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Walter, Susanna
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Tack, J., Stanghellini, V., Mearin, F., Yiannakou, Y., Layer, P., Coffin, B., . . . Marciniak, A. (2019). Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries. BMC Gastroenterology, 19(1), Article ID 69.
Öppna denna publikation i ny flik eller fönster >>Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries
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2019 (Engelska)Ingår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 19, nr 1, artikel-id 69Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Irritable bowel syndrome with predominant constipation (IBS-C) is a complex disorder with gastrointestinal and nervous system components. The study aim was to assess the economic burden of moderate to severe IBS-C in six European countries (France, Germany, Italy, Spain, Sweden and the UK). Methods: An observational, one year retrospective-prospective (6 months each) study of patients diagnosed in the last five years with IBS-C (Rome III criteria) and moderate to severe disease at inclusion (IBS Symptom Severity Scale score = 175). The primary objective was to assess the direct cost to European healthcare systems. Results: Five hundred twenty-five patients were included, 60% (range: 43.1-78.8%) suffered from severe IBS-C. During follow-up 11.1-24.0% of patients had a hospitalisation/emergency room (ER) visit, median stay range: 1.5-12.0 days and 41.1-90.4% took prescription drugs for IBS-C. 21.4-50.8% of employed patients took sick leave (mean: 11.6-64.1 days). The mean annual direct cost to the healthcare systems was €937.1- €2108.0. The total direct cost (combined costs to healthcare systems and patient) for IBS-C was €1421.7-€2487.1. Conclusions: IBS-C is not a life-threatening condition; however, it has large impact on healthcare systems and society. Direct and indirect costs for moderate to severe IBS-C were high with the largest direct cost driver being hospitalisations/ER visits. © 2019 The Author(s).

Ort, förlag, år, upplaga, sidor
BioMed Central Ltd., 2019
Nyckelord
Economic analysis; Europe; Healthcare resource utilisation; IBS; IBS-C
Nationell ämneskategori
Gastroenterologi
Identifikatorer
urn:nbn:se:liu:diva-158060 (URN)10.1186/s12876-019-0985-1 (DOI)000467407000001 ()31064345 (PubMedID)2-s2.0-85065501524 (Scopus ID)
Anmärkning

Funding agencies:This study and all data analyses were funded in full by Almirall, S.A. The preparation of this paper was funded by Almirall, S.A and Allergan International.

Tillgänglig från: 2019-06-24 Skapad: 2019-06-24 Senast uppdaterad: 2019-11-04
Bednarska, O., Icenhour, A., Tapper, S., Witt, S. T., Tisell, A., Lundberg, P., . . . Walter, S. (2019). Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome. Pain, 160(9), 2004-2012
Öppna denna publikation i ny flik eller fönster >>Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome
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2019 (Engelska)Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, nr 9, s. 2004-2012Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstratealtered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However,alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changesremain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthycontrols [HC]) with respect to aINS glutamate 1 glutamine (Glx) and g-aminobutyric acid (GABA1) concentrations and addressedpossible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonancespectroscopy of bilateral aINS to assess Glx and GABA1 concentrations. Questionnaire data from all participants and prospectivesymptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with IBS-related andpsychological parameters. Concentrations of Glx were lower in IBS compared with HC (left aINS P , 0.05, right aINS P , 0.001),whereas no group differences were detected for GABA1concentrations. Lower right-lateralized Glx concentrations in patients weresubstantially predicted by longer pain duration, while less frequent use of adaptive pain‐coping predicted lower Glx in left aINS. Ourfindings provide first evidence for reduced excitatory but unaltered inhibitory neurotransmitter levels in aINS in IBS. The results alsoindicate a functional lateralization of aINS with a stronger involvement of the right hemisphere in perception of abdominal pain and ofthe left aINS in cognitive pain regulation. Our findings suggest that glutaminergic deficiency may play a role in pain processing in IBS.

Ort, förlag, år, upplaga, sidor
Lippincott Williams & Wilkins, 2019
Nyckelord
Irritable bowel syndrome, Functional magnetic resonance imaging, Quantitative magnetic resonance spectroscopy, Insula, Visceral pain, Coping
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:liu:diva-160012 (URN)10.1097/j.pain.0000000000001589 (DOI)000512903900011 ()31045748 (PubMedID)
Anmärkning

Funding agencies: NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [P41-RR14075, R01 RR16594-01A1, R01 NS052585-01, K08 MH01573, K01 MH01798]; County Council of Ostergotland; AFA research foundation [DNR. 140407]; Bengt-Ihre f

Tillgänglig från: 2019-09-02 Skapad: 2019-09-02 Senast uppdaterad: 2020-04-28Bibliografiskt granskad
Jönsson, D., Bergström, A., Algström, I., Simon, R., Engström, M., Walter, S. & Hotz, I. (2019). Visual Analysis for Understanding Irritable Bowel Syndrome. In: Paul Rea (Ed.), Biomedical Visualisation: (pp. 111-122). Cham: Springer
Öppna denna publikation i ny flik eller fönster >>Visual Analysis for Understanding Irritable Bowel Syndrome
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2019 (Engelska)Ingår i: Biomedical Visualisation / [ed] Paul Rea, Cham: Springer, 2019, s. 111-122Kapitel i bok, del av antologi (Refereegranskat)
Abstract [en]

The cause of irritable bowel syndrome (IBS), a chronic disorder characterized by abdominal pain and disturbed bowel habits, is largely unknown. It is believed to be related to physical properties in the gut, central mechanisms in the brain, psychological factors, or a combination of these. To understand the relationships within the gut-brain axis with respect to IBS, large numbers of measurements ranging from stool samples to functional magnetic resonance imaging are collected from patients with IBS and healthy controls. As such, IBS is a typical example in medical research where research turns into a big data analysis challenge. In this chapter we demonstrate the power of interactive visual data analysis and exploration to generate an environment for scientific reasoning and hypothesis formulation for data from multiple sources with different character. Three case studies are presented to show the utility of the presented work.

Ort, förlag, år, upplaga, sidor
Cham: Springer, 2019
Serie
Advances in Experimental Medicine and Biology ; 1156
Nyckelord
Explorative data analytics, Visualization in medicine, Irritable bowel syndrome
Nationell ämneskategori
Medieteknik
Identifikatorer
urn:nbn:se:liu:diva-160859 (URN)10.1007/978-3-030-19385-0_8 (DOI)000514372000009 ()31338781 (PubMedID)9783030193843 (ISBN)9783030193850 (ISBN)
Forskningsfinansiär
Knut och Alice Wallenbergs Stiftelse, 2013-0076Vetenskapsrådet, 2015-05462ELLIIT - The Linköping‐Lund Initiative on IT and Mobile CommunicationsSwedish e‐Science Research Center
Anmärkning

Funding agencies:  Knut and Alice Wallenberg Foundation (KAW)Knut & Alice Wallenberg Foundation [2013-0076]; Swedish research councilSwedish Research Council [2015-05462]; SeRC (Swedish e-Science Research Center); ELLIIT environment for strategic research in Sweden

Tillgänglig från: 2019-10-10 Skapad: 2019-10-10 Senast uppdaterad: 2020-03-19Bibliografiskt granskad
Hadizadeh, F., Walter, S., Belheouane, M., Bonfiglio, F., Heinsen, F.-A., Andreasson, A., . . . DAmato, M. (2017). Stool frequency is associated with gut microbiota composition [Letter to the editor]. Gut, 66(3), 559-560
Öppna denna publikation i ny flik eller fönster >>Stool frequency is associated with gut microbiota composition
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2017 (Engelska)Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 66, nr 3, s. 559-560Artikel i tidskrift, Letter (Övrigt vetenskapligt) Published
Ort, förlag, år, upplaga, sidor
BMJ Publishing Group Ltd, 2017
Nyckelord
GASTROINTESTINAL TRANSIT; INTESTINAL BACTERIA
Nationell ämneskategori
Gastroenterologi
Identifikatorer
urn:nbn:se:liu:diva-145580 (URN)10.1136/gutjnl-2016-311935 (DOI)000426089000001 ()27196592 (PubMedID)2-s2.0-84966389012 (Scopus ID)
Tillgänglig från: 2018-03-25 Skapad: 2018-03-25 Senast uppdaterad: 2019-02-05Bibliografiskt granskad
Walter, S. A., Forsgren, M., Lundengård, K., Simon, R., Torkildsen Nilsson, M., Söderfeldt, B., . . . Engström, M. (2016). Positive Allosteric Modulator of GABA Lowers BOLD Responses in the Cingulate Cortex. PLoS ONE, 11(3)
Öppna denna publikation i ny flik eller fönster >>Positive Allosteric Modulator of GABA Lowers BOLD Responses in the Cingulate Cortex
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2016 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 3Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Knowledge about the neural underpinnings of the negative blood oxygen level dependent (BOLD) responses in functional magnetic resonance imaging (fMRI) is still limited. We hypothesized that pharmacological GABAergic modulation attenuates BOLD responses, and that blood concentrations of a positive allosteric modulator of GABA correlate inversely with BOLD responses in the cingulate cortex. We investigated whether or not pure task-related negative BOLD responses were co-localized with pharmacologically modulated BOLD responses. Twenty healthy adults received either 5 mg diazepam or placebo in a double blind, randomized design. During fMRI the subjects performed a working memory task. Results showed that BOLD responses in the cingulate cortex were inversely correlated with diazepam blood concentrations; that is, the higher the blood diazepam concentration, the lower the BOLD response. This inverse correlation was most pronounced in the pregenual anterior cingulate cortex and the anterior mid-cingulate cortex. For subjects with diazepam plasma concentration > 0.1 mg/L we observed negative BOLD responses with respect to fixation baseline. There was minor overlap between cingulate regions with task-related negative BOLD responses and regions where the BOLD responses were inversely correlated with diazepam concentration. We interpret that the inverse correlation between the BOLD response and diazepam was caused by GABA-related neural inhibition. Thus, this study supports the hypothesis that GABA attenuates BOLD responses in fMRI. The minimal overlap between task-related negative BOLD responses and responses attenuated by diazepam suggests that these responses might be caused by different mechanisms.

Ort, förlag, år, upplaga, sidor
San Francisco, CA, United States: Public Library of Science, 2016
Nyckelord
quantitative magnetic resonance imaging; brain tissue modeling; myelin; edema; T-1 relaxation; T-2 relaxation; proton density
Nationell ämneskategori
Neurovetenskaper
Identifikatorer
urn:nbn:se:liu:diva-126192 (URN)10.1371/journal.pone.0148737 (DOI)000371434500011 ()26930498 (PubMedID)
Anmärkning

Funding agencies: Linkoping University; County Council of Ostergotland

Tillgänglig från: 2016-03-18 Skapad: 2016-03-18 Senast uppdaterad: 2018-01-10Bibliografiskt granskad
Sjödahl, J., Walter, S., Johansson, E., Ingemansson, A., Ryn, A.-K. & Hallböök, O. (2015). Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women - a randomized controlled trial. Scandinavian Journal of Gastroenterology, 50(8), 965-974
Öppna denna publikation i ny flik eller fönster >>Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women - a randomized controlled trial
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2015 (Engelska)Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, nr 8, s. 965-974Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. Biofeedback and medical treatments have been extensively used for moderate fecal incontinence (FI). There is limited data comparing and combining these two treatments. The objective of this study was to evaluate the effect of biofeedback and medical treatments, separately and in combination. Material and methods. Sixty-four consecutive female patients, referred to a tertiary centre for FI, were included. The patients were randomized to start with either biofeedback (4-6 months) or medical treatment with loperamide and stool-bulking agents (2 months). Both groups continued with a combination of treatments, i.e. medical treatment was added to biofeedback and vice versa. A two-week prospective bowel symptom diary and anorectal physiology were evaluated at baseline, after single-and combination treatments. Results. Fifty-seven patients completed the study. Median number of leakage episodes during two weeks decreased from 6 to 3 (p less than 0.0001) from baseline to completion. The patients showed a significant (1) decrease in number of leakages without forewarning (p = 0.04); (2) decrease in number of stools with urgency (p = 0.001); (3) decrease in number of loose stool consistency; and (4) an increase in rectal sensory thresholds, both for maximum tolerable rectal pressure and first sensation (less than 0.01). The combination treatment was superior to both single treatments in terms of symptoms and functions. There was no significant difference between the two groups at any time point. Conclusions. The combination therapy with biofeedback and medical treatment is effective for symptom relief in FI. The symptom improvement was associated with improved fecal consistency, reduced urgency, and increased rectal sensory thresholds.

Ort, förlag, år, upplaga, sidor
TAYLOR and FRANCIS LTD, 2015
Nyckelord
anorectal manometry; biofeedback; incontinence; pelvic floor exercises
Nationell ämneskategori
Gastroenterologi
Identifikatorer
urn:nbn:se:liu:diva-121926 (URN)10.3109/00365521.2014.999252 (DOI)000361323200005 ()25892434 (PubMedID)
Anmärkning

Funding Agencies|County Council of Ostergotland

Tillgänglig från: 2015-10-13 Skapad: 2015-10-12 Senast uppdaterad: 2017-12-01
Lowén, M. B. O., Mayer, E., Tillisch, K., Labus, J., Naliboff, B., Lundberg, P., . . . Walter, S. (2015). Deficient habituation to repeated rectal distensions in irritable bowel syndrome patients with visceral hypersensitivity. Neurogastroenterology and Motility, 27(5), 646-655
Öppna denna publikation i ny flik eller fönster >>Deficient habituation to repeated rectal distensions in irritable bowel syndrome patients with visceral hypersensitivity
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2015 (Engelska)Ingår i: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 27, nr 5, s. 646-655Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Irritable bowel syndrome (IBS) patients show evidence of altered central processing of visceral signals. One of the proposed alterations in sensory processing is an altered engagement of endogenous pain modulation mechanisms. The aim was to test the hypothesis that IBS patients with (IBS-S) and without visceral hypersensitivity (IBS-N) differ in their ability to engage endogenous pain modulation mechanism during habituation to repeated visceral stimuli.

Methods Brain blood oxygen level dependent (BOLD) response was measured during repeated rectal distension and its anticipation in 33 IBS patients with and without visceral hypersensitivity and 18 healthy controls (HCs). BOLD response to early and late phase of the distension series was compared within and between groups.

Key Results While BOLD response was similar during the early phase of the experiment, IBS-S showed greater BOLD response than IBS-N and HCs during the late phase of the distension series. IBS-S showed increasing BOLD response both to the anticipation and delivery of low intensity rectal distensions in brain regions including insula, anterior and mid cingulate cortex. IBS-N showed decreasing BOLD response to repeated rectal distensions in brain regions including insula, prefrontal cortex and amygdala.

Conclusions & Inferences These findings are consistent with compromised ability of IBS-S to respond to repeated delivery of rectal stimuli, both in terms of sensitization of sensory pathways and habituation of emotional arousal. The fact that both IBS subgroups met Rome criteria, and did not differ in terms of reported symptom severity demonstrates that similar symptom patterns can result from different underlying neurobiological mechanisms.

Nyckelord
irritable bowel syndrome, brain-gut interaction, fMRI, visceral sensitivity
Nationell ämneskategori
Gastroenterologi Neurovetenskaper
Identifikatorer
urn:nbn:se:liu:diva-122143 (URN)10.1111/nmo.12537 (DOI)000364742000007 ()25777251 (PubMedID)
Anmärkning

Funding agencies: County Council of Ostergotland, Sweden; National Institute of Health [DK 64531]

Tillgänglig från: 2015-10-20 Skapad: 2015-10-20 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
Ek, W. E., Reznichenko, A., Ripke, S., Niesler, B., Zucchelli, M., Rivera, N. V., . . . D'Amato, M. (2015). Exploring the genetics of irritable bowel syndrome: a GWA study in the general population and replication in multinational case-control cohorts.. Gut, 64, 1774-1782
Öppna denna publikation i ny flik eller fönster >>Exploring the genetics of irritable bowel syndrome: a GWA study in the general population and replication in multinational case-control cohorts.
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2015 (Engelska)Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, s. 1774-1782Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: IBS shows genetic predisposition, but adequately powered gene-hunting efforts have been scarce so far. We sought to identify true IBS genetic risk factors by means of genome-wide association (GWA) and independent replication studies.

DESIGN: We conducted a GWA study (GWAS) of IBS in a general population sample of 11 326 Swedish twins. IBS cases (N=534) and asymptomatic controls (N=4932) were identified based on questionnaire data. Suggestive association signals were followed-up in 3511 individuals from six case-control cohorts. We sought genotype-gene expression correlations through single nucleotide polymorphism (SNP)-expression quantitative trait loci interactions testing, and performed in silico prediction of gene function. We compared candidate gene expression by real-time qPCR in rectal mucosal biopsies of patients with IBS and controls.

RESULTS: One locus at 7p22.1, which includes the genes KDELR2 (KDEL endoplasmic reticulum protein retention receptor 2) and GRID2IP (glutamate receptor, ionotropic, delta 2 (Grid2) interacting protein), showed consistent IBS risk effects in the index GWAS and all replication cohorts and reached p=9.31×10(-6) in a meta-analysis of all datasets. Several SNPs in this region are associated with cis effects on KDELR2 expression, and a trend for increased mucosal KDLER2 mRNA expression was observed in IBS cases compared with controls.

CONCLUSIONS: Our results demonstrate that general population-based studies combined with analyses of patient cohorts provide good opportunities for gene discovery in IBS. The 7p22.1 and other risk signals detected in this study constitute a good starting platform for hypothesis testing in future functional investigations.

Nationell ämneskategori
Gastroenterologi Medicinsk genetik
Identifikatorer
urn:nbn:se:liu:diva-112750 (URN)10.1136/gutjnl-2014-307997 (DOI)000362593700016 ()25248455 (PubMedID)
Tillgänglig från: 2014-12-12 Skapad: 2014-12-12 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
Molinder, H., Agreus, L., Kjellström, L., Walter, S., Talley, N. J., Andreasson, A. & Nyhlin, H. (2015). How individuals with the irritable bowel syndrome describe their own symptoms before formal diagnosis. Upsala Journal of Medical Sciences, 120(4), 276-279
Öppna denna publikation i ny flik eller fönster >>How individuals with the irritable bowel syndrome describe their own symptoms before formal diagnosis
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2015 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, nr 4, s. 276-279Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim: To investigate how individuals fulfilling the Rome II criteria for irritable bowel syndrome (IBS) spontaneously described their symptoms. Method: From a general population, 1,244 randomly sampled adults were asked to describe their gastrointestinal symptoms (if any) verbally, in their own words, at a semi-structured interview. Their own descriptions were sorted into five symptom clusters. The participants independently completed a written questionnaire (the Rome II Modular Questionnaire (RMIIMQ)). Results: A total of 601 participants reported at least one gastrointestinal symptom, and 128 had IBS according to the RMIIMQ. After exclusion of organic causes, previously diagnosed IBS, or additional gastrointestinal diagnosis, 81 participants with IBS according to RMIIMQ remained. Five participants (6%) described symptoms included in the full definition of IBS, but none fulfilled the Rome II criteria completely. Abdominal pain or other IBS-related symptoms were reported by 64 (79%), and 12 (15%) did not report any IBS-like symptom. Conclusion: Previously undiagnosed individuals, who fulfil criteria for Rome II-IBS, often express their complaints in words that do not fit into the current diagnostic criteria.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2015
Nyckelord
Diagnosis; digestive symptoms; irritable bowel syndrome (IBS); laymans wording; medical history-taking; questionnaires
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-123836 (URN)10.3109/03009734.2015.1040529 (DOI)000365684900007 ()25947550 (PubMedID)
Anmärkning

Funding Agencies|Swedish Research Council; Ersta Hospital, Stockholm, Sweden; AstraZeneca RD, Sweden; Stockholm County Council; Karolinska Institutet, Stockholm, Sweden

Tillgänglig från: 2016-01-11 Skapad: 2016-01-11 Senast uppdaterad: 2017-12-01Bibliografiskt granskad
Grodzinsky, E., Walter, S., Viktorsson, L., Carlsson, A.-K., Jones, M. P. & Olsen Faresjö, A. (2015). More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS - a case-control study in primary care. BMC Family Practice, 16(6)
Öppna denna publikation i ny flik eller fönster >>More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS - a case-control study in primary care
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2015 (Engelska)Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, nr 6Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background

Irritable Bowel Syndrome (IBS) is a chronic, relapsing gastrointestinal disorder,that affects approximately 10% of the general population and the majority are diagnosed  in primary care. IBS has been reported to be associated with altered psychological and cognitive functioning such as mood disturbances, somatization, catastrophizing or altered visceral interoception by negative emotions and stress. The aim was to  investigate the psychosocial constructs of self-esteem and sense of coherence among IBS patients compared to non-IBS patients in primary care.     

Methods

A case–control study in primary care setting among IBS patients meeting the ROME III         criteria (n = 140) compared to controls i.e. non-IBS patients (n = 213) without any         present or previous gastrointestinal complaints. The data were collected through self-reportedquestionnaires of psychosocial factors.     

Results

IBS-patients reported significantly more negative self-esteem (p < 0.001), lower scores         for positive self-esteem (p < 0.001), and lower sense of coherence (p < 0.001) than the controls. The IBS-cases were also less likely to report ‘good’ health status (p < 0.001) and less likely to report a positive belief in the future (p < 0.001). After controlling for relevant confounding factors in multiple regressions, the elevation  in negative self-esteem among IBS patients remained statistically significant (p =0.02), as did the lower scores for sense of coherence among IBS cases (p = 0.04).     

Conclusions

The more frequently reported negative self-esteem and inferior coping strategies among         IBS patients found in this study suggest the possibility that psychological therapies         might be helpful for these patients. However these data do not indicate the causal         direction of the observed associations. More research is therefore warranted to determine whether these psychosocial constructs are more frequent in IBS patients.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2015
Nyckelord
Primary care; IBS; Self-esteem; Coping; Psychosocial factors
Nationell ämneskategori
Gastroenterologi Psykologi
Identifikatorer
urn:nbn:se:liu:diva-114578 (URN)10.1186/s12875-015-0225-x (DOI)000349125500001 ()25626450 (PubMedID)
Anmärkning

Funding Agencies|FORSS (Research fund in South of Sweden)

Tillgänglig från: 2015-02-27 Skapad: 2015-02-26 Senast uppdaterad: 2017-12-04
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