Limiting FODMAP consumption for patients with IBS.

Irritable bowel syndrome (IBS) is a chronic disorder affected by stress and dietary habits. This article explores the role of diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in reducing IBS symptoms.

Improving clinical care for patients with irritable bowel syndrome.

Progress has been made in the past year in the guidance available for health professionals caring for patients with irritable bowel syndrome (IBS). In April 2016, the first National Institute for Health and Care Excellence (NICE) quality standard on IBS in adults was published and new dietary guidelines were developed. Nurses are at the forefront of caring for people with IBS across all healthcare sectors and may have more time to understand the patient's perspective and advise on lifestyle changes than a general practitioner in the average 10-minute consultation. Rapid diagnosis and evidence-based treatments using treatment pathways significantly reduces healthcare costs in primary care and improves quality of life. First-line treatment modalities remain a combination of lifestyle factors, diet and medications, but for persistent refractory symptoms, referral to specialist practitioners should be considered. This article aims to update nurses on new practice guidance and provide information on when it is appropriate to refer patients for specialist care.

Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory.

AIMS AND OBJECTIVES: This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome. BACKGROUND: Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations. METHODS: We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter. RESULTS: The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome. CONCLUSIONS: Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals. RELEVANCE TO CLINICAL PRACTICE: A deepened understanding of patients' experiences of healthcare encounters in irritable bowel syndrome could enable more helpful and supporting interventions by healthcare professionals.

Nutritional advice for community patients: insights from a panel discussion.

This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.

Nurse-Administered, Gut-Directed Hypnotherapy in IBS: Efficacy and Factors Predicting a Positive Response.

Hypnotherapy is an effective treatment in irritable bowel syndrome (IBS). It is often delivered by a psychotherapist and is costly and time consuming. Nurse-administered hypnotherapy could increase availability and reduce costs. In this study the authors evaluate the effectiveness of nurse-administered, gut-directed hypnotherapy and identify factors predicting treatment outcome. Eighty-five patients were included in the study. Participants received hypnotherapy by a nurse once/week for 12 weeks. Patients reported marked improvement in gastrointestinal (GI) and extra-colonic symptoms after treatment, as well as a reduction in GI-specific anxiety, general anxiety, and depression. Fifty-eight percent were responders after the 12 weeks treatment period, and of these 82% had a favorable clinical response already at week 6. Women were more likely than men to respond favorably to the treatment. Nurse-administered hypnotherapy is an effective treatment for IBS. Being female and reporting a favorable response to treatment by week 6 predicted a positive treatment response at the end of the 12 weeks treatment period.

An experience with the Patient-Reported Outcomes Measurement Information System: pros and cons and unanswered questions.

The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descriptive studies and clinical trials. Doing this has created opportunities and challenges for investigators. This article highlights three projects to show the perspectives of nurse scientists who incorporated PROMIS measures into their research. The first project describes advantages of PROMIS to allow for comparisons of a study population with a national sample and to compliment legacy measures. The second project examines issues in the translation of tools for region-specific Hispanic populations. The third project provides a perspective on the use of PROMIS measures to capture cancer-related fatigue and to develop new components of a sexual function scale. As indicated by these three examples, nurse scientists can contribute an important role in moving the PROMIS initiative forward. Results from these types of projects also move symptom science forward within a more interdisciplinary approach to common measures of interest.

Anxiety, depression, and catecholamine levels after self-management intervention in irritable bowel syndrome.

Patients with irritable bowel syndrome (IBS) often report higher levels of psychological distress, specifically anxiety, and depression than non-IBS patients. The management of gastrointestinal symptoms and psychological distress is demonstrably amenable to cognitive-behavioral therapies in a significant number of patients with IBS. The present secondary analysis evaluates the impact of nurse-delivered self-management interventions on anxiety, depression, and urine catecholamine levels in adult IBS patients. Participants in the study were randomized to 2 intervention groups of either comprehensive self-management (CSM) intervention or usual care control. Daily diary ratings of gastrointestinal symptoms, anxiety, and depression were recorded every evening for 28 days during the baseline period and subsequently at 3, 6, and 12 months postrandomization. Catecholamine levels of epinephrine and norepinephrine were measured from 4 weekly 1st morning urine samples at baseline as well as at each follow-up time. The CSM group reported significantly lower levels of anxiety and depression at follow-up than the usual care group (p = .018 and .021, respectively). In contrast, urine catecholamine levels displayed no appreciable change. Thus, although nurse-delivered CSM interventions showed no impact on urinary catecholamine levels, daily psychological distress was measurably reduced.

Everyday life, healthcare, and self-care management among people with irritable bowel syndrome: an integrative review of qualitative research.

Irritable bowel syndrome is a commonly recognized chronic disease in all healthcare settings. This integrative review investigated current knowledge about adults' illness-related experiences of this disease from the perspectives of everyday life, healthcare, and self-care management. The overarching findings related to everyday life with irritable bowel syndrome were life-limiting experiences of the body-self as unfamiliar and of the body and symptoms as shameful and unpredictable. The limitations manifested as lack of ability to move about freely, fulfill ambitions or commitments at work, maintain social activities, uphold or develop close and/or sexual relationships and parenting, and live a life with spontaneity. Physical condition, knowledge about disease/illness-related matters, and one's own perceived ability to find adequate strategies were significant for the ability of self-care management. Healthcare was experienced as being unsupportive and not providing information and guidance for enabling self-care management. These results suggest a need for controlled intervention trials of healthcare models that take as their point of departure the individual's experience of illness, needs, and life situation, and that enable learning and sharing of illness experiences, combined with the provision of scientific knowledge and advice from healthcare professionals.

Study of irritable bowel syndrome and co-existing psychological illness.

AIM: To assess the feasibility of using qualitative methods to explore psychological comorbidities associated with irritable bowel syndrome (IBS). BACKGROUND: IBS is a condition that often has a significant effect on quality of life. It has a high prevalence of co-existing psychological illness, which has been associated with more severe and persistent symptoms and an increased need for specialist referral. Only a small number of research studies have explored patients' perceptions and experiences of IBS, particularly when they are compounded by the presence of psychological comorbidity. DATA SOURCES: Semi-structured interview methods were used to explore the patients' experiences and perceptions of IBS and co-existing psychological illness. REVIEW METHODS: All interview data were transcribed before conducting a thematic analysis. DISCUSSION: The paper reports the methods used to conduct a small feasibility study and discusses and justifies these methods. Methodological issues and the implications these may have on the conduct of the study are presented and critically discussed. CONCLUSION: Important issues were identified during the design and conduct of the feasibility study relating to the quality of participant information, participant recruitment and the suitability of the proposed methods. IMPLICATIONS FOR RESEARCH/PRACTICE: Semi-structured interviews are suitable methods for exploring complex issues such as the psychological comorbidities associated with IBS. Further research should explore the patient perception and experience of concomitant psychological illness, which would help researchers develop effective interventions for patients with IBS.

Assessing and supporting patients who have IBD.

This two-part series gives general nurses information about inflammatory bowel disease. Part 1 explored the aetiology, pathophysiology, signs and symptoms. This second part looks at how patients are assessed and treated, and the nurse's role. Although treatment of this condition may be complex, nurses can embed the 6Cs into practice to ensure they provide care and support of a high quality.

Recovery through suggestion.

Nurse Helen Bremner established a hypnotherapy service for patients with irritable bowel syndrome in 2010. Despite achieving impressive results, funding was withdrawn in April this year.

Individual treatment for irritable bowel syndrome.

Irritable bowel syndrome is a debilitating and distressing condition. This article explores the prevalence, causes, investigation and treatment of it.

Does a self-management program change dietary intake in adults with irritable bowel syndrome?

Making dietary changes such as increasing fiber intake is recommended for the management of irritable bowel syndrome symptoms. Few studies have explored the efficacy of education on compliance with recommendations such as increasing fiber, vegetable, and fruit intake in adults with irritable bowel syndrome. This study examined the effect of a multicomponent self-management intervention that included strategies to enhance fiber, vegetable, and fruit intake. Participants with medically diagnosed irritable bowel syndrome were randomized to usual care or individualized comprehensive self-management, delivered either in-person or by telephone. Since previously published analyses show the two delivery modes to be equally effective, the two intervention groups were combined. Of the 188 individuals randomized, 173 participants (113 in the self-management group and 60 in the usual care group; 23 men, 150 women) provided data on at least one of the three follow-up occasions (3, 6, and 12 months postrandomization). Fiber, vegetable, and fruit intakes were measured using the Food Frequency Questionnaire. Participants in the intervention group demonstrated increases (p < .05) in fiber and fruit intake and a trend in vegetable intake at 6 and 12 months postintervention. Improvement in dietary fiber intake following a self-management intervention for IBS continues to 1 year.

Frequency of irritable bowel syndrome, entrance examination-related stress, mental health, and quality of life in high school students.

The purpose of this study was to examine entrance examination-related stress, mental health, and the quality of life of high school students with and without irritable bowel syndrome. We administered a descriptive survey by collecting data from 1,877 students from eight schools in Gyeonggi province, Korea. This study employed the Rome III criteria for the assessment of irritable bowel syndrome, an entrance examination stress scale for measuring entrance examination-related stress, the revised Symptom Checklist-90-Revised for measuring mental health, and the World Health Organization Quality of Life Scale Abbreviated Version for measuring the quality of life. The frequency of irritable bowel syndrome in students was 19.0%. A majority had a mixed constipation and diarrhea subtype of irritable bowel syndrome. Compared with the high school students without irritable bowel syndrome, those with irritable bowel syndrome reported a significantly higher score on the entrance examination stress scale, Symptom Checklist-90-Revised, and World Health Organization Quality of Life Scale Abbreviated Version. Results suggest support for creating a high school education program that provides knowledge and information about irritable bowel syndrome to students. Furthermore, it is important to explore suitable therapeutic approaches and nursing interventions for this population.

The process of symptom control in Korean women with irritable bowel syndrome.

Irritable bowel syndrome is chronic, uncontrollable, and unpredictable in nature. This study explored how Korean women with irritable bowel syndrome decipher the meaning of their symptoms and implement irritable bowel syndrome health management strategies. Data were collected in 2009 from 14 Korean women in their 20s and 30s through in-depth interviews using grounded theory. The constant comparative method was adopted for data analysis. The core category identified in the study was the "process of controlling irritable bowel syndrome symptoms." Strategies showed a temporal change progressing through stages of helplessness, searching, realization, struggling, and controlling. Early in symptom management, subjects tended to rely on medication or did not have a strategy. After a trial and error process, subjects did not use medication and natural symptom management that incorporated regular living habits, dietary control, and stress management. The introduction of strategic nursing interventions for irritable bowel syndrome based on the temporal stage of health management is recommended.

A holistic approach for planning care of patients with irritable bowel syndrome.

The aims of this study were to determine whether a registered nurse can collect information and plan a holistic and individual strategy for the treatment of patients with irritable bowel syndrome (IBS) and whether this approach can reduce these patients' health aspects. The referrals of 50 Swedish-speaking female patients aged between 18 and 65 years with the preliminary diagnosis of IBS were collected and scrutinized by a gastroenterologist at a university hospital. Of these, 41 patients agreed to participate but 2 did not show up. The 39 patients were randomized into one of two groups: (1) the intervention group (n = 19) where the subjects were interviewed on the basis of the theory of culture care by a nurse before visiting a gastroenterologist and (2) the control group (n = 20) where the subjects first met a gastroenterologist. After the medical examination, 19 subjects were found to have diseases other than IBS. The interview gave a holistic view of the subjects' problems, which could be of use when planning further care. Because subjects sometimes did not receive an accurate diagnosis by their primary care physician, however, the clinic nurse could not give these subjects IBS-specific information because the subjects' diagnosis had not been established. The initial medical assessments based on the primary care doctors' care of many subjects with IBS symptoms were a noted weak point.

What do patients with irritable bowel syndrome know about their disorder and how do they use their knowledge?

Irritable bowel syndrome (IBS) is a common disorder for which many patients experience a lack of information. By using a questionnaire, we aimed to explore how much knowledge these patients have, and what they find important to receive information and explanation about. Eighty-six subjects with IBS diagnosed in primary care and referred to a gastroenterologist completed the questionnaire before meeting the gastroenterologist. Approximately 80% had knowledge about IBS, although 55% stated that their knowledge was "just vague." According to visual analogue scale measurement, knowledge as well as satisfaction with knowledge was poor. Most patients had correct knowledge about IBS. Only 15% considered themselves to be thoroughly informed, and 24% stated that they had not received any information at all. The most important issue they wanted information about was what to do to improve symptoms. Many IBS patients seem to have correct knowledge about IBS; however, they do not consider themselves to have that knowledge, and therefore probably do not feel confident in using their knowledge. Encouraging and supporting patients with IBS could contribute to an increased ability to use their knowledge in a more appropriate way.

Hydrogen breath testing in adults: what is it and why is it performed?

A hydrogen breath test is a safe, easy-to-perform, 2-to 3-hour outpatient procedure used to identify the presence of small intestine bacterial overgrowth, evaluate carbohydrate maldigestion or malabsorption, and measure intestinal transit time. Breath sample analysis can reveal bacterial overgrowth in the small intestine by the characteristic early rise in breath hydrogen concentration (i.e., an earlier-than-expected rise at approximately 90 minutes when the substrate reaches the colon). Patients with irritable bowel syndrome are often referred for a hydrogen breath test because of symptoms of abdominal bloating, cramping, and diarrhea that are also characteristic of bacterial overgrowth. The elderly are at greater risk for nutritional compromise from untreated small intestine bacterial overgrowth than are younger patients. Treatment often consists of one or more courses of antibiotics. Most patients experience a reduction in symptoms with treatment.

Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion.

The purpose of this pilot study was to assess the effect of an individualized traditional Chinese medicine (TCM) acupuncture and moxibustion (Acu/Moxa) treatment on symptom control in patients with irritable bowel syndrome (IBS) in a preliminary, randomized, sham/placebo-controlled trial. Twenty-nine men and women with IBS were randomized to either individualized Acu/Moxa (treatment group) or sham/placebo Acu/Moxa (control group). All subjects were assessed by a diagnostic acupuncturist for a TCM evaluation and individualized point prescription. Only those subjects assigned to the experimental group received the individually prescribed treatment. The diagnostic acupuncturist did not administer treatments and was blind to treatment assignments. All subjects kept a symptom diary for the duration of the study, enabling measurement of symptom frequency, severity, and improvement. The Clinical Global Impression Scale was administered preintervention to establish baseline severity and on completion of the 4-week, eight-session treatment intervention. After 4 weeks of twice-weekly Acu/Moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.