Doctor of Philosophy / Nineteenth century philosophy and anatomy regarded the nervous system as the only pathway of communication between the brain and body but now, research in the field of psychoneuroimmunology (PNI) has provided evidence to prove the age-old belief that there is a connection between the mind (or mental/emotional states) and the body. Researchers in PNI have now shown that the communication between the nervous and immune systems is bi-directional – i.e. there is a psychological reaction to physical disease and a somatic presentation of psychological disorders - and that the immune system, the autonomic nervous system, the endocrine system and the neuropeptide systems all communicate with each other by means of chemicals called messenger molecules or ligands. This paper outlines research into the treatment of Irritable Bowel Syndrome (IBS) with hypnotherapy, taking into account the mind-body connection and treating both the patient’s physiological and emotional/psychological symptoms rather than treating the physiological symptoms only. In other words, using a more holistic approach to the treatment of IBS. IBS is probably the most common functional gastrointestinal disorder encountered by both gastroenterologists and physicians in primary care. It is estimated that from 10% to 25% of the general population suffer from this condition and that it comprises about 30-50% of the gastroenterologists’ workload, yet the aetiology of IBS is unknown and, so far, there is no cure. Researchers are beginning to view IBS as a multi-faceted disorder in which there appears to be a disturbance in the interaction between the intestines, brain, and autonomic nervous system, resulting in an alteration in the regulation of bowel motility and/or sensory function. Most researchers agree that a subset of IBS sufferers have a visceral hypersensitivity of the gut or, more specifically, an increased perception of sensations in the gut. To date, studies of IBS have proposed previous gastroenteritis, small intestine bacterial overgrowth, psychosocial factors, a genetic contribution, and an imbalance of neurotransmitters as either possible causes or playing a part in the development of IBS. It is generally agreed that a patient’s emotional response to stress can exacerbate the condition. In section 1 of the thesis, the introduction, a detailed description and background appropriate to the study undertaken are provided, including aspects of epidemiology, diagnostic symptom criteria and clinical relevance of the Irritable Bowel Syndrome. Previous studies of various forms of treatment for IBS are discussed with the main emphasis being on treatment with hypnotherapy. All these therapies have concentrated on either mind or body treatments whereas this study demonstrates how hypnotherapy, and the use of imagery, addresses both mind and body. Finally, the rationale for the current study and the specific aims of the thesis are outlined. In section 2, the methodology and assessment instruments used in the clinical trial are discussed, as well as recruitment processes, research plan and timetable, and treatment schedule. Statistical analyses are provided and the main outcomes measures of the clinical trial, its limitations and scientific implications are addressed.

Doctor of Philosophy / Nineteenth century philosophy and anatomy regarded the nervous system as the only pathway of communication between the brain and body but now, research in the field of psychoneuroimmunology (PNI) has provided evidence to prove the age-old belief that there is a connection between the mind (or mental/emotional states) and the body. Researchers in PNI have now shown that the communication between the nervous and immune systems is bi-directional – i.e. there is a psychological reaction to physical disease and a somatic presentation of psychological disorders - and that the immune system, the autonomic nervous system, the endocrine system and the neuropeptide systems all communicate with each other by means of chemicals called messenger molecules or ligands. This paper outlines research into the treatment of Irritable Bowel Syndrome (IBS) with hypnotherapy, taking into account the mind-body connection and treating both the patient’s physiological and emotional/psychological symptoms rather than treating the physiological symptoms only. In other words, using a more holistic approach to the treatment of IBS. IBS is probably the most common functional gastrointestinal disorder encountered by both gastroenterologists and physicians in primary care. It is estimated that from 10% to 25% of the general population suffer from this condition and that it comprises about 30-50% of the gastroenterologists’ workload, yet the aetiology of IBS is unknown and, so far, there is no cure. Researchers are beginning to view IBS as a multi-faceted disorder in which there appears to be a disturbance in the interaction between the intestines, brain, and autonomic nervous system, resulting in an alteration in the regulation of bowel motility and/or sensory function. Most researchers agree that a subset of IBS sufferers have a visceral hypersensitivity of the gut or, more specifically, an increased perception of sensations in the gut. To date, studies of IBS have proposed previous gastroenteritis, small intestine bacterial overgrowth, psychosocial factors, a genetic contribution, and an imbalance of neurotransmitters as either possible causes or playing a part in the development of IBS. It is generally agreed that a patient’s emotional response to stress can exacerbate the condition. In section 1 of the thesis, the introduction, a detailed description and background appropriate to the study undertaken are provided, including aspects of epidemiology, diagnostic symptom criteria and clinical relevance of the Irritable Bowel Syndrome. Previous studies of various forms of treatment for IBS are discussed with the main emphasis being on treatment with hypnotherapy. All these therapies have concentrated on either mind or body treatments whereas this study demonstrates how hypnotherapy, and the use of imagery, addresses both mind and body. Finally, the rationale for the current study and the specific aims of the thesis are outlined. In section 2, the methodology and assessment instruments used in the clinical trial are discussed, as well as recruitment processes, research plan and timetable, and treatment schedule. Statistical analyses are provided and the main outcomes measures of the clinical trial, its limitations and scientific implications are addressed.

M.A. / The purpose of the study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non- IBS clients in terms of their defense mechanisms. Although irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by primary care physicians and gastroenterologists, it is one of the least well understood. Part of the reason for this is the lack of real consensus of opinion regarding the nature of the complaint (Read, 1985). Today it is widely agreed that irritable bowel syndrome is a psychosomatic disorder, that is, a disorder of physiological functioning and anatomical structure, which are determined for most part by psychological factors (Lachman, 1972; Moser, 1986). Evidence linking psychological variables to gastrointestinal disorders is surprisingly sparse, and all too often confusing and contradicting. Such conflicting results probably reflect the many methodological weaknesses common to all areas of study (Bennett, .1989). Although evaluation of the impact of psychological interventions on both symptomatic and psychological relief has been pursued, its findings provide tangential support for the importance of psychological disorders. Nevertheless, these studies have shown a consistency of positive results not found in the etiological research (Read, 1985). Using a variety of techniques, most with the therapeutic goal of stress reduction, psychological therapy has been shown to produce. symptomatic relief, increase periods of remission, and to reduce the impact of stress resulting from severe symptomatic flare ups in IBS (Bennett, 1989). In .addition, most IBS patients may not identify their gut symptoms in psychological terms. Therefore, they inappropriately and repeatedly subject themselves to unnecessary, expensive and harmful medical procedures in search of an organic cause. Further research into the psychological factors of IBS, including the defense mechanisms underlying it may lead to a reduction in type of anxiety (Folkman, Lazarus, Gruen & DeLongis, 1986). The ways in which people cope with intense emotions may have a significant effect on their psychological and physical health. StresS factors and the suppression of emotions, for example through defense mechanisms, are thought to be especially relevant in the etiology and exacerbation of psychosomatic illness (Ogden & Von Sturmer, 1984). The role that defense mechanisms play in the development of IBS forms the cornerstone of the present research.

No description available.

Objetivo: Determinar la prevalencia y factores de riesgo de síndrome de intestino irritable en estudiantes e internos de medicina de la Universidad Ricardo Palma. Materiales y Métodos: Estudio observacional, analítico, de corte transversal. La población estuvo conformada por los estudiantes e internos de medicina de la Universidad Ricardo Palma durante los meses de Julio y Agosto del 2016. Se realizó un muestreo aleatorio estratificado y se añadió criterios de inclusión y exclusión para obtener el tamaño total de una muestra significativa (207 alumnos). Los datos fueron recolectados mediante una ficha de recolección de datos basadas en los protocolos seguidos por STEPwise. Asimismo, se utilizó la escala de HADS para la detección de ansiedad/depresión clínica. Para el diagnostico de Síndrome de Intestino Irritable se hizo uso del cuestionario autoevaluativo según criterios de ROMA III. Resultados: El sexo femenino fue el género predomínate dentro de los estudiantes de medicina (66.2 %). La edad promedio de la población de estudio fue de 22.23 años. Se halló una prevalencia de 24% de Síndrome de Intestino Irritable. La variedad predominante fue el subtipo mixto (52%), seguido de los subtipos de diarrea (24%), estreñimiento (20%) y no especificado (4%) respectivamente. Los predictores de SII con significancia estadística hallados durante la presente investigación fueron la presencia de ansiedad borderline (p=0.001; OR=4.505; IC 95%: 1.84-11.01), seguido de la presencia de Ansiedad Clínica (p=0.005; OR: 4.332; IC 95%: 1.54-12.12) y el antecedente de enfermedad crónica (p=0.012; OR=2.805; IC 95%: 1.26-6.24) Conclusiones: El sexo femenino, no practicar ejercicio regularmente, dormir menos de 6 horas, el antecedente de enfermedad crónica, el estrés emocional y tanto la ansiedad borderline como la ansiedad clínica son factores de riesgo para el desarrollo de Síndrome de Intestino Irritable. El antecedente de enfermedad crónica, la presencia de ansiedad borderline o clínica calificaron como predictores de esta entidad al ser estadística mente significativos.

Introduktion: Irritable bowel syndrome [IBS] är den vanligaste kroniska sjukdomen som uppträder i gastrointestinal-kanalen. Sjukdomen förekommer hos 10–20% av världsbefolkningen och kan upptäckas hos både barn och vuxna. Etiologin för IBS är mycket komplex och ännu inte helt klarlagd då det saknas fullständig förståelse för den patofysiologiska processen. IBS kännetecknas ofta av buksmärtor, magkramper, uppblåsthet, förstoppning och diarré. Definitionen av coping är en konstant kognitiv och beteendemässig förändring i syfte om att kunna hantera yttre och inre påfrestningar, som överstiger personens förmåga att hantera dem. Där det finns olika copingstrategier att tillämpa för att hantera en viss situation. Syfte: Syftet med litteraturstudien var att belysa copingstrategier vid IBS.   Metod: Litteraturstudie genomfördes i enlighet med Polit och Becks (2017) nio steg. Litteraturstudiens resultat grundas på tio vetenskapliga artiklar. Resultat: Resultatet delades in i kategorier, första kategorin var Copingstrategier i sociala sammanhang där underkategorierna som identifierades var Söka stöd och information som copingstrategi och Utforska personliga copingstrategier. Den andra kategorin var Copingstrategier för att anpassa sig till det dagliga livet, där underkategorierna som identifierades var Rutiner och vanor som copingstrategi, Kosthantering som copingstrategi och Fysisk aktivitet som copingstrategi. Den sista kategorin var Psykologiska copingstrategier, där underkategorierna som identifierades var Inställning och kontroll som copingstrategi och Undvikande och anpassade copingstrategier i sociala sammanhang. Slutsats: Personer med IBS upplever att copingstrategier är nödvändiga för att kunna hantera sjukdomen. Det är därför viktigt att personen utforskar strategier som passar personen bäst, genom att prova olika strategier och se vilka som fungerar kort- och långsiktigt. En förutsättning för att kunna tillämpa copingstrategierna är att ha kunskap om vikten av individualiserade copingstrategier, samt att en kombination av flera strategier är nödvändigt för att kunna kontrollera situationen.

No description available.

No description available.

Irritable Bowel Syndrom en kronisk sjukdom med symtom som buksmärtor, diarré och förstoppning. Diagnosen ställs genom anamnes på symtomen och genom att utesluta andra sjukdomar. Syftet med litteraturstudien var att belysa faktorer som påverkar patienter att leva med Irritable Bowel Syndrome. Metoden var baserad på Polit och Becks niostegsmodell. Databaserna var CINAHL och PubMed. Artiklar valdes ut och lästes noggrant igenom, granskades med granskningsmall för kvantitativ och kvalitativ metod. Slutligen valdes elva artiklar ut som grund för resultatet, åtta var kvalitativa och tre kvantitativa. Resultatet Faktorerna som påverkade delades in i huvudkategorierna kontroll, socialt och emotionellt. Subkategorierna kost, behandling, begränsningar, kunskap, relation patient - omgivning, relation patient - vårdpersonal och känslor. Subsubkategorierna kost som påverkar, koststrategier och utbildning. Slutsats Patienter kände sig kontrollerade av sjukdomen och försökte finna olika sätt för att ta tillbaka kontrollen. De önskade mer kunskap och stöd från vårdpersonal. Socialt stöd var en hjälp i att hantera sjukdomen.

Introducción: El SII se caracteriza por la presencia de dolor abdominal, diarrea, estreñimiento, o la alternancia de ambas, la causa de esta patología tiene que ver con muchos factores: alimentación, antecedentes de enfermedades, estilo de vida, etc. En el Hospital Guillermo Almenara Irigoyen (HGAI), se desconoce la prevalencia del SII. Objetivos: Determinar la prevalencia del SII en la consulta ambulatoria del servicio de Gastroenterología del HGAI, así como también describir los subtipos de SII que se presentan. Material y Métodos: El presente estudio es de tipo descriptivo y de corte transversal. La muestra consta de 1365 pacientes, se utilizo el muestreo por conveniencia. Se confecciono una encuesta ad hoc, con dos partes: una ficha de recolección de datos (clínicos y sociodemográficos) y otra con los criterios de ROMA II para el diagnostico de SII. Los pacientes fueron encuestados en la sala de espera de los dos (02) consultorios ambulatorios del Servicio de Gastroenterología (SG) del HGAI, del 06 de Abril del 2003 al 06 de Junio del 2003. Se realizo el análisis estadístico con el programa SPSS v11, para la descripción de los resultados. Resultados: La prevalencia del SII en el SG del HGAI fue de 38.8%. De los pacientes con SII de acuerdo a los criterios de Roma II tenemos; el 44% presento SII tipo diarrea, el 32% fue tipo estreñimiento, el 19% fue tipo mixto y el 5% no se pudo determinar. De la prevalencia general de 38.8 %, el sexo femenino aportó una prevalencia del 26.5%, y el sexo masculino aporto una prevalencia del 12.2 %. La variable Sexo fue significativa, por lo que la probabilidad de que el diagnostico de SII se relaciona mas con el sexo femenino. Por lo que existiría un riesgo de 1.8 veces en el sexo femenino de tener el SII en relación al sexo masculino. El grupo etareo de 60 a 69 años es el que presenta la mayor prevalencia en el diagnostico de SII (10.2%). El grupo de edad de 50 años hacia delante presenta una prevalencia acumulada de 28.8%. Asimismo se encontraron hallazgos secundarios con las variables que tuvieron significancia estadística las cuales fueron: Sexo, Grupo etareo, Diabetes Mellitus (DM), Antecedente de Cirugía Pélvica y Antecedente personal de Cáncer gastrointestinal, Conclusión: Existe una alta prevalencia del SII (38.8%) en la población estudiada, siendo el SII de tipo Diarrea el más frecuente. El grupo de edad de 50 años hacia delante presenta una prevalencia acumulada de 28.8%.