Epidemiological features of irritable bowel syndrome and its subtypes among Iranian adults

Abstract Background The epidemiological features of irritable bowel syndrome (IBS) have not been properly investigated in Iran. Also, worldwide there is limited knowledge about the characteristics of IBS subtypes. The aim of the study was to explore the epidemiological features of IBS and its subtypes among Iranian adults

The Role of Positive Personality Traits in Emotion Regulation of Patients with Irritable Bowel Syndrome (IBS)

Background: Personality traits and emotion regulation processes play an important role in human health. The purpose of this study was to investigate the role of positive personality traits (psychological hardiness and interpersonal forgiveness) in emotion regulation of patients with Irritable Bowel Syndrome. Methods: The research was a cross-sectional study. Statistical population included all of IBS patients referred to the Subspecialty Center of Psychiatry in Isfahan in 2013. Overall, 123 subjects (100 women, 83.3%, and 30 men, 16.7%) were selected by census method, according to criteria of research and during a particular period. To collect data, the Difficulties in Emotion Regulation Scale )DERS), Lang and Goulet Hardiness Scale (LGHS) and Interpersonal forgiveness Inventory (IFI) were used. Data was analyzed using Pearson,s correlation coefficient and Multivariate and Binary Logistic regression analyses. Results: Mean age of patients was 33.82±10.45 years and 83.3% (100) of them were female. Regression analyses showed  that both personality traits of hardiness and forgiveness were as protective factors for emotional dysregulation with OR, 95% CI: 0.93 and 0.96 sequentially, with adjusting demographic variables (age, gender, and education level and disease duration). Conclusion: Patients who are more hardy and forgiving toward others, are likely more successful at adaptive emotion regulation. It emphasizes the positive and beneficial role of the personality traits in regulating of emotional problems of IBS patients. Hence, these variables should be considered as effective factors in the treatment process of the patients

The Effectiveness of the Unified Protocol on Emotional Dysregulation and Cognitive Emotion Regulation Strategies in Patients with Psychosomatic Disorders

Background: The unified treatment approach (UP) is an emotion-focused cognitive-behavioral therapy in which the main object of treatment is emotional processes. The aim of the present research was to examine the effectiveness of The Unified Protocol (UP) on emotional dysregulation and cognitive emotion regulation strategies in patients with psychosomatic disorders. Methods: Emotion-focused cognitive behavioral therapy (ECBT), a unified treatment, with 12 weekly group sessions of 2 hours, was presented to 14 patients with psychosomatic complaints at the Subspecialty Center of Psychiatry in Isfahan in 2013. Pre- and post-intervention assessments were done by means of the self-report tests of Difficulties in Emotion Regulation Scale (DERS) and Cognitive Emotion Regulation Questionnaire (CERQ). Results: Significant reductions in post-test scores of total emotional dysregulation (P &lt; 0.01) as well as the factors of non-acceptance (P &lt; 0.05) and strategy (P &lt; 0.01) were seen, while the other factors (goal, impulse, awareness, and clarity) did not change. Moreover, a significant reduction was observed in the catastrophizing strategy score (P &lt; 0.05), in comparison with other cognitive strategies. Conclusion: This pilot study including 14 patients with psychosomatic disorders indicates that the Unified treatment approach is an effective treatment in improvement of emotional dysregulation and in reduction of utilizing maladaptive cognitive strategies.</div

The comparison of treatments with and without azithromycin in irritable bowel syndrome with diarrhea-predominant in gastrointestinal Clinic of Al-Zahra Hospital, Isfahan, Iran

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Recent studies suggest the importance of gut flora in the pathophysiology of it. Therefore, antibiotics have demonstrated a substantial benefit to reduce gut flora. Having few side effects, and applying one-dose per day, we studied the effect of azithromycin to treat IBS. Materials and Methods: One hundred and twenty-six patients enrolled a randomized, double-blind, placebo-controlled study. The treatment group received azithromycin in addition to common treatment. Patients were followed for 12 weeks. Patients completed daily diaries documenting their symptoms. Results: One hundred and thirteen patients completed the study. The onset of relief occurred significantly sooner, and duration of relief was significantly longer in azithromycin group. Movement, abdominal pain, bloating, and gas were significantly better in azithromycin group. Monthly results showed superior relief in bloating, gas, overall symptom, and overall bloating during 3 months. Significantly more patients in azithromycin group felt relief in bloating and gas and had greater consistency relief in almost all weeks. Conclusion: In our study, azithromycin significantly relieved most symptoms, such as abdominal pain, bloating, and gas. Overall symptom and overall bloating were relieved significantly in more patients in the intervention group in all weeks

Solitary Rectal Ulcer Syndrome: A Biopsychosocial Assessment

Background: Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the gastrointestinal tract and its etiology is not well understood. There is no specific treatment for this syndrome and patients with SRUS may, for years, experience many complications. The aim of the present research was the biopsychosocial study of patients with SRUS.Methods: The study participants consisted of 16 patients with SRUS (7 men and 9 women). Their medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Moreover, psychiatric and personality disorders [based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision (DSM IV-TR)], psychosocial stressors, early life traumas, and coping mechanisms were assessed through structured interviews.Results: At presentation, mean age of the patients was 39 years (16 to 70). Common symptoms reported included rectal bleeding (93.8%), rectal self-digitations (81.2%), passage of mucous (75%), anal pain (75%), and straining (75%). Endoscopically, solitary and multiple lesions were present in 9 (60%) and 4 (26.7%) patients, respectively, and 87% of lesions were ulcerative and 13.3% polypoidal. The most common histological findings were superficial ulceration (92.85%) and intercryptic fibromuscular obliteration (87.71%). Common psychosocial findings included anxiety disorders (50%), depression (37.5%), obsessive-compulsive personality disorder (OCPD) or traits (62.5%), interpersonal problems (43.75%), marital conflicts (43.75%), occupational stress (37.5%), early life traumas, physical abuse (31.25%), sexual abuse (31.25%), dysfunctional coping mechanisms, emotional inhibition (50%), and non-assertiveness (37.5%).Conclusion: Given the evidence in this study, we cannot ignore the psychosocial problems of patients with SRUS and biopsychosocial assessment of SRUS is more appropriate than biomedical evaluation alone.</div

Type D personality and quality of life in patients with irritable bowel syndrome*

Background: Some studies indicate that psychological factors and extra-intestinal symptoms affect health related quality of life (HRQoL) in patients with irritable bowel syndrome (IBS) more than what bowel symptoms themselves. Type D personality characterized by global traits including negative affectivity and social inhibition has been proposed to be related to HRQoL. The aim of this study was to determine the association between type D personality and HRQoL inpatients with IBS. Methods: In a cross-sectional study, 194 consecutive patients with IBS referred to two referral gastrointestinal clinics affiliated with Isfahan University of Medical Sciences were selected in respect of inclusion and exclusion criteria. The patients completed type D personality (DS-14), IBS quality of life and the IB severity scoring (IBS-SSS) scales. The patients were divided into two groups with and without type D personality using DS-14. The data was analyzed using ANCOVA and multiple regression. Results: The findings indicated that 40.7% of the patients had type D personality. The results of ANCOVA with con-trolling for the influence of severity of IBS and treatment duration showed significant difference between the two groups in health related quality of life (F = 11.89, p < 0.01). Multiple regression analysis indicated negative affectivity (ß =-0.283, p < 0.01), severity of symptoms (ß = 0.279, p = 0.000) and duration of treatment (ß =-0.189, p < 0.05) as the significant predictors for HRQoL in patients with IBS. Conclusions: Type D personality may be an important determinant of individual differences in HRQoL among IBS patients. Negative affectivity as one of type D dimensions may have an adverse effect on HRQoL in patient with IBS. Therefore, additional attention is needed in IBS patients with type D personality

Life stressors, coping strategies, and social supports in patients with irritable bowel syndrome

Background: The frequency and the perceived intensity of life stressors, coping strategies, and social supports are very important in everybody′s well-being. This study intended to estimate the relation of irritable bowel syndrome (IBS) and these factors. Materials and Methods: This was a cross-sectional study carried out in Isfahan on 2013. Data were extracted from the framework of the study on the epidemiology of psychological, alimentary health, and nutrition. Symptoms of IBS were evaluated by Talley bowel disease questionnaire. Stressful life event, modified COPE scale, and Multidimensional Scale of Perceived Social Support were also used. About 4763 subjects were completed questionnaires. Analyzing data were done by t-test and multivariate logistic regression. Results: Of all returned questionnaire, 1024 (21.5%) were diagnosed with IBS. IBS and clinically-significant IBS (IBS-S) groups have significantly experienced a higher level of perceived intensity of stressors and had a higher frequency of stressors. The mean score of social supports and the mean scores of three coping strategies (problem engagement, support seeking, and positive reinterpretation and growth) were significantly lower in subjects with either IBS-S or IBS than in those with no IBS. Multivariate logistic regression revealed a significant association between frequency of stressors and perceived intensity of stressors with IBS (odds ratio [OR] =1.09 and OR = 1.02, respectively) or IBS-S (OR = 1.09 and OR = 1.03, respectively). Conclusions: People with IBS had higher numbers of stressors, higher perception of the intensity of stressors, less adaptive coping strategies, and less social supports which should be focused in psychosocial interventions

Association of anxiety, depression, and psychological distress in people with and without functional dyspepsia

Background: Current studies have indicated a high ratio of psychological problems in functional dyspepsia (FD) which causes disturbance in its management, so recognition these problems help the process of treatment. Materials and Methods: This was a cross-sectional study with a sample size of 4763 carried out in Isfahan University of Medical Sciences in 2011. Modified ROME III questionnaire was used to evaluate FD symptoms. Hospital anxiety and depression scale and 12-item General Health Questionnaire-12 was used to assess the psychological issue. Logistic regression analysis was used to assess the association of psychological problems and FD. Results: We showed that overly 654 (13.7%), 1338 (28.1%), and 1067 (22.4%) of participants, respectively had anxiety, depression, and of psychological distress. Seven hundred and ten (15.5%) participants were diagnosed with FD. Of all participants Mean scores of anxiety (P < 0.001), depression (P < 0.001), and psychological distress (P < 0.001) in participants with FD were significantly more than those with no FD. Multivariate logistic regression analysis showed that psychological problems, whether in the form of psychological distress odds ratio (OR): 2 (95% confidence interval [CI]: 1.3–3) and OR: 1.3 (95% CI: 1.1–1.7) in males and females, respectively, anxiety OR: 2.4 (95% CI: 1.5–3.9) and OR: 2.3 (95% CI: 1.7–3.2) in males and females, respectively) or depression OR: 2.2 (95% CI: 1.5–3.3) and OR: 1.7 (95% CI: 1.3–2.3) in males and females, respectively) were significantly linked to FD in both genders. Conclusions: The prevalence of FD is less in males than females, but psychological links were stronger in males. Thus, it is essential to consider and detect the psychological distress in these patients

Physical activity in relation to irritable bowel syndrome among Iranian adults.

BACKGROUND:Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder worldwide. Physical activity in relation to IBS has been investigated in few studies and data in this regard are conflicting. AIM:To investigate the association between physical activity and IBS in a large sample of Iranian adults. METHODS:This cross-sectional study was done on 4763 Iranian adults in the framework of SEPAHAN (The Study on the Epidemiology of Psycho-Alimentary Health and Nutrition) project. The physical activity of study participants was assessed using the General Practice Physical Activity Questionnaire (GPPAQ). Using a validated self-administered modified Rome III questionnaire, functional gastrointestinal disorders including irritable bowel syndrome was assessed. RESULTS:The mean age of study participants was 36.5 years. Irritable bowel syndrome was prevalent among 21.5% of participants. Compared with physically active individuals (≥ 1 hour/wk), those with sedentary physical activity (<1 hour/wk) had 1.27 times greater probability of suffering from IBS (OR: 1.27, 95% CI: 1.08-1.49). However, this association was attenuated after adjusting for age, sex, cigarette smoking and medical history of colitis and diabetes. When the analysis was additionally adjusted for diet-related practices and body mass index (BMI), a non-significant association was found between sedentary physical activity and IBS (OR: 1.18, 95% CI: 0.98-1.41). Gender-stratified analysis revealed similar findings in women either before (OR: 1.29, 95% CI: 1.04-1.61) or after controlling for covariates (OR: 1.27, 95% CI: 0.99-1.62). In BMI-stratified analysis, a significant positive association was seen between sedentary physical activity and IBS among individuals with normal BMI (OR: 1.38, 95% CI: 1.07-1.79). CONCLUSION:We found a significant positive association between sedentary physical activity and IBS, particularly among women and individuals of normal weight

Can Mindfulness-Based Cognitive Therapy Reduce the Symptoms of Irritable Bowel Syndrome in Women?

Background: Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract caused by stress, which may benefit from a biopsychosocial treatment such as mindfulness-based cognitive therapy (MBCT). The thrust of the study was to examine the efficacy of MBCT on physical and psychological symptoms of women who suffered from IBS. It was hypothesized that MBCT patients would experience greater reduction in overall IBS symptoms in comparison to control patients. Methods: This survey was conducted in Isfahan, Iran, to investigate the impact of MBCT on a group of Iranian women diagnosed with IBS. In this quasi-experimental study 20 women with the diagnosis of IBS were randomly and equally assigned to experimental and control groups. Severity of IBS was measured by the IBS Severity Scoring System (IBS-SSS) while the patients’ psychopathology was assessed by Symptom Checklist 90-R (SCL-90-R). The experimental group was exposed to 8 sessions of MBCT on a weekly basis; each session lasting 90 minutes. Data were analyzed using SPSS software and MANCOVA. Results: A significant reduction was noted in anxiety, depression, and somatization symptoms after the intervention and in anxiety and obsessive–compulsive disorder (OCD) at follow-up (p &lt; 0.05). However, during the follow-up there was no significant progress in the level of somatization and depression. Apparently our treatment modality did not have any impact on the severity of physical symptoms. Conclusion: Psychological symptoms of IBS can be managed largely with the help of MBCT, resulting in the promotion of mental health in women afflicted by this disorder.</div