OJGas  Vol.3 No.8 , December 2013
A randomized controlled trial of lifestyle self-monitoring for irritable bowel syndrome in female nursing school students

Background: The aim of this study was to verify the efficacy of life self-monitoring for the improvement of the IBS and reveal what has been changed due to the intervention. Methods: A total of 111 nursing school students were randomized into three groups, two intervention groups (a two-month intervention group, n = 34, and a four-month intervention group, n = 35) and a control group (n = 34). The intervention groups conducted life self-monitoring in conjunction with a 15-minutes group work for either two or four months. The primary outcome measure was Rome II criteria for IBS. Other outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Symptom Rating Scale (GSRS). They were assessed at the baseline and the end of both of the intervention periods. Analysis was conducted as intention-to-treat. Results: The prevalence of IBS did not change significantly after the intervention in any of the groups. The HAD-A score, a subscale of the HADS score for anxiety, decreased 1.4 points in the two-month intervention group (p = 0.02) and 2.3 points in the four-month intervention group of (p = 0.01) after intervention. The average GSRS decreased 0.2 points in the control group (p = 0.05) and 0.3 points in the four-month intervention group (p < 0.01). Conclusions: Life self-monitoring for two or four months did not reduce the prevalence of the IBS significantly, but it did decrease anxiety and improved the QOL related to gastrointestinal symptoms in female nursing school students.


Cite this paper
Okami, Y. , Nin, G. , Harada, K. , Iwasa, M. , Kitaoka, K. , Saruwatari, A. , Aoi, W. , Wada, S. , Kimura, M. , Asano, H. , Okuyama, Y. , Takakuwa, S. , Kanazawa, M. , Fukudo, S. , Tsuji, T. and Higashi, A. (2013) A randomized controlled trial of lifestyle self-monitoring for irritable bowel syndrome in female nursing school students. Open Journal of Gastroenterology, 3, 328-336. doi: 10.4236/ojgas.2013.38058.
[1]   Fujii, Y. and Nomura, S. (2006) The effects of psychosocial factors and daily habits of irritable bowel syndrome carriers on the symptoms and disease-specific QOL. Shokaki Shinshin Igaku, 13, 14-25.

[2]   Talley, N.J. (1999) Irritable bowel syndrome: definition, diagnosis and epidemiology. Best Practice & Research Clinical Gastroenterology, 13, 371-384.

[3]   Russo, M.W., Gaynes, B.N. and Drossman, D.A. (1999) A national survey of practice patterns of gastroenterologists with comparison to the past two decades. Journal of Clinical Gastroenterology, 29, 339-343.

[4]   Thompson, W.G., Heaton, K.W., Smyth, G.T., et al. (2000) Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut, 46, 78-82.

[5]   Fukudo, S., Nomura, T. and Hongo, M. (1998) Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut, 42, 845-849. http://dx.doi.org/10.1136/gut.42.6.845

[6]   Okami, Y., Kato, T., Nin, G., et al. (2011) Lifestyle and psychological factors related to irritable bowel syndrome in nursing and medical school students. Journal of Gastroenterology, 46, 1403-1410.

[7]   Okami, Y., Nin, G., Harada, K., et al. (2013) Irritable bowel syndrome in Chinese nursing and medical school students—Related lifestyle and psychological factors. Open Journal of Gastroenterology, 3, 55-63.

[8]   Chang, L., Toner, B.B., Fukudo, S., et al. (2006) Gender, age, society, culture, and the patient’s perspective in the functional gastrointestinal disorders. Gastroenterology, 130, 1435-1446.

[9]   Faresjo, A., Anastasiou, F., Lionis, C., et al. (2006) Health-related quality of life of irritable bowel syndrome patients in different cultural settings. Health and Quality of Life Outcomes, 4, 21.

[10]   Farnam, A., Somi, M.H., Sarami, F., et al. (2007) Personality factors and profiles in variants of irritable bowel syndrome. World Journal of Gastroenterology, 13, 6414-6418. http://dx.doi.org/10.3748/wjg.13.6414

[11]   Handa, M., Nukina, H., Hosoi, M., et al. (2008) Childhood physical abuse in outpatients with psychosomatic symptoms. BioPsychoSocial Medicine, 2, 8.

[12]   Bengtson, M.B., Ronning, T., Vatn, M.H., et al. (2006) Irritable bowel syndrome in twins: Genes and environment. Gut, 55, 1754-1759.

[13]   Saito, Y.A., Zimmerman, J.M., Harmsen, W.S., et al. (2008) Irritable bowel syndrome aggregates strongly in families: a family-based case-control study. Neurogastroenterology & Motility, 20, 790-797.

[14]   Ali, A., Toner, B.B., Stuckless, N., et al. (2000) Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome. Psychosomatic Medicine, 62, 76-82.

[15]   Drossman, D.A., Richter, J.E., Talley, N.J., et al. (1994) Functional gastrointestinal disorders. Little, Brown and Co., Boston, pp. 1-174.

[16]   Kamaura, M., Ohono, H., Takahashi, M., et al. (2007) Evaluation of a guidance method for reducing lifestylerelated diseases by the self-monitoring of blood collection in small and medium-sized enterprises. Sangyo Eiseigaku Zassh., 49, 89-97.

[17]   Aittasalo, M., Miilunpalo, S., Kukkonen-Harjula, K., et al. (2006) A randomized intervention of physical activity promotion and patient self-monitoring in primary health care. Preventive Medicine, 42, 40-46.

[18]   Halme, L., Vesalainen, R., Kaaja, M., et al. (2005) Self-monitoring of blood pressure promotes achievement of blood pressure target in primary health care. American Journal of Hypertension, 18, 1415-1420.

[19]   Soumerai, S.B., Mah, C., Zhang, F., et al. (2004) Effects of health maintenance organization coverage of selfmonitoring devices on diabetes self-care and glycemic control. Archives of Internal Medicine, 164, 645-652.

[20]   Mossavar-Rahmani, Y., Henry, H., Rodabough, R., et al. (2004) Additional self-monitoring tools in the dietary modification component of The Women’s Health Initiative. Journal of the American Dietetic Association, 104, 76-85. http://dx.doi.org/10.1016/j.jada.2003.10.017

[21]   Sjoberg, S., Carlson, A., Rosenqvist, U., et al. (1988) Health attitudes, self-monitoring of blood glucose, metabolic control and residual insulin secretion in type 1 diabetic patients. Diabetic Medicine, 5, 449-453.

[22]   Andersson, E., Ljótsson, B., Smit, F., et al. (2011) Costeffectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: Results from a randomized controlled trial. BMC Public Health, 11, 215.

[23]   Everitt, H.A., Moss-Morris, R.E., Sibelli, A., et al. (2010) Management of irritable bowel syndrome in primary care: Feasibility randomised controlled trial of mebeverine, methylcellulose, placebo and a patient self-management cognitive behavioural therapy website. (MIBS trial). BMC Gastroenterology, 10, 136.

[24]   Kennedy, T.M., Chalder, T., McCrone, P., et al. (2006) Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: Randomised controlled trial. Health Technology Assessment, 10, 1-67.

[25]   Mahvi-Shirazi, M., Fathi-Ashtiani, A., Rasoolzade-Tabatabaei, S.K., et al. (2012) Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment. Archives of Medical Science, 8, 123-129.

[26]   Reme, S.E., Stahl, D., Kennedy, T., et al. (2011) Mediators of change in cognitive behaviour therapy and mebeverine for irritable bowel syndrome. Psychological Medicine, 41, 2669-2679.

[27]   Thompson, W.G., Longstreth, G.F., Drossman, D.A., et al. (1999) Functional bowel disorders and functional abdominal pain. Gut, 45, 43-47.

[28]   Shinozaki, M., Kanazawa, M., Sagami, Y., et al. (2006) Validation of the Japanese version of the Rome II modular questionnaire and irritable bowel syndrome severity index. Journal of Gastroenterology, 41, 491-494.

[29]   Dimenas, E., Glise, H., Hallerback, B., et al. (1995) Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer. Scandinavian Journal of Gastroenterology, 30, 1046-1052. http://dx.doi.org/10.3109/00365529509101605

[30]   Hongo, M., Fukuhara, S. and Joseph, G. (1999) Evaluation of Japanese gastrointestinal symptom rating scale. Diagnosis and Treatment, 87, 731-736.

[31]   Hatta, H., Higashi, A., Yashiro, H., et al. (1998) A validation of the hospital anxiety and depression scale. Japanese Journal of Psychosomatic Medicine, 38, 309-315.

[32]   Gros, D.F., Antony, M.M., McCabe, R.E., et al. (2011) A preliminary investigation of the effects of cognitive behavioral therapy for panic disorder on gastrointestinal distress in patients with comorbid panic disorder and irritable bowel syndrome. Depression and Anxiety, 28, 1027-1033. http://dx.doi.org/10.1002/da.20863

[33]   Lackner, J.M., Jaccard, J., Krasner, S.S., et al. (2007) How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology, 133, 433-444.

[34]   Lackner, J.M., Jaccard, J., Krasner, S.S., et al. (2008) Self-administered cognitive behavior therapy for moderate to severe irritable bowel syndrome: Clinical efficacy, tolerability, feasibility. Clinical Gastroenterology and Hepatology, 6, 899-906.

[35]   Sugaya, N., Nomura, S. and Shimada, H. (2012) Relationship between cognitive factors and anxiety in individuals with irritable bowel syndrome. International Journal of Behavioral Medicine, 19, 308-315.

[36]   Moss-Morris, R., McAlpine, L., Didsbury, L.P., et al. (2010) A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40, 85-94.

[37]   Lackner, J.M., Gudleski, G.D., Keefer, L., et al. (2010) Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 8, 426-432. http://dx.doi.org/10.1016/j.cgh.2010.02.007