Research Proposals

Determination of Yoga Effect on Irritant Bowel Disorder Symptoms in Qatar Women

Name (s)

University

Abstract

The gastrointestinal dysfunction referred to as Irritable Bowel syndrome is a chronic gastroenteric disorder, frequently characterized by unexplained symptoms including abdominal pains, flatulence and bowel disturbance. Treatment of IBS includes use of pharmacology-regimens and other complementary approaches where yoga has improved stress management. The study objects to determining the impact of yoga on IBS symptoms among adults’ Qatari women aged between 20 to 30 years old. Twenty IBS patient participants will be purposively sampled in a random manner, after administration of Rome III questionnaire. Ten of them will be selected for the experimental-group and the other ten for the control-group. Hamilton depression and anxiety scales will be administered on the experimental-group and the two parameters will help in determining the yoga effect with other associated observations and interview responses. Data will be analyzed using SPSS at p 0.05. Descriptive statistics will report the yoga effects.

Chapter 1: Introduction to the Problem

Introduction

The gastrointestinal (GI) dysfunction commonly referred to as Irritable Bowel syndrome or abbreviated IBS is a chronic gastroenteric disorder that depicts a plethora of signs and symptoms (Chey, 2011). It is identified as a continuous or intermittent ailment frequently characterized by unexplained symptoms including abdominal pains, flatulence and bowel disturbance with diarrhea or disorderly bowel-release (JHH, 2013). However, the condition has been identified as less characterized in terms of structural disorders, infection amelioration, or metabolic disturbances (Kabra and Nadkarni, 2013). In Qatar, the bowel disease is reported in a plethora of research that shows the scope of adversity associated with the illness. In one of the studies in an outpatient (case study) in Qatar, 48% of the IBS patients depicted symptoms that were characteristic of Hysterionic and depressive status, while 26% were in a deep depression feature (Fadil, 1991).

Problem Statement

IBS is a chronic disease and one of the frequently reported gastrointestinal disorders that have an overall prevalence approximate of 8-22% in population-estimates (Kabra and Nadkarni, 2013). Higher levels of depression or stress, anxiety and neuroticism are reported in IBS subjects within a myriad of trials as compared to the controls (JHH, 2013). In Qatar, the stressful living conditions due to work and family pressure especially for women do promote the implications of IBS illness (Fadil, 1991). Women are the most predisposed to developing this ailment at two times more likely than men who represent a critical public health issue due to associated costs with lowered quality of life from associated symptoms.

Rationale and Significance of the Study

While IBS has not shown high mortality among patients, they suffer from a disproportionately elevated rate of co-morbidity with other disorders like fibromyalgia, pelvic aches, chronic fatigue, and mental disorders (Alfetni et al., 2013). It lays an immense burden on health services accounting for 20-50% of clinical referrals to gastroenterology practitioners. Lack of definitive diagnosis and treatment regimens due to the myriad symptoms has led to patients opting for other therapies such as relaxation exercise therapy with yoga and acupuncture. Stress aggravates the IBS symptoms while Yoga and other exercises aid manage symptoms by maintaining gastrointestinal function, reducing stress, and relieving IBS symptoms (Yoon et al., 2011). Women have a higher likelihood of being affected; therefore, the Yoga effect trial in Qatar women is paramount for determining levels of symptom management.

Research question

This research will be based on the research question:

• What is the effect of yoga on IBS among adult Qatari women aged between 20 to 30 years old?

Definition of terms

Irritable Bowel Syndrome condition (IBS): Described as a chronic ailment characterized by recurrent and inexplicable symptoms that among others include abdominal pain, bloating/bowel disturbance with a disordered defecation (JHH, 2013).

Yoga: An ancient practical exercise known as a relaxation and stress alleviating tool (Art of Living, 2014).

Chapter 2: Literature Review

Introduction

IBS is defined as a physical disorder characterized by prolonged abdominal ache and discomfort that associates to abnormal bowel habits (flatulence and diarrhea) (Chey, 2011). In a Qatar study, other diagnosed symptoms from the applied Minnesota Multiphasic Personality Inventory (M.M.P.I.) were mild depression, psychopathic features, Schizoid and psychopathic personality (Fadil, 1991). Due to the myriad of symptoms associated with this condition, the treatment regimen varies from pharmacological type to psychological interventions (Lehrer and Katz, 2014).

IBS characteristics and prevalence

Among the major manifestations of IBS, they include altered bowel habits, abdominal ache or distention (Lehrer and Katz, 2014). The features in bowel habits get represented by constipation with hard stools that have painful or infrequent defecation and intractable to laxatives. Diarrhea and postprandial urgency are also common. The abdominal pain experienced is versatile but frequently is diffuse with no radiation. However, there is the absence of a physical/structural, inflammatory or biochemical mechanism that expounds these symptoms. Population centred studies that have gotten conducted estimate the prevalence of Irritable Bowel Syndrome at an approximate occurrence of 10-20%. The frequency of occurrence is at 1-2% on the annuity basis for the affected. Some of the explanatory for the higher IBS event in women deciphered include physiological variations between men and women, influence gastrointestinal transit time, central nervous system responses, visceral sensitivity to changes and specified implications of estrogen and progesterone on gut digestive function (ADAA, 2014).

Causes of IBS

Psychosocial factors have been enumerated to have a significant impact, with 40-60% of IBS patients reporting psycho-symptoms such as depression, anxiety or somatization (JHH, 2013). Stress has been reported to alter gastrointestinal function, and the brain’s limbic system (where stress is perceived and experienced) gets critically involved. Neurotransmitters roles such as serotonin in the central nervous system (5%) and the GI tract (95%) have gotten associated with the symptoms. The occurrence of enteric infections such as inflammation of the mucosa or neural plexuses and infectious enteritis are also responsible for IBS symptoms onset (Allred et al., 2010).

Diagnosis methodologies

In the diagnosis of IBS two major tests have gotten reported including Rome III and Rome II criterions. The basis of Rome III for diagnosis of IBS is that patients must have recurrent abdominal ache or discomfort in at least three days per month during the recent 3 months. They should get associated with two or more of the following: pain or discomfort relieved by defecation; condition onset attached to change in stool frequency, and onset characterized with an alteration in stool form or appearance (Yoon et al., 2011).

Since the diagnosis is not based on morphological changes or biochemical dysregulation, IBS is distinguished from other functional bowel disorders (FBD) via exclusion. Based on a diagnostic tool, Rome III, the subtypes of IBS are categorized into diarrhea-predominant (IBS-D); constipation predominant (IBS-C); alternating subtype (both subtypes recurring alternatively, IBS-M) and undefined (IBS-U) (ADAA, 2014).

Impact on quality of life (QOL)

The symptoms of IBS bear a negative effect on the patient’s QOL, and while (IBS-C) and (IBS-D) have higher impact, bloating and diarrhea are more negative on patient self-confidence frequently resulting in avoidance of social settings. It affects patient’s occupation and lifestyle with an interruption of sleep mainly resulting from fatigue. An example is that many IBS individuals stay near a toilet (above 50%), face distress from symptoms (69%) with a persistent lack of life control (57%) (Yoon et al., 2011). Patients have reported stress and anxiety as symptoms aggravate, making it paramount to consider an individual’s history and co-occurring conditions (diet, exercise, bowel infection, and family predisposition to colon cancer). The direct and indirect cost-implications are estimated at $200 billion globally (Chey, 2011), which creates a burden on the society and the healthcare system.

IBS conventional treatment

The wide range of symptoms results in pharmacological treatments mainly targeted for symptom reduction. Examples include:

Table: conventional IBS treatments

Source: Yoon et al., 2011

The diverse symptoms have resulted in patients using un-prescribed or complementary and alternative medications (CAM) including herbal therapies.

Therapy and other exercise benefits

Mind-body therapies encompassing hypnotherapy and cognitive to behavioral therapy have a wide application in combination with pharmacological treatment. Patients have also used relaxation therapies and acupuncture, though the effect and use of exercise in maintaining GI function and stress reduction is limited. Physical activity protects against GI symptom aggravation, alleviating gas and pain (Chey, 2011). Pranayama-yoga has been enumerated as an exercise regimen increasing sympathetic tone, decreased in IBS-D patients. In a study, a yoga intervention set practiced twice and a conventional-treatment set used 2-6mg loperamide per-day. In the results yoga demonstrated augmented IBS symptoms equivalent to the usual model (Yoon et al., 2011).

Chapter 3: Methodology

Setting

The research shall be undertaken in a gastroenterology outpatient clinic in a specific Doha hospital, from where the patient members will be selected.

Participants

The sample will include 20 adult Qatari women aged in range of 20 to 30 years and identified as IBS patients. They will belong to the same/equal socioeconomic strata.

Research Design

The participants will be selected using purposive sampling with randomization. Ten of the 20 IBS members will be assigned to the experimental group and they will practice yoga twice daily for two months. The rest, 10 participants, will be assigned to the control-group and they shall not have any yoga practices but carry on with their regular daily activities.

Description of Tools

The Rome III criteria questionnaire, which is valid in many studies (Alfetni et al., 2013), will be used in this case to select members (IBS patients) with interpretation to the Arabic language for appropriate applicability. The bowel patterns for IBS detected by the tool include IBS-D, IBS-C, IBS-M, IBS-U.

Before administering Yoga and after administration, the members’ depression will be diagnosed using Hamilton depression rating scale and stress will also be diagnosed using Hamilton Anxiety rating scale respectively. The rating scales have been validated in previous studies (Kabra and Nadkarni, 2013). Observations, medical history and other comorbid conditions will be enumerated through interviews and a semi-structured questionnaire.

Data Collection

On the first day, 20 IBS patient members will be purposively sampled in a random manner, after administration of Rome III questionnaire. Ten of them will get selected for the experimental group and the other ten for the control group. On the second day, the Hamilton depression and anxiety scales will be provided, and Yoga sessions started for the experimental-group. At the end of the period, the scales will be administered and results compiled for entry and analysis.

Data Analysis

Data will be collected and verified by hand, then, coded for analysis. Statistical Package used for Social Sciences (SPSS) shall get used for analysis and descriptive statistics (number or percentage) will be used, at p≤ 0.05 (Alfetni et al., 2013).

Human Subjects Protection

Before the study is carried out, permission will be sought from the university’s research ethical committee with a presentation of the acceptance letter from the gastroenterology out-patient clinic. Before any inclusion of a participant, they will sign a consent form, and the data obtained shall be confidential and purposively applied for reporting.

Conclusion

IBS is categorized in general as a functional gastrointestinal disorder that is mainly attached to the lower gastrointestinal tract. The life implications are immense and the associated disorders further aggravate the effects, which increases the social and economic burden on the victims. The use of relaxation exercise/therapies has been shown to have an almost equal effect with the pharmacology-regimen. Yoga will be used to deduct symptoms management in the IBS patients considering women are highly predisposed than men. It will aid in understanding the improved quality of life at a less economic implication on patients.

References

Alfetni, A.M., Alturkstani, A.H., Saeedi, A.Y., Aljizani, H.M., Alzhrani F.M., Bughdadi, K.H…

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Allred, K.D., Byers, J.F. and Sole, M.L. (2010, March 1). Decreased pain inhibition

in irritable bowel syndrome depends on altered descending modulation and higher-order brain processes. Retrieved May 27, 2014, from http://worldwidescience.org/topicpages/p/pain+anxiety+irritability.html

Anxiety and Depression Association of America (ADAA). (2014). Irritable Bowel Syndrome

(IBS). Retrieved May 27, 2014, from http://www.adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibs

Art of Living. (2014). Yoga Makes Irritable Bowel Syndrome Vanish. Retrieved May 27, 2014,

from http://www.artofliving.org/yoga/health-and-wellness/yoga-for-ibs

Chey, W.D. (Ed.). (2011). Irritable Bowel Syndrome: Gastroenterology Clinics of North

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Fadil, K.H. (1991). Psychopathology of Irritable Bowel Syndrome among Arab Patients in Qatar.

Arab Journal of Psychiatry (AJP), 2(1), 53-63.

John Hopkins Hospital (JHH). (2013). Irritable Bowel Syndrome (IBS): Introduction. Retrieved

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Kabra, N. and  Nadkarni, A. (2013). Prevalence of depression and anxiety in irritable bowel

syndrome: A clinic based study from India. Indian Journal Psychiatry, 55(1), 77-80.

Lehrer, J.K. and Katz, J. (2014, April 22). Irritable Bowel Syndrome. Retrieved May 28, 2014,

from http://emedicine.medscape.com/article/180389-overview

Yoon, S.L., Grundmann, O., Koepp, L. and Farrell, L. (2011). Management of Irritable Bowel

Syndrome (IBS) in Adults: Conventional and Complementary/ Alternative Approaches. Alternative Medicine Review, 16(2), 134-151.