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The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review

This report compares prevalence rates of IBS in different geographic regions of the world. Prevalence rates describe how often a condition exists in the entire population. A group of IBS experts reviewed medical journals from 1999 to 2011 and analyzed results from all IBS surveys that included at least 100 individuals and that were based on prevalence in the community, not in a hospital based population. The main conclusion is that rates differ significantly between The U.S. and Canada, Latin America, Europe, Asia and Africa and the notion of a world-wide prevalence rate is meaningless. Additionally, studies culled from the literature show that methodology differs and it is essential that a universal standard be established for prevalence measurement in the future.

Click here to download the complete article.

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Multi-cultural aspects of FGID’s

This is a chapter in the latest edition, Rome IV: The Functional Gastrointestinal Disorders, not yet published. This book is the main text that acts as the standard for anyone interested in this area. The chapter describes the latest research findings that reflect cross-cultural effects and differences among patients with functional GI disorders.

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A Cross-Cultural Investigation of Attachment Style, Catastrophizing, Negative Pain Beliefs and Symptom Severity in Irritable Bowel Syndrome

This important research study, directed by Drs. Gerson, publishes results from almost 500 IBS patients and 200 contols at nine geographic sites across the globe. There were two new and original findings. First, relational attachment style was different for IBS patients versus controls, Second, there were differences in attachment patterns, catastrophizing and negative pain beliefs based on geographical location. This study underlines our emphasis on cross-cultural factors in functional GI symptoms.

Click here to download the complete article.

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Conducting Multinational, Cross-Cultural Research`in the Functional Gastrointestinal Disorders: Issues and Recommendations. A Rome Foundation Working Team Reports

This report describes appropriate methodology for performing cross-cultural research, including possible pitfalls. It is a result, in part, of the role taken by Drs. Gerson in highlighting the importance of this kind of research in IBS.

Click here to download the complete article.

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A Four Country Comparison of Healthcare Systems for Functional Gastrointestinal Disorders

This is an article that compares health care for patients with functional gastro-intestinal disorders, in four countries: Italy, South Korea, India and Mexico. These countries provided the opportunity to perform this research report because they are geographically and culturally diverse and differ in their health care delivery systems.

Click here to download the complete article.

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An ePRO Patient Reported Outcome Program for IBS

This is an article written by Drs. Gerson that describes a new and novel method called ePRO or electronic patient reported outcome, for tracking the clinical progress of patients with IBS. After creating their own secure log-in in the office and completing some questionnaires on a computer, patients complete several questionnaires indexing their psychological as well as physical status at home on their computer every few weeks. Results are automatically summed and placed on a time-line graph. The graph is then available for review by patient and physician at the next office visit. This article has been accepted for publication by Neurogastroenterology and Motility, the official journal of the American Neurogastroentrology and Motility Society and the European Society of Neurogastroenterology and Motility.

Click here to download the complete article.

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The IBS Mind-Body Belief Scale

The IBS Mind-Body Belief Scale is an original measure that we created and have used in several research studies. It is designed to help understand the degree to which IBS patients attribute their symptoms to physical or psychological causes. We offer it here to aid others in their research. Click here to download the IBS Mind-Body Belief Scale in PDF format.

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Group Hypnotherapy for Irritable Bowel Syndrome with Long-Term Followup

The main finding in this report is the success of gut-focused hypnotherapy, designed to help patients with IBS, in a group format. Previous research has demonstrated significant symptom reduction with the use of individual hypnotherapy; this is the first report of treatment in a group format that is a much more cost-effective and efficient manner of treatment.

In addition, The IBS Mind-Body Belief Scale and a relationship questionnaire were administered to patients before treatment began. These measures were correlated with degree of symptom improvement after one year and significant results will be reported.

A total of 75 patients were studied and a majority of them had significant reduction in IBS symptoms one year after termination of the treatment sessions. Thus, the treatment was highly effective and benefit was sustained long after treatment had stopped.

Click here to download the complete article.

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The Importance of Relationships in Irritable Bowel Syndrome: A Review

In this review, a number of publications are cited and described that underline the concept that IBS is experienced by patients in a context of family, friends and work relationships. Symptoms may be affected, both positively and negatively, by the quality of relationships. In addition, the chronic suffering of an IBS patient may affect relationships. This is an area that has been under-valued in medical practice and it is hoped that this article will help bring attention to it. You can read this paper here.

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A Cross-Cultural Perspective on Irritable Bowel Syndrome

Drs. Charles and Mary-Joan Gerson describe their current view of the interaction of culture and IBS in "A Cross-Cultural Perspective on Irritable Bowel Syndrome," published in the Mount Sinai Journal of Medicine. Drs. Gerson edited a Cross-Cultural Column in the Functional Brain-Gut Research Group bi-annual newsletter and invited colleagues to describe ways in which patients and physicians viewed the IBS illness experience. This resulted in a number of interesting and unique observations from geographic locations as diverse as Mexico, Italy, Romania, India, Hong Kong and Japan, which are included in the article.

Click here to download the complete article.

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Relationships and Irritable Bowel Syndrome

Relationships affect health! When a concerned relative asks a patient if she feels ready to take a long car ride, anxiety may increase and symptoms may worsen. Because of their own frustration, family members may blame an IBS patient for his/her illness, and accuse the patient of eating the wrong foods or being too tense.
      In a research study, we showed that IBS patients with a supportive family have milder symptoms than a patient who experiences conflict in the family. Patients must communicate about problem areas, be specific about what type of support is needed, and explain that it takes time and personal research to understand what helps and hurts symptoms.

Click here to download the article.

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Embodied Experience: The Psychoanalyst and Medical Illness

There exists a challenge of collaboration between psychologists and physicians, and furthermore a challenge to psychoanalysts in working with individuals with medical illness. Physicians think in terms of specific causes to syndromes, whereas psychoanalysts focus on the experience of illness. Patients ultimately want relief from suffering, and often view the psychoanalytic focus on meaning and experience as incidental. However, if psychoanalysts attend empathically to symptomatology, join their patients in curiosity about its ebb and flow, capture its essence metaphorically and locate pain and illness in relationship context, treatment can yield significant relief from distress.

Click here to download the entire article.

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Irritable Bowel Syndrome: A Cross-Cultural Perspective in Our Research

IBS was originally described predominantly in the United States, Canada and Western Europe. There are now articles documenting the presence of IBS in most countries of the world. Many local factors may influence a mind-body illness such as IBS (e.g. cultural beliefs, psychological differences, family relationship issues, dietary habits, health care delivery systems and level of economic development).

Click here to download the article.

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Irritable Bowel Syndrome: An International Study of Symptoms in Eight Countries

Introduction & Methods

• IBS symptoms were compared in eight different geographic locations around the globe: New York, Mexico City, Montreal, London, Bari (Italy), Beersheva (Israel), Kolkata (India) and Beijing (China).

Results

• Significant differences were found between locations in incidence of bloating, abdominal pain, diarrhea, and constipation.
• In Italy and Mexico, patients experienced more bloating and constipation. Patients in Italy had more abdominal pain, and patients in China had more diarrhea.
• IBS symptom differences may be explained by local diet, rural vs. urban residence, intestinal infection, access to medical care, or psycho-social and cultural differences.

Click here to download the entire article.

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Relationship Between Pain Beliefs, Stress Perception and Symptom Severity in IBS

Introduction & Methods

• While stress is considered an important variable in IBS, little is known about the effects of perceived stress. In psychological treatment of patients with IBS it may be helpful to attempt to reshape these negative illness beliefs.
• Patient questionnaires measured the degree to which a patient viewed various life situations as stressful. Additionally, the questionnaires assessed the belief that the pain will be enduring, that the pain is not understood, and that the pain is due to self-blame.

Results

• IBS patients with more severe symptoms are more likely to hold certain negative pain beliefs.
• For women, the belief that pain will endure was significantly predictive of symptom severity.
• For men, the belief that pain was due to self blame predicted symptom severity.
• In men and women, the greater perceived stress, the more severe the symptoms score. Additionally, the belief that the pain was mysterious was a modestly significant predictor of symptom severity.

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An International Study of Irritable Bowel Syndrome: Family Relationships and Mind-Body Attributions

Introduction & Methods

• Patients in eight countries (US, Mexico, Canada, United Kingdom, Italy, Israel, India and China) filled out a series of questionnaires which examined the degree to which patients attribute their illness to physical and emotional factors. Additionally, quality of family relationships (depth, support, and conflict) were recorded and compared to symptom severity scores.

Results

• The main findings were universal, suggesting that globalization and urbanization were more important variables than local cultural differences, though some geographic differences were noted.
• If patients thought their symptoms were predominantly caused by physical factors (e.g. food allergies or intestinal parasites), symptom severity was worse. If they recognized that IBS symptoms could be caused by emotional factors, symptoms were less severe.
• If family relationships were conflicted, symptom severity was high. If family relationship showed depth and support, severity was low.

Click here to download the entire article.

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A Collaborative Family-Systemic Approach to Treating Chronic Illness: Irritable Bowel Syndrome as Exemplar

Introduction & Methods

• This study integrated family therapist, physician, family, and patient into a collaborative model to reduce physical symptoms and psychological distress.
• Patients attended a total of five small group sessions. Two focused on medical issues, two on psychological issues, and one on nutritional aspects of IBS; additionally, at-home follow-up tasks were prescribed. All meetings integrated mind and body linkages, and active participation was encouraged.

Results

• Patients often served as impressive resources for each other—sharing stories and advice, offering emotional support and understanding, and helping to relieve the sense of isolation and shame often experienced by IBS patients.
• At three months post-treatment no significant results were seen. One year-post treatment a significant delayed benefit was seen: it is hypothesized that it may take time for mind-body connections to solidify, which then reconfigure responsiveness to urgency and pain.
• A collaborative, balanced focus on psyche and soma, self and other, can result in significant experiential and empirically validated symptomatic relief in patients, as long-term outcome results indicated significant reduction in IBS symptoms.

Click here to download the entire article.

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A Collaborative Health Care Model for the Treatment of Irritable Bowel Syndrome

Introduction & Methods

• Patients were randomly assigned to 3 treatment groups: collaborative (psychological therapy + medical treatment), medical treatment alone, and psychological therapy alone.
• Collaborative sessions focused on the following: social experience of IBS, personal life history of IBS, onset of symptoms, and current symptom pattern.
• Patients completed a daily diary and questionnaires measuring quality of life, anxiety, depression and relationships. The questionnaires were administered before treatment, after treatment, and three months post-treatment.

Results

• The collaborative treatment group: Global self-assessment improved significantly at long-term follow-up in the collaborative group. Abdominal pain, diarrhea and constipation also improved significantly.
• The psychological treatment group: 50% improvement in global score.
• The medically treated group: No significant improvement.

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