Nucleotide supplementation: a randomised double-blind placebo controlled trial of IntestAidIB in people with Irritable Bowel Syndrome [ISRCTN67764449].

BACKGROUND: Dietary nucleotide supplementation has been shown to have important effects on the growth and development of cells which have a rapid turnover such as those in the immune system and the gastrointestinal tract. Work with infants has shown that the incidence and duration of diarrhoea is lower when nucleotide supplementation is given, and animal work shows that villi height and crypt depth in the intestine is increased as a result of dietary nucleotides. Dietary nucleotides may be semi-essential under conditions of ill-health, poor diet or stress. Since people with Irritable Bowel Syndrome tend to fulfil these conditions, we tested the hypothesis that symptoms would be improved with dietary nucleotide supplementation. METHODS: Thirty-seven people with a diagnosis of Irritable Bowel gave daily symptom severity ratings for abdominal pain, diarrhoea, urgency to have a bowel movement, incomplete feeling of evacuation after a bowel movement, bloating, flatulence and constipation for 28 days (baseline). They were then assigned to either placebo (56 days) followed by experimental (56 days) or the reverse. There was a four week washout period before crossover. During the placebo and experimental conditions participants took one 500 mg capsule three times a day; in the experimental condition the capsule contained the nutroceutical substances. Symptom severity ratings and psychological measures (anxiety, depression, illness intrusiveness and general health) were obtained and analysed by repeated measures ANOVAs. RESULTS: Symptom severity for all symptoms (except constipation) were in the expected direction of baseline>placebo>experimental condition. Symptom improvement was in the range 4 - 6%. A feeling of incomplete evacuation and abdominal pain showed the most improvement. The differences between conditions for diarrhoea, bloating and flatulence were not significant at the p < .05 level. There were no significant differences between the conditions for any of the psychological measures. CONCLUSION: Dietary nucleotide supplementation improves some of the symptoms of irritable bowel above baseline and placebo level. As expected, placebo effects were high. Apart from abdominal pain and urgency to have a bowel movement, the improvements, while consistent, are modest, and were not accompanied by improvements in any of the psychological measures. We suggest that the percentage improvement over and above the placebo effect is a physiological effect of the nucleotide supplement on the gut. The mechanisms by which these effects might improve symptoms are discussed.

The understanding of their illness amongst people with irritable bowel syndrome: a Q methodological study.

Irritable Bowel Syndrome (IBS) refers to a collection of gastrointestinal symptoms which affect up to 22% of the Western population. Although the disorder costs the British National Health Service and employers vast sums of money in terms of repeated physician visits, medications, and loss of productivity, the cause or causes of IBS are still unknown, and there is no cure which is lastingly effective. Since IBS is not life-threatening, and the symptoms can be hidden from others, many consider it a trivial disorder. For an individual with IBS, however, the uncertainty regarding cause, diagnosis and treatment may lead to anxiety and constant searching for causes, or to hopelessness and resignation. The present study aims to help clarify these problems by discovering how those who suffer from IBS understand the nature and causality of their own illness. Through use of Q methodology with a sample of 60 people with IBS, a taxonomy of 7 clear and distinct accounts is identified and described. These data (based on Q factor analysis) are described in qualitative detail and discussed in relation to the problem of improving communication with doctors, and untangling issues of responsibility for illness.

The measurement of irritable bowel syndrome (IBS)-related misconceptions in people with IBS.

Irritable bowel syndrome (IBS) is a common chronic disorder affecting between 15% and 22% of Western populations; core symptoms include abdominal pain and disturbed bowel function. Adjusting to living with IBS may entail considerable coping effort and, because medical treatments are largely ineffective, people with IBS must learn to manage the condition themselves. Self-management programs that include an increased awareness of and information relating to chronic illness have been shown to lead to positive benefits. The present article describes the development of the IBS misconceptions scale, an instrument designed to measure the misconceptions held by people with IBS. The final 17-item questionnaire was able to differentiate between three groups expected to differ in terms of IBS-related misconceptions, and showed good validity and reliability. The IBS-MS may be a useful tool in patient education programs, because it should be sensitive to changes in illness-related knowledge gained during intervention programs, and it is hoped that further research will lend further support to its reliability, validity, and usefulness.

The relationship between daily stress and symptoms of irritable bowel: a time-series approach.

Irritable bowel syndrome (IBS), a chronic disorder that includes symptoms such as abdominal pain and altered bowel habits, affects up to 22% of people in Western populations. The causes of IBS are not well understood, but are believed to be multifactorial. Although stress is widely believed to be implicated, empirical evidence in support of this is lacking, perhaps because a typical between-participants analysis ignores individual differences and therefore may obscure any link. The present study used a within-person, lagged time-series approach to investigate the links between everyday stress and symptomatology in 31 IBS sufferers. Both everyday stress and symptomatology exhibited serial dependence for a statistically significant proportion of sufferers. Multiple regression analysis carried out on same-day and lagged relationships up to and including 4 days found that, for over half the participants, everyday stress and symptoms were related. The best regression model was one in which symptoms were a function of hassles and symptoms on the previous 2 days, and hassles on the same day, fitting the data for 67% of participants. This prospective study confirms other studies that have suggested stress is a significant factor in IBS, and concludes that stress management programs may be both useful and cost-effective in the treatment of IBS.

Symptoms of irritable bowel in school children: prevalence and psychosocial effects.

INTRODUCTION: This study was to ascertain the prevalence of symptoms of irritable bowel in a sample of school children 11 to 17 years of age and to determine whether children with such symptoms differed from children without symptoms on various psychosocial questions. METHOD: Eight hundred fifty-one school children completed a 20-item questionnaire consisting of questions related to symptoms of irritable bowel, psychosocial questions, and filler questions. Questions referred to a 1-week time frame to minimize memory distortion. RESULTS: Of the sample, 133 (16.2%) had one or more symptoms of irritable bowel. A significant association was found between bowel symptoms and other factors. Children with symptoms were more likely to report that they felt different from other children (chi 2 analysis = 10.06, p = 0.002), were embarrassed about their health (chi 2 analysis = 16.14, p = 0.0001), and felt their health prevented them from going out with their friends (chi 2 analysis = 4.69 p = 0.03). DISCUSSION: The study suggests that a large number of children have symptoms of irritable bowel and that having such symptoms can have a significant impact on children's lives beyond the immediate physical effects. Because children with symptoms of irritable bowel are likely to come to the attention of health professionals, nurses are in an ideal position to give such children both information and reassurance about their condition.

Nurses' perceptions of irritable bowel syndrome (IBS) and sufferers of IBS.

The present study set out to discover nurses' attitudes towards, and beliefs about, irritable bowel syndrome (IBS) and IBS sufferers. A 54-item questionnaire was completed by 254 qualified nurses from 18 London hospitals. Nurses rated statements relating to IBS on a scale from disagree (1) to agree (5). Questionnaire items fell into four broad categories. The first related to the way nurses felt about the sufferers of IBS; the vast majority of nurses agreed with items stating that IBS patients are demanding, unable to cope with life, lazy and crave attention, and waste doctors' time. The second category related to nurses' beliefs regarding their knowledge of the syndrome; only half the sample believed that they would recognize the symptoms of IB and that they had a good understanding of the disorder. Ratings on items relating to the nurses' general knowledge of the symptoms showed that between a quarter and a half of the sample felt uncertain about the veracity of the statements. A fourth category was the nurses' beliefs regarding the attitudes held by health professionals, with half of the sample believing that doctors and health professionals generally had a poor understanding of IBS. Surprisingly, results showed that older, more experienced nurses, and those suffering from the syndrome were not more sympathetic and understanding than younger, non-sufferers. The present study shows that the majority of nurses hold negative attitudes towards IBS sufferers, which can only be detrimental to the treatment of those patients with IBS.

The relationship between hassles, uplifts and irritable bowel syndrome: a preliminary study.

In a preliminary study, 30 sufferers of irritable bowel syndrome filled in daily symptom sheets and the combined Hassles and Uplifts questionnaire for five weeks. Initially, analyses were carried out for each symptom separately. Results showed that ratings on the hassles and symptoms questionnaires completed in the same week were more highly associated than ratings for hassles and symptoms in different weeks. No one symptom in any week was significantly associated with the following week's hassles. Similarly, hassles in any one week were not associated with the following week's symptoms. However, total symptoms were found to be significantly associated with hassles in the following weeks, whereas the association between hassles and total symptoms in the following weeks was not significant. The study suggests that there is a cumulative effect of symptoms such that an increase in the severity of the combined effect of symptoms is associated with an increase in severity of stress in the next week. Increased hassles do not appear to exacerbate symptoms. There was no evidence of an association between uplifts and IB symptoms.

Towards a better understanding of patients with irritable bowel syndrome.

This study was undertaken by sending a questionnaire to 148 people suffering from irritable bowel syndrome (IBS). The respondents all were members of the IBS Network, a national independent organization formed to help alleviate the suffering and distress of people diagnosed as having irritable bowel. They were asked about their symptoms, the medical tests they had undergone, how they felt about the treatment they received, and how IBS affected their lives. The study found that IBS affected all aspects of their lives: work, leisure, travel and relationships. Sufferers indicated that they felt they would have coped better if they had been provided with more information about IBS, its possible causes and treatment, and greater sensitivity from members of the medical profession in dealing with them.

The relationship of instrumentality and expressivity to sexual orientation in women.

The study reported here investigated the relationship between Instrumentality (I) and Expressivity (E) (two personality variables related to sex roles), sexual orientation, occupational level and marital status. The hypothesis was that women high in I and low in E may find traditional heterosexual relationships to be in conflict with their personality traits, and that a lesbian choice may offer a way of life more in keeping with such traits. The study used a sample of 159 women, and found that neither I nor E alone, nor I x E, could predict sexual orientation. A weak relationship was found between I and housewifery, such that women who were married with children and did not have a job outside the home tend to score lower on I. Expressivity bore no relationship to any of the variables. Women who were high on I and low on E were not more likely to be lesbian. The study concludes that there is no relationship between I, E, and sexual orientation; also that it is inappropriate to use housewives as a heterosexual comparison group for lesbian women.

Sexual orientation in women: an investigation of hormonal and personality variables.

There are conflicting findings from the few existing studies of levels of sex hormones in lesbian and heterosexual women. MacCulloch and Waddington (1981) suggest that levels of certain sex hormones will only be "abnormal" in "primary" lesbians, defined by these authors as those lesbians who have no previous heterosexual experience and who score less than 20 on the heterosexual component of the Sexual Orientation Method questionnaire (SOM). They define secondary lesbians as those who have previous heterosexual experience and who score more than 20 on the heterosexual component of the SOM. In the present study (part of a wider investigation of a large number of variables, Dancey 1990) 40 lesbian women were classified into primary and secondary groups according to the above criteria. These two groups, and another lesbian and a heterosexual group, were measured at the same point in the menstrual cycle for levels of testosterone, androstenedione, oestradiol and progesterone. They were also tested on instrumentality and expressivity, two traits measured by the Personal Attributes Questionnaire (PAQ), related to sex roles. No significant differences were found between the groups on any of the measures, apart from the defining criteria. This study has therefore failed to validate the distinction between primary and secondary lesbianism.