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Background Irritable bowel syndrome (IBS) is a common, chronic, relapsing, and sometimes disabling, symptombased disorder of gut brain interactions. It has got a female predominance and occurs in all ages, with a slight decrease among elderly. The IBS symptoms can affect everyday work and social life in addition to an increased use of health care resources. Most IBS patients are diagnosed and helped in primary health care (PHC). For many patients, available treatment is insufficient. It is known that both extraintestinal symptoms such as fatigue, as well as comorbidities such as mood disorders, chronic pain syndromes, and insomnia contribute to the illness burden, often to a larger extent than the gastrointestinal symptoms as such. Even though the pathophysiology of IBS is not completely known, it is now conceptualized as a disorder of altered brain-gut interactions, where a biopsychosocial model helps in understanding the symptoms. Exposure to stress is thought to play an important role overall in the pathology of IBS, as well as immune activation at least in a subgroup of patients. This thesis aimed to gain deeper understanding of the biopsychosocial mechanisms of IBS and its associations with stress, comorbidities, and fatigue. Methods Study I and II are based on the Twin cities IBS study population, which included IBS patients and a control group of other patients without gastrointestinal complaints from ten PHC centres in the county of Östergötland. Alongside demographics, psychosocial questionnaires and a GI symptom diary, it included analyses of hair cortisol concentrations (HCC) evaluated in study I, and data on self-rated health as well as diagnoses of comorbidities, and number of health care contacts from a regional registry, evaluated for study II. Study III of this thesis is based on the Brain-Gut study with a population of secondary care IBS patients, and healthy controls (HC). It included self-rated measures of fatigue impact on the daily life and early adverse life events, as well as measures of circulating TNF-α, and analyses of resting-state functional magnetic resonance imaging of brain areas within a mesocorticolimbic circuitry of known relevance for fatigue. Results Study I: Perceived stress was higher in the IBS group while a considerable portion of IBS patients had low levels of HCC. No association between perceived stress and HCC was seen in either group. Study II: IBS patients had lower self-rated health and more PHC utilization than the non-IBS patients. Good self-rated health was independently associated with younger age, higher sense of coherence and less gastrointestinal pain in both groups. In IBS, PHC utilization was associated with comorbidities in general, and sleep disorders in particular. Study III: Fatigue impact on daily life, and TNF- α were higher in IBS patients than in HC. In IBS, further an association was seen between fatigue impact on the one hand, and TNF- α, emotional abuse in childhood, as well as altered mesocorticolimbic connectivity on the other. Conclusion In conclusion this thesis firstly emphasizes that IBS patients in many ways, including health outcomes, consists a vulnerable group of PHC patients. We add evidence for a possible suppression of the stress response system in a substantial portion of IBS patients. Further, comorbid sleep disorders seem to be particularly associated with excess PHC utilization in IBS and could possibly be a target for treatment interventions. Moreover, alongside treating gastrointestinal pain, efforts to improve the individuals’ sense of coherence could be one way to achieve better self-rated health in both IBS and non-IBS patients. Finally, we suggest that fatigue in IBS is associated with immune activation, central alterations and to some extend also previous childhood trauma. IBS (Irritable Bowel Syndrome) är en vanlig, kronisk tarmsjukdom med återkommande symtom av buksmärta tillsammans med ändrade avföringsvanor. Den drabbar cirka 10% av befolkningen och är vanligast hos kvinnor samt något mindre vanlig hos äldre. För många innebär IBS ett stort lidande, försämrad livskvalitet och ökad sjukvårdskonsumtion. De flesta IBS-patienter tas om hand i primärvården. Nuvarande, tillgänglig behandling är ofta otillräcklig. En del IBS-patienter har också andra symtom, så som muskelsmärta och uttalad trötthet, som inte går över vid vila, så kallad fatigue. Det är också vanligt förekommande med andra sjukdomstillstånd såsom depression och andra smärtsyndrom. Det är visat att den typen av symtom och samsjuklighet många gånger är värre för IBS-patienten än de faktiska magtarmsymptomen. Numera tror man att symtomen vid IBS beror på störningar i det ömsesidiga samspelet mellan tarm och hjärna, men de bakomliggande mekanismerna är inte helt klarlagda. För att förstå IBS-patientens symtom är en så kallad biopsykosocial förklaringsmodell till stor hjälp, då symtomen inte bara beror av biologiska mekanismer, utan individens sociala miljö samt psykologiska reaktioner spelar också stor roll. Stress är centralt för så väl utveckling av, som symtom vid IBS och även för förståelsen av den biopsykosociala förklaringsmodellen generellt. Tidigare forskning visar också att immunsystemet är påverkat hos åtminstone en andel av IBS-patienterna. Syftet med den här avhandlingen var att nå en djupare förståelse av biopsykosociala mekanismer vid IBS med fokus på stress, samsjuklighet och fatigue. Delstudie I och II jämförde IBS-patienter och en kontrollgrupp med andra primärvårdspatienter, utan magtarmsymtom på 10 vårdcentraler i Östergötland. Delstudie III undersökte IBS-patienter på magtarmkliniken i Linköping i jämförelse med friska kontroller. I delstudie I undersökte vi kortisol i hår-nivåer, som ett mått på hur stresshormonnivåerna varit över tid. Trots att IBS-patienterna som grupp beskrev en större självupplevd stress än icke-IBS-patienterna hade en andel förhållandevis låga nivåer av kortisol i håret. I delstudie II undersökte vi hur samsjuklighet i form av totalt antal registrerade diagnoser, samt vissa specifika diagnoser och psykologiska aspekter samt magtarmsymtom, påverkade självskattad hälsa och primärvårdskonsumtion hos IBS- och icke-IBS-patienterna. I båda grupperna var lägre ålder, större känsla av sammanhang, och lägre grad av buksmärta oberoende associerat med bättre självskattad hälsa. Hos IBS-patienterna fann vi närmast en femfaldigt ökad risk att ha många kontakter med primärvården vid samtidigt diagnostiserad sömnstörning. Den kopplingen sågs inte hos patienterna utan IBS. Däremot var det totala antalet diagnoser också en faktor av betydelse för vårdkonsumtionen i båda grupperna. I delstudie III belyste vi fatigue och eventuella kopplingar till nivåer av en proinflammatorisk signalmolekyl (TNF-α) samt till självrapporterade missförhållanden under uppväxten hos IBS patienter och friska kontroller. Med funktionell magnetkameraundersökning av hjärnan undersökte vi också kopplingen mellan aktivitetsmönster i områden som är relaterade till emotionella, kognitiva och motivationsrelaterade aspekter av fatigue hos IBS patienter och friska kontroller. Vi fann att IBS-patienterna upplevde fyrfaldigt mer påverkan av fatigue på sina dagliga liv än kontrollerna. Den ökade trötthetsupplevelsen var också relaterad till högre nivåer av TNF-α i blodet hos IBS-patienterna, liksom i viss mån till missförhållanden under uppväxten. Slutligen såg vi att högre grad av upplevd fatigue hos IBS-patienterna ledde till minskad samtida aktivitet (konnektivitet) i de undersökta hjärnområdena som representerade de motivationsrelaterade och kognitiva aspekterna av trötthetsupplevelsen. Någon liknande koppling mellan TNF-α och förändringar i hjärnaktiviteten sågs ej. Sammanfattningsvis pekar våra resultat gällande samsjuklighet, självskattad hälsa, psykosociala faktorer samt fatigue på att IBS-patienterna är en sårbar patientgrupp som bör uppmärksammas. Våra resultat från delstudie I pekar vidare mot att stressaxeln kan vara uttröttad hos vissa IBS-patienter. Enligt resultaten i delstudie II är känsla av sammanhang jämte buksmärta faktorer, som bör tas i beaktande för att om möjligt uppnå bättre självskattad hälsa både hos IBS- och andra primärvårdspatienter. Vidare synes IBS-patienternas förhållandevis stora vårdkonsumtion vara särskilt avhängig av samtidig sömnstörning, vilket också det torde vara av betydelse i klinisk praxis och av intresse för framtida forskning. Delstudie III, visar ett samband mellan fatigue, som bisymtom vid IBS, och så väl barndomstrauman som möjlig immunaktivering. Vi fann även att IBS patienter som upplevde stor påverkan av fatigue på sina dagliga liv, också hade en minskad konnektivitet mellan hjärnstrukturer av betydelse för kognition och motivation.
The brain-gut connection has been increasingly implicated in biopsychosocial well-being. While there are numerous factors that directly and indirectly impact on how the gut and the brain interact, there is a growing awareness that gastrointestinal conditions need to be viewed and treated as part of a multidisciplinary approach. Psychogastroenterology for Adults: A Handbook for Mental Health Professionals is the first book to provide mental health professionals with an evidence-based, practical guide for working with patients living with gastrointestinal conditions. Timely and accessibly written, this book provides a unique, comprehensive introduction to psychogastroenterology, offering a step-by-step guide to evidence-based psychological treatment protocols. Broad in scope and expertise, the book is divided into four parts. It opens with an overview of the field, moving on to outline psychological concerns and conditions in gastroenterological (GI) cohorts. Further, it covers various approaches to psychogastroenterology, including psychopharmacological and eHealth practices. In closing, the book looks to the future, providing guidance on supervision in psychogastroenterology, and exploring challenges in the field. Written by experts in the field, this book will be an indispensable resource for those who wish to enhance their knowledge and practice of psychogastroenterology in the mental health profession, including psychologists, psychiatrists, psychosomatic medicine specialists, nurses and social workers.
In the Western world around 360 in every 100,000 individuals have inflammatory bowel disease (IBD), a relapsing-remitting autoimmune disease that affects the gastrointestinal tract. Its impact on individual functioning across physical and psychosocial domains is significant and psychological distress is a common feature, with research suggesting that active IBD is associated with one of the highest rates of depression and anxiety of all chronic illnesses. Despite the high prevalence of mental health co-morbidities in IBD, psychological illness remains largely undertreated, with studies showing that 60% of IBD patients experiencing mental health problems do not receive adequate help. In this book, Knowles and Mikocka-Walus bring together world experts who practice integrated and holistic approach in their care for IBD patients, to provide an overview of research across a range of topics associated with the biopsychosocial treatment of IBD. Each chapter provides an up-to-date comprehensive consolidation and evaluation of the current literature alongside recommendations for practice. Key themes include: current understanding of the interrelationship of the neurological and biological aspects of IBD common concerns and issues individuals with IBD face exploring challenges across individual life-stages current evidence for psychosocial interventions recommendations for future directions of biopsychosocial work. Psychological Aspects of Inflammatory Bowel Disease: A biopsychosocial approach is a key resource for researchers, practitioners and academics considering psychosocial aspects of the disease and psychological interventions. It will also appeal to health psychologists and mental health practitioners working with clients with IBD, as well as gastroenterologists interested in a comprehensive and holistic approach to IBD management.
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This eBook is a collection of articles from a Frontiers Research Topic. Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author by contacting the Frontiers Editorial Office: frontiersin.org/about/contact.
This comprehensive yet concise guide to the diagnosis and management of IBS is divided into four main parts: Overview, Diagnosis, Symptom-specific Treatment, and What's Next in IBS. Each chapter includes a summary of key points, and most chapters include cases and multiple choice questions for rapid review. Clinicians who manage patients with IBS will want to keep this dependable reference close at hand.
Presenting empirically tested and successful treatment programs for specific psychological disorders, each manual in this series targets problems and presents step-by-step treatment protocols that are easily implemented in practice.This book presents a brief cognitive-behavioral treatment approach that is suitable for use with individuals or groups suffering from Irritable Bowel Syndrome (IBS). Delineating a clear medical rationale, the authors help clinicians both to reduce the stigma associated with IBS and to overcome client resistance to psychological treatment. Effective techniques are outlined for helping clients manage anxiety, anger, and shame, enhance their self-efficacy and stress management skills, and alleviate gastrointestinal distress.
Sex/gender - specific medicine (SGM) is defined as the practice of medicine based on the understanding that biology and social roles are important in men and women for disease prevention, screening, diagnosis, and treatment. Current research demonstrates differences in disease incidence, symptomatology, morbidity, and mortality based on sex and gender. Sex/gender-specific medicine is a fundamental aspect of tailored therapy and precision medicine. Therefore, the variables must be considered in medical education and practice as well as in research models ranging from human participants, animals and cells. Gastroenterology is very big and important division of Internal Medicine, which include esophagus, stomach, small and large intestine, pancreatobiliary tract and liver. Nowadays estrogen is known to play a key role in the prevention of colon cancer and progression of liver cirrhosis and hepatocellular carcinoma, especially in women. This book covers the sex/gender-specific medicine in the area of gastrointestinal (GI) tract in the adults as well as in the pediatrics and in the gut microbiota.
This third edition brings together the latest in research and clinical practice of the expanding field of pediatric neurogastroenterology. In addition to a comprehensive review of the current state of the art, many chapters have been significant revised and updated, covering the latest discoveries of the delicate and detailed mechanisms of the neuroenteric system as well as relationships of the latter with microbiota and metabolites produced by resident intestinal bacteria. The book also covers rapidly-changing techniques to assess clinical problems, along with international diagnostic criteria and recommendations and guidelines for clinical management. The content is supported by ample figures, photographs and selected video segments. Remaining the gold standard text in this up-and-coming field, Pediatric Neurogastroenterology 3e is dedicated to reporting the most accurate and recent knowledge available. Written by international experts in the field, the book is a comprehensive and up-to-date theoretical review and practical guide to pediatric gastrointestinal motility and functional disorders to pediatricians, pediatric gastroenterologists and all professionals involved in the treatment of children with such disorders.
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