NUR1213 NUR 2
Re: scholarly writing assignment
This writing assignment will enhance your understanding of topic required for NUR1213 NUR2 as well as demonstrate your ability to write a short, academic, APA formatted paper.
1. Choose one of the LWW Articles related to the first 6 weeks of NUR1213.
2. Read and summarize the article in your own words. If you choose to quote any information, be sure to cite the original author in APA format.
3. Type this paper, use double-spacing, and your font should be “Times New Roman” in size 12.
Be sure to check both spelling and grammar prior to submitting.
4. Include a cover page and a reference page. These are separate pages and are not included in the 3 pages of content required.
5. Make sure the content is a maximum of 3 pages. Explain the condition or topic you have chosen in your own words.
6. Use the student library to access to add at least one additional reference/article on the same topic – to support your statements and increase your understanding of the topic.
7. Sample headings may include but are not limited to:
· The disease condition or topic
· Summary paragraph to include a conclusive statement. (I suggest using a reflective statement as to what you have learned doing this assignment).
· Reference page
Please see the Grading Rubric below. This assignment is due by week 6
Below Expectations (0-7)
Meets Expectation (8)
Exceeds Expectations (8-10)
Introduction of Topic/description
Introduces/describes is unclear, leaves out two or more main ideas crucial to demonstrating understanding of the topic.
Introduces/describes the topic but leaves out 1 component or main idea to demonstrate understanding of the topic.
Introduces/describes the topic clearly and includes all crucial components demonstrating comprehensive understanding of the topic.
No main idea identified or vague sense of main idea, weakly supported throughout the paper.
The main idea is threaded throughout most of the paper.
Clearly presents the main idea and supports it throughout the paper.
Paper is haphazardly expressed, lacks logical organization and is difficult to follow.
Content of paper has minor flaws in flow or organization of main ideas.
Content is clearly expressed and organization is logical and easy to follow.
Lacks any supportive literature, references do not apply to the main topic.
Supporting literature/article related to main topic but is not fully explained and/or references only partially apply to topic.
Supporting literature is pertinent and is clearly explained. Content supports the main ideas of the paper.
None or minimal examples of reflection and analysis noted. Mostly generalized statement, uses all quotations and does not present topic in their own words.
Adequate reflection of the topic, uses examples or quotations only as needed. Presents ideas clearly and in their own words.
Clearly presented, detailed ideas and statements in the student’s own words only using key citations as needed.
Lacks a conclusive statement. No demonstration of what student has learned.
Conclusive statement included but is difficult to follow or understand. Unclear what student has learned.
Clearly delineated conclusive statement or summary of what the student has learned.
Used the one article furnished and did not include one journal article using student library access or used a website link and not an article.
Used the article provided and supplied at least one additional journal article.
Used the journal article provided and supplied more than one additional article or citation from the textbook to support the topic.
APA format (title, reference page and content of maximum 3 pages)
5 or more APA errors.
3 to 4 APA errors.
2 or fewer APA errors
Grammar, punctuation, spelling
Over 4 mistakes.
Less than 4 mistakes.
2 or fewer mistakes.
1 page or less
Less than 2 pages
3 pages in length
48 AJN ▼ June 2017 ▼ Vol. 117, No. 6 ajnonline.com
An evidence-based review of new diagnostic criteria and treatment
ABSTRACT: Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized
by disturbances in bowel habits and abdominal pain in the absence of known organic pathology. IBS reduces
quality of life and is costly to treat. It is diagnosed using the symptom-based Rome criteria for functional GI
disorders, which was recently updated and released as Rome IV. Both physiologic and psychological variables
play a role in the etiology of IBS and perpetuate symptoms. Although research has shed light on IBS patho-
physiology, therapeutic interventions remain symptom driven, employing both pharmacologic and nonphar-
macologic approaches. Here, the authors review the epidemiology and pathophysiology of IBS, summarize
diagnostic and treatment strategies, and discuss implications for nursing practice.
Keywords: irritable bowel syndrome, Rome criteria, treatment approaches
Irritable bowel syndrome (IBS) is one of the most
commonly diagnosed gastrointestinal (GI) dis-
orders. Occurring most often in patients under
age 50,1 this chronic condition is characterized by
abdominal pain and bowel dysfunction, presenting
as constipation, diarrhea, or alternating periods of
both.2 In addition to its physiologic manifestations,
IBS is recognized as having a psychological compo-
nent. In 40% to 60% of cases, IBS is accompanied
by such psychological disorders as depression or anx-
iety,3 and patients with IBS have been found to have
a greater frequency of somatic symptoms than pa-
tients who have GI symptoms in the absence of IBS.4
The development and persistence of IBS symp-
toms are understood to be multifactorial. Conse-
quently, diagnosis and treatment are complicated
clinical endeavors. Diagnosis is made according to the
symptom-based Rome criteria for functional GI disor-
ders, most recently updated and released as Rome IV.5
Because curative medical interventions have yet to
be discovered, treatment focuses on reducing patient
symptoms. Current pharmacologic approaches, how-
ever, often provide suboptimal relief.
Evidence of biologic dysregulation has been re-
ported in patients with IBS and efforts to understand
the neurohormonal underpinnings of the disorder
are ongoing, but the exact mechanisms leading to IBS
symptoms are not completely understood.6, 7 This ar-
ticle discusses recent developments in the field of IBS
research and the updated diagnostic criteria. It sum-
marizes the epidemiology, pathophysiology, and treat-
ment of IBS, with a focus on nursing practice.
EPIDEMIOLOGY AND BURDEN OF IBS
Incidence rates of IBS are seldom calculated, and prev-
alence estimates fluctuate both between and within
countries.2 A recent literature review by Sperber and
colleagues attributed discrepancies to such factors as
differences in the use of instruments, methods, and di-
agnostic criteria, as well as variations in populations
and cultures assessed.8 This review evaluated 83
community-based studies of IBS prevalence con-
ducted in a total of 41 countries, and confirmed the
global predominance of IBS among women, but could
not estimate a global prevalence rate owing to the
heterogeneity of the studies. The pooled prevalence
rate that the investigators cited for North America,
Europe, Australia, and New Zealand was 8.1%.
While IBS is not associated with increased mortal-
ity rates, it represents a significant burden on affected
By Kristen Ronn Weaver, MS, ACNP, ANP, Gail D’Eramo Melkus, EdD, C-NP, FAAN, and
Wendy A. Henderson, PhD, MSN, CRNP
patients and society as a result of direct medical
costs, lost productivity, and reduced health-related
quality of life.9 In 2010, IBS accounted for more
than 2 million diagnoses in U.S. ambulatory care
settings, including office, ED, and hospital outpa-
tient visits.10 In the United States, estimates of IBS
costs, both direct (medical management) and indi-
rect (lost productivity and leisure time), exceeded
$1 billion in 2004.11
A disproportionate amount of health care resources
is expended treating patients with IBS and addressing
the negative effects it has on patients’ quality of life.12
Despite receiving increased medical attention, how-
ever, patients with IBS frequently report problematic
visits with health care providers that leave them feel-
ing unsupported, humiliated, insignificant, and aban-
doned.13, 14 An additional burden of IBS falls on those
Figure 1. The Brain–Gut Axis
who live with and care for patients with the disorder.
Studies report adverse effects on the quality of life of
domestic partners of patients with IBS.15
IBS ETIOLOGY AND PATHOPHYSIOLOGY
The following physiologic and psychological variables
have been proposed as potential factors in the etiology
and pathophysiology of IBS16:
• GI dysmotility
• visceral hypersensitivity
• altered intestinal microbiota
• genetic predisposition
• stress exposure (including early life events)
IBS and stress. Stress has been identified as a
mechanism in the development of IBS, and the major
The mechanisms that disrupt “cross talk” between the brain and the gut along endocrine, neural, and neuroimmune pathways are not
fully understood, but this disruption appears to play a role in producing the symptoms of irritable bowel syndrome. Shown here are
layers of the colon wall along with some of the structures that may be affected. Illustration by Sara Jarret.
email@example.com AJN ▼ June 2017 ▼ Vol. 117, No. 6 49
components of the stress response system—the
autonomic nervous system and the hypothalamic–
pituitary–adrenal axis—have been the subject of
numerous IBS studies. An analysis of medical data
collected from active-duty U.S. service members be-
tween 2001 and 2009 found the risk of developing
IBS was significantly increased in those with a greater
number of life stressors, a positive screen for panic
syndrome or other anxiety syndromes on the Patient
Health Questionnaire, and previous infectious gastro-
enteritis.17 Posttraumatic stress disorder (PTSD) and
depression were also associated with elevated risk,
though in this study the increased risk was not found
to be significant. Since both depression and PTSD
have been significantly associated with IBS in previ-
ous studies of military veterans, the investigators at-
tribute their finding to study design. These findings
illustrate the interdependence or “cross talk” between
the brain and the gut in IBS, a connection commonly
known as the brain–gut axis.
The brain–gut axis refers to endocrine, neural, and
neuroimmune pathways that facilitate bidirectional
communication between the gut, the central nervous
system, the enteric nervous system, the autonomic
nervous system, and the hypothalamic–pituitary–
adrenal axis.18, 19 Disturbances in the brain–gut axis,
including disruption of central and autonomic func-
tions, peripheral hormones, amines, and peptides,
have been documented in patients with IBS.6 Clinical
reviews of neuroimaging studies have also shown
that, compared with healthy control participants, pa-
tients with IBS demonstrate differences in the central
processing mechanisms of the brain–gut axis, such
as changes in connectivity and functional responsive-
ness.20 Although disruptions in the brain–gut axis
may play a significant role in producing many clinical
manifestations of IBS, the underlying mechanisms are
not fully understood.21 For the most part, patient diag-
nosis remains one of exclusion, with treatment being
The Rome III criteria for functional GI disorders
served as the symptom-based diagnostic criteria for
IBS since its release in 2006 until early 2016, when
the Rome Foundation updated the criteria with the
release of Rome IV (see Table 122, 23).5 Like Rome III,
the Rome IV criteria maintains that an IBS diagnosis
requires symptoms to be chronic (having persisted for
at least six months), active (having occurred within
the previous three months), and like all functional
bowel disorders, to occur in the absence of an ana-
tomic or physiologic abnormality.23 Requisite symp-
tom frequency, however, has been increased from at
least three days per month in Rome III to at least one
day per week in Rome IV. Furthermore, in contrast
to Rome III, Rome IV specifically calls for abdominal
pain (rather than pain or discomfort) to be related to
(versus improved with) defecation, and clarifies that
it is the abdominal pain (rather than the pain’s onset)
that must be associated with changes in stool fre-
quency or form.22, 23 In Rome IV, subtyping by pre-
dominant stool pattern—as IBS-C (with constipation),
IBS-D (with diarrhea), IBS-M (with a mixed stool pat-
tern), and IBS-U (unclassified because of an insufficient
consistency of stool abnormality)—is now based on
Table 1. Comparison of Rome III and Rome IV Criteria22, 23
Characteristic Rome III Rome IV
Diagnostic time frame
(2 or more)
Predominant stool pattern of IBS
subtype (IBS-C, IBS-D, IBS-M, IBS-U)
Tool to categorize bowel habit
• Symptom onset at least six
• Symptom activity during the
last three months
• Symptom frequency at least
three days per month
Abdominal discomfort or pain
• Improvement with defecation
• Onset associated with change
in the form of stool
• Onset associated with a change
the frequency of stool
Stool type based on bowel move-
ments on all days
Bristol Stool Form Scale
• Symptom onset at least six
• Symptom activity during the
last three months
• Symptom frequency at least
one day per week
• Related to defecation
• Associated with a change in
the form of stool
• Associated with a change in
the frequency of stool
Stool type based on days with
abnormal bowel movements
Bristol Stool Form Scale
IBS = irritable bowel syndrome; IBS-C = IBS with constipation; IBS-D = IBS with diarrhea; IBS-M = IBS with a mixed stool pattern; IBS-U = IBS unclassified.
50 AJN ▼ June 2017 ▼ Vol. 117, No. 6 ajnonline.com
stool form on the days in which at least one bowel
movement is abnormal, as opposed to stool form on
all days since onset.23 Rome IV retains the Bristol Stool
Form Scale24 as a means of categorizing abnormal
stool form, using 25% of stools as the threshold for
subtyping the stool pattern.23
use of invasive medical procedures and spurred efforts
to develop biomarkers to aid in IBS diagnosis.
Biomarkers. Over the years, it’s been suggested
that various biomarkers could aid in diagnosing
IBS. In 2009, Lembo and colleagues proposed a se-
rum panel consisting of 10 biomarkers that included
Pharmacologic management of IBS focuses on the predominant
bowel symptom (diarrhea or constipation) and abdominal pain.
Patient education, suggestions for lifestyle modifications, and
reassurance should be provided with all IBS treatments.
The differential diagnosis of IBS should include ce-
liac disease, microscopic colitis, inflammatory bowel
disease, bile acid malabsorption, colorectal cancer,
and dyssynergic defecation.25 However, using the
Rome IV criteria, clinicians can diagnose IBS based
on the following data23:
• patient history, including diet as well as symptoms
• physical examination, including an anorectal ex-
• complete blood count
• C-reactive protein or fecal calprotectin level
• celiac serology, if clinical suspicion is high
• a colonoscopy or upper endoscopy, if recom-
mended by guidelines because of patient age,
alarm signs, or family history
Symptom overlap. In clinical practice, GI diagno-
ses commonly share symptoms. For instance, a sys-
tematic review and meta-analysis of IBS symptoms
in patients with inflammatory bowel disease (IBD)
found that IBS symptoms were significantly higher
in both patients with active IBD and patients whose
IBD was in remission than in control participants
without IBD.26 The pooled prevalence of IBS symp-
toms in the two IBD groups was 39%, 35% among
patients believed to be in remission and 44% among
those with active IBD. Clinical trials are needed to de-
velop evidence-based approaches for treating patients
with IBD who have IBS-type symptoms.27 It’s been
suggested that fecal calprotectin, which is a very sen-
sitive measure of disease activity in IBD, should be
measured in the initial evaluation of such patients.27
A recent systematic review and meta-analysis dem-
onstrated that IBS symptoms also overlap with those
of microscopic colitis, though therapeutic interventions
are very different.28 This review reported the pooled
prevalence of IBS symptoms in patients with micro-
scopic colitis to be 33.4%, similar to that seen in pa-
tients with other diarrhea etiologies. Symptom overlap
between IBS and other GI disorders has prompted the
two cytokines, two antibodies, a chemokine, a nerve
growth factor, a tissue-repair enzyme, an autoantibody,
a metalloproteinase inhibitor, and a lipocalin protein.29
A few years later, Jones and colleagues extended the
panel, incorporating an additional 24 biomarkers, in-
cluding serologic markers for gene expression, and in-
corporating four psychological measures.30
Biomarker initiatives have included studies of
• colonic transit and fecal bile acids to distinguish
patients with IBS from healthy participants or to
discriminate among IBS subgroups.31
• anticytolethal distending toxin B and antivincu-
lin antibodies to distinguish IBS-D from other di-
• intestinal microbiota to identify and characterize
fecal dysbiosis in patients with IBS or IBD.33
Although the diagnostic value of these tests is en-
couraging, biomarkers have yet to become the gold
standard for diagnosing IBS in clinical practice.
IBS is a multifactorial disorder. For this reason, phar-
macologic management focuses on the predominant
bowel symptom (diarrhea or constipation) and ab-
dominal pain (see Table 223). Patients with IBS-M may
require treatments for both diarrhea and constipa-
tion.34 Patient education, suggestions for lifestyle mod-
ifications, and reassurance should be provided with all
The American Gastroenterological Association
(AGA) guidelines on the pharmacologic manage-
ment of IBS characterizes the strength of its recom-
mendations as conditional (weak) or strong and
grades the quality of the supporting evidence as very
low, low, moderate, or high.35 Although these guide-
lines discuss nine pharmaceutical agents or classes
used in the treatment of IBS—linaclotide, lubipros-
tone, polyethylene glycol laxatives, rifaximin, alose-
tron, loperamide, tricyclic antidepressants, selective
firstname.lastname@example.org AJN ▼ June 2017 ▼ Vol. 117, No. 6 51
Table 2. Pharmacologic Interventions for IBS23
Abdominal Pain Bowel Subtype: IBS-C Bowel Subtype: IBS-D
Selective serotonin reuptake inhibitors
Chloride channel activators
Guanylate cyclase-C agonists
Bile acid sequestrants
Mixed opioid receptor modulators
IBS = irritable bowel syndrome; IBS-C = IBS with constipation; IBS-D = IBS with diarrhea.
serotonin reuptake inhibitors, and antispasmodics—
only the use of linaclotide for IBS-C was given a
strong recommendation, based on high-quality evi-
dence.35 Linaclotide (Linzess), a guanylate cyclase-C
agonist, stimulates the secretion of chloride and bi-
carbonate into the intestine, thereby increasing intes-
tinal fluid and accelerating GI transit.36
The American College of Gastroenterology (ACG)
performed a systematic review to determine the effi-
cacy of 11 IBS therapies, both pharmacologic and
nonpharmacologic, compared with placebo or no
treatment.37 The nonpharmacologic interventions
included dietary manipulation, fiber, probiotics, pre-
biotics, peppermint oil, and psychological therapies,
including hypnotherapy. As with the AGA guide-
lines, the ACG graded the quality of the evidence on
which its recommendations were based (very low,
low, moderate, or high) and characterized the strength
of its recommendations as strong or weak. Only two
therapies overall received strong recommendations for
use and were supported, respectively, by evidence of
high and moderate quality: linaclotide and lubipros-
tone for the treatment of IBS-C. Lubiprostone (Ami-
tiza), a chloride channel activator, increases intestinal
fluid secretion, thereby increasing intestinal motility
and stool passage.38
Nonpharmacologic interventions, such as diet modifi-
cation, exercise, mind–body therapies, and other com-
plementary approaches, are often used to provide relief
of IBS symptoms. A Cochrane review of the efficacy
of psychological interventions found that cognitive
behavioral therapy and interpersonal psychotherapy
may benefit patients with IBS, though issues regard-
ing study heterogeneity, validity, and sample size were
noted.39 A systematic review and meta-analysis by
Ford and colleagues, which included 30 studies on the
effect of psychological therapies on patients with IBS,
found some beneficial effects of cognitive behavioral
therapy, multicomponent psychological therapy, dy-
namic psychotherapy, and hypnotherapy.40
Dietary modifications to alleviate IBS symp-
toms have garnered increasing interest in recent
years.41 Food ingestion can stimulate chemorecep-
tors, mechanoreceptors, osmotic actions, altered se-
cretion, activation of motor reflexes, and colonic
fermentation, which may contribute to IBS symp-
toms.42 Patients with IBS are more likely than the
general population to report adverse reactions to
food, with dietary intolerance often attributed to
gluten (wheat and related grain species); lactose; fer-
mentable oligosaccharides, disaccharides, monosac-
charides, and polyols (FODMAPs); and fructose
malabsorption.43 Patients with IBS have used diets
excluding suspected IBS triggers with conflicting re-
In a recent prospective study of 41 patients with
IBS-D, a six-week gluten-free diet significantly im-
proved symptom severity scores in 29 (71%), and
there was significant overall improvement in anxiety,
depression, fatigue, and quality of life.45 The low-
FODMAP diet has also been found to improve ab-
dominal and bowel symptoms in some patients with
IBS, although guidance from a nutritionist is generally
recommended.34 A systematic review and meta-analysis
of 14 randomized controlled trials, which included
96 patients with various IBS subtypes, found that
soluble fiber supplementation had beneficial effects
on global IBS symptoms.46
Intestinal microbiota play a major role in GI pro-
cesses and overall health.47 Numerous studies have in-
vestigated the value of probiotics in manipulating the
intestinal microbiota and improving IBS symptoms.
A meta-analysis of 10 randomized controlled trials
that compared the efficacy of probiotics with pla-
cebo in treating IBS symptoms found that probiotics
containing Bifidobacterium breve, Bifidobacterium
longum, or Lactobacillus acidophilus significantly
reduced IBS pain.48 Abdominal distension was signif-
icantly reduced by probiotics containing B. breve,
Bifidobacterium infantis, Lactobacillus casei, or
Lactobacillus plantarum. The researchers noted,
however, that further research into such variables as
52 AJN ▼ June 2017 ▼ Vol. 117, No. 6 ajnonline.com
probiotic dose, species, combinations, treatment dura-
tion, IBS subtypes, and specific symptoms was needed,
and emphasized that clinicians should always consider
comorbid conditions when prescribing probiotics to
patients.48 A systematic review and meta-analysis of
43 randomized controlled trials similarly concluded
that probiotics can be effective in treating global IBS
symptoms, flatulence, abdominal pain, and bloating,
though investigators could draw no conclusions about
individual strains or species.49
Fecal microbiota transplantation (FMT). Whereas
probiotics aim to alter the native gut microbiota, FMT
introduces a community of gut microorganisms to re-
place or repair the native gut microbiota.50 Although it
has been suggested that FMT may improve IBS symp-
toms, the procedure has been performed on a limited
number of patients.51 Randomized controlled trials are
needed to confirm the safety and efficacy of FMT, and
the U.S. Food and Drug Administration requires an in-
vestigational drug application to perform FMT for any
condition other than Clostridium difficile infection
that is not responsive to standard therapy.51
use of needles or pressure.54 Whereas acupuncture
is the insertion of needles into these acupoints,
moxibustion is the application of heat (by ignited
A systematic review and meta-analysis evaluating
the efficacy of acupuncture in treating IBS found no
differences between actual and sham acupuncture on
either IBS symptoms or quality of life.55 Other investi-
gations have used functional magnetic resonance im-
aging (fMRI) to evaluate the effects of acupuncture
on brain activation in patients with IBS-D during rec-
tal distension. Chu and colleagues reported significant
fMRI differences between actual and sham acupunc-
ture groups: true electroacupuncture significantly
heightened activation at the right insula, the pulvinar,
and the medial nucleus of the thalamus, compared
with sham treatment.56 Another fMRI study of pa-
tients with IBS-D and rectal distension found that pa-
tients who received actual moxibustion treatment
experienced a significant reduction in IBS symptoms
compared with those who received sham moxibustion
A nurse-delivered intervention of cognitive-behavioral strategies,
diet, relaxation, and education resulted in significantly improved
GI symptoms and quality of life and greater reductions in daily
depression and anxiety scores in patients with IBS.
Increased physical activity. In a randomized
controlled trial of 102 patients, Johannesson and
colleagues found that a 12-week intervention of
moderately increased physical activity significantly
reduced IBS symptom severity and improved qual-
ity of life.52 In addition, this study found that the pro-
portion of worsening IBS symptoms was significantly
greater in the physically inactive control group than
in the physically active intervention group.
Yoga. A recent systematic review of six random-
ized controlled trials found that yoga may have sig-
nificant beneficial effects on IBS severity, anxiety,
and quality of life.53 Investigators, however, could not
make recommendations regarding yoga practice for
IBS because of methodologic flaws in the studies re-
Traditional Chinese medicine modalities, such as
acupuncture and moxibustion, have been explored as
potential IBS treatments. In traditional Chinese medi-
cine, the natural life force, or qi, flows through con-
duits or meridians, with disease resulting when there is
circulatory interference. Stimulating acupoints restores
the flow of qi, and may be accomplished through the
Comprehensive self-management. Jarrett and
colleagues evaluated the effect on patients with IBS of
a nine-session, nurse-delivered, comprehensive self-
management intervention that incorporated cognitive–
behavioral strategies, diet, relaxation, and education.
These investigators found that patients who under-
went the intervention experienced significantly im-
proved GI symptoms and quality of life compared
with patients who received usual care.58 A secondary
data analysis of that study revealed long-term, bene-
ficial effects of the intervention, reflected by signifi-
cantly lower daily levels of patient-reported stress at
three-, six-, and 12-month follow-up.59 Patients with
IBS who received the comprehensive self-management
intervention were also found to have significantly
greater reductions in daily depression and anxiety
scores across three-, six-, and 12-month follow-up,
compared with patients who received usual care.60 A
recent follow-up evaluation of this program found that
94% of the participants who received the interven-
tion still incorporate comprehensive self-management
strategies into their lives, one year after their last ses-
sion.61 These investigations highlight the potential for
email@example.com AJN ▼ June 2017 ▼ Vol. 117, No. 6 53
nurse-led initiatives to impart long-lasting, positive
health effects to patients with IBS.
IMPLICATIONS FOR NURSING PRACTICE
Nurses can promote early consideration of IBS as a
potential diagnosis and improve patient education,
support, and communication in the following ways:
• Become familiar with IBS prevalence rates, as
well as IBS sex and age predominance.
• Learn about the disorders that can mimic IBS
signs and symptoms.
• Review the Rome IV guidelines, noting which
tests and invasive procedures may be avoided.
• Remain aware of the advances in research into
IBS etiology and perpetuation of symptoms.
• Understand the high frequency of comorbid psy-
chological disorders and possible life stressors in
patients with IBS.
• As part of patient assessment, inquire about di-
etary and medication changes, life stressors, and
Although IBS is a common, multifactorial, GI dis-
order that exacts a significant toll on both patients
and society, significant advances have been made in
the field, and therapeutic options show promise. On-
going efforts to understand the many components
of IBS will foster a comprehensive, personalized ap-
proach to patient care that recognizes the individu-
ality of each affected patient. Nursing professionals
play a vital role in the collaborative process of pa-
tient care and can aid in the development of diagnos-
tic and therapeutic approaches, in both the clinical
and the research domains. Such innovation, when
attuned to the diverse needs of patients with IBS, can
produce therapeutic gains and bring symptomatic
relief to this deserving patient population. ▼
3. Dekel R, et al. The use of psychotropic drugs in irritable
bowel syndrome. Expert Opin Investig Drugs 2013;22(3):
4. Patel P, et al. Irritable bowel syndrome is significantly asso-
ciated with somatisation in 840 patients, which may drive
bloating. Aliment Pharmacol Ther 2015;41(5):449-58.
5. Drossman DA. Functional gastrointestinal disorders: history,
pathophysiology, clinical features and Rome IV. Gastroen-
terology 2016 Feb 19 [Epub ahead of print].
6. Camilleri M. Physiological underpinnings of irritable bowel
syndrome: neurohormonal mechanisms. J Physiol 2014;
7. Mayer EA, Tillisch K. The brain-gut axis in abdominal pain
syndromes. Annu Rev Med 2011;62:381-96.
8. Sperber AD, et al. The global prevalence of IBS in adults re-
mains elusive due to the heterogeneity of studies: a Rome
Foundation working team literature review. Gut 2016 Jan 27
[Epub ahead of print].
9. Inadomi JM, et al. Systematic review: the economic impact
of irritable bowel syndrome. Aliment Pharmacol Ther 2003;
10. Peery AF, et al. Burden of gastrointestinal, liver, and pancre-
atic diseases in the United States. Gastroenterology 2015;
11. Everhart JE, Ruhl CE. Burden of digestive diseases in the
United States part I: overall and upper gastrointestinal dis-
eases. Gastroenterology 2009;136(2):376-86.
12. Agarwal N, Spiegel BM. The effect of irritable bowel syn-
drome on health-related quality of life and health care ex-
penditures. Gastroenterol Clin North Am 2011;40(1):11-9.
13. Håkanson C, et al. Being in the patient position: experiences
of health care among people with irritable bowel syndrome.
Qual Health Res 2010;20(8):1116-27.
14. Ringstrom G, et al. The importance of a person-centered
approach in diagnostic workups of patients with irritable
bowel syndrome: a qualitative study. Gastroenterol Nurs
15. Canavan C, et al. Review article: the economic impact of the
irritable bowel syndrome. Aliment Pharmacol Ther 2014;
Kristen Ronn Weaver is a predoctoral fellow in the Digestive
Disorders Unit, National Institute of Nursing Research (NINR),
National Institutes of Health (NIH), Bethesda, MD, and a doc-
toral student at the New York University (NYU) Rory Meyers
College of Nursing, New York City. Gail D’Eramo Melkus is as-
sociate dean for research and the Florence and William Downs
Professor in Nursing Research at the NYU Rory Meyers College
of Nursing. Wendy A. Henderson is an investigator and chief of
the Digestive Disorders Unit, NINR, NIH. Contact author: Kris-
ten Ronn Weaver, firstname.lastname@example.org. The authors have re-
ceived funding from the Division of Intramural Research, NINR,
NIH, U.S. Department of Health and Human Services (KRW,
an Intramural Research Training Award, Graduate Partnership
Program; WAH, No. 1ZIANR000018, 01-05). Additional sup-
port was provided to KRW by the NYU Rory Meyers College
of Nursing, the Jonas Center for Nursing and Veterans Health-
care, and the Columbia University Presbyterian Hospital School
of Nursing Alumni Association. The authors have disclosed no
potential conflicts of interest, financial or otherwise.
1. Lovell RM, Ford AC. Global prevalence of and risk factors
for irritable bowel syndrome: a meta-analysis. Clin Gastro-
enterol Hepatol 2012;10(7):712-21 e4.
2. Canavan C, et al. The epidemiology of irritable bowel syn-
drome. Clin Epidemiol 2014;6:71-80.
16. Heitkemper M, et al. Update on irritable bowel syndrome
program of research. J Korean Acad Nurs 2013;43(5):
17. Riddle MS, et al. The epidemiology of irritable bowel syn-
drome in the US military: findings from the Millennium Co-
hort Study. Am J Gastroenterol 2016;111(1):93-104.
18. Fichna J, Storr MA. Brain-gut interactions in IBS. Front Phar-
19. Ohman L, Simrén M. New insights into the pathogenesis and
pathophysiology of irritable bowel syndrome. Dig Liver Dis
20. Stasi C, et al. Altered neuro-endocrine-immune pathways in
the irritable bowel syndrome: the top-down and the bottom-
up model. J Gastroenterol 2012;47(11):1177-85.
21. Coss-Adame E, Rao SS. Brain and gut interactions in irritable
bowel syndrome: new paradigms and new understandings.
Curr Gastroenterol Rep 2014;16(4):379.
22. Longstreth GF, et al. Functional bowel disorders. Gastroen-
23. Lacy BE, et al. Bowel disorders. Gastroenterology 2016;150:
54 AJN ▼ June 2017 ▼ Vol. 117, No. 6 ajnonline.com
24. Lewis SJ, Heaton KW. Stool form scale as a useful guide to
intestinal transit time. Scand J Gastroenterol 1997;32(9):
25. Chey WD, et al. Irritable bowel syndrome: a clinical review.
26. Halpin SJ, Ford AC. Prevalence of symptoms meeting criteria
for irritable bowel syndrome in inflammatory bowel disease:
systematic review and meta-analysis. Am J Gastroenterol
27. Quigley EM. Overlapping irritable bowel syndrome and in-
flammatory bowel disease: less to this than meets the eye?
Therap Adv Gastroenterol 2016;9(2):199-212.
28. Kamp EJ, et al. Irritable bowel syndrome and microscopic
colitis: a systematic review and meta-analysis. Clin Gastro-
enterol Hepatol 2016;14(5):659-68 e1.
29. Lembo AJ, et al. Use of serum biomarkers in a diagnostic
test for irritable bowel syndrome. Aliment Pharmacol Ther
30. Jones MP, et al. A biomarker panel and psychological mor-
bidity differentiates the irritable bowel syndrome from health
and provides novel pathophysiological leads. Aliment Phar-
macol Ther 2014;39(4):426-37.
31. Camilleri M, et al. Validating biomarkers of treatable mech-
anisms in irritable bowel syndrome. Neurogastroenterol Mo-
32. Pimentel M, et al. Development and validation of a biomarker
for diarrhea-predominant irritable bowel syndrome in human
subjects. PLoS One 2015;10(5):e0126438.
33. Casen C, et al. Deviations in human gut microbiota: a novel
diagnostic test for determining dysbiosis in patients with IBS
or IBD. Aliment Pharmacol Ther 2015;42(1):71-83.
34. Lacy BE, et al. New and emerging treatment options for irri-
table bowel syndrome. Gastroenterol Hepatol (N Y) 2015;
11(4 Suppl 2):1-19.
35. Weinberg DS, et al. American Gastroenterological Associa-
tion Institute Guideline on the pharmacological management
of irritable bowel syndrome. Gastroenterology 2014;147(5):
36. Forest Pharmaceuticals, Inc. Prescribing infomation: Linzess
(linaclotide) capsules, for oral use. St. Louis; 2012. https://
37. Ford AC, et al. American College of Gastroenterology mono-
graph on the management of irritable bowel syndrome and
chronic idiopathic constipation. Am J Gastroenterol 2014;
109 Suppl 1:S2-S26.
38. Sucampo Pharmaceuticals, Inc. Prescribing information: Am-
itiza (lubiprostone) capsules. Bethesda, MD; 2006. https://
39. Zijdenbos IL, et al. Psychological treatments for the man-
agement of irritable bowel syndrome. Cochrane Database
Syst Rev 2009(1):CD006442.
40. Ford AC, et al. Effect of antidepressants and psychological
therapies, including hypnotherapy, in irritable bowel syn-
drome: systematic review and meta-analysis. Am J Gastro-
41. Chey WD. Food: the main course to wellness and illness in
patients with irritable bowel syndrome. Am J Gastroenterol
42. Eswaran S, et al. Food: the forgotten factor in the irritable
bowel syndrome. Gastroenterol Clin North Am 2011;40(1):
43. Mullin GE, et al. Irritable bowel syndrome: contemporary
nutrition management strategies. JPEN J Parenter Enteral
44. Halland M, Saito YA. Irritable bowel syndrome: new and
emerging treatments. BMJ 2015;350:h1622.
45. Aziz I, et al. Efficacy of a gluten-free diet in subjects with irri-
table bowel syndrome-diarrhea unaware of their HLA-DQ2/8
genotype. Clin Gastroenterol Hepatol 2016;14(5):696-703 e1.
46. Moayyedi P, et al. The effect of fiber supplementation on
irritable bowel syndrome: a systematic review and meta-
analysis. Am J Gastroenterol 2014;109(9):1367-74.
47. Barbara G, et al. The intestinal microenvironment and func-
tional gastrointestinal disorders. Gastroenterology 2016 Feb
18 [Epub ahead of print].
48. Ortiz-Lucas M, et al. Effect of probiotic species on irrita-
ble bowel syndrome symptoms: a bring up to date meta-
analysis. Rev Esp Enferm Dig 2013;105(1):19-36.
49. Ford AC, et al. Efficacy of prebiotics, probiotics, and synbiotics
in irritable bowel syndrome and chronic idiopathic constipa-
tion: systematic review and meta-analysis. Am J Gastroenterol
50. Borody TJ, Khoruts A. Fecal microbiota transplantation and
emerging applications. Nat Rev Gastroenterol Hepatol 2011;
51. Pinn DM, et al. Is fecal microbiota transplantation (FMT)
an effective treatment for patients with functional gastroin-
testinal disorders (FGID)? Neurogastroenterol Motil 2015;
52. Johannesson E, et al. Physical activity improves symptoms in
irritable bowel syndrome: a randomized controlled trial. Am
J Gastroenterol 2011;106(5):915-22.
53. Schumann D, et al. Effect of yoga in the therapy of irritable
bowel syndrome: a systematic review. Clin Gastroenterol
54. Weaver MT. Acupressure: an overview of theory and appli-
cation. Nurse Pract 1985;10(8):38-42.
55. Manheimer E, et al. Acupuncture for irritable bowel syn-
drome: systematic review and meta-analysis. Am J Gastro-
56. Chu WC, et al. Does acupuncture therapy alter activation
of neural pathway for pain perception in irritable bowel syn-
drome?: a comparative study of true and sham acupuncture
using functional magnetic resonance imaging. J Neurogas-
troenterol Motil 2012;18(3):305-16.
57. Zhu Y, et al. Brain regions involved in moxibustion-induced
analgesia in irritable bowel syndrome with diarrhea: a func-
tional magnetic resonance imaging study. BMC Complement
Altern Med 2014;14:500.
58. Jarrett ME, et al. Comprehensive self-management for irrita-
ble bowel syndrome: randomized trial of in-person vs. com-
bined in-person and telephone sessions. Am J Gastroenterol
59. Deechakawan W, et al. Effect of self-management interven-
tion on cortisol and daily stress levels in irritable bowel syn-
drome. Biol Res Nurs 2013;15(1):26-36.
60. Deechakawan W, et al. Anxiety, depression, and catechol-
amine levels after self-management intervention in irritable
bowel syndrome. Gastroenterol Nurs 2014;37(1):24-32.
61. Zia JK, et al. A comprehensive self-management irritable
bowel syndrome program produces sustainable changes in
behavior after 1 year. Clin Gastroenterol Hepatol 2016;
email@example.com AJN ▼ June 2017 ▼ Vol. 117, No. 6 55
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.Read more
Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.Read more
Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.Read more
Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.Read more
By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.Read more
Our specialists are always online to help you! We are available 24/7 via live chat, WhatsApp, and phone to answer questions, correct mistakes, or just address your academic fears.See our T&Cs