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 .

M.A. (Counselling Psychology) / Please refer to full text to view abstract

Bakgrund: Irritable Bowel Syndrome (IBS) är en vanlig mag- och tarmsjukdom som är dubbelt så vanlig hos kvinnor som hos män. Orsaken till IBS är inte fastställd dock kan de fysiska symtomen ha koppling till den psykiska hälsan. Studier visar att kvinnor och män ofta har olika symtom. Behandlingen för IBS verkar endast symtomlindrande eftersom det inte finns något botemedel för IBS i dagsläget. Det är viktigt att sjuksköterskor har kunskap om betydelsen av genus i vården med tanke på att kvinnor och män idag inte har samma förutsättningar i vården. Sjuksköterskor kommer möta personer med IBS i vården och majoriteten kommer att vara kvinnor, det är därför av betydelse att vara medveten om deras upplevelse av sjukdomen för att kunna ge dessa kvinnor bästa möjliga vård. Syfte: Syftet var att belysa kvinnliga patienters upplevelse av att leva med Irritable Bowel Syndrome (IBS). Metod: Metoden som användes var en litteraturöversikt. Författarna använde sig av elva artiklar till resultatdelen som hämtades från tre olika databaser, CINAHL complete, PubMed samt Medline. Fokus låg på artiklar med kvalitativ design dock användes även en artikel med kvantitativ design. Resultat: När författarna analyserade artiklarna trädde fem teman fram. Dessa teman var Sociala svårigheter och begränsningar, Att leva med en förändrad kropp, Hjälplöshet på grund av oförutsägbara symtom, Känslor av skam samt Misstro i mötet med vården. Diskussion: Resultatet diskuterades utifrån Roys adaptionsmodell, vetenskaplig forskning och litteratur samt författarnas egna reflektioner. Författarna valde att diskutera de delar av resultatet som ansågs av dem vara viktigast. / Background: Irritable Bowel Syndrome (IBS) is a common stomach and intestinal disease that is twice as common in women as in men. The cause of IBS has not been determined, however, the physical symptoms may be related to mental health. Studies show that women and men often experience different symptoms. The treatment for IBS is only symptom-relieving as there is no cure for IBS at the present time. It is important that nurses have knowledge of the importance of gender in health care, given that women and men today do not have the same conditions in health care. Nurses will meet people with IBS and the majority will be women, therefore it is important to be aware of their experience of the disease in order to provide these women with the best possible care. Aim: The aim was to enlighten how it is for women to live with Irritable Bowel Syndrome (IBS). Method: The method used for this study was a literature review. The authors used eleven articles for the result which were obtained from three different databases, CINAHL complete, PubMed and Medline. The focus was set on articles with a qualitative design, an article with a quantitative design was also used. Results: When the authors analyzed the articles, five themes emerged. These themes were Social hardships and limitations, Living with a changed body, Helplessness due to unpredictable symptoms, Feelings of shame as well as Missbelief in the meeting with healthcare. Discussion: The result was chosen to be discussed based on Roy's adaptation model. The authors chose to discuss the parts of the result that were considered to be the most important.

Irritable Bowel Syndrome (IBS) is a common chronic illness thought to be originated and maintained by a combination of physiological, psychological and social factors. IBS is known to be associated with a high psychosocial impact on patients’ lives. Acceptance and Commitment Therapy (ACT) is an emerging model of conceptualization and treatment that states that most suffering in chronic illness can be explained by a lack of psychological flexibility or acceptance to experience aversive bodily sensations, thoughts or emotions. ACT treatments target the increase of psychological flexibility as a key change for improvement in outcomes. Recent studies suggest that ACT could not only be an effective alternative treatment for IBS, as it might provide a valuable model of understanding of the relations between the different factors related to this condition and its outcomes. The first aim of the present research was to investigate the role of psychological flexibility in IBS, in particular, how acceptance relates to psychological, emotional and physical factors in this condition. The second aim was to investigate the effectiveness of an ACT based intervention in increasing psychological flexibility in IBS and thereby improving IBS Outcomes. These aims were addressed by conducting two related studies. In Study 1, a sample of 121 IBS patients attending a specialized gastroenterology clinic completed a series of self-report measures of psychological flexibility (acceptance), psychological factors known to be associated with IBS and IBS outcomes. Results indicated that higher levels of acceptance were generally associated with and predicted better levels of IBS biopsychosocial factors. Results also showed that acceptance mediated most of the relationships between IBS predictors and Outcomes. Also, psychometric analyses of a novel measure of IBS Acceptance (i.e. IBS Acceptance and Action Questionnaire) created for this study demonstrated that it had good reliability and validity. In Study 2, fifty six IBS patients enrolled in an intervention involving a one day ACT workshop and an ACT based self-help workbook. Thirty six participants provided follow-up data up to 6 months after the workshop. Results indicated that there were significant increases in acceptance and significant improvement in IBS outcomes between pre-treatment and follow-up. Further to that, analyses indicated that changes in IBS Outcomes occurred through changes in acceptance as hypothesized by the ACT model. These studies suggest that psychological flexibility processes are important in the understanding of IBS and that improvement in this condition may result from a more psychologically flexible stance to it. Although preliminary, these studies provide a basis for the further development and application of the ACT model of conceptualization and treatment in IBS.

Submitted by Natalia Vieira (natalia.vieira@famerp.br) on 2016-05-19T22:35:49Z No. of bitstreams: 1 carlarodrigueszanin_dissert.pdf: 1343932 bytes, checksum: 87ed11d894ae43ccaba6aec342c754e8 (MD5) / Made available in DSpace on 2016-05-19T22:35:49Z (GMT). No. of bitstreams: 1 carlarodrigueszanin_dissert.pdf: 1343932 bytes, checksum: 87ed11d894ae43ccaba6aec342c754e8 (MD5) Previous issue date: 2015-07-31 / Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disorder that causes significant impairment on the patients´ quality of life. It is associated with anxiety, depression and stress. The objective of this study was to evaluate the impact of cognitive-behavioral therapy (CBT) associated with the conventional treatment of IBS . Fourteen adult patients (21 and 65 years old) participated in the study. They were attended once in a week during four months and had a six month-follow up in the outpatient clinic of a school hospital in the interior of São Paulo state . A convenience sample for the intervention groups (cognitive-behavioral therapy - CBT) and control (Conventional Treatment – CT) was used as selection standard. Hospital Scale of Anxiety and Depression ; Inventory of Stress-Related Symptoms; Scale of Modes Coping Problems; Quality of life; Visual Analog Scale (VAS ) and a register with sociodemographic data were used. Patients in both groups showed symptoms of anxiety, depression and stress, with reduction of symptoms in the evaluation after the four months and their follow up , in the CBT with significant clinical improvement of anxiety and depression and stress symptoms. No significant changes were observed in pre- and follow up of the CT G according to the symptoms of anxiety, depression and pain. All patients in both groups had pain at baseline, with a reduction in pain intensity in the post (4 months) at follow up (6 months), in the CBT, showing significant difference. At follow up (TC G and CBT G) a significant difference pointing out a decrease of pain complaints after psychological intervention in CBT G, suggesting that CBT has shown efficacy on the pain control treatment of IBS patients . Most of quality of life domains were assessed as unsatisfactory for both groups, with clinical improvement in post intervention assessment and follow up, in the CBT G. Comparing the follow up of the CT G and CBT G, data showed significant differences in the domains functional capacity, physical aspect, social aspect and emotional aspect, pointing out that psychological intervention plays an important role in the control and reduction of physical and emotional symptoms as well as showing significant difference in pre- and post intervention and pre and follow up in the CBT G. The least used coping strategy was facing the problem and social GTC in the pre and follow-up, the CBT G, the social confrontation was the least used in the pre. However, there was acquisition of coping strategies observed in post evaluation (4 months) and follow up (6 months) in the GTCC. The results showed some anxiety, depression, stress and impaired quality of life in this sample as well as positive impact of CBT for the control of physical and emotional symptoms and improvement in the quality of life and acquisition of coping strategies, demonstrating the need for appropriate intervention for patients with IBS. / A Síndrome do Intestino Irritável (SII) é um transtorno gastrintestinal crônico que acarreta prejuízos significativos na qualidade de vida dos pacientes e está associada à ansiedade, depressão e estresse. O objetivo do estudo foi avaliar o impacto da terapia cognitivo-comportamental (TCC) associado ao tratamento convencional da SII. Participaram do estudo 14 pacientes adultos (21 a 65 anos) em acompanhamento uma vez na semana durante quatro meses no Ambulatório de um Hospital de Ensino do interior paulista e follow-up de seis meses. A seleção foi por amostra de conveniência para os grupos de intervenção (Terapia Cognitivo-Comportamental - GTCC) e controle (Tratamento Convencional – GTC). Foram utilizados Escala Hospitalar de Ansiedade e Depressão; Inventário de Sintomas de Stress; Escala Modos de Enfrentamento de Problemas; Qualidade de Vida; Escala Visual Analógica (E.V.A.) e ficha com dados sóciodemográficos. Pacientes de ambos os grupos, apresentaram sintomas de ansiedade, depressão e estresse, com redução dos sintomas na avaliação, após os quatro meses e no follow up, no GTCC, com melhora clínica significante tanto dos sintomas de ansiedade, depressão e estresse. Não houve mudanças significantes na avaliação pré e follow up do G TC quanto aos sintomas de ansiedade, depressão e dor. Todos os pacientes de ambos os grupos apresentaram dor na avaliação inicial, com redução da intensidade da dor no pós (4 meses) no follow up (6 meses), no G TCC, mostrando diferença significante. No follow up (G TC e G TCC) houve diferença significante indicando diminuição das queixas de dor, após intervenção psicológica no G TCC, sugerindo que a TCC tem demonstrado eficácia no tratamento dos pacientes com SII para o controle da dor. A maioria dos domínios de qualidade de vida foi avaliado como insatisfatório para ambos os grupos, apresentando melhora clínica na avaliação pós intervenção e no follow up, no G TCC. Em comparação no follow up do GTC e GTCC, os dados mostraram diferenças significantes nos domínios capacidade funcional, aspecto físico, aspecto social e aspecto emocional, indicando que a intervenção psicológica desempenha papel importante no controle e redução dos sintomas físicos e emocionais, bem como apresentou diferença significante na avaliação pré e pós intervenção e pré e follow up no GTCC. A estratégia de enfrentamento menos utilizada foi o enfrentamento no problema e social no GTC na avaliação pré e follow up, no GTCC, o enfrentamento social foi o menos utilizado na avaliação pré. Entretanto houve aquisição de estratégias de enfrentamento observadas na avaliação pós (4 meses) e follow up (6 meses) no GTCC. Os resultados demonstraram a presença de ansiedade, depressão, estresse e prejuízos na qualidade de vida presentes nessa amostra e impacto positivo da TCC para o controle dos sintomas físicos e emocionais, bem como melhora na qualidade de vida e aquisição de estratégias de enfrentamento, demonstrando a necessidade de intervenção adequada para pacientes com SII.

Personer med IBS lider av en sjukdom som inte syns utåt vilket kan skapa påfrestningar i det dagliga livet och i mötet med vården. Därför är det väsentligt att sjuksköterskan har empati, kunskap och engagemang i mötet med dessa personer. Syftet med studien var att belysa det stöd som efterfrågas av personer med IBS i mötet med sjukvården och hur sjuksköterskan förhåller sig i mötet. Metoden som användes till studien var litteraturstudie. Resultatet visar att personer med IBS är i behov av stöd genom information, bekräftelse och ett professionellt förhållningssätt av vårdarna i mötet. Sjuksköterskans förhållningssätt i mötet med dessa personer visades vara oprofessionellt genom b1.a. ignorans, fördomar och även förlöjligande av deras symptom. I diskussionen framkom det att personer med IBS upplever välbefinnande när vårdare besitter ett professionellt förhållningssätt. Slutsatsen blev att personer med IBS gynnas av stöd i form av information och bekräftelse från sjukvården.

The gastro-intestinal (GI) tract represents the largest surface of the body and is continuously exposed to the microbial environment. In such anatomy, the survival of the host requires that the intestinal microbial flora be contained without excessive immune-reactivity to commensal bacteria while retaining the ability to respond to episodic pathogens. The discriminative recognition between beneficial commensal bacteria and potentially harmful pathogens demands an accurate interpretation by the GI mucosal immune system. Any defects in the processes of innate immune recognition and killing may lead to the development and perpetuation of chronic intestinal inflammation, namely inflammatory bowel disease (i.e. Crohn's disease (CD) and ulcerative colitis (UC)) and post-infectious irritable bowel syndrome (PI-IBS). The aim of ours studies was to evaluate the contribution of candidate genes, involved in the homeostasis and regulation of the intestinal innate immune response, to the susceptibility to CD, DC, and PI-IBS. In the first phase, we describe functional and genetic association results supporting NLRP3, encoding NALP3/cryopyrin, as a novel CD susceptibility gene. We subsequently report that the MEFV gene, encoding pyrin, known to interact with and be involved in the same pathway as NALP3/cryopyrin, does not contribute to CD and DC susceptibility. No CD or DC additional associations were observed upon NLRP3-MEFV gene-gene interaction analyses. In the third phase, we report the first association study evaluating genetic determinants for PI-IBS, using the well-characterized Walkerton population cohort. We uncovered variants in the TLR9, CDH1, and IL6 regions associated with PI-IBS susceptibility. These results are in keeping with the pathophysiologic changes observed in patients with PI-IBS, which include increased intestinal permeability and intestinal immune activation. / Overall, these results contribute to a better understanding of the genetic susceptibility to CD, DC and PI-IBS and shed light on new pathogenic signaling pathways in the development of these diseases.

Abdominal pain is a common symptom of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Although the extent differs, visceral inflammation is thought to play a significant role in nociception in these disorders. This thesis describes studies examining mechanisms of inflammation-induced changes in nociceptive signaling from the colon using human colonic biopsy and animal models of the conditions. Citrobacter rodentium infection in mice produced profound colitis at day 10 post-infection which resolved by day 30. Perforated current clamp recordings showed that inflammation induced hyperexcitability of colonic DRG neurons that persisted at day 30 post-infection. Similarly, multi-unit afferent nerve recordings revealed enhanced firing of colonic afferents following colon distension at this time. In voltage clamp studies, suppression of IA K+ currents in post-infected C. rodentium neurons was observed. Combining water-avoidance stress (WAS) and C. rodentium infection exaggerated these effects. Interactions between proteases and stress mediators underlie these actions. In vivo studies revealed WAS combined with C. rodentium post-infection induced visceral hyperalgesia and allodynia. A separate series of studies examined the possible role of cysteine proteases in post-infectious IBS. The cysteine protease cathepsin-s (Cat-S) induced neuronal excitability and, provoked visceral hypersensitivity in mice. Human IBS supernatants increased neuronal excitability, but this was reversed in neurons pre-treated with the cysteine protease inhibitor E-64. Together these data suggest that Cat-S is a secreted neuromodulator in human IBS supernatants and could be important in nociceptive signaling in IBS. In studies examining whether similar mechanisms operate in a traditional inflammatory condition, IBD, human ulcerative colitis (UC) supernatants showed elevated TNF-α levels. Exogenous TNF-α and UC-supernatants increased colonic nociceptor excitability, which was attenuated in neurons from TNFR knock-out animals. TNF-α and UC-supernatants both increased TTX-R Nav1.8 and suppressed IA and IK K+ currents. Together these results suggest that inflammation significantly increases and sustains peripheral nociceptive signaling in IBD and IBS. These effects involve changes in the properties of nociceptive DRG neurons through actions of specific secreted factors which modulate specific voltage-gated ion channels. Chronic stress exaggerates these changes through synergistic actions of stress hormones and local mediators, suggesting an interplay between central and peripheral mechanisms. / Thesis (Ph.D, Physiology) -- Queen's University, 2011-07-28 10:17:58.863

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 116-130).