Bakgrund: Irritable bowel syndrome (IBS) karakteriseras av obehag i magtarmkanalen och förändrade avföringsvanor. Sjukdomen delas in i subtyperna IBS-C (förstoppning), IBS-D (diarré), IBS-M (blandad) och IBS-U (odiagnostiserad). Patofysiologin och etiologin är inte klarlagd, men bland annat störd tarmflora och inflammation har föreslagits. Prevalensen är 10-20 %. Denna litteraturstudie fokuserar på probiotika som behandling vid IBS-D, ett område med ökat intresse inom forskningen.  Syfte och Metod: Syftet med litteraturstudien är att undersöka effekten och säkerheten av probiotika Clostridium butyricum, Saccharomyces boulardii, Bio-Kult® samt BIO-25 på IBS-D patienter. Sökning i den medicinska databasen PubMed januari 2021 genererade 5 dubbelblindade, randomiserade, placebokontrollerade studier. Resultat: Bio-Kult® och Clostridium butyricum resulterade i signifikant skillnad på symtom jämfört med placebo. Den förstnämnda hade inga biverkningar, medan den senare medförde åtta biverkningsfall. Saccharomyces boulardii förbättrade interleukin-8 (IL-8), tumor necrosis-α (TNF-α), IL-10 och IL-10/IL-12 kvoten, men inte symtomen jämfört med placebo. Nära hälften av deltagarna fick lättare biverkningar. BIO-25 medförde en förbättrad tarmflora vad gäller Lactococcus och Lactobacillus, men det gav inga symtomförbättringar jämfört med placebo. Inga biverkningar upptäcktes. Quality of Life (QOL) förbättrades i alla studier där variabeln mättes. Slutsats: Liksom tidigare studier av andra forskare genererade artiklarna i detta arbete ett tvetydigt utfall. En anledning till det varierande resultatet kan härledas till placeboeffekten. En del av resultaten är hoppingivande, speciellt när det gäller QOL. Samtidigt antyder undersökningarna att probiotikans effekt är beroende av tarmflorans sammansättning. Saccharomyces boulardii förbättrade IL-8, TNF-α, IL-10 och IL-10/IL-12 kvoten, medan BIO-25 förbättrade Lactococcus och Lactobacillus. Fyra av fem studier hade en bra biverkningsprofil. Slutsatsen blir att probiotika har viss effekt på IBS-D patienter och få biverkningar. Fler och större studier behövs för att få en klarare bild av probiotikans effekt och biverkningar på IBS-D patienter. / Background: Irritable bowel syndrome (IBS) is characterized by discomfort in gastrointestinal tract and change in the bowel motility. The subtypes of the disease are diveded into IBS-C (constipation), IBS-D (diarrhea), IBS-M (mixed) and IBS-U (undefined). The pathophysiology and etiology are incompletely understood but changed gut microbiota and inflammation has been proposed among other things as the underlying causes. The prevalence is 10-20 %. This study focused on probiotics as a treatment for IBS-D, which has been used during the last decade in the treatment of the disease. Purpose and method: This study aimed to assess the efficacy and safety of Clostridium butyricum, Saccharomyces boulardii, Bio-Kult® and BIO-25 on IBS-D patients. Searches in the medical database PubMed in January 2021 resulted in 5 double-blind, randomized, placebo-controlled trials. Results: Bio-Kult® and Clostridium butyricum resulted in significant differences compared with placebo. The prior had no adverse events, while the latter had eight adverse events. Saccharomyces boulardii improved interleukin-8 (IL-8), tumor necrosis-α (TNF-α), IL-10 och IL-10/IL-12 ratio, but not the symptoms compared with placebo. Nearly fifty percent of the patients had mild adverse events. BIO-25 resulted in improved Lactococcus and Lactobacillus but showed no improvements in symptoms compared with placebo. No adverse events were discovered. Quality of Life (QOL) improved in all studies the variable was measured. Conclusion: The outcome of this study was inconclusive and thus similar to previous studies. One of the reasons for the various outcomes can be derived from the placebo effect. In some of the results the use of probiotic treatment were positive, especially when it comes to the improvement of QOL. The studies suggested that the effect of probiotics is dependent on the composition of the gut microbiota. Saccharomyces boulardii improved IL-8, TNF-α, IL-10 och IL-10/IL-12 kvoten, while BIO-25 improved Lactococcus och Lactobacillus. Four out of five studies had a good outcome when it comes to adverse events. The conclusion of this thesis is that probiotics have some effect on IBS-D patients and few adverse events. Larger studies need to be done to evaluate the effect of probiotics and its adverse events.

No description available.

Detta är en kvalitativ studie med fenomenologisk ansats, som beskriver kvinnor med Irritable Bowel Syndrome (IBS) och deras upplevelser av sjukdomen. Vårt syfte med studien är att öka kunskapen och förståelsen hos sjuksköterskor och övrig vårdpersonal, genom att låta kvinnor med diagnosen IBS beskriva sina upplevelser av att leva med syndromet samt hur de blivit bemötta vid kontakter med sjukvården. Målsättningen är att det holistiska omhändertagandet av patienten skall förbättras. Studien baseras på semistrukturerade intervjuer med sju diagnostiserade kvinnor. Materialet har sedan bearbetats utifrån Philip Burnards modell för textanalys. Resultaten presenteras i följande kategorier sociala aktiviteter, sociala relationer, okunskap, bemötande och utredning, vilka kan relateras till de aktuella frågeställningarna (1) Hur upplever kvinnor med IBS att sjukdomen påverkar deras dagliga liv? Och (2) Hur upplever kvinnor med IBS att de blivit bemötta vid kontakter med sjukvården. Våra resultat ger en uppfattning av hur kvinnorna upplever att deras IBS påverkar det dagliga livet. Utmärkande för studiepopulationen är upplevelser av att sociala relationer och sociala aktiviteter förändrats till följd av sjukdomen. Gällande bemötande vid kontakter med sjukvården upplever kvinnorna att de bemötts med okunskap från sjuksköterskor och annan vårdpersonal. De upplever sig dessutom ofta åsidosatta och lågprioriterade av sjukvårdssystemet. / This is a qualitative study with a phenomenological approach, about females with Irritable Bowel Syndrome (IBS). The purpose of the study is to increase the knowledge and understanding among nurses and other caring personnel, by letting females diagnosed with IBS describe their experiences of living with the syndrome, and how they have been treated in contacts with the Swedish healthcare system. The intention of the study is that the holistic care should be improved. The study is based on seven semi-structured interviews of IBS-diagnosed females. The data has been analysed with Burnard´s method for transcripts. The results are presented in the following categories social activities, social relations, ignorance, treatment, analysis, which can be related to the actual questions of the study: (1) How do females with IBS experience that the illness affects their daily life? and (2) How do females with IBS experience the treatment in contacts with the Swedish care-system? The results have been presented in categories that can be related to the empiric questions in the study. The results of the study give us a conception of how IBS influences the daily life. Distinguishing for the study population is their experiences of changes in their social activities and relations due to their illness. About treatment in contacts with the Swedish healthcare system the females experience that they have been treated with ignorance from nurses and other health care personnel. They also experience themselves as disregarded and low prioritised by the healthcare system.

Irritable bowel syndrome (IBS) är en av våra vanligaste funktionella tarmsjukdomar med en prevalens på ca 10% värden över. Diagnosen ställs utifrån ROME-kriterierna vilka är ett symptombaserat diagnostiskt verktyg samt uteslutande av andra allvarliga tillstånd. Vidare kan IBS delas in i undergrupper beroende på avföringens konsistens mätt utifrån The Bristol stool form scale (BSFS). Patologin bakom sjukdomen är idag inte helt klarlagd men flera faktorer och mekanismer tros spela in. Däribland finns visceral hypersensitivitet och avvikande uttryck av smärtreglerande signalsubstanser, rubbningar i den gastrointestinala mikrobiotan, genetik, ökad inflammation, defekt mucosabarriär med ökad permeabilitet, psykosociala faktorer och kost. Behandling är främst inriktad på symptomlindring och att utbilda patienten i att hantera sjukdomen genom att undvika triggande faktorer som kan förvärra symptom. Probiotika är levande icke-patogena mikroorganismer som används i behandlande syfte. Några av de mest studerade släkterna av bakterier som används vid behandling av IBS är Lactobacillus och Bifidobacterium. Detta arbete syftade till att analysera effekten av probiotika i form av en kombination med dessa två släkten som symptomlindrande behandling vid IBS. Detta gjordes genom litteratursökning på databasen PubMed där fem artiklar filtrerades fram utifrån satta kriterier. Resultatet visade att probiotika innehållande Lactobaciullus och Bifidobacteirum har potential att förändra den gastrointestinala mikrobiotan. Man kunde också se att en ökad nivå Bifidobacteriumkorrelerade med sänkt symptomgrad och lägre nivå inflammatoriska markörer. Studierna visade också på sänkt tarmpermeabilitet efter intag av probiotika. Den generella symptombilden och allvarlighetsgraden av sjukdomen förbättrades och även flera specifika symptom. Trots det kunde en entydig och signifikant förbättring av livskvalitén inte fastställas. Dosen probiotika som användes var mellan 5-10 miljarder colony forming units (CFU) i alla utom en studie. Denna undersökte en betydligt högre dos om 52 miljarder CFU men gav trots det inte bättre resultat än övriga studier. Studiepopulationen var sammantaget enhetlig i de olika studierna och speglade också den vanligaste patientgruppen. Slutsatsen var att probiotika innehållande släkterna Bifidobacterium och Lactobacillus kan förbättra allvarlighetsgraden av IBS och ge en generell och specifik symptomlindring. / Irritable bowel syndrome (IBS) is one of the most common functional bowel disorders without any detectable biochemical or structural changes with a prevalence of about 10 % worldwide. The diagnosis is based on the ROME-criteria which is a symptom based diagnostic tool and also exclusion of other severe diseases. Further on, IBS can be divided into different subgroups based on stool texture evaluated by the Bristol stool form scale (BSFS).  The pathology behind IBS is not fully understood but several factors and mechanisms are thought to be involved. Amongst those are hypersensitivity in the gut and divergent pain transmission, disturbance in gut microbiota, genetics, increased inflammation, defective mucosal barrier function with increased permeability, psychosocial factors and diet. Treatment is mainly used to alleviate symptoms so as to help the patients to manage the disease by education and by avoiding the triggering factors that may exacerbate the symptoms.  Probiotics are living non-pathogen microorganisms, meaning they are not harmful, used to treat or favor the host. Some of the most studied genera of bacteria, both in general and used as treatment of IBS, are Lactobacillus and Bifidobacterium. These bacteria are often referred to as lactic acid bacteria due to their ability to metabolize specific carbohydrates and produce lactic acid.  This study aimed to investigate the effect of probiotics consisting of these two genera on symptom relief for patients with IBS. It was achieved by carrying out a literature review in the PubMed database. Five articles were found based on set criteria.  The results showed that probiotics based on Lactobacillus and Bifidobacterium have potential to alter the gut microbiota and that levels of Bifidobacterium corresponding to level of symptoms and inflammatory markers. Also, the intestinal permeability was lowered by probiotics administration. The overall symptoms and severity were decreased as well as several specific symptoms. Despite that, a significant increase in quality of life was not observed.  The dose used was between 5-10 billion colony forming units (CFU) in all but one study. This study used a much higher dose of 52 billion CFU and did also last a longer period of time but did not get better results than the other studies. The study population was in general similar in all studies and did also reflect the most common patient group based on prevalence.  In conclusion, probiotics consisting of Lactobacillus and Bifidobacterium can be used to improve severity of IBS and to relieve general and specific symptoms.

No description available.

Geosynthetic Reinforced Soil (GRS) is a promising technology that can be implemented in walls, culverts, rock fall barriers, and bridge abutments. Its use in walls and abutments is similar to Mechanically Stabilized Earth Walls (MSEW) reinforced with geosynthetics. Both GRS and MSEW are reinforced soil technologies that use reinforcement to provide tensile capacity within soil masses. However, the soil theories behind each method and the design methodologies associated with GRS and MSEW technologies are quite different. Therefore, a study was undertaken to compare the required tensile strength predicted by these various reinforced soil design methodologies. For the purposes of this study, the required ultimate tensile strength was defined as the ultimate tensile strength needed in the reinforcement after all applicable factors of safety, load factors, and reduction factors were applied. The investigation explored both MSEW and GRS. GRS has been made an FHWA "Every Day Counts" initiative. Due to the push to implement GRS technology, it is critical to understand how GRS design methods differs from classic MSEW design methods, specifically in the prediction of ultimate tensile strength required. A parametric study was performed comparing five different reinforced soil analysis methods. Two are current MSEW design methods and one was a proposed revision to an existing MSEW design method. The final two were GRS design methods. These design methods are among the most current and/or widely used design references in the United States regarding reinforced soil technology. There are significant differences between the methods in the governing soil theory particularly between GRS and MSEW design methods. The goal of the study was to understand which design parameters had the most influence on calculated values of the required ultimate tensile strength and nominal "unfactored" tensile strength. A base case was established and a reasonable set of parameter variations was determined. Two loading conditions were imposed, a roadway loading scenario and a bridge loading scenario. Based on parametric study findings, conclusions were drawn about which design parameters had the most influence for different design methods. Additionally, the difference in overall predicted required tensile strength was assessed between the various methods. Finally, the underlying soil theory and assumptions employed by the different methods and their influence on predicted required tensile strength values was interpreted. / Master of Science

Bakgrund: Irritabel tjocktarm (IBS) är en funktionell tarmsjukdom med okänd etiologi. De typiska symtomen är obehag och/eller smärta vid tarmtömning, obehagliga gaser eller ändrad avföringskonsistens. Diagnostiken utgår från diagnoskriterier (Rom IV-kriterier). Behandlingsmetoder innefattar förändringar i livsstils- och kostvanor, kognitiv beteendeterapi samt läkemedelsbehandling och egenvårdsstrategier. Allmänsjuksköterskans roll är att lyssna, stötta och bekräfta den drabbade patienten i sitt lidande. Syfte: Syftet var att undersöka patienters upplevelser av att leva med IBS. Metod: En systematisk litteraturöversikt med induktiv ansats. Studien bygger på tio stycken kvalitativa originalartiklar som analyserades genom metasyntes, inspirerad av Friberg. Resultat:  I resultatet identifierades tre teman med sex tillhörande subteman. Temat upplevelse av att möta vården beskriver patientens negativa och positiva upplevelser av att möta vården samt upplevelser av sin egenvårdsbehandling. Temat känslor kring IBS beskriver patienternas fysiska och psykiska smärtor samt deras stunder av lättnad. Temat IBS inverkan på sociala relationer beskriver sjukdomens påverkan på den intima relationen/familjen samt på arbetslivet/vänner. Slutsats: Patienter upplever frustration till följd av ett negativt bemötande från sjukvården. Det finns stunder av lättnad och välbefinnande när patienten upplever symtomfrihet. Ett stort lidande skapas till följd av IBS symtomen, vilket även har en inverkan på patientens sociala relationer. Allmänsjuksköterskan bör i sin yrkesroll skapa och upprätthålla en vårdande relation för att öka patientens hälsa och minska lidande.

There is a significant comorbidity between anxiety/depression and functional gastrointestinal syndromes, such as irritable bowel syndrome (IBS) and functional dyspepsia. The pathophysiological link between emotions and the gut is not known. A model of an emotional motor system (EMS) which reacts to interoceptive and exteroceptive stress has been proposed. EMS consists of specific brain structures including anterior cingulate cortex (ACC), amygdala, hippocampus and hypothalamus and mediates their communication to the rest of the body (including the gastrointestinal tract) through the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS) and by a pain modulation system. The aim of this thesis was to test the EMS model by studying the relationship between symptoms of anxiety and depression and IBS-like symptoms in patients with recurrent unipolar depression, in patients with IBS and in a sample of a normal Swedish population. The peripheral limb of EMS (ANS, HPA axis and the pain modulations system) was tested in patients with IBS and control subjects. Spectral heart rate variability was used to investigate ANS function in patients with refractory IBS and in healthy controls. The HPA axis function was tested by a weight adjusted low dose dexamethasone suppression test in control subjects. The influence of catecholamine degradation on pain modulation was tested by analyzing val158met catechol-o-methyl transferase (COMT) polymorphism in patients with IBS and in control subjects. We found a significant relationship between symptoms of anxiety/depression and IBS-like symptoms in patients with recurrent unipolar depression, in patients with IBS and in a sample of the normal population. Interestingly, patients with recurrent unipolar depression in remission had no more IBS-like symptoms than controls, indicating that the gastrointestinal symptoms may resolve when depression is treated to remission. Patients with IBS have an increased mid-frequency power in rest and in supine position (after tilt test) compared to healthy controls indicating an increased sympathetic ANS drive. The symptoms of diarrhea and early satiety has in the litterature been associated to the stimulation of corticotropin releasing hormone (CRH) receptors and was also in our study related to HPA axis function tested by a low dose dexamethasone test. Interestingly both hypo- and hyperfunction of the HPA axis was related to these symptoms in control subjects. The val158met COMT polymorphism was associated to IBS-like symptoms. Control subjects with IBS-like symptoms (defined by the upper quartile in total GSRS-IBS score) had a higher frequency of the met/met and a significantly lower frequency of the val/met genotype. Also patients with IBS tended to have a lower frequency of the heterozygous val/met genotype so we conclude that this genotype may be protective against IBS/IBS like symptoms. In addition, the val/val genotype in patients with IBS was associated to diarrhea symptoms. Conclusions: Our results support the model of an emotional motor system in the genesis of functional gastrointestinal symptoms by the finding of the association of IBS-like symptoms and mood disturbances, and by finding alterations in the peripheral limbs of EMS (ANS, HPA axis and catecholamines) in subjects with IBS and IBS-like symptoms.

Self-organization of regular surface pattern under ion beam erosion was described in detail by Navez in 1962. Several years later in 1986 Bradley and Harper (BH) published the first self-consistent theory on this phenomenon based on the competition of surface roughening described by Sigmund’s sputter theory and surface smoothing by Mullins-Herring diffusion. Many papers that followed BH theory introduced other processes responsible for the surface patterning e.g. viscous flow, redeposition, phase separation, preferential sputtering, etc. The present understanding is still not sufficient to specify the dominant driving forces responsible for self-organization. 3D atomistic simulations can improve the understanding by reproducing the pattern formation with the detailed microscopic description of the driving forces. 2D simulations published so far can contribute to this understanding only partially. A novel program package for 3D atomistic simulations called trider (TRansport of Ions in matter with DEfect Relaxation), which unifies full collision cascade simulation with atomistic relaxation processes, has been developed. The collision cascades are provided by simulations based on the Binary Collision Approximation, and the relaxation processes are simulated with the 3D lattice kinetic Monte-Carlo method. This allows, without any phenomenological model, a full 3D atomistic description on experimental spatiotemporal scales. Recently discussed new mechanisms of surface patterning like ballistic mass drift or the dependence of the local morphology on sputtering yield are inherently included in our atomistic approach. The atomistic 3D simulations do not depend so much on experimental assumptions like reported 2D simulations or continuum theories. The 3D computer experiments can even be considered as ’cleanest’ possible experiments for checking continuum theories. This work aims mainly at the methodology of a novel atomistic approach, showing that: (i) In general, sputtering is not the dominant driving force responsible for the ripple formation. Processes like bulk and surface defect kinetics dominate the surface morphology evolution. Only at grazing incidence the sputtering has been found to be a direct cause of the ripple formation. Bradley and Harper theory fails in explaining the ripple dynamics because it is based on the second-order-effect ‘sputtering’. However, taking into account the new mechanisms, a ‘Bradley-Harper equation’ with redefined parameters can be derived, which describes pattern formation satisfactorily. (ii) Kinetics of (bulk) defects has been revealed as the dominating driving force of pattern formation. Constantly created defects within the collision cascade, are responsible for local surface topography fluctuation and cause surface mass currents. The mass currents smooth the surface at normal and close to normal ion incidence angles, while ripples appear first at θ ≥ 40°. The evolution of bimetallic interfaces under ion irradiation is another application of trider described in this thesis. The collisional mixing is in competition with diffusion and phase separation. The irradiation with He+ ions is studied for two extreme cases of bimetals: (i) Irradiation of interfaces formed by immiscible elements, here Al and Pb. Ballistic interface mixing is accompanied by phase separation. Al and Pb nanoclusters show a self-ordering (banding) parallel to the interface. (ii) Irradiation of interfaces by intermetallics forming species, here Pt and Co. Well-ordered layers of phases of intermetallics appear in the sequence Pt/Pt3Co/PtCo/PtCo3/Co. The trider program package has been proven to be an appropriate technique providing a complete picture of mixing mechanisms.

Irritable bowel syndrome (IBS) is a functional disorder that affects the gastrointestinal tract and especially the large intestine. The pathogenesis of the disease is not fully understood, for that reason there is still no cure and current therapy focuses on symptom relief. The disease manifests itself in the form of abdominal pain, bloating, constipation or diarrhoea. New studies have shown a link between IBS and communication between the central nervous system and the gut. Serotonin and norepinephrine seem to be important for the course of the disease. The purpose of this literature review was to study the efficacy and safety of certain antidepressant preparations belonging to tricyclic antidepressants and selective serotonin reuptake inhibitors in the treatment of IBS. This work focused on the effect of preparations and how tolerable they are with respect to their side effects. Articles presented in this work were found in the PubMed database with the keywords "irritable bowel syndrome", "serotonin reuptake inhibitor", " tricyclic antidepressants ". Amitriptyline 10 mg and imipramine 25 mg provided a statistically significant symptom relief in IBS with diarrhoea (IBS-D) compared to placebo. In addition, tianeptine 12.5 mg 3 times / day, which belongs to the selective serotonin reuptake enhancer (SSRE) group, gave a corresponding symptom relief as amitriptyline 10 mg once / day. The difference between the two was not statistically significant, but the study was open label and non-placebo-controlled, which made it difficult to draw any conclusions. Fluoxetine, which belongs to the selective serotonin reuptake inhibitor (SSRI) group, produced a statistically significant effect compared to placebo in the treatment of constipation IBS (IBS-C). In contrast, paroxetine-CR did not have any statistically significant effect on abdominal pain in IBS-C compared with placebo. However, more patients in the paroxetine group achieved the secondary outcome (clinical global improvement) with scores of 1-2 on the scale Clinical Global Impressions-Improvement (CGI-I). Based on the studies presented in this literature study, it is concluded that a low dose of TCA is an effective and safe treatment for IBS-D while SSRIs are effective and safe in the treatment of IBS-C compared to placebo. / Irritable bowel syndrome (IBS), är funktionella störningar som drabbar gastrointestinalkanalen och framför allt kolon. Patogenesen till sjukdomen är inte helt klarlagd, av den anledningen saknas fortfarande någon botande behandling och dagens terapi fokuserar på symtomlindring. Sjukdomen yttrar sig i form av buksmärta, uppblåsthet, förstoppning eller diarré. Senaste studier har visat en koppling mellan IBS och kommunikation mellan centrala nervsystemet och tarmen. Serotonin och noradrenalin verkar ha betydelse för sjukdomsförlopp. Syftet med detta litteraturarbete var att studera effektivitet och säkerhet för några antidepressiva preparat som tillhör tricykliska antidepressiva och selektiva serotonin återupptagshämmare vid behandling av IBS. Detta arbete fokuserade på effekten av preparaten och hur tolererbara de är med avseende på deras biverkningar. Artiklar som presenteras i detta arbete söktes i databasen Pubmed med sökord ”irritable bowel syndrome”, ”serotonin reuptake inhibitors”, ” tricyclic antidepressants”. Amitriptylin 10mg och imipramin 25mg gav en statistiskt signifikant symtomlindring vid IBS med diarré (IBS-D) jämfört med placebo. Dessutom gav tianeptin 12,5mg 3 gånger/dag, som tillhör läkemedelsgruppen selektiv serotonin återupptagsenhancer (SSRE), en likvärdig symtomlindring som amitriptylin 10mg en gång/dag. Skillnaden mellan de två var inte statistiskt signifikant, däremot var studien openlabel och icke-placebokontrollerad vilket gör det svårt att dra någon slutsats. Fluoxetin, som tillhör läkemedelsgruppen selektiva serotonin återupptagshämmare SSRI, gav en statistiskt signifikant effekt jämfört med placebo vid behandling av IBS med förstoppning (IBS-C). Däremot gav paroxetin-CR ingen statistiskt signifikant effekt på buksmärta vid IBS-C jämfört med placebo, dock uppnådde fler i paroxetingruppen den sekundära utfallsvariabeln (global klinisk förbättring) och fick poäng mellan 1 – 2 på skalan Clinical Global Impressions-Improvement (CGI-I).  Baserat på studierna som presenteras i denna litteraturstudie dras slutsatsen att en låg dos TCA är en effektiv och säker behandling vid IBS-D medan SSRI är effektiva och säkra vid behandling av IBS-C jämfört med placebo.