Journal Reviews

Association Between Intimate Partner Violence and Irritable Bowel Syndrome: A Population-Based Study in Nicaragua

• Intimate partner violence has been associated with many negative long-term health problems including depression, post-traumatic stress disorder (PTSD), chronic pelvic pain and sexually transmitted diseases. A history of abuse (physical or sexual, including childhood) has been reported in some patients with Irritable Bowel Syndrome (IBS) as well. Most published data address populations in industrialized countries.
• Nicaragua is one of many countries in the world that are not only plagued by poverty but also by physical and sexual abuse, especially against women. War and violence, first against Somoza and subsequently against the Contras, resulted in a destabilized society that may have contributed to the findings in this study.
• To determine whether a relationship between partner abuse and IBS transcends cultural boundaries, the researchers conducted a population-based, cross-sectional survey in Nicaragua using the innovative Health and Demographic Surveillance System. This carefully done study was performed in León where data was collected in 1000 women.

• 19.4% of the women had experienced abuse. There was a significantly increased risk of having IBS if there was a history of abuse. Among the women with a history of physical abuse or sexual abuse, IBS was present in 23.8% and 9.3% respectively. Among the women without a history of physical or sexual abuse, IBS was present in only 13.1%. and 3.5%. While Nicaragua has had a particularly traumatic history, the findings are dramatic.
• This report suggests that screening for a history of violence and offering appropriate help to women in Nicaragua with IBS is warranted. Whether this study applies to other locations in the world with post-traumatic conflict awaits further research.

Physical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled Trial

• Physical exercise has been shown to have a beneficial effect on certain abdominal symptoms such as passage of gas and abdominal distension. Regular activity helps regulate the bowel pattern and may improve colonic transit time in patients with constipation.
• This randomized, control study asks the question, does physical activity decrease the symptoms of Irritable Bowel Syndrome (IBS)? And does physical activity change the quality of one’s life including psychological symptoms and fatigue?

• 102 patients were randomly assigned to either a control group that did not partake in physical activity or a physical activity group.
• The patients in the physical activity group were guided by a physiotherapist. They were told to engage in moderate to strenuous cardiovascular exercise from 20 to 60 minutes, 3 to5 times a week for 12 weeks. The control group was encouraged to maintain their lifestyle for 12 weeks and then was given the same advice to increase their exercise.
• Questionnaires addressed IBS severity of symptoms, anxiety and depression, quality of life and fatigue. In addition, weight, oxygen uptake, intestinal transit time, and stool form were recorded.

• After eliminating drop-outs, there were 45 subjects in each group. The results showed that exercise produced a significant decrease in symptom severity compared to the control group. 43% of exercise patients had a significant reduction in score vs. 26% of the control group. None of the other measures showed significant differences except for a sense of physical well-being, which would be expected.

• This is the first carefully conducted research study to prove that exercise is good for IBS. While this might seem obvious, common beliefs are not always borne out by careful study. Why might symptoms be relieved? There may be unknown physiological links between improved exercise tolerance and gastro-intestinal function. On the other hand, patients are often urged to exercise as a way to reduce their stress level, which certainly could be beneficial to IBS.

Couples’ Support Provision During Illness: The Role of Perceived Emotional Responsiveness

Introduction & Methods

• Perceived emotional support of a significant other may have an effect on the psychosocial adjustment experienced by women with lupus; this study sought to examine this relationship. Researchers theorized that findings would generalize to other chronic illnesses with an unpredictable and episodic nature of symptoms.
• The female lupus patients in this study had not been diagnosed with other chronic illnesses, and were married and living with their husbands for an average of 13 years.
• Couples completed questionnaires which measured emotional support (empathy, understanding, care, and concern) and problematic support (minimizing, criticizing, ignoring, and withdrawing). Questionnaires also measured marital satisfaction, depressive symptoms, and wives' and husbands' perceptions of their partners' emotional responsiveness during the wives' most current lupus episode.

Results

• When husbands provided more emotional support, wives tended to perceive their husbands as being more emotionally responsive to their needs. This was associated with a higher degree of wives' marital satisfaction and lower depressive symptoms. Similarly, when husbands provided more problematic support, wives tended to perceive their husbands as being less emotionally responsive to their needs, which was associated with a lower degree of psychosocial well-being.

What Patients Know About Irritable Bowel Syndrome and What They Would Like To Know: National Survey on Patient Educational Needs in IBS and Development and Validation of the Patient Educational Needs Questionnaire

Introduction & Methods

• Psychosocial factors (e.g. stress and coping skills) are known to significantly impact symptom severity in IBS patients. This study investigated how patient education might be helpful to patients with Irritable Bowel Syndrome.
• Researchers conducted a national survey of patients with IBS to assess their current knowledge. The authors sought to identify common perceptions held by IBS patients, the areas in which IBS patients would like to receive further education, response differences between patients who sought health care versus those who did not, and response differences between users and nonusers of the internet.

Results

• Knowledge of IBS: 70% of participants correctly identified stress at work and psychological factors as significant triggers. Most patients were also familiar with first-line treatments for IBS (e.g. antispasmodics, antidiarrheals and fiber agents). 42% of IBS patients believed that measures such as psychological therapy and relaxation techniques might be effective treatment options. The majority of participants believed that dietary and lifestyle modifications would help.
• Misconceptions: A significant number of respondents believed that IBS is caused by a lack of digestive enzymes, is a form of colitis, will worsen with age, is caused by a particular diet, and can develop into a problem requiring surgery, colitis, malnutrition or cancer. These misconceptions, such as the fear that IBS may develop into cancer or shorten life expectancy, have the potential to produce anxiety and worsen symptom severity. It is also important to note that a dysfunctional intestine, rather than any particular food, is triggering symptoms.
• The majority of IBS patients surveyed were interested in learning about the causes of IBS, coping strategies, what constitutes a normal bowel habit, whether IBS will worsen, and which foods to avoid. Common concerns among participants included whether or not IBS would shorten their lives, how psychological factors impact their symptoms, and what measures can be taken to prevent a symptom attack.
• Individuals who used the internet held more accurate conceptions about IBS and were more interested in learning about the causes of IBS, foods to avoid, and coping strategies in comparison to non-users of the internet.

Differentiation of Self, Perceived Stress, and Symptom Severity Among Patients with Fibromyalgia Syndrome

Introduction & Methods

• Both fibromyalgia (FMS) and IBS are considered mind-body conditions; IBS involves pain related to the intestinal tract while FMS involves pain of the surface of the body. Additionally, a significant percentage of patients with IBS have FMS.
• “The human family is a multigenerational, natural, living system and that the emotional functioning of each member of the system affects the functioning of the other members." - Bowen family systems theory (BFST). With inspiration from this theory, researchers looked at the combined impact of family relationships and perceived stress on the development and severity of FMS. Knowledge of this relationship has the potential to strengthen the effectiveness of symptom management.
• Over 6 weeks, adult FMS patients completed an online survey which measured emotional functioning, intimacy and autonomy in interpersonal relationships, the individual’s level of perceived stress in everyday life, and the overall well-being of the participant in the course of 7 days.

Results

• FMS symptom severity was significantly predicted by the patient's level of perceived stress.
• Patients who had a higher level of fusion between emotional and intellectual functioning had lower FMS symptom scores while patients who made use of the defense mechanism of distancing oneself physically or emotionally in response to stress in a familial context had higher symptom scores. As the level of emotional cutoff increased, the patient's level of FMS symptom severity increased.

Psychosocial Risk Markers for New Onset Irritable Bowel Syndrome: Results of a Large Prospective Population-Based Study

Introduction & Methods

• Previous studies have found that individuals who have IBS also have an increased level of psychological symptoms such as depression and anxiety. This study sought to determine if these psychosocial factors act as risk markers for the onset of IBS or if they are a consequence of having IBS.
• A postal survey was conducted to ascertain randomly selected participants' psychosocial status and severity of abdominal pain. The study focused on individuals who did not have IBS at the time of the initial questionnaires.

Results

• 3.5% of patients who were free of IBS at the outset were found to develop IBS over the 15 month time course of the study. The onset of IBS was higher in women (4.6%) than men (2.1%).
• Patients with scores indicating psychological distress and excess concern about their health were more likely to develop IBS.
• The more abnormal questionnaire scores, the higher probability of developing IBS. 80.2% of the subjects who developed IBS had at least two abnormal questionnaire scores. High levels of illness behavior, anxiety, sleep problems and other somatic symptoms were all independent predictors for IBS.