Eleanor F. Bond

Symptoms across the menstrual cycle in women with irritable bowel syndrome.

OBJECTIVE:The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern.METHODS:A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison.RESULTS:For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most symptoms of irritable bowel syndrome. All symptoms except diarrhea were highest in the alternating group and lowest in the diarrhea group, with the constipation group either intermediate or close to the alternating group. This pattern was significant after multiple comparisons adjustment for GI symptoms, and trending toward significance (p < 0.05, but not significant after multiple comparison adjustment) for menstrual, sleep, and cognitive symptoms. The strongest menstrual cycle effect was seen in somatic and menstrual symptoms. The pattern of symptoms over the menstrual cycle did not differ by predominant bowel pattern or by oral contraceptive use.CONCLUSIONSMany of the symptoms examined differed by predominant bowel pattern and menstrual cycle phase, not just the GI symptoms. The menstrual cycle variation was similar regardless of oral contraceptive use or predominant bowel pattern.

Evidence for Autonomic Nervous System Imbalance in Women with Irritable Bowel Syndrome

Autonomic nervous system function was assessedin women with and without irritable bowel syndrome usingfrequency domain measures of heart rate variability.Women were interviewed and placed into the irritable bowel syndrome (N = 25) group based on historyof diagnosis and self-report of current gastrointestinalsymptoms. Women in the control group denied a history ofchronic gastrointestinal symptoms (N = 15). Women werefollowed for one menstrual cycle with a symptom diary,and during mid-luteal phase they wore a Holter 24-hrelectrocardiograph monitor. Women with irritable bowelsyndrome demonstrated significantly lower vagal tone as measured by the highfrequency spectrum relative to control women. Inaddition, women with irritable bowel syndrome had aflattened 24-hr pattern of heart rate variability, withsignificantly lower levels of vagal tone during sleep. Theseresults suggest that systemic sympathovagal balance maybe shifted in a subset of women with irritable bowelsyndrome.

Impact of sex and gender on irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and change in defecation pattern. This review addresses the topic of possible sex (genetic, biological) and gender (experiential, perceptual) differences in individuals with and without IBS. Several observations make the topic important. First, there is a predominance of women as compared to men who seek health care services for IBS in the United States and other industrialized societies. Second, menstrual cycle-linked differences are observed in IBS symptom reports. Third, women with IBS tend to report greater problems with constipation and nongastrointestinal complaints associated with IBS. Fourth, serotonin (5-HT3) receptor antagonist and 5-HT 4 partial agonist drugs appear to more effectively diminish reports of bowel pattern disruption in women with IBS as compared to men. This review examines sex and gender modulation of gastrointestinal motility and transit, visceral pain sensitivity, autonomic nervous system function, serotonin biochemistry, and differences in health care-seeking behavior for IBS.

The relationship between psychological distress and gastrointestinal symptoms in women with irritable bowel syndrome.

BACKGROUND Individuals with irritable bowel syndrome (IBS) are reported to experience more symptoms compatible with psychopathologic disorders, abnormal personality traits, and psychological distress. Conversely, individuals with psychiatric disorders report higher levels of gastrointestinal (GI) symptoms compatible with IBS. Thus, psychological distress may contribute to GI symptoms in individuals with IBS. OBJECTIVES To examine psychological distress in women with IBS, women with similar GI symptoms but not diagnosed (IBS nonpatients, IBS-NP), and asymptomatic Control women. METHODS The women (N=97) were interviewed, completed questionnaires, and maintained daily diaries for 2 months. Across-women and within-woman analyses were used to calculate the results. RESULTS The IBS and IBS-NP groups had a higher percentage of lifetime psychopathology and recalled psychological distress. At least 40% of the women in the IBS and IBS-NP groups had positive relationships between daily psychological distress and daily GI symptoms. CONCLUSIONS Psychological distress is an important component of the IBS symptom experience and should be considered when treatment strategies are designed.

Breast-feeding by A cyclosporine-treated mother

Background Cyclosporine is known to be excreted in breast milk, but levels in infants are not known. Post-transplant breast-feeding has been contraindicated in mothers treated with calcineurin inhibitors such as cyclosporine. Case A 35-year-old woman exclusively breast-fed her infant during the first 10.5 months of life while she was being treated with cyclosporine. Cyclosporine measurements in infant and maternal blood and breast milk revealed a mean breast milk/maternal blood level ratio of 84%, but undetectable levels in the infant. The infant grew and developed normally. Conclusion The infant of a cyclosporine-treated mother was breast-fed exclusively during the first 10.5 months of life and did not absorb a detectable amount of the drug. Fetal growth and development were normal.

Comparison of diet composition in women with and without functional bowel disorder.

Nurses are often involved in helping patients alleviate chronic distressing gastrointestinal symptoms such as those associated with irritable bowel syndrome or functional bowel disorder. One therapeutic strategy is to increase dietary fiber intake and to eliminate gastrointestinal (GI) irritants such as caffeine, alcohol, and tobacco smoking. However, little work has been done to establish a relationship between dietary factors and chronic GI symptoms. In this article, the authors: (a) describe and compare caloric and dietary constituent intake in symptomatic (n = 18) and asymptomatic (n = 37) women, and (b) examine the relationships among diet, GI symptoms, and stool characteristics in the two groups. In particular, total calories, fiber, fat, protein, and carbohydrates as well as alcohol and caffeine intakes were compared in women who do not smoke. Because menstrual cycle phase modulates both symptoms and appetite, women were studied during the follicular phase. Groups had similar caloric, fat, and protein intakes. Fiber intakes were similar and similar to national norms in both groups. When compared with asymptomatic women, the symptomatic women consumed more refined carbohydrates. Relationships were observed among dietary intake of refined carbohydrates, fiber, GI symptoms, and stool characteristics in women with functional bowel disorder.

Clinical nurse specialists: state of the profession and challenges ahead.

Clinical nurse specialists (CNSs) are enjoying a rebirth. As health science and healthcare increase in complexity, it is critical that nurse experts provide leadership to improve patient care, advance nursing practice, and strengthen healthcare delivery systems. CNSs with specialty expertise combined with competencies in patient care, nursing practice, and healthcare delivery systems are essential to translating the products of our vast research enterprise into policies and practices that serve the patient. Many challenges loom. New diseases have emerged; treatments change constantly. We are newly aware of the gravity of the perils posed by natural and man-made disasters. Patients use complimentary and alternative health practices but we do not understand the power and risks of these approaches. Information technology makes possible new approaches to educating nurses and patients and tracking clinical outcomes. CNSs are vital to building a healthcare system that is evidence based, patient centered, outcome effective, safe, ethical, interdisciplinary, and cost-effective.

Effect of Sexual and Physical Abuse on Symptom Experiences in Women With Irritable Bowel Syndrome

BACKGROUND Irritable Bowel Syndrome (IBS) is a common chronic functional bowel disorder characterized by alterations in bowel patterns and abdominal pain. One factor that is conjectured to contribute to the onset of IBS is sexual and/or physical abuse in childhood or as an adult. This conjecture is supported by the increased prevalence of abuse experiences in persons with IBS when compared to healthy controls or those with organically-defined gastrointestinal (GI) disorders. OBJECTIVES The purposes of the present study were to (a) compare the history of sexual and physical abuse in a sample of women with IBS to a sample of women without IBS and (b) to compare women with IBS who had sexual and physical abusive experiences to those who had not on GI symptoms, psychological distress, healthcare-seeking behavior, and physiological measures. METHODS Data were collected from two samples of women (ages 18-40 years) with IBS and controls were recruited through community advertisements and letters from a health maintenance organization. Participants completed questionnaires (i.e., Sexual and Physical Abuse, Bowel Disease Questionnaire, Symptom Checklist-90-R) during an in-person interview and completed a symptom diary each night across one menstrual cycle. Cortisol and catecholamine levels were determined in morning urine samples on 6 days across the menstrual cycle. RESULTS More women in the IBS group reported unwanted sexual contact during childhood relative to control women. Within the IBS group, minimal differences were found between those who had experienced abuse and those who had not. Women with IBS who had experienced abuse reported greater impact of GI symptoms on activity. CONCLUSIONS The prevalence of a history of childhood sexual abuse experiences is elevated among women with IBS. However, within women with IBS, those with a history of abuse do not appear to be different from those with no history of abuse on GI symptoms, psychological symptoms, or physiological arousal indicators.

Women with gastrointestinal symptoms: implications for nursing research and practice.

Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GIGl symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments. In humans, symptoms are highest when these hormones are at the lowest levels. Thus, symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies.

Gastric Emptying and Gastric-Intestinal Transit in Rats with Varying Ovarian Hormone Status

Basal and stimulated gastric emptying and gastrointestinal (GI) transit in rats of varying ovarian hormone status were compared to define direct ovarian hormone effects on GI function. Thyrotropin-releasing hormone (TRH) was used to evoke vagal GI motility stimulation. Adult female Sprague-Dawley rats were anesthetized (equithesin), ovariectomized, and implanted with 28-day estrogen (E), progesterone, (P), E+P, or vehicle (V) pellets; males were also studied. On Day 26, fasted rats were anesthetized (urethane). Nonabsorbable 14C polyethylene glycol-4000 in saline was gavaged at t = 0. At t = 5 minutes, TRH or saline was administered intracisternally. At t = 30 or 60 minutes, the GI tract was removed, ligated, sectioned, and counted. Gastric emptying was expressed as 100% minus the ratio of gastric to total counts; GI transit was expressed as geometric center of radioactivity. In saline-treated rats, gastric emptying and GI transit at 60 minutes varied significantly among ovarian hormone-treated groups, with E lower and males elevated. TRH-significantly increased both variables at both times in all groups. Results are consistent with acceleration of upper GI function in the absence of E, possibly contributing to GI symptoms during menopause and late luteal phase.