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February 9, 2018
Nurse Researcher Talks About Understanding, Treating IBS

NINR director Dr. Patricia Grady (l) with Dr. Margaret Heitkemper
NINR director Dr. Patricia Grady (l) with Dr. Margaret Heitkemper

If you or your loved one has ever been affected by irritable bowel syndrome (IBS), you are not alone. About 1 in 10 people in the United States has IBS and it is among the most-cited reasons for visiting the doctor. Additionally, 2 to 3 times more women than men seek a diagnosis for the disorder in most countries.

Dr. Margaret Heitkemper discussed IBS, its relation to other disorders and an intervention that she developed in “Symptom Science in Irritable Bowel Syndrome: Bench to Intervention,” the final NINR Director’s Lecture of 2017.

Heitkemper is professor and chairperson, department of biobehavioral nursing and health informatics, Elizabeth Sterling Soule chair in nursing, adjunct professor, division of gastroenterology and co-director, Center for Innovations in Sleep Self-Management at the University of Washington.

IBS is defined as a combination of abdominal pain and constipation, diarrhea or an alternating pattern of these problems. Currently, there is no universally accepted biomarker for IBS, but Heitkemper and her team are hoping their research will help identify one.

So what causes this common, chronic problem? Heitkemper uses the biopsychosocial model as guidance for researching this condition. The model outlines a range of factors that influence IBS, including genetics, epigenetics, psychological and environmental factors.

Although IBS is a stand-alone problem, Heitkemper showed that IBS often exists with many other chronic pain-related conditions and that symptoms can vary depending on sleep, stress and hormone levels.

Heitkemper was inspired to research IBS because of its “female predominance in most countries” and wanted to better understand why women seek a diagnosis for the condition and health care for their symptoms more often than men. She noted that the hysterectomy rate is three-fold higher in women with IBS than without, suggesting potential long-term consequences of the condition. Additionally, Heitkemper’s research shows that “the presence of distress,” such as anxiety, makes a difference in how women with IBS respond to pain.

Building on her understanding of IBS, Heitkemper developed and tested an intervention based largely on cognitive behavioral therapy. The intervention showed that behavioral therapy can be effective for approximately two-thirds of individuals with IBS. Later research also indicated that certain biomarkers may help in identifying those who are most likely to benefit from behavioral therapy.

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