The proposed study is a competitive renewal of the NINR funded study Nursing Management of IBS: Improving Outcomes. Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder characterized by gastrointestinal (GI) discomfort and alterations in bowel pattern. It is estimated that IBS accounts of over 2 million physician visits per year making it the 4th most expensive GI disorder in the U.S. The burden of IBS has been measured in the significant amount of health care resources used and reductions in health related quality of life (HRQOL) in those affected. The 10-17% prevalence of IBS in the U.S. challenges health care providers to develop and test effective therapeutic strategies to enhance patient self management. The current study builds directly on our prior study of a comprehensive self-management (CSM) program that includes cognitive behavioral therapy to reduce GI symptoms and enhance HRQOL in IBS patients. At the same time there is building evidence that probiotics may provide relief for IBS patients via alterations in gut flora. To date, head to head comparison of probiotics with CSM are lacking. The 2 foci of this study are as follows: 1) Test the effectiveness of probiotics and CSM therapy in patients with IBS as compared to a placebo-control group. The primary outcomes will be abdominal pain and HRQOL. 2) Test the relative effectiveness of probiotics compared to CSM in subgroups of patients defined by degree of intestinal inflammation, as measured by fecal calprotectin, intestinal permeability, and serum cytokine levels. 3) Explore whether other characteristics such as genotype, mental health disorders, abuse history, current levels of anxiety and depression, hypothalamic-pituitary-adrenal axis (cortisol), autonomic nervous system balance (heart rate variability), and symptom severity predict which patients will benefit more from probiotics than from CSM and vice versa. The use of both psychologic and physiologic measures will provide information on not only how 2 diverse therapies work but also information on which they might be most effective. The long term goal is to enhance self management of a chronic, and at times, disabling condition. The current study builds directly on our prior study of irritable bowel syndrome (IBS) which used comprehensive self-management to reduce GI symptoms and enhance quality of life. At the same time there is building evidence that probiotics may provide relief via alterations in gut flora. Clinically, the challenge is to identify which treatment is most appropriate for an individual patient.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Tully, Lois
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Other Health Professions
Schools of Nursing
United States
Zip Code
Han, Claire J; Kohen, Ruth; Jun, Sangeun et al. (2017) COMT Val158Met Polymorphism and Symptom Improvement Following a Cognitively Focused Intervention for Irritable Bowel Syndrome. Nurs Res 66:75-84
Ferranti, Erin P; Grossmann, Ruth; Starkweather, Angela et al. (2017) Biological determinants of health: Genes, microbes, and metabolism exemplars of nursing science. Nurs Outlook 65:506-514
Zia, Jasmine K; Barney, Pamela; Cain, Kevin C et al. (2016) A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year. Clin Gastroenterol Hepatol 14:212-9.e1-2
Heitkemper, Margaret M; Han, Claire Jungyoun; Jarrett, Monica E et al. (2016) Serum Tryptophan Metabolite Levels During Sleep in Patients With and Without Irritable Bowel Syndrome (IBS). Biol Res Nurs 18:193-8
Jarrett, Monica E; Cain, Kevin C; Barney, Pamela G et al. (2016) Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome. J Neurogastroenterol Motil 22:102-11
Kohen, Ruth; Tracy, Julia H; Haugen, Eric et al. (2016) Rare Variants of the Serotonin Transporter Are Associated With Psychiatric Comorbidity in Irritable Bowel Syndrome. Biol Res Nurs 18:394-400
Shulman, Robert J; Jarrett, Monica E; Cain, Kevin C et al. (2014) Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome. J Gastroenterol 49:1467-76
Jun, Sang-Eun; Kohen, Ruth; Cain, Kevin C et al. (2014) TPH gene polymorphisms are associated with disease perception and quality of life in women with irritable bowel syndrome. Biol Res Nurs 16:95-104
Deechakawan, Wimon; Heitkemper, Margaret M; Cain, Kevin C et al. (2014) Anxiety, depression, and catecholamine levels after self-management intervention in irritable bowel syndrome. Gastroenterol Nurs 37:24-32
Deechakawan, Wimon; Cain, Kevin C; Jarrett, Monica E et al. (2013) Effect of self-management intervention on cortisol and daily stress levels in irritable bowel syndrome. Biol Res Nurs 15:26-36

Showing the most recent 10 out of 27 publications