Joochul Lee

Background: Irritable bowel syndrome (IBS) is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with IBS is limited. Objectives: This study aimed to examine the effect of a nurse-led self-management program on IBS related pain and symptoms, and quality of life (QOL) among young adults with IBS. Theoretical framework: The Individual and Family Self-Management Theory (IFSMT). Design: A randomized controlled trial with data collected at baseline, 6- and 12-week follow up. Settings and participants: Eighty young adults with IBS recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a Self- Management Online education and learning Modules group (SMOM, n = 41) or a Nurse-Led SMOM group (NL + SMOM, n = 39). Twenty-one healthy controls (HCs) were also recruited from these two campuses. Methods: All the IBS participants received the SMOM after baseline data collection. Participants in the NL + SMOM received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow up. Self-reported pain, symptoms, IBS-related QOL, self- efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12- week follow up among the IBS participants. The HCs completed data collection of pain and symptoms at baseline and 12-week follow up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions. Results: Both the SMOM and NL + SMOM groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing IBS-QOL among young adults with IBS at the 12-week follow up (all p < 0.05). The NL + SMOM also had significant effect on reducing anxiety and greater improvement in IBS-QOL compared with the SMOM at the 12- week follow up (both p < 0.05). Increased self-efficacy mediated the intervention effect of the NL + SMOM on reducing pain interference and improving IBS-QOL, while the effect of the SMOM was mediated through decreased an inefficient coping strategy-catastrophizing. Conclusions: Guided by the IFSMT, this study showed that both the pain self-management online education and nurse-led interventions were effective for alleviating pain and improving QOL among young adults with IBS by targeting the self-management process. The nurse-led program had a better outcome than the online education alone in improving IBS-QOL. Registration number : NCT03332537 What is already known about the topic: Irritable bowel syndrome (IBS) is a chronic condition warranting lifelong self- management. Unrelieved abdominal pain is associated with increased healthcare expenditures and decreased quality of life (QOL) in young adults with IBS. Self-management interventions have moderate effect on attenuating IBS related pain and symptoms. What this paper adds: Both the IBS Self-Management Online education and learning Modules (SMOM) and Nurse-Led SMOM (NL + SMOM) developed in this study were efficient in reducing pain intensity and pain interference and ameliorating IBS-QOL among young adults with IBS. The NL + SMOM had a greater interventional effect on improving IBS-QOL compared with the SMOM alone. The NL + SMOM had an indirect effect on pain and QOL by increasing self-efficacy, while the indirect effect of SMOM on pain and QOL was derived by decreasing inefficient coping (e.g., catastrophizing).

The interplay between diet and gut microbiota has gained interest as a potential contributor in pathophysiology of irritable bowel syndrome (IBS). The purpose of this study was to compare food components and gut microbiota patterns between IBS patients and healthy controls (HC) as well as to explore the associations of food components and microbiota profiles. A cross-sectional study was conducted with 80 young adults with IBS and 21 HC recruited. The food frequency questionnaire was used to measure food components. Fecal samples were collected and profiled by 16S rRNA Illumina sequencing. Food components were similar in both IBS and HC groups, except in caffeine consumption. Higher alpha diversity indices and altered gut microbiota were observed in IBS compared to the HC. A negative correlation existed between total observed species and caffeine intake in the HC, and a positive correlation between alpha diversity indices and dietary fiber in the IBS group. Higher alpha diversity and gut microbiota alteration were found in IBS people who consumed caffeine more than 400 mg/d. Moreover, high microbial diversity and alteration of gut microbiota composition in IBS people with high caffeine consumption may be a clue toward the effects of caffeine on the gut microbiome pattern, which warrants further study.