Primary healthcare utilisation and self-rated health among patients with Irritable Bowel Syndrome: What are the impacts of comorbidities, gastrointestinal symptom burden, sense of coherence and stress?

Rome Foundation Working Team Report on overlap in disorders of gut-brain interaction

In patients with disorders of gut-brain interaction (DGBI), overlapping non-gastrointestinal conditions such as fibromyalgia, headaches, gynaecological and urological conditions, sleep disturbances and fatigue are common, as is overlap among DGBI in different regions of the gastrointestinal tract. These overlaps strongly influence patient management and outcome. Shared pathophysiology could explain this scenario, but details are not fully understood. This overlap has been shown to be of great relevance for DGBI. In addition, symptoms considered to be caused by a DGBI could have a detectable organic cause, and in patients with a diagnosed organic gastrointestinal disease, symptoms not clearly explained by the pathology defining this organic disease are common. Thus, the aims of this Rome Foundation Working Team Report were to review the literature on overlapping conditions among patients with paediatric and adult DGBI and, based on the available epidemiological and clinical evidence, make recommendations for the current diagnostic and therapeutic approach, and for future research. Specifically, we focused on other DGBI in the same or different gastrointestinal anatomical region(s), DGBI overlap with organic bowel diseases in remission, and DGBI overlap with non-gastrointestinal, non-structural conditions.

The Developmental Origins of Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVES

The Developmental Origins of Health and Disease (DOHaD) framework contends that chronic diseases are attributable to behavioral and environmental risks encountered during vital periods of fetal and childhood development. Clinical research investigating irritable bowel syndrome (IBS) largely focuses on adult risk factors, with emerging evidence of epigenetic contributions. Limited work considers potential childhood exposures. This paper applies a life course approach to the study of IBS, exploring the available evidence to ascertain the potential developmental origins of IBS.

METHODS

A systematic literature review was conducted adhering to MOOSE and PRISMA protocols, identifying papers from 1970 through April 2024 examining all IBS risk factors during the prenatal, postnatal, childhood, and adolescent periods. Data were extracted from screened papers and analyzed via meta-analysis using a random effects model.

RESULTS

A total of 27 case-control, cohort, and cross-sectional studies were identified for analysis. The meta-analysis revealed significant childhood risk factors for adult IBS, including family history (pooled OR 2.17, 95% CI 1.89-2.49, p < 0.0001, n = 11) and the occurrence of any childhood trauma event (pooled OR 1.61, 95% CI 1.29-2.01, p < 0.0001, n = 6). Physical and sexual trauma were the strongest trauma predictors. Factors including breastfeeding and Cesarean section were not significant.

CONCLUSIONS

This study found IBS is strongly predicted by traumatic childhood experiences, as well as having an immediate family member with IBS. These demonstrated environmental and genetic components indicate a potential gene-environment interaction during childhood, suggesting a need for primary research to better understand the developmental origins of IBS.

Defecation symptoms in primary health care patients with irritable bowel syndrome

BACKGROUND

The objectives of the present study were to (a) measure the prevalence of defecation symptoms in IBS, (b) investigate the relationship between stool consistency and defecation symptoms in IBS, and (c) investigate the association of defecation symptoms with health-related quality of life (HRQL) and self-reported stress in patients with IBS cared for in a primary health care setting.

METHODS

Ten primary health care centres joined the study. 282 patients with IBS as well as 372 non-IBS controls filled in gastrointestinal symptom diaries prospectively for two weeks as well as the Perceived Stress Scale-14 (PSS14) and the EuroQol barometer to measure perceived stress and HRQL, respectively.

RESULTS

Incomplete evacuation was present in 51% vs. 21% of the stools among the IBS patients and the non-IBS controls, respectively. The need to strain during defecation was existing in 41% vs. 33% of the stools for the IBS patients and the non-IBS controls, respectively. Urgency was experienced in 37% of the stools in the IBS patients compared with 18% of the stools in the non-IBS controls. Patients with IBS experienced in a significant higher degree of overlapping symptoms per stool (p < 0.001 to p = 0.007). The occurrence of all defecation symptoms in the same patient was related to decreased HRQL, and increased stress (p = 0.001 to p < 0.001).

CONCLUSIONS

An overlap between IBS and symptoms from the anorectal region related to defecation was found in a primary health care population. Defecation symptoms are very common in primary care IBS-patients, it co-occurs with increased self-perceived stress, and decreased HRQL.

Relationships Between Sense of Coherence, Self-perception of Voice and Work Environment Among Teachers

OBJECTIVE

to analyze the relationship between sense of coherence and sociodemographic data, remote physical work environment, and self-perception of symptoms, vocal handicap and vocal fatigue in teachers.

METHODS

Seventy eight teachers pertaining to the municipal education network of a Brazilian capital city participated in the study, during the period of social isolation by COVID-19. An online questionnaire was applied with sociodemographic and physical remote work environment questions, the Sense of Coherence Scale (SOC-13), the Brazilian Dysphonia Screening Tool (Br-DST), the Vocal Fatigue Index (VFI), and the Vocal Handicap Index (VHI-10). Descriptive analysis, bivariate and multivariate Logistic regression models were performed to check the proportion of teachers with high and low SOC among the different categories of independent variables. Student's t test and Mann Whitney test were used to compare SOC, IDV, and VFI scores between the groups, and Hedge's g test was used to access the effect size. The total scores of SOC, VHI and VFI were correlated using Pearson's Correlation Coefficient. All tests adopted a 5% significance level.

RESULTS

Male teachers and those over 45 years old were, respectively, 6.79 (95%CI = 1.16-39.58) and 5.27 (95%CI = 1.40-19.76) times more likely to present a high SOC. The variables associated with a lower chance of presenting high SOC were vocal restriction (OR = 0.21; 95%CI = 0.06-0.79) and voice-related physical discomfort (OR = 0.13; 95%CI = 0.02-0.78). Regarding the remote work environment, in bivariate analysis, teachers who were dissatisfied with air quality (OR = 0.08; 95%CI = 0.01-0.65), temperature (OR = 0.11; 95%CI = 0.01-0.92), and noise (OR = 0.25; 95%CI = 0.61-0.99) were less likely to have high SOC. Higher values of SOC are associated with lower self-perception of vocal fatigue and voice handicap (P < 0,001).

CONCLUSION

The way individuals face stressful situations interferes with the self-perception of their voice and their work environment. The relationship between the sense of coherence and voice perception is relevant to favor programs to promote vocal health and stress management in teachers.

Symptoms and health experience in irritable bowel syndrome with focus on men

BACKGROUND

Irritable bowel syndrome (IBS) is a disorder with a predominance in women; IBS in men is less studied. The present study evaluated symptoms as well as health and social experiences of men with IBS.

METHODS

This cross-sectional study included 293 patients with IBS (64 men) and 363 non-IBS controls (62 men). Gastrointestinal symptom diaries were filled in prospectively, and data on comorbidities and healthcare-seeking behavior were assessed by questionnaires. Men with IBS were compared with men without IBS and women with IBS.

KEY RESULTS

Compared with women with IBS, men with IBS had fewer contacts with the healthcare system, fewer psychiatric comorbidities, fewer sleeping problems, and less chronic pain. Urgency to defecate and nausea were less common, and stool frequency was higher in men with IBS. There was no difference between men with and without IBS in terms of educational level, satisfaction with household economy, or living with a partner. In contrast, women with IBS more often lived alone, were more often dissatisfied with household economy, and had a lower educational level than women without IBS. Men with IBS had the same proportion of full-time employment as men without IBS but in contrast, the proportion of women with IBS in full-time employment was only 34%, compared to 50% of the women without IBS.

CONCLUSION AND INFERENCES

The present study improves the understanding of men's experiences of IBS and suggests that sex and gender may be integrated into the biopsychosocial model of IBS.

Irritable bowel syndrome in women: Association between decreased insular subregion volumes and gastrointestinal symptoms

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All insular subregions are smaller in IBS compared to healthy women.

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Insular volume associates with GI symptoms independent of psychiatric comorbidity.

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GI symptoms associate with anterior but not posterior insular volume.

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More nausea associated with smaller dorsal anterior insula bilaterally.

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Insula in major depression is not significantly smaller than in healthy women.

Objective

Irritable bowel syndrome (IBS) is a chronic pain disorder characterized by disturbed interactions between the gut and the brain with depression as a common comorbidity. In both IBS and depression, structural brain alterations of the insular cortices, key structures for pain processing and interoception, have been demonstrated but the specificity of these findings remains unclear. We compared the gray matter volume (GMV) of insular cortex (IC) subregions in IBS women and healthy controls (HC) and examined relations to gastrointestinal (GI) symptoms and glutamate + glutamine (Glx) concentrations. We further analyzed GMV of IC subregions in women with major depression (MDD) compared to HC and addressed possible differences between depression, IBS, IBS with depression and HC.

Design

Women with IBS (n = 75), MDD (n = 41) and their respective HC (n = 39 and n = 43) underwent structural brain MRI. IC subregion volumes were estimated using statistical parametric mapping software. General linear model approaches were applied to IC volumetric data and FDR-corrected partial correlation analyses assessed relations between GMV, GI symptoms and Glx concentrations.

Results

IBS patients had significantly smaller IC subregions than HC in both hemispheres but there was no significant difference between MDD compared with IBS and HC for any insular subregion. In IBS, the dorsal anterior insular volumes were negatively correlated with symptoms of nausea and pain, and the left ventral subregion showed a positive correlation with straining to defecate, while the posterior subregion volumes showed no relation to symptoms. In the anterior insula, concentration of Glx showed positive correlations with GMV bilaterally in HC and with GMV of the right anterior insula in IBS.

Conclusion

As the interoceptive cortex, the insula shows substantial and disease-specific structural differences in patients with chronic interoceptive visceral pain. Particularly changes in the anterior proportions might be related to chronic exposure to or enhanced salience towards adverse interoceptive visceral signals and could be linked to biochemical changes, calling for further multimodal and longitudinal work.

The effect of salutogenesis-based care on the sense of coherence in peritoneal dialysis patients

AIMS

This research is conducted to determine the effect of salutogenesis-based home care on the sense of coherence in patients with peritoneal dialysis.

BACKGROUND

Recent studies on the salutogenesis model have shown that the model is effective in promoting and improving health. It was observed that studies based on the salutogenesis model were carried out in the form of a training programme, and there was no study that shows its effectiveness on patient care by integrating it into the nursing process.

DESIGN

The research is conducted as a pre-test-post-test control group experimental study.

METHODS

The study included 73 patients, including 36 in the intervention group and 37 in the control group. The research data are collected using the Patient Identifier Information Form, Dialysis Symptom Index (DSI), General Self-Efficacy Scale (GSES) and the Sense of Coherence Scale (SIS). The intervention group is provided care based on the salutogenesis model by making home visits 1 time per week for 8 weeks. In this study, the TREND checklist was followed for non-randomised controlled trials.

RESULTS

In the study, the pre-test DSI, GSES and SIS (meaningfulness, comprehensibility, manageability sub-dimension) mean scores of the individuals in the intervention and control groups are similar. The third-month and sixth-month intervention group SIS total and sub-dimension scores and GSES scores are found to be statistically significantly higher than the scores of the control group.

CONCLUSIONS

As a result of the study, it is determined that the care based on the salutogenesis model provided to peritoneal dialysis patients increases the sense of coherence and self-efficacy and provides symptom control and decreases the dialysis symptoms.

RELEVANCE TO CLINICAL PRACTICE

It has been observed that the salutogenesis model can be used as a step of nursing care in providing symptom control by strengthening the self-efficacy of patients in clinical and home care.