DOI QR코드

DOI QR Code

Update on Irritable Bowel Syndrome Program of Research

  • Heitkemper, Margaret (Department of Biobehavioral Nursing & Health Systems, University of Washington) ;
  • Jarrett, Monica (Department of Biobehavioral Nursing & Health Systems, University of Washington) ;
  • Jun, Sang-Eun (College of Nursing, Keimyung University)
  • 투고 : 2013.09.09
  • 심사 : 2013.09.23
  • 발행 : 2013.10.31

초록

Purpose: This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). Methods: This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. Results: IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. Conclusion: The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.

키워드

참고문헌

  1. Aguilera, M., Vergara, P., & Martinez, V. (2013). Stress and antibiotics alter luminal and wall-adhered microbiota and enhance the local expression of visceral sensory-related systems in mice. Neurogastroenterology and Motility, 25(8), e515-e529. http://dx.doi.org/10.1111/nmo.12154
  2. Alonso, C., Guilarte, M., Vicario, M., Ramos, L., Ramadan, Z., Antolin, M., et al. (2008). Maladaptive intestinal epithelial responses to life stress may predispose healthy women to gut mucosal inflammation. Gastroenterology, 135(1), 163-172, e161. http://dx.doi.org/10.1053/j.gastro.20 08.03.036
  3. Amaral, F. A., Sachs, D., Costa, V. V., Fagundes, C. T., Cisalpino, D., Cunha, T. M., et al. (2008). Commensal microbiota is fundamental for the development of inflammatory pain. Proceedings of the National Academy of Sciences of the United States of America, 105(6), 2193-2197. http://dx.doi.org/10.1073/pnas.0711891105
  4. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt, L.J., Chey, W.D., Foxx-Orenstein, A.E. , Schiller, L.R., Schoenfeld, P.S., et al. (2009). An evidence-based position statement on the management of irritable bowel syndrome. The American Journal of Gastroenterology, 104 (Suppl 1), S1-S35. http://dx.doi.org/10.1038/ajg.2008.122
  5. Arumugam, M., Raes, J., Pelletier, E., Le Paslier, D., Yamada, T., Mende, D. R., et al. (2011). Enterotypes of the human gut microbiome. Nature, 473(7346), 174-180. http://dx.doi.org/10.1038/nature09944
  6. Bellini, M., Gemignani, A., Gambaccini, D., Toti, S., Menicucci, D., Stasi, C., et al. (2011). Evaluation of latent links between irritable bowel syndrome and sleep quality. World Journal of Gastroenterology, 17(46), 5089-5096. http://dx.doi.org/10.3748/wjg.v17.i46.5089
  7. Bercik, P., Park, A. J., Sinclair, D., Khoshdel, A., Lu, J., Huang, X., et al. (2011). The anxiolytic effect of bifidobacterium longum NCC3001 involves vagal pathways for gut-brain communication. Neurogastroenterology and Motility, 23(12), 1132-1139. http://dx.doi.org/10.1111/j.1365-2982.2011.01796.x
  8. Bradford, K., Shih, W., Videlock, E. J., Presson, A. P., Naliboff, B. D., Mayer, E. A., et al. (2012). Association between early adverse life events and irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 10(4), 385-390, e381-e383. http://dx.doi.org/10.1016/j.cgh.2011.12.018
  9. Cain, K. C., Headstrom, P., Jarrett, M. E., Motzer, S. A., Park, H., Burr, R. L., et al. (2006). Abdominal pain impacts quality of life in women with irritable bowel syndrome. The American Journal of Gastroenterology, 101(1), 124-132. http://dx.doi.org/10.1111/j.1572-0241.2006.00404.x
  10. Cain, K. C., Jarrett, M. E., Burr, R. L., Hertig, V. L., & Heitkemper, M. M. (2007). Heart rate variability is related to pain severity and predominant bowel pattern in women with irritable bowel syndrome. Neurogastroenterology and Motility, 19(2), 110-118. http://dx.doi.org/10.1111/j.1365-2982.2006.00877.x
  11. Camilleri, M., & Katzka, D. A. (2012). Irritable bowel syndrome: Methods, mechanisms, and pathophysiology. Genetic epidemiology and pharmacogenetics in irritable bowel syndrome. American Journal of Physiology: Gastrointestinal and Liver Physiology, 302(10), G1075-G1084. http://dx.doi.org/10.1152/ajpgi.00537.2011
  12. Camilleri, M., Lasch, K., & Zhou, W. (2012). Irritable bowel syndrome: Methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. American Journal of Physiology: Gastrointestinal and Liver Physiology, 303(7), G775-G785. http://dx.doi.org/10.1152/ajpgi.00155.2012
  13. Camilleri, M., McKinzie, S., Busciglio, I., Low, P. A., Sweetser, S., Burton, D., et al. (2008). Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 6(7), 772-781. http://dx.doi.org/10.1016/j.cgh.2008.02.060
  14. Camilleri, M., & Talley, N. J. (2004). Pathophysiology as a basis for understanding symptom complexes and therapeutic targets. Neurogastroenterology and Motility, 16(2), 135-142. http://dx.doi.org/10.1111/j.13 65-2982.2004.00516.x
  15. Cani, P. D., Bibiloni, R., Knauf, C., Waget, A., Neyrinck, A. M., Delzenne, N. M., et al. (2008). Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice. Diabetes, 57(6), 1470-1481. http://dx.doi.org/10.2337/db07-1403
  16. Chang, L., Adeyemo, M., Karagiannides, I., Videlock, E. J., Bowe, C., Shih, W., et al. (2012). Serum and colonic mucosal immune markers in irritable bowel syndrome. The American Journal of Gastroenterology, 107(2), 262-272. http://dx.doi.org/10.1038/ajg.2011.423
  17. Chitkara, D. K., van Tilburg, M. A., Blois-Martin, N., & Whitehead, W. E. (2008). Early life risk factors that contribute to irritable bowel syndrome in adults: A systematic review. The American Journal of Gastroenterology, 103(3), 765-774, quiz 775. http://dx.doi.org/10.1111/j.1572-0241.2007.01722.x
  18. Coeffier, M., Gloro, R., Boukhettala, N., Aziz, M., Lecleire, S., Vandaele, N., et al. (2010). Increased proteasome-mediated degradation of occludin in irritable bowel syndrome. The American Journal of Gastroenterology, 105(5), 1181-1188. http://dx.doi.org/10.1038/ajg.2009.700
  19. Cremon, C., Gargano, L., Morselli-Labate, A. M., Santini, D., Cogliandro, R. F., De Giorgio, R., et al. (2009). Mucosal immune activation in irritable bowel syndrome: Gender-dependence and association with digestive symptoms. The American Journal of Gastroenterology, 104(2), 392-400. http://dx.doi.org/10.1038/ajg.2008.94
  20. Dinan, T. G., & Cryan, J. F. (2012). Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology. Psychoneuroendocrinology, 37(9), 1369-1378. http://dx.doi.org/10.1016/j.psyneuen.2012.03.007
  21. Drossman, D. A., Corazziari, E., Delvaux, M., Spiller, R. C., Talley, N. J., Thompson, W. G., et al. (Eds.). (2006). Rome III: The functional gastrointestinal disorders (3rd ed.). McLean, VA: Degnon Associates.
  22. Elsenbruch, S., Thompson, J. J., Hamish, M. J., Exton, M. S., & Orr, W. C. (2002). Behavioral and physiological sleep characteristics in women with irritable bowel syndrome. The American Journal of Gastroenterology, 97(9), 2306-2314. http://dx.doi.org/10.1111/j.1572-0241.2002.05984.x
  23. Eutamene, H., Lamine, F., Chabo, C., Theodorou, V., Rochat, F., Bergonzelli, G. E., et al. (2007). Synergy between Lactobacillus paracasei and its bacterial products to counteract stress-induced gut permeability and sensitivity increase in rats. The Journal of Nutrition, 137(8), 1901-1907. https://doi.org/10.1093/jn/137.8.1901
  24. Foster, J. A., & McVey Neufeld, K. A. (2013). Gut-brain axis: How the microbiome influences anxiety and depression. Trends in Neurosciences, 36(5), 305-312. http://dx.doi.org/10.1016/j.tins.2013.01.005
  25. Goo, Y. A., Cain, K., Jarrett, M., Smith, L., Voss, J., Tolentino, E., et al. (2012). Urinary proteome analysis of irritable bowel syndrome (IBS) symptom subgroups. Journal of Proteome Research, 11(12), 5650-5662. http://dx.doi.org/10.1021/pr3004437
  26. Gwee, K. A., & Ghoshal, U. C. (2010). The Rome criteria divides, distorts and dilutes the prevalence of irritable bowel syndrome. Saudi Journal of Gastroenterology, 16(3), 143-144. http://dx.doi.org/10.4103/1319-3767. 65178
  27. Halpert, A. D. (2010). Importance of early diagnosis in patients with irritable bowel syndrome. Postgraduate Medicine, 122(2), 102-111. http://dx.doi.org/10.3810/pgm.2010.03.2127
  28. Heitkemper, M., Jarrett, M., Burr, R., Cain, K. C., Landis, C., Lentz, M., et al. (2005). Subjective and objective sleep indices in women with irritable bowel syndrome. Neurogastroenterology and Motility, 17(4), 523-530. http://dx.doi.org/10.1111/j.1365-2982.2005.00700.x
  29. Heitkemper, M. M., Cain, K. C., Deechakawan, W., Poppe, A., Jun, S. E., Burr, R. L., et al. (2012). Anticipation of public speaking and sleep and the hypothalamic-pituitary-adrenal axis in women with irritable bowel syndrome. Neurogastroenterology and Motility, 24(7), 626-631, e270-e271. http://dx.doi.org/10.1111/j.1365-2982.2012.01915.x
  30. Heitkemper, M. M., Jarrett, M. E., Levy, R. L., Cain, K. C., Burr, R. L., Feld, A., et al. (2004). Self-management for women with irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 2(7), 585-596. https://doi.org/10.1016/S1542-3565(04)00242-3
  31. Heitkemper, M. M., Kohen, R., Jun, S. E., & Jarrett, M. E. (2011). Genetics and gastrointestinal symptoms. Annual Review of Nursing Research, 29, 261-280. https://doi.org/10.1891/0739-6686.29.261
  32. Hsueh, H. F., Jarrett, M. E., Cain, K. C., Burr, R. L., Deechakawan, W., & Heitkemper, M. M. (2011). Does a self-management program change dietary intake in adults with irritable bowel syndrome? Gastroenterology Nursing, 34(2), 108-116. http://dx.doi.org/10.1097/SGA.0b013e31821092e8
  33. Hughes, P. A., Zola, H., Penttila, I. A., Blackshaw, L. A., Andrews, J. M., & Krumbiegel, D. (2013). Immune activation in irritable bowel syndrome: Can neuroimmune interactions explain symptoms? The American Journal of Gastroenterology, 108(7), 1066-1074. http://dx.doi.org/10.1038/ajg.2013.120
  34. Hyams, J. S., Hyman, P. E., & Rasquin-Weber, A. (1999). Childhood recurrent abdominal pain and subsequent adult irritable bowel syndrome. Journal of Developmental and Behavioral Pediatrics, 20(5), 318-319. https://doi.org/10.1097/00004703-199910000-00004
  35. Inadomi, J. M., Fennerty, M. B., & Bjorkman, D. (2003). Systematic review: The economic impact of irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 18(7), 671-682. https://doi.org/10.1046/j.1365-2036.2003.t01-1-01736.x
  36. Jarrett, M. E., Cain, K. C., Burr, R. L., Hertig, V. L., Rosen, S. N., & Heitkemper, M. M. (2009). Comprehensive self-management for irritable bowel syndrome: Randomized trial of in-person vs. combined in-person and telephone sessions. The American Journal of Gastroenterology, 104(12), 3004-3014. http://dx.doi.org/10.1038/ajg.2009.479
  37. Jarrett, M. E., Kohen, R., Cain, K. C., Burr, R. L., Poppe, A., Navaja, G. P., et al. (2007). Relationship of SERT polymorphisms to depressive and anxiety symptoms in irritable bowel syndrome. Biological Research for Nursing, 9(2), 161-169. http://dx.doi.org/10.1177/1099800407307822
  38. Jarrett, M., Heitkemper, M., Cain, K. C., Burr, R. L., & Hertig, V. (2000). Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome. Digestive Diseases and Sciences, 45(5), 952-959. https://doi.org/10.1023/A:1005581226265
  39. Jarrett, M., Visser, R., & Heitkemper, M. (2001). Diet triggers symptoms in women with irritable bowel syndrome. The patient's perspective. Gastroenterology Nursing, 24(5), 246-252. https://doi.org/10.1097/00001610-200109000-00006
  40. Jeffery, I. B., O'Toole, P. W., Ohman, L., Claesson, M. J., Deane, J., Quigley, E. M., et al. (2012). An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut, 61(7), 997-1006. http://dx.doi.org/10.1136/gutjnl-2011-301501
  41. Jeffery, I. B., Quigley, E. M., Ohman, L., Simren, M., & O'Toole, P. W. (2012). The microbiota link to irritable bowel syndrome: An emerging story. Gut Microbes, 3(6), 572-576. http://dx.doi.org/10.4161/gmic.21772
  42. Jun, S., Kohen, R., Cain, K. C., Jarrett, M. E., & Heitkemper, M. M. (2011). Associations of tryptophan hydroxylase gene polymorphisms with irritable bowel syndrome. Neurogastroenterology and Motility, 23(3), 233-239, e116. http://dx.doi.org/10.1111/j.1365-2982.2010.01623.x
  43. Jung, H. K., Jang, B., Kim, Y. H., Park, J., Park, S. Y., Nam, M. H., et al. (2011). Health care costs of digestive diseases in Korea. The Korean Journal of Gastroenterology, 58(6), 323-331. https://doi.org/10.4166/kjg.2011.58.6.323
  44. Konturek, P. C., Brzozowski, T., & Konturek, S. J. (2011). Stress and the gut: Pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology, 62(6), 591-599.
  45. Kumar, S., Ranjan, P., Mittal, B., & Ghoshal, U. C. (2012). Serotonin transporter gene (SLC6A4) polymorphism in patients with irritable bowel syndrome and healthy controls. Journal of Gastrointestinal and Liver Diseases, 21(1), 31-38.
  46. Lackner, J. M., Gudleski, G. D., Zack, M. M., Katz, L. A., Powell, C., Krasner, S., et al. (2006). Measuring health-related quality of life in patients with irritable bowel syndrome: Can less be more? Psychosomatic Medicine, 68(2), 312-320. http://dx.doi.org/10.1097/01.psy.0000204897.25745.7c
  47. Lackner, J. M., Mesmer, C., Morley, S., Dowzer, C., & Hamilton, S. (2004). Psychological treatments for irritable bowel syndrome: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 72(6), 1100-1113. https://doi.org/10.1037/0022-006X.72.6.1100
  48. Larsen, N., Vogensen, F. K., van den Berg, F. W., Nielsen, D. S., Andreasen, A. S., Pedersen, B. K., et al. (2010). Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS One, 5(2), e9085. http://dx.doi.org/10.1371/journal.pone.0009085
  49. Ledochowski, M., Widner, B., Bair, H., Probst, T., & Fuchs, D. (2000). Fructose-and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers. Scandinavian Journal of Gastroenterology, 35(10), 1048-1052. https://doi.org/10.1080/003655200451162
  50. Ljótsson, B., Hedman, E., Andersson, E., Hesser, H., Lindfors, P., Hursti, T., et al. (2011). Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: A randomized trial. The American Journal of Gastroenterology, 106(8), 1481-1491. http://dx.doi.org/10.1038/ajg.2011.139
  51. Marshall, J. K., Thabane, M., Garg, A. X., Clark, W., Meddings, J., & Collins, S. M. (2004). Intestinal permeability in patients with irritable bowel syndrome after a waterborne outbreak of acute gastroenteritis in Walkerton, Ontario. Alimentary Pharmacology and Therapeutics, 20(11-12), 1317-1322. http://dx.doi.org/10.1111/j.1365-2036.2004.02284.x
  52. McKenzie, Y. A., Alder, A., Anderson, W., Wills, A., Goddard, L., Gulia, P., et al. (2012). British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. Journal of Humam Nutrition and Dietetics, 25(3), 260-274. http://dx.doi.org/10.1111/j.1365-277X.2012.01242.x
  53. Messaoudi, M., Violle, N., Bisson, J. F., Desor, D., Javelot, H., & Rougeot, C. (2011). Beneficial psychological effects of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in healthy human volunteers. Gut Microbes, 2(4), 256-261. http://dx.doi.org/10.4161/gmic.2.4.16108
  54. Moayyedi, P., & Ford, A. C. (2011). Symptom-based diagnostic criteria for irritable bowel syndrome: The more things change, the more they stay the same. Gastroenterology Clinics of North America, 40(1), 87-103. http://dx.doi.org/10.1016/j.gtc.2010.12.007
  55. Moayyedi, P., Ford, A. C., Talley, N. J., Cremonini, F., Foxx-Orenstein, A. E., Brandt, L. J., et al. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: A systematic review. Gut, 59(3), 325-332. http://dx.doi.org/10.1136/gut.2008.167270
  56. Neufeld, K. M., Kang, N., Bienenstock, J., & Foster, J. A. (2011). Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterology and Motility, 23(3), 255-264, e119. http://dx.doi.org/10.1111/j.1365-2982.2010.01620.x
  57. Nojkov, B., Rubenstein, J. H., Chey, W. D., & Hoogerwerf, W. A. (2010). The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses. The American Journal of Gastroenterology, 105(4), 842-847. http://dx.doi.org/10.1038/ajg.2010.48
  58. Park, D. W., Lee, O. Y., Shim, S. G., Jun, D. W., Lee, K. N., Kim, H. Y., et al. (2010). The differences in prevalence and sociodemographic characteristics of irritable bowel syndrome according to Rome II and Rome III. Journal of Neurogastroenterology and Motility, 16(2), 186-193. http://dx.doi.org/10.5056/jnm.2010.16.2.186
  59. Rajilic-Stojanovic, M., Biagi, E., Heilig, H. G., Kajander, K., Kekkonen, R. A., Tims, S., et al. (2011). Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology, 141(5), 1792-1801. http://dx.doi.org/10.1053/ j.gastro.2011.07.043
  60. Robert, J. J., Orr, W. C., & Elsenbruch, S. (2004). Modulation of sleep quality and autonomic functioning by symptoms of depression in women with irritable bowel syndrome. Digestive Diseases and Sciences, 49(7-8), 1250-1258. https://doi.org/10.1023/B:DDAS.0000037820.54069.6c
  61. Rodriguez-Fandino, O., Hernandez-Ruiz, J., & Schmulson, M. (2010). From cytokines to toll-like receptors and beyond-current knowledge and future research needs in irritable bowel syndrome. Journal of Neurogastroenterology and Motility, 16(4), 363-373. http://dx.doi.org/10.5056/jnm.2010.16.4.363
  62. Rotem, A. Y., Sperber, A. D., Krugliak, P., Freidman, B., Tal, A., & Tarasiuk, A. (2003). Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome. Sleep, 26(6), 747-752. https://doi.org/10.1093/sleep/26.6.747
  63. Saulnier, D. M., Riehle, K., Mistretta, T. A., Diaz, M. A., Mandal, D., Raza, S., et al. (2011). Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology, 141(5), 1782-1791. http://dx.doi.org/10.1053/j.gastro.2011.06.072
  64. Schmulson, M., Pulido-London, D., Rodriguez, O., Morales-Rochlin, N., Martinez-Garcia, R., Gutierrez-Ruiz, M. C., et al. (2012). Lower serum IL-10 is an independent predictor of IBS among volunteers in Mexico. The American Journal of Gastroenterology, 107(5), 747-753. http://dx.doi.org/10.1038/ajg.2011.484
  65. Shulman, R. J., Eakin, M. N., Czyzewski, D. I., Jarrett, M., & Ou, C. N. (2008). Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome. The Journal of Pediatrics, 153(5), 646-650. http://dx.doi.org/10.1016/j.jpeds.2008.04.062
  66. Walther, D. J., & Bader, M. (2003). A unique central tryptophan hydroxylase isoform. Biochemical Pharmacology, 66(9), 1673-1680. https://doi.org/10.1016/S0006-2952(03)00556-2
  67. Zill, P., Buttner, A., Eisenmenger, W., Moller, H. J., Ackenheil, M., & Bondy, B. (2007). Analysis of tryptophan hydroxylase I and II mRNA expression in the human brain: A post-mortem study. Journal of Psychiatric Research, 41(1-2), 168-173. http://dx.doi.org/10.1016/j.jpsychires.2005.05.004

피인용 문헌

  1. So-Eum Type as an Independent Risk Factor for Irritable Bowel Syndrome: A Population-Based Study in Korea vol.20, pp.11, 2013, https://doi.org/10.1089/acm.2014.0077
  2. Efficacy and Safety of High Specific Volume Polysaccharide—A New Type of Dietary Fiber for Treatment of Functional Constipation and IBS-C vol.61, pp.4, 2015, https://doi.org/10.3177/jnsv.61.326
  3. Aspects of the non-pharmacological treatment of irritable bowel syndrome vol.21, pp.40, 2015, https://doi.org/10.3748/wjg.v21.i40.11439
  4. Tong Xie Yao Fang relieves irritable bowel syndrome in ratsviamechanisms involving regulation of 5-hydroxytryptamine and substance P vol.21, pp.15, 2013, https://doi.org/10.3748/wjg.v21.i15.4536
  5. Irritable Bowel Syndrome vol.117, pp.6, 2013, https://doi.org/10.1097/01.naj.0000520253.57459.01
  6. Role of Different Blood Purification Nursing Models in Uremic Patients: A Preliminary Report vol.24, pp.None, 2018, https://doi.org/10.12659/msm.910877
  7. Yoga for Teens With Irritable Bowel Syndrome : Results From a Mixed-Methods Pilot Study vol.32, pp.5, 2013, https://doi.org/10.1097/hnp.0000000000000288
  8. 대학생의 과민성 장 증후군의 유병률과 영향요인 vol.25, pp.4, 2018, https://doi.org/10.7739/jkafn.2018.25.4.282
  9. 과민대장증후군 여대생을 위한 동기강화 자가관리 프로그램의 효과 vol.22, pp.2, 2013, https://doi.org/10.7586/jkbns.2020.22.2.148
  10. Dysbiosis of the Gut Microbiome: A Concept Analysis vol.38, pp.2, 2013, https://doi.org/10.1177/0898010119879527