Bakgrund: Att leva med Irritable Bowel Syndrome (IBS) innebär en stor utmaning i det vardagliga livet. Personerna kan bli funktionshindrade på grund av de livslånga symtomen som IBS medför trots att IBS i sig inte är livshotande. Många personer med IBS upplever idag att information om egenvård från sjukvården är bristfällig, att de inte blir tagna på allvar, och att deras egna upplevelser förbises. Eftersom sjuksköterskan kommer i kontakt med dessa personer i sin yrkesutövning kan det anses vara användbart att ha kunskaper om dessa personers upplevelser för att bättre kunna bemöta dem och öka deras välbefinnande och livskvalitet. Syfte: Syftet var att belysa personers upplevelser av att leva med Irritable Bowel Syndrome. Metod: Studien genomfördes som en litteraturstudie med kvalitativ ansats som baserades på sju artiklar och analyserades enligt Graneheim och Lundmans tolkning av innehållsanalys. Resultat: I resultatet framkom fem kategorier av upplevelser; Olika känslouttryck, att acceptera den förändrade vardagen, önskan om förståelse och stöd, påverkan på integritet och självkänsla och social isolering och utanförskap. Slutsats: Denna studie har visat att personer med IBS har ett behov av att bli förstådda av sjukvården. Sjuksköterskan kan genom att öka sin kunskap om personers livsvärld och upplevelser av att leva med IBS bidra till att fler personer får stöd och hjälp från sjukvården. Detta gör det möjligt att erbjuda en mer välanpassad vård och ge personerna en högre känsla av välbefinnande och livskvalitet än vad de upplever idag.

Introduktion: Irritable Bowel Syndrome (IBS) är en vanlig kronisk mag- och tarmsjukdom. Sjukdomens olika symtom orsakas av en störning i mag- och tarmkanalen. Syfte: Litteraturstudiens syfte var att beskriva patienters upplevelse av att leva med IBS. Metod: Polit och Becks niostegsmodell användes i litteraturstudien. Litteratursökningen genomfördes i PubMed och CINAHL. En urvals- och kvalitetsgranskning är genomförd. Resultatet baserades på åtta kvalitativa och två kvantitativa artiklar. Resultat: Resultatet redovisades i tre teman existentiell upplevelse, upplevelser av hinder i vardagen och upplevelser av att hantera sjukdomen med tillhörande kategorier. Personer med IBS upplevde negativa känslor på grund av sjukdomens symtom i form av konstant oro och ångest relaterad till sjukdomens oförutsägbarhet. Sjukdomen var ett hinder för att utföra vardagliga aktiviteter. Ett undvikande beteende och en social isolering utvecklades. Personer med IBS använde sig av olika strategier för att hantera sjukdomen. De tyckte varken anhöriga eller hälso- och sjukvården förstod dem och upplevde att de inte fick tillräckligt med stöd. Något som däremot upplevdes givande för att hantera sjukdomen, var att få samtala och byta erfarenheter med andra människor med IBS. Slutsats: Personer med IBS upplever sig ha en försämrad livskvalité. Mer kunskap behövs om hur personer IBS upplever och hanterar vardagliga situationer och symtom. Detta för att upplevelserna och erfarenheterna kan föras vidare till andra personer med sjukdomen.

Diss. (sammanfattning)--Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet , 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Lund : Lunds universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 77-90).

Includes bibliographical references and index.

Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 109-120).

Irritable bowel syndrome (IBS), majorly characterized by irregular bowel movements and abdominal pain, is one of the most prevalent functional gastrointestinal disorders (FGIDs) in the world. Disturbance of gut microbiota, closely linking with gut dysfunction, has been regarded as one of important pathogenetic factors for IBS. However, gut microbiota-driven mechanism underlying IBS remains unclear, which leads to inefficient and non-specific effects of current microbiota-oriented therapy. In this thesis, function-based microbiota investigation with combination of metagenomic and metabolomic analyses was separately performed in IBS cohort and model to precisely link pathogenic species with disordered GI motor function. A series of microbiota manipulation studies in rodents were conducted to explore bacteria-driven molecular mechanism. Firstly, a pilot study with 'omics' analyses revealed fecal microbial structure significantly varied in IBS patients with disorder GI motility relative to healthy controls (HC). Such changed IBS enterotype was functionally characterized by disturbed metabolism of bile acids (BAs) that are previously proved to regulate GI motor function. It indicates microbiota-driven GI dysmotility relevant to disturbance of BA metabolism in IBS. Secondly, a systematic review with meta-analysis was performed to comprehensively understand existing findings related to BA metabolism and its linkage with IBS. Results showed that abnormal BA excretion, previously reported in at least one IBS subtype, is associated with dysregulation of BA synthesis, marked with abnormalities of circulating indices 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19). However, what's the role of gut microbiota in abnormal BA excretion is undetermined. Thirdly, to explore possible role of gut microbiota in abnormal BA excretion in IBS, BA metabolites and BA-related microbiome were simultaneously analyzed in stools of recruited subjects. Results found that total BA and microbiota-derived BAs were remarkably elevated in a quarter of IBS-D patients (BA+IBS-D) who exhibited more frequent defecation, higher level of serum C4 but lower level of serum FGF19 than those with normal BA excretion (BA-IBS-D). In line with metabolic results, abundances of BA-metabolizing bacteria, particularly Clostridium scindens (C. scindens) simultaneously expressed hdhA and bais that are responsible for BA 7α oxidation and dehydroxylation, were highly enriched in fecal metagenomes of such particular IBS-D population. These findings suggest the increased BA-metabolizing microbiome is associated with the dysregulated host BA synthesis in the subgroup of BA+IBS-D patients. Fourthly, by analyzing metabolites and bacteria related to BA metabolism, a neonatal maternal separation (NMS)-induced IBS-D rat model characterized by accelerated GI motility and excessive BA excretion were found to largely mimic gut microbial BA metabolism in BA+IBS-D patients. Specifically, intraluminal total and secondary BAs were significantly elevated in the large intestinal lumens (cecum, proximal colon and feces) of NMS rats, together with increased abundances of hdhA- and bais-expressing Clostridium species, including C. scindens. Moreover, quantitative polymerase chain reaction (PCR) analysis showed upregulated mRNA expression of cholesterol 7 α-hydroxylase (CYP7A1) whereas downregulated mRNA expression of small heterodimer partner (SHP) in the liver of NMS rats, indicating enhanced hepatic BA synthetic level. These observations based on such IBS-D model suggest the association of excessive BA-metabolizing microbiome and increased hepatic BA synthesis. Fifthly, to further clarify whether excessive BA-metabolizing bacteria contribute to enhanced hepatic BA synthesis and to explore the underlying molecular mechanism, we performed bacterial intervention in pseudo germ-free (GF) or/and specific pathogen free (SPF) mice by transplantation of human fecal microbiota and the signal strain C. scindens. Compared with GF mouse recipients of HC and BA-IBS-D fecal microbiota, BA+IBS-D fecal microbial recipients displayed shorter GI transit and increased subsistence of C. scindens in the cecal contents. In line with higher level of serum C4, taurine-conjugated BA contents and mRNA expressions of BA synthetase CYP7A1 and sterol 12α-hydroxylase (CYP8B1) were significantly elevated in the liver of BA+IBS-D recipients. These findings showed bioactive effects of BA+IBS-D fecal microbiota with enrichment of C. scindens on hepatic BA synthesis. Next, to further confirm the effects of the species C. scindens on host BA synthesis, we individually colonized C. scindens strains (ATCC 37504) to pseudo GF and SPF mice. Results showed both mice models with single strain colonization exhibited accelerated GI transit and higher contents of hepatic total and taurine-conjugated BAs compared with individual vehicles treated with PBS. Combining metabolic changes, the upregulated expressions of hepatic CYP7A1 mRNA in colonized mice indicate that C. scindens substantially promote hepatic BA synthesis in colonized mice. Furthermore, contents of taurine-conjugated BAs, served as natural antagonists of farnesoid X receptor (FXR) that negatively control of new BA synthesis, were elevated in ileal lumens of colonized mice. Expressions of FXR-targeted genes SHP and fibroblast growth factor 15 (FGF15) were consistently reduced in the liver and ileum tissues of colonized mice, respectively. Results suggest that suppression of FXR-mediated feedback signaling is involved in Clostridium-driven hepatic BA oversynthesis, which deserve the further investigation. Collectively, the works of this thesis integrating clinical and animal studies indicate that BA-metabolizing bacteria, particularly C. scindens, enhance hepatic BA synthesis and consequently leads to BA overexcretion. It provides novel bacteria-driven mechanism for enhanced GI motility, and supply a direction in precise microbiota-related pathogenesis and medication for IBS-D population in future.

M.A. / Irritable Bowel Syndrome is defined as a chronic relapsing functional bowel disorder of unknown causes (Weber & McCallum, 1992). IBS is characterized by attacks of abdominal pain and change of bowel habit resulting in diarrhoea, constipation or both, where no structural alteration of the colon is found (Varis, 1987). The symptoms appear to result from a dysfunction of the intestine and are therefore said to be “functional” (Heaton & Thompson, 1999). The prevalence of IBS in the general population of Western countries is 14-24% of women. It is the most common cause of gut symptoms, and the most common reason that people go to their family doctor with a gut complaint. Despite all of this, physicians are still groping to understand the pathogenesis of IBS. The secret of success with IBS is to recognize it quickly and confidently. This is done primarily from the history, as there are no clinical tests that may be done to diagnose IBS. Once the diagnosis has been made it is of utmost importance that the sufferer is told, the syndrome is explained, and a good relationship is established with the health-care giver. Thereafter it becomes important to search for unspoken agendas in the life of the sufferer. According to the literature, stress can exacerbate IBS, and sexual, physical and emotional abuse can pose complex problems that require the assistance of a skilled counsellor. These problems, if left, may lead to the intensified symptoms of IBS. Society is becoming increasingly abusive and women and children often bear the brunt of physical, emotional and sexual abuse. Studies in America of women who present at medical facilities as well as those sampled from the community have found abuse rates that range from 20-76%. There is no reason to believe that these figures would be that different for South Africa. These studies have also found that abused women report a significantly higher number of medical problems and health-care system usage. A number of researchers have also found that there was a significant association between IBS and sexual abuse and physical abuse in childhood and adulthood. For the counselling psychologist the challenge is to unravel the mechanisms behind the symptoms, and to provide a rationale for therapy. The role that abuse may play in the development of IBS forms the cornerstone of the present study.