaktighet; att vara social med andra och i samhället i stort, fått en helt ny mening i och med deras sjukdom.   Min förhoppning är att denna studie ska uppmärksamma läsaren kring den nya folksjukdomen IBS och hur den påverkar individens sociala liv. / This essay deals with the new widespread disease IBS and its consequences for the social participation of the individual. The purpose of the study is to look at the experience of social participation of the individual and her experience of living with this disease. IBS is a so-called dynamic/functional belly- and intestinal disease, which stands for Irritable Bowel Syndrome, and is symbolized by recurrent or chronical symptom from the belly- and intestinal canal. From a medical view IBS is considered as a benign disease, but it can be tricky to live with and sometimes give heavy problems for the individual and its social life. The scientists doesn`t know what the cause is behind the disease and it doesn`t exist any medical test who can prove that a patient is suffering by IBS, but they do know that the case-history of the individual is very typical and that the disease is more common among women. From a social view studies show that the social life of the individual is strongly affected, and that the identity and how she look at normalcy/variation is no longer the same as it was when she was healthy. For every individual whos is living with this disease has also the concept of participation; to be social with other people and in society at large, got a whole new meaning as a result of their disease.

One of the main obstacles to maintaining patients with short bowel syndrome on parenteral nutrition, or successfully transplanting these patients with a small bowel graft, is the many severe infections that occur. Evidence is accumulating that translocating bacteria from the patient’s bowel causes a significant part of these infections. In this thesis bacterial translocation is studied in a Thiry-Vella loop of defunctionalised small bowel in the rat. Bacterial translocation to the mesenteric lymph nodes (MLNs) occurs in almost 100% of the rats after three days. No systemic spread of bacteria is observed unless there is additional immunosupression with depletion of Kupffer cells in the liver. However, blocking the function of α/β T cells does not increase the translocation. Removal of MLNs does not either aggravate bacterial translocation in the Thiry-Vella loop model. Conversely, after small bowel transplantation translocating bacteria spread systemically if the MLNs are removed. The Thiry-Vella loop should also be a suitable model for the testing of potentially translocation-inhibiting substances. Reinforcement of the intestinal barrier with glutamine or phosphatidylcholine proved insufficient in decreasing bacterial translocation. Even selective bowel decontamination with tobramycin failed to abolish bacterial translocation. Thus, it seems that the driving force for translocation in this model is strong regardless of the relatively small trauma of intestinal defunctionalisation. Flow cytometric studies of the immune cells in the spleen MLNs showed a decrease in MHC class II positive T cells in the MLNs of the Thiry-Vella loop. Concurrently the number of macrophages increased with time as observed by immunohistochemistry. The fraction of MHC class II negative macrophages increased in the spleens of rats treated with glutamine. In conclusion, the Thiry-Vella loop model offers possibilities of immunological as well as mechanistic studies on bacterial translocation from small intestine.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser. NB: Rätt ISBN från spikblad.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Este estudo teve por objetivo avaliar o hábito intestinal e os fatores de risco para incontinência anal (IA) em adultos da população geral, residentes na área urbana da cidade de Londrina - PR. Estudo epidemiológico de base populacional, de corte transversal, realizado após a aprovação do Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo. Dois mil cento e sessenta e dois indivíduos, com idade igual ou superior a 18 anos, condições físicas e mentais adequadas e que aceitaram a participar do estudo, compuseram a amostra, estabelecida a partir de amostragem estratificada por conglomerado, constituídos pelas ruas sorteadas aleatoriamente dentro dos 390 setores censitários do município. Todos os residentes nos domicílios das ruas sorteadas, que atenderam aos critérios de inclusão foram entrevistados utilizando-se dois instrumentos: Dados demográficos e o Hábito intestinal na comunidade (adaptado e validado para a língua portuguesa por Domansky e Santos, 2007). Os dados foram submetidos aos testes de Qui-Quadrado e Exato de Fischer. O predomínio foi do sexo feminino (1203 / 56%); média etária de 40,6±16,4; brancos (1591/74%); união estável (1290 / 60%); 9 a 12 anos de estudo (784/ 36%); 37% pessoas sem ocupação definida; 44% tinham remuneração entre 2 e 3,9 SM; 38% com renda per capita entre 0,6 a 1 salário mínimo. Para o padrão intestinal normal (1.875/87%; p<,0001), predominância de uma evacuação por dia (1.133/52%; p<0,0001), entre as mulheres (968/52%; p<0,0001); os brancos (1591/85%; p<0,0001), ausência de esforço evacuatório (1956/90%), exonerações de fezes macias (1379/64%), esvaziamento retal completo (1938/90%). Padrão intestinal constipado (261/12,1%), entre mulheres (219/84%), esforço evacuatório (99/41,8%), fezes endurecidas (176/67%); esvaziamento retal incompleto (99/38%). Padrão intestinal diarréico (26/1,2%), sem esforço evacuatório (26/100%) fezes líquidas e amolecidas (5/19%), esvaziamento retal completo (16/61%). A prevalência das doenças anorretais, foi de 53 (2%) abscessos, 22 (1%) fístulas, 81 (3%) fissuras, 20(1%) prolapsos retais, 30 (1%) traumas anais; 229 (11%) doença hemorroidária, 58 (3%) cirurgias anorretais, para todas o predomínio foi feminino. O histórico de parto e ginecológico: 886 (74%) tiveram partos, 709 (73%) com padrão intestinal normal; 432 (49%) entre 31 e 50 anos; 168 (14%) tiveram um parto normal; destas 33 (3%) tiveram laceração anal pós-parto que necessitou de intervenção cirúrgica; porém mantiveram o padrão intestinal normal (25/75%); 109 (9%) fizeram histerectomia (109 /9%), 90 (90%) padrão intestinal normal e menos de um por cento tiveram retocele e quatro (50%) eram constipadas. Os fatores de risco para incontinência anal: 35 (2%) radioterapia pélvica, 133 (6%) diabetes mellitus, 330 (15%) doenças ou distúrbios do sistema nervoso, 291 (13%) lesão na coluna espinhal e 29 (1%) relataram o acidente vascular encefálico (AVE), para todos os fatores houve predomínio do padrão intestinal normal, predomínio feminino para distúrbios do sistema nervoso e AVE. Este estudo permitiu conhecer o hábito intestinal da população geral de uma cidade no norte do Paraná, os fatores de risco para IA que estão expostos, cooperando para a elucidação do tema entre a população, ampliando os conhecimentos daqueles que atuam na área, e colaborando para o desenvolvimento de programas de prevenção ou diagnóstico precoce das doenças intestinais / The objective of this study was to evaluate the bowel habits and anal incontinence (AI) risk factors in adults living in the urban area of Londrina, PR, Brazil. This population-based, transversal epidemiological study was carried out after being approved by the University of São Paulo Nursing School Ethics Committee. Population sample established from a stratified sampling procedure by a conglomerate constituted of streets taken randomly from 390 county census sectors, included 2162 individuals , 18 years old and over, in adequate physical and mental conditions, who accepted to participate in the study. All residents in the selected streets who met the inclusion criteria established by the study were interviewed, using two instruments: Demographic data and the Bowel function in the community (adapted and validated for the Portuguese language by Domansky and Santos, 2007). Data were submitted to Chi-square and Fischer exact tests. There was a predominance of female subjects (1203/56%); ages 40,6 ± 16,4; white (1591/74%); with a stable relationship (1290/60%), with 9 to 12 years of formal education ( 784/36%), subjects without a defined job (37%) with salaries around 2 to 3,9 / minimum wage (44%) and per capita income between 0,6 to one/minimum wage (38%). As for normal intestinal pattern (1.875/87%; p<0,0001), there was the predominance of one bowel movement per day (1.133/52%; p<0,0001), among women (968/52%; p<0,0001); whites (1591/85%; p<0,0001), absence of defecation strain (1956/90%), soft feces (1379/64%), total rectal emptying (1938/90%). Constipated intestinal pattern (261/12,1%), among women (219/84%), defecation strain (99/41,8%), hard feces (176/67%); incomplete rectal emptying (99/38%). Diarrheic intestinal pattern (26/1,2%), no defecation strain (26/100%) liquid and soft feces (5/19%), total rectal emptying (16/61%). Prevalence of anorectal diseases was 53 (2%) abscesses, 22 (1%) fistules, 81 (3%) fissures, 20(1%) rectal prolapse, 30 (1%) anal traumas; 229 (11%) hemorrhoidal disease 58 (3%) ; anorectal surgeries, mainly among females. Gynecological and delivery history, 886 (74%) had deliveries, 709 (73%) with normal intestinal pattern; 432 (49%) between 31 and 50 years old; 168 (14%) had normal deliveries; 33 (3%) with postpartum laceration that needed surgical intervention; however, they maintained a normal intestinal pattern (25/75%); 109 (9%) had hysterectomy (109 /9%), 90 (90%) normal intestinal pattern and less than one percent had rectocele and four (50%) were constipated. Anal incontinence risk factors, 35 (2%) pelvic radiotherapy, 133 (6%) diabetes mellitus, 330 (15%) nervous systems diseases and dysfunctions, 291 (13%) spinal cord lesion and 29 (1%) reported having had an encephalic vascular stroke. In all factors there was the predominance of the normal intestinal pattern; however, females presented more nervous system dysfunctions and encephalic vascular strokes. This study reports on the bowel habits of a general population in a city in Northern Paraná, and the AI risk factors they are exposed to, bringing more information about the topic to the population and to those who work in the area , helping develop prevention programs or early diagnoses of intestinal diseases

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Datortomografiundersökning av tjocktarmen har blivit en vanlig undersökning som utförs på röntgenavdelningar. Inför denna undersökning krävs förberedelser i form av laxering och födorestriktioner. Information till patienter inför denna undersökning är av stor vikt för förberedelsernas resultat och därmed även för en optimal undersökning.                       Syftet med denna studie var att beskriva om patienterna upplever att de fått tillräcklig information om laxeringsförberedelserna inför en DT-undersökning av tjocktarmen. Ett annat syfte med studien var att studera om patienterna förstått den information de fått.                       Tio patienter med en ålder mellan 62-81 år intervjuades efter DT-kolografiundersökningen på en röntgenavdelning i mellansverige under en period på två veckor. Det insamlade materialet analyserades sedan genom kvalitativ innehållsanalys.                       De intervjuade patienterna upplevde att informationen om förberedelserna inför DT-kolografiundersökningen var tillräcklig. Patienterna kunde ordagrant återberätta den information som de erhållit men det fanns en bristande förståelse av informationen som behandlade definitionen klar dryck och tillvägagångssättet med vissa mediciner. De flesta patienterna förstod syftet med de tarmförberedelser som utförs innan undersökningen.                       Studien visade att det fanns oklarheter i den skriftliga informationen inför DT-kolografiundersökningar som patienterna inte förstod, trots att de bedömde att informationen var tillräcklig. Genom att ta i beaktanden de brister i informationen om de tarmförberedelser som studiens resultat visar finns det förutsättning att undersökningens förberedelser och genomförande utförs på bästa möjliga sätt. / Computed tomography (CT) scan of the colon has become a common investigation in radiology departments. Prior to this examination preparation in form of purgation and food restrictions are required. Information to patients facing this examination are of great importance for the results of preparations and thus for optimal investigation.                The aim of this studie was describe whether patients feel that they received sufficient information about the bowel preparations before a CT scan of the colon. Another purpose of the study was to see whether patients understood the information they receive before the examination.                              Ten patients with an age between 62-81 years were interviewed after the CT colography examination at the radiology department in a hospital in the middle of Sweden for a period of two weeks. The collected material was then analyzed by qualitative content analysis.                              The interviewed patients felt that information on preparations for the CT colonography examination was sufficient. Patients can literally retell the information received but there is a lack of understanding of the information that deals with the definition of clear liquids and the approach of certain medications. Most patients understood the purpose of the bowel preparations performance before the examination.                The study showed that there were unclarities in the written infomrmation given before the CT colonography examination that the patients did not understand, even though they considered that the information was sufficient. By taking into considerations the lack of information about bowel preparation that the studies results show there are subject to examination, preparation and implementation is carried out in the best manner.

Intestinal homeostasis is a delicate balance between suppression of immune responses against innocuous antigens and stimulation of immune responses against pathogens. Type I interferon (IFN-1) cytokines have both immunostimulatory and immunomodulatory effects. Colon mononuclear phagocytes (MP) constitutively produced IFN-1 in a TRIFdependent manner. We explored the function of endogenous IFN-1 in the colon using the T cell adoptive transfer model of colitis. Transfer of CD4⁺CD45RB^hi naïve T cells from wild type (WT) or IFNAR subunit 1 knockout (IFNAR1^-/-) mice into RAG^-/- hosts resulted in similar onset and severity of colitis. In contrast, RAG^-/- x IFNAR1^-/- double knockout (DKO) mice developed accelerated severe colitis compared to RAG^-/- hosts when transferred WT CD4⁺CD45RB^hi T cells. Although WT or IFNAR1^-/- regulatory T (Treg) cells equally prevented disease caused by CD45RB^hi naïve T cells, WT Treg cells co-transferred with naïve CD4⁺ T cells into DKO recipients failed to expand or maintain Foxp3 expression and gained effector functions in the colon. IFNAR signaling on host hematopoietic cells inhibited T cell-mediated colitis, but not innate colitis. MPs isolated from the colon lamina propria (cLP) required IFNAR signaling for the production of the anti-inflammatory cytokines, IL-10, IL-27, and IL-1RA, but not for the production of classic pro-inflammatory cytokines. IFN-1-dependent secretion of IL-1RA was particularly important in inhibiting the migration of inflammatory DCs with potent T cell proliferative capacity from the cLP to the mesenteric lymph nodes. Finally, preliminary results suggested that IFN-1 may shape the commensal microbiota, but is not essential for controlling specific colitis-inducing bacteria.