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Reed-Knight B, Claar RL, Schurman JV, van Tilburg MAL. Implementing psychological therapies for functional GI disorders in children and adults. Expert Rev Gastroenterol Hepatol 2016; 10:981-4. [PMID: 27356273 DOI: 10.1080/17474124.2016.1207524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Functional GI disorders (FGIDs) are common in adults and children. Psychological factors play an important role in the onset and maintenance of FGIDs and in explaining the associated disability. Psychological treatments such as Cognitive Behavioral Therapy and Hypnotherapy have been found efficacious in FGIDs but Integrating psychological treatments into traditionally medically-oriented care can be challenging. AREAS COVERED This review outlines the case for integrating psychological therapies into medical care for FGIDs and examine various models of integrated care that can be adapted to fit specific practice scenarios. Expert commentary: We advise integrating a psychologist in the care and treatment planning of every patient. Clinic-specific needs dictate how integrated care for patients with FGIDs can be delivered.
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Affiliation(s)
- Bonney Reed-Knight
- a Children's Healthcare of Atlanta , Department of Pediatrics Emory University School of Medicine, and GI Care for Kids , Atlanta , GA , USA
| | - Robyn Lewis Claar
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
| | | | - Miranda A L van Tilburg
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
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Riehl ME, Pandolfino JE, Palsson OS, Keefer L. Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn. Dis Esophagus 2016; 29:490-6. [PMID: 25824436 PMCID: PMC4589470 DOI: 10.1111/dote.12353] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention.
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Affiliation(s)
- M E Riehl
- Division of Gastroenterology and Hepatology, Esophageal Center at Northwestern, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - J E Pandolfino
- Division of Gastroenterology and Hepatology, Esophageal Center at Northwestern, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - O S Palsson
- Division of Gastroenterology and Hepatology, Esophageal Center at Northwestern, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - L Keefer
- Division of Gastroenterology and Hepatology, Esophageal Center at Northwestern, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Talley NJ. Functional dyspepsia: new insights into pathogenesis and therapy. Korean J Intern Med 2016; 31:444-56. [PMID: 27048251 PMCID: PMC4855108 DOI: 10.3904/kjim.2016.091] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/05/2016] [Indexed: 01/06/2023] Open
Abstract
One in 10 people suffer from functional dyspepsia (FD), a clinical syndrome comprising chronic bothersome early satiety, or postprandial fullness, or epigastric pain or burning. Postprandial distress syndrome (PDS, comprising early satiety and/or postprandial fullness) and epigastric pain syndrome (EPS) are increasingly accepted as valid clinical entities, based on new insights into the pathophysiology and the results of clinical trials. Diagnosis is based on the clinical history, and exclusion of peptic ulcer and cancer by endoscopy. Evidence is accumulating FD and gastroesophageal ref lux disease are part of the same disease spectrum in a major subset. The causes of FD remain to be established, but accumulating data suggest infections and possibly food may play an important role in subsets. FD does not equate with no pathology; duodenal eosinophilia is now an accepted association, and Helicobacter pylori infection is considered to be causally linked to dyspepsia although only a minority will respond to eradication. In those with EPS, acid suppression therapy is a first line therapy; consider a H2 blocker even if proton pump inhibitor fails. In PDS, a prokinetic is preferred. Second line therapy includes administration of a tricyclic antidepressant in low doses, or mirtazapine, but not a selective serotonin reuptake inhibitor.
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Affiliation(s)
- Nicholas J. Talley
- Correspondence to Nicholas J. Talley, M.D. Department of Gastroenterology, The University of Newcastle Australia Faculty of Health and Medicine, HMRI Building Lot 1 Kookaburra Circuit, University Drive, Callaghan 2308, Australia Tel: +61-2-49215855 Fax: +61-2-40420034 E-mail:
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Naumann J. Effect of Amitriptyline and Escitalopram on Functional Dyspepsia. Gastroenterology 2016; 150:532. [PMID: 26718171 DOI: 10.1053/j.gastro.2015.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/02/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Johannes Naumann
- Institute for Environmental Health Sciences and Hospital Infection Control, University Medical Center Freiburg, Freiburg, Germany
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Palsson OS. Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:134-58. [PMID: 26264539 DOI: 10.1080/00029157.2015.1039114] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain's handling of sensory signals from the GI tract.
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Mahler T. Education and Hypnosis for Treatment of Functional Gastrointestinal Disorders (FGIDs) in Pediatrics. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:115-28. [PMID: 26046720 DOI: 10.1080/00029157.2015.1033676] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
FGIDs in children and adolescents (ROME III classification) have a significant impact on the daily functioning and quality of life. Often it is the pain that is one of the main contributors to the burden of functional dyspepsia, functional abdominal pain (syndrome), and irritable bowel syndrome. Current knowledge confirms that a number of integrated networks at cortical and subcortical sites are responsible for the experience of pain. From the work of Mayer and Tillisch (2011), mainly based on structural and functional magnetic resonance imaging and positron emission tomography, it has become clear that abdominal pain syndromes are disorders of the bi-directional mind-brain-gut interactions. In this multi-factorial bio-psycho-social model we recognize the importance of neurobiological processes in the mind-brain-gut interactions, leading to alterations in motility, sensation, and immune functions. Medical treatment often offers little or no relief. Until now pharmaceutical research has not succeeded in developing safe new drugs with an effect on the brain-gut axis. More recent published research shows the rationale for the use of medical hypnosis in FGID. In this article the author will illustrate her specific approach in a pediatric gastroenterology clinic with children and adolescents with FGIDs. Being a pediatric gastroenterologist, the author emphasizes the importance of a clear diagnosis, explains the rationale for educating the patient and his or her parents on the multi-factorial bio-psycho-social model and the concepts of chronic pain, discusses the specific settings and pitfalls for hypnosis treatment in children, and last but not least, provides some examples of hypnotic sessions used with FGIDs.
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Abstract
Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms--visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.
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Orive M, Barrio I, Orive VM, Matellanes B, Padierna JA, Cabriada J, Orive A, Escobar A, Quintana JM. A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia. J Psychosom Res 2015; 78:563-8. [PMID: 25791668 DOI: 10.1016/j.jpsychores.2015.03.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Epidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD. METHODS One hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6 months later. Linear mixed-effects models were used, in intention-to-treat analysis. RESULTS At the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs. the 45% of the CT; SS: 75% vs. 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs. 41%). CONCLUSIONS These findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710.
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Affiliation(s)
- M Orive
- Research Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Bizkaia, Spain.
| | - I Barrio
- Department of Applied Mathematics, Statistics and Operational Research, University of the Basque Country UPV/EHU, Leioa, Spain.
| | - V M Orive
- Digestive Service, Basurto University Hospital, Bilbao, Bizkaia, Spain.
| | - B Matellanes
- Psychology Department of Personality, Assessment and Treatment, University of Deusto, Bilbao, Bizkaia, Spain.
| | - J A Padierna
- Department of Psychiatry, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain.
| | - J Cabriada
- Digestive Service, Galdakao-Usansolo Hospital, Bilbao, Bizkaia, Spain.
| | - A Orive
- Digestive Service, Galdakao-Usansolo Hospital, Bilbao, Bizkaia, Spain.
| | - A Escobar
- Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Bizkaia, Spain.
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Bizkaia, Spain.
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Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther 2015; 41:844-55. [PMID: 25736234 DOI: 10.1111/apt.13145] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/18/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gut-focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided. AIM To review the effect of hypnotherapy in a large cohort of refractory IBS patients. METHODS One thousand IBS patients fulfilling Rome II criteria, mean age 51.6 years (range 17-91 years), 80% female, receiving 12 sessions of hypnotherapy over 3 months, were studied. The primary outcome was a 50 point reduction in the IBS Symptom Severity Score. The fall in scores for Noncolonic Symptoms, Quality of Life and Anxiety or Depression, were secondary outcomes. The Federal Drug Administration's recommended outcome of a 30% or more reduction in abdominal pain was also recorded. RESULTS Overall, 76% met the primary outcome which was higher in females (females: 80%, males: 62%, P < 0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010). The mean reduction in other scores was: IBS Symptom Severity Score, 129 points (P < 0.001), Noncolonic Symptom Score, 65 (P < 0.001) and Quality of Life Score, 66 (P < 0.001). Sixty-seven per cent reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patients with anxiety and depression fell from 63% to 34% and 25% to 12% respectively (P < 0.001). Outcome was unaffected by bowel habit subtype. CONCLUSION These results provide further evidence that gut-focused hypnotherapy is an effective intervention for refractory IBS.
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Affiliation(s)
- V Miller
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, UK
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Kinsinger SW, Ballou S, Keefer L. Snapshot of an integrated psychosocial gastroenterology service. World J Gastroenterol 2015; 21:1893-1899. [PMID: 25684957 PMCID: PMC4323468 DOI: 10.3748/wjg.v21.i6.1893] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/11/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize the patients utilizing a gastroenterology behavioral medicine service and examine the effect of treatment on health care utilization.
METHODS: Patients were referred by their gastroenterologists for psychological treatment during a 15 mo period. Patients seen for an intake with a psychologist completed the Brief Symptom Inventory (BSI) and a checklist of psychosocial concerns. A subset of patients with functional bowel disorders also completed a disease specific quality of life measure. Chart review was conducted to obtain information on type and frequency of sessions with the psychologist, the number of outpatient gastroenterology visits, and number of gastroenterology-related medical procedures during the 6 mo following psychological intake.
RESULTS: Of 259 patients referred for treatment, 118 (46%) completed an intake with a psychologist. Diagnoses included: irritable bowel syndrome (42%), functional dyspepsia (20%), inflammatory bowel diseases (20%), esophageal symptoms (10%), and “other” (8%). Demographic variables and disease type did not differentiate between those who did and did not schedule an intake. Mean t-scores for the BSI global score index and the depression, anxiety, and somatization subscales fell below the cutoff for clinical significance (t = 63). Treatments were predominantly gut-directed hypnosis (48%) and cognitive behavioral therapy (44%). Average length of treatment was 4 sessions. Among functional gastrointestinal (GI) patients, those patients who initiated treatment received significantly fewer GI-related medical procedures during the 6 mo following the referral than patients who did not schedule an intake [t (197) = 2.69, P < 0.01].
CONCLUSION: Patients are receptive to psychological interventions for GI conditions and there is preliminary evidence that treatment can decrease health-care utilization among patients with functional GI conditions.
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Abstract
INTRODUCTION Functional dyspepsia (FD) is a relatively common gastrointestinal clinical condition that remains poorly understood. Controversies remain regarding the definition, pathophysiology and optimum treatment. The current treatment of FD is limited and no established regimen is available. AREAS COVERED Recent advances have improved our understanding of the pathophysiology of the disease and have led to the development of newer tailored therapies. Novel agents such as the motilin receptor agonist camicinal and the muscarinic M1 and M2 receptor antagonist acotiamide appear promising; however, the need for a safe and efficacious treatment remains largely unmet. This review describes the currently available management options for FD and critically evaluates emerging therapies. EXPERT OPINION The optimal treatment for FD is yet to be determined. A proton pump inhibitor or a prokinetic agent constitutes primary treatment. Helicobacter pylori testing and eradication is recommended. Based on currently available data, acotiamide appears promising, particularly in postprandial distress syndrome. Further large-scale multicentered trials are required to define the duration of treatment and the side-effect profile.
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Affiliation(s)
- Alkesh V Zala
- John Hunter Hospital, Department of Gastroenterology, New Lambton Heights , Newcastle, NSW , Australia
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Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol 2015; 50:125-39. [PMID: 25586651 DOI: 10.1007/s00535-014-1022-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 02/06/2023]
Abstract
General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list "functional dyspepsia" as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.
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Yoshida M, Kinoshita Y, Watanabe M, Sugano K, Kato M, Joh T, Suzuki H, Tominaga K, Nakada K, Nagahara A, Futagami S, Manabe N, Inui A, Haruma K, Higuchi K, Yakabi K, Hongo M, Uemura N, Kinoshita Y, Sugano K, Shimosegawa T. JSGE Clinical Practice Guidelines 2014: standards, methods, and process of developing the guidelines. J Gastroenterol 2015; 50:4-10. [PMID: 25448314 DOI: 10.1007/s00535-014-1016-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/29/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Masahiro Yoshida
- Guidelines Committee for the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13 Ginza, Chuo, Tokyo, 104-0061, Japan,
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Stanghellini V, Cogliandro R. Review article: adherence to Rome criteria in therapeutic trials in functional dyspepsia. Aliment Pharmacol Ther 2014; 40:435-66. [PMID: 25056101 DOI: 10.1111/apt.12865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/26/2014] [Accepted: 06/19/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Rome criteria are currently required by health authorities for the inclusion of patients affected by functional dyspepsia in therapeutic trials. However, the degree of adherence to these criteria has not been formally verified. AIM To review adherence to the Rome criteria for inclusion criteria, outcome measures and endpoints in therapeutic trials on functional dyspepsia and the potential impact on the conclusions that can be drawn from these studies. METHODS A total of 1818 articles were screened. Fifty-eight trials claiming to include adults affected by functional dyspepsia as defined by the Rome criteria published as full articles in English between 2000 and 2013 were considered. RESULTS Lack of full adherence to the Rome criteria of inclusion criteria was found in 54% of the studies, due to inclusion of patients with symptoms not reported in the Rome criteria or definitions of dyspeptic symptom that varied from those proposed by the Rome criteria. Ninety-five per cent of clinical trials adopted therapeutic outcome measures that were not adherent to the Rome criteria, using questionnaires that did not include all dyspeptic symptoms or including symptoms other than those proposed by the Rome criteria. CONCLUSIONS Stringent criteria have not been adopted for inclusion criteria and outcome measures in the vast majority of published studies on functional dyspepsia that claim to have been carried out according to the Rome criteria. Appropriate questionnaires should be developed to promote adherence to internationally accepted definitions of the syndrome in future studies.
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Affiliation(s)
- V Stanghellini
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Bologna, Italy
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Yeh AM, Golianu B. Integrative Treatment of Reflux and Functional Dyspepsia in Children. CHILDREN (BASEL, SWITZERLAND) 2014; 1:119-33. [PMID: 27417471 PMCID: PMC4928719 DOI: 10.3390/children1020119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications-such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture.
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Affiliation(s)
- Ann Ming Yeh
- Department of Pediatrics, Stanford University, 750 Welch Road, Suite 116, Palo Alto, CA 94304, USA.
| | - Brenda Golianu
- Department of Anesthesiology, Stanford University, 300 Pasteur Dr. Stanford, CA 94304, USA.
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Abstract
Inflammatory bowel diseases (IBD) are chronic disorders of unknown aetiology which are characterized by episodes of exacerbations and remissions. There is evidence that perceived distress contributes to IBD symptom flares; anxiety and depression are frequently found in patients with the active disease. Because there is no cure, treatment has to focus on prevention of complications, induction/maintenance of remission and improvement of quality of life. Gut-directed hypnotherapy (GHT) has been used successfully in functional gastrointestinal disorders. Few experimental studies and case reports have been published for IBD; GHT increases the health-related quality of life and reduces symptoms. Additionally, GHT seems to have an immune-modulating effect and is able to augment clinical remission in patients with quiescent ulcerative colitis.
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Affiliation(s)
- Gabriele Moser
- Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien, Austria
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Pinto-Sanchez MI, Yuan Y, Bercik P, Moayyedi P. Proton pump inhibitors for functional dyspepsia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Enck P, Hefner J, Herbert BM, Mazurak N, Weimer K, Muth ER, Zipfel S, Martens U. Sensitivity and specificity of hypnosis effects on gastric myoelectrical activity. PLoS One 2013; 8:e83486. [PMID: 24358287 PMCID: PMC3865216 DOI: 10.1371/journal.pone.0083486] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 11/11/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation. DESIGN Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points. RESULTS Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions. CONCLUSION Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity.
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Affiliation(s)
- Paul Enck
- Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany
| | - Jochen Hefner
- Department of Internal Medicine II, University Hospital, Würzburg, Germany
| | - Beate M. Herbert
- Department of Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Nazar Mazurak
- Central Research Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Katja Weimer
- Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany
| | - Eric R. Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, United States of America
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany
| | - Ute Martens
- Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany
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69
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Keller J, Layer P. [Functional gastrointestinal diseases]. Internist (Berl) 2013; 54:1337-49. [PMID: 24154499 DOI: 10.1007/s00108-013-3379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most important functional gastrointestinal diseases (FGID), and both affect about 5-15 % of the German population. The patients' symptoms are caused by disturbances of gastrointestinal (GI) motility, secretion and sensitivity. Central processing of visceral afferences is disturbed, and the course of the disease and individual symptom perception are influenced by psychosocial factors. Diagnosis of FD and IBS is based on a compatible symptom pattern, absence of alarm symptoms and exclusion of relevant differential diagnoses. The diagnosis of FD requires a normal upper GI endoscopy. Current German guidelines also demand a normal colonoscopy for diagnosis of IBS. Basic therapeutic measures include explanation of the nature of the disease and its harmlessness quo ad vitam . Individual trigger factors should be identified and eliminated if possible. Drug therapy of persisting complaints is guided by the dominant symptom.
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Affiliation(s)
- J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Orchideenstieg 14, 22297, Hamburg, Deutschland,
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70
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Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther 2013; 38:761-71. [PMID: 23957526 PMCID: PMC4271841 DOI: 10.1111/apt.12449] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 06/20/2013] [Accepted: 07/19/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases. AIMS To determine the feasibility and acceptability of HYP and estimate the impact of HYP on clinical remission status over a 1-year period in patients with an historical flare rate of 1.3 times per year. METHODS A total of 54 patients were randomised at a single site to seven sessions of gut-directed HYP (n = 26) or attention control (CON; n = 29) and followed for 1 year. The primary outcome was the proportion of participants in each condition that had remained clinically asymptomatic (clinical remission) through 52 weeks post treatment. RESULTS One-way analysis of variance comparing HYP and CON subjects on number of days to clinical relapse favoured the HYP condition [F = 4.8 (1, 48), P = 0.03] by 78 days. Chi-squared analysis comparing the groups on proportion maintaining remission at 1 year was also significant [χ²(1) = 3.9, P = 0.04], with 68% of HYP and 40% of CON patients maintaining remission for 1 year. There were no significant differences between groups over time in quality of life, medication adherence, perceived stress or psychological factors. CONCLUSION This is the first prospective study that has demonstrated a significant effect of a psychological intervention on prolonging clinical remission in patients with quiescent ulcerative colitis (Clinical Trial # NCT00798642).
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Affiliation(s)
- Laurie Keefer
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL,Northwestern University, Center for Psychosocial Research in GI, Chicago, IL,Northwestern University, Feinberg School of Medicine, Division of Psychiatry and Behavioral Sciences Chicago, IL
| | - Tiffany H Taft
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL,Northwestern University, Center for Psychosocial Research in GI, Chicago, IL
| | - Jennifer L Kiebles
- Edward Hines, Jr. VA Hospital, Mental Health / Rehabilitation Services, Hines, IL
| | - Zoran Martinovich
- Northwestern University, Feinberg School of Medicine, Division of Psychiatry and Behavioral Sciences Chicago, IL
| | - Terrence A Barrett
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL
| | - Olafur S Palsson
- University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill, NC
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71
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Moshiree B, Barboza J, Talley N. An update on current pharmacotherapy options for dyspepsia. Expert Opin Pharmacother 2013; 14:1737-53. [DOI: 10.1517/14656566.2013.809063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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72
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Faramarzi M, Azadfallah P, Book HE, Tabatabaei KR, Taheri H, Shokri-shirvani J. A randomized controlled trial of brief psychoanalytic psychotherapy in patients with functional dyspepsia. Asian J Psychiatr 2013; 6:228-34. [PMID: 23642981 DOI: 10.1016/j.ajp.2012.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/23/2012] [Accepted: 12/29/2012] [Indexed: 12/12/2022]
Abstract
Functional dyspepsia (FD) is a common cause of upper gastrointestinal symptoms and discomfort. The present study aimed to assess the effectiveness of brief core conflictual relationship theme (CCRT) psychoanalytic psychotherapy on changing gastrointestinal symptoms, alexithymia, and defense mechanisms in patients with FD. In a randomized controlled trial study, 49 patients with FD were randomly assigned to medical treatment with brief psychodynamic therapy (24 subjects) or medical treatment alone (25 subjects). Gastrointestinal symptoms, defense mechanisms, and alexithymia were assessed before the trial, after treatment, and at 1- and 12-month follow-ups. The results showed that brief psychodynamic therapy improved all of the gastrointestinal symptoms, including heartburn, nausea, fullness, bloating, upper abdominal pain, and lower abdominal pain, after treatment and at two follow-ups. The CCRT therapy significantly improved many psychological symptoms, including mature defenses, neurotic defenses, immature defenses, difficulties in identifying feelings, difficulties in describing feelings, and total alexithymia score. In conclusion, brief psychodynamic therapy is a reliable method to improve gastrointestinal symptoms, mature defenses, and alexithymia scores in patients with functional dyspepsia.
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Affiliation(s)
- Mahbobeh Faramarzi
- Social Determinants of Health Research Center, Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
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73
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van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res 2013; 74:486-92. [PMID: 23731745 PMCID: PMC3673027 DOI: 10.1016/j.jpsychores.2013.03.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/07/2013] [Accepted: 03/13/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is evidence that psychological factors affect the onset, severity and duration of irritable bowel syndrome (IBS). However, it is not clear which psychological factors are the most important and how they interact. The aims of the current study are to identify the most important psychological factors predicting IBS symptom severity and to investigate how these psychological variables are related to each other. METHODS Study participants were 286 IBS patients who completed a battery of psychological questionnaires including neuroticism, abuse history, life events, anxiety, somatization and catastrophizing. IBS severity measured by the IBS Severity Scale was the dependent variable. Path analysis was performed to determine the associations among the psychological variables, and IBS severity. RESULTS Although the hypothesized model showed adequate fit, post hoc model modifications were performed to increase prediction. The final model was significant (Chi(2)=2.2; p=0.82; RMSEA<.05) predicting 36% of variance in IBS severity. Catastrophizing (standardized coefficient (β)=0.33; p<.001) and somatization (β=0.20; p<.001) were the only two psychological variables directly associated with IBS severity. Anxiety had an indirect effect on IBS symptoms through catastrophizing (β=0.80; p<.001); as well as somatization (β=0.37; p<.001). Anxiety, in turn, was predicted by neuroticism (β=0.66; p<.001) and stressful life events (β=0.31; p<.001). CONCLUSION While cause-and-effect cannot be determined from these cross-sectional data, the outcomes suggest that the most fruitful approach to curb negative effects of psychological factors on IBS is to reduce catastrophizing and somatization.
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Abstract
Functional dyspepsia refers to painful and nonpainful symptoms that are perceived to arise in the upper digestive tract but are not secondary to organic, systemic or metabolic diseases. The symptoms of this syndrome often overlap with those of GERD and IBS, making its management far from simple. If Helicobacter pylori infection is diagnosed in patients with functional dyspepsia, it should be treated. In patients with mild or intermittent symptoms, reassurance and lifestyle advice might be sufficient; in patients not responding to these measures, or in those with more severe symptoms, drug therapy should be considered. Both PPIs and prokinetics can be used in initial empirical pharmacotherapy based on symptom patterns--a PPI is more likely to be effective in the presence of retrosternal or epigastric burning or epigastric pain, whereas a prokinetic is more effective in dyspepsia with early satiation or postprandial fullness. Although combinations of PPIs and prokinetics might have additive symptomatic effects, single-drug therapy is initially preferable. Antidepressants or referral to a psychiatrist or psychotherapist can be considered in nonresponders and in those whose symptoms have a marked effect on daily functioning. Despite extensive research, functional dyspepsia treatment often remains unsatisfactory. Better characterization of dyspeptic subgroups and understanding of underlying mechanisms will enable treatment advances to be made in the future.
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75
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Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol 2013; 11:208-16; quiz e22-3. [PMID: 23103907 PMCID: PMC3591464 DOI: 10.1016/j.cgh.2012.10.031] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/09/2012] [Accepted: 10/10/2012] [Indexed: 12/12/2022]
Abstract
The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve functional gastrointestinal disorder patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3-6 months of medical care and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, which are based on multiple randomized controlled trials, include cognitive behavioral therapy and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain, cognitive behavioral therapy for functional chest pain, and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of and communication with an appropriate psychological services provider.
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Affiliation(s)
- Olafur S Palsson
- Center for Functional Gastrointestinal and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA
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76
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Abstract
In this Review, after a brief historical introduction, we first provide an overview of epidemiological studies that demonstrate an association between functional dyspepsia and psychological traits, states or psychiatric disorders. These studies suggest an important intrinsic role for psychosocial factors and psychiatric disorders, especially anxiety and depression, in the aetiopathogenesis of functional dyspepsia, in addition to their putative influence on health-care-seeking behaviour. Second, we describe pathophysiological evidence on how psychosocial factors and psychiatric disorders might exert their role in functional dyspepsia. Novel insights from functional brain imaging studies regarding the integration of gut-brain signals, processed in homeostatic-interoceptive brain regions, with input from the exteroceptive system, the reward system and affective and cognitive circuits, help to clarify the important role of psychological processes and psychiatric morbidity. We therefore propose an integrated model of functional dyspepsia as a disorder of gut-brain signalling, supporting a biopsychosocial approach to the diagnosis and management of this disorder.
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77
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Gerson CD, Gerson J, Gerson MJ. Group hypnotherapy for irritable bowel syndrome with long-term follow-up. Int J Clin Exp Hypn 2013; 61:38-54. [PMID: 23153384 DOI: 10.1080/00207144.2012.700620] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind-Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p < .001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.
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78
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Miwa H. Why dyspepsia can occur without organic disease: pathogenesis and management of functional dyspepsia. J Gastroenterol 2012; 47:862-71. [PMID: 22766746 DOI: 10.1007/s00535-012-0625-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 02/04/2023]
Abstract
Functional dyspepsia (FD), one of the most common conditions in medicine, is a gastrointestinal disorder in which the patient suffers from chronic dyspeptic symptoms such as epigastralgia and a heavy feeling in the stomach despite the absence of organic disease. Elucidating the pathogenesis of FD means answering the question, "Why do symptoms occur?" The factors contributing to symptom manifestation in FD probably should be divided into 3 categories: (1) physiological abnormalities that directly induce symptoms, (2) factors that modify those physiological abnormalities, and (3) factors that govern abnormal responses to stress. The symptoms of FD are directly caused by two major physiological abnormalities-abnormal gastric motility and visceral hypersensitivity-occurring in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle. If the basis of this model of FD pathogenesis is excessive responsiveness of gastrointestinal function to stress and external stimuli, psychosomatic approaches to alter stress perception could be important treatment options. However, in the primary care setting, the treatment of FD has focused on local gastric factors, including abnormal gastric acid secretion, abnormal gastric motility, and H. pylori infection. Acid secretion inhibitors and prokinetics have been commonly used, and H. pylori eradication therapy has been carried out, but the effectiveness of drug therapy has been limited.
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Affiliation(s)
- Hiroto Miwa
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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79
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Lacy BE, Talley NJ, Locke GR, Bouras EP, DiBaise JK, El-Serag HB, Abraham BP, Howden CW, Moayyedi P, Prather C. Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther 2012; 36:3-15. [PMID: 22591037 PMCID: PMC3970847 DOI: 10.1111/j.1365-2036.2012.05128.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/26/2012] [Accepted: 04/21/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89-90%), postprandial fullness (75-88%), and early satiety (50-82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive. AIM To present current management options for the treatment of FD (therapeutic gain/response rate noted when available). RESULTS The utility of Helicobacter pylori eradication for the treatment of FD is modest (6-14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7-10% therapeutic gain), histamine-type-2-receptor antagonists (8-35% therapeutic gain), prokinetic agents (18-45%), tricyclic antidepressants (TCA) (response rates of 64-70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies. CONCLUSIONS A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an anti-nociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.
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Affiliation(s)
- B E Lacy
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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80
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Reinhard J, Hayes-Gill BR, Schiermeier S, Hatzmann W, Heinrich TM, Hüsken-Janßen H, Herrmann E, Louwen F. Change of Spectral Analysis of Fetal Heart Rate During Clinical Hypnosis: a Prospective Randomised Trial from the 20th Week of Gestation Till Term. Geburtshilfe Frauenheilkd 2012; 72:316-321. [PMID: 25284838 DOI: 10.1055/s-0031-1298399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/31/2012] [Accepted: 02/28/2012] [Indexed: 01/13/2023] Open
Abstract
Objective: To investigate the functional adaptive process of the fetal autonomic nervous system during hypnosis from the 20th week of gestation till term. Are there changes in the power spectrum analysis of fetal heart rate when the mother is having a clinical hypnosis or control period? Study Design: Fourty-nine FHR recordings were analysed. Included recordings were from singletons and abdominal fetal ECG-monitored pregnancies. All women were randomised to receive clinical hypnosis followed by a period with no intervention or vice versa. Statistical analyses were performed with the Wilcoxon signed ranks and Spearman rho correlation tests. Results: There was a significant difference found between fetal heart rate at baseline (144.3 ± 6.0) and hypnosis (142.1 ± 6.4). A difference was also detected between the standard deviation of the heart rate between baseline (6.7 ± 1.9) and hypnosis (6.8 ± 3.5). LFnu was smaller during baseline (80.2 ± 5.3) than during hypnosis (82.1 ± 5.7), whereas HFnu was significantly larger (19.8 ± 5.3 vs. 17.9 ± 5.7). There was no correlation between the gestation age and the change in LFnu, HFnu or ratio LF/HF due to the hypnosis intervention. Conclusion: The functional adaptive process of the fetal autonomic system during hypnosis is reflected by a sympathovagal shift towards increased sympathetic modulation.
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Affiliation(s)
- J Reinhard
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt
| | - B R Hayes-Gill
- School of Electrical and Electronic Engineering, University of Nottingham, Nottingham, United Kingdom
| | - S Schiermeier
- Obstetrics and Gynaecology, Teaching Hospital of the Ruhr-University Bochum, Witten
| | - W Hatzmann
- Obstetrics and Gynaecology, Teaching Hospital of the Ruhr-University Bochum, Witten
| | - T M Heinrich
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt
| | - H Hüsken-Janßen
- Deutsche Gesellschaft für Hypnose und Hypnotherapie, German Society for Clinical Hypnosis, Coesfeld
| | - E Herrmann
- Department of Biostatistics and Mathematical Models, Johann Wolfgang Goethe University Frankfurt am Main, Frankfurt
| | - F Louwen
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt
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Abstract
'Behavioural medicine' is poised to contribute to the quality of health to the benefit of patients and physicians. There is a need for medical students and residents to better understand the field of behavioural medicine, and for practising physicians to incorporate it in medical education and clinical practice. This paper seeks to correct an erroneous conceptualization of behavioural medicine as being limited to psychosocial and mental health adjustments, and to provide examples of selected applications for medical conditions, including those that are not primarily regarded as requiring changes in lifestyle or psychotherapy. In fact, there are dramatic treatment and intervention protocols available that employ behavioural procedures that can provide relief for patients in all medical and dental specialties and that deserve to be considered along with conventional treatment protocols.
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82
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Kandulski A, Venerito M, Malfertheiner P. Therapeutic strategies for the treatment of dyspepsia. Expert Opin Pharmacother 2011; 11:2517-25. [PMID: 20726822 DOI: 10.1517/14656566.2010.501794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE OF THE FIELD Dyspeptic symptoms are highly prevalent in the population and represent a major burden for healthcare systems. The ROME III criteria address and define two separate entities of functional dyspepsia: epigastric pain syndrome and postprandial distress syndrome. The etiology of dyspeptic symptoms is heterogeneous, underlying mechanisms are poorly understood and symptomatic improvement after drug therapy is often incomplete. AREAS COVERED IN THIS REVIEW This review of the literature included Medline data being published in the field of functional dyspepsia and different therapies. WHAT THE READER WILL GAIN The reader will gain a current, unbiased understanding of the pathophysiological mechanisms underlying functional dyspepsia and of the therapeutic regimens based on randomized, controlled trials and on the meta-analyses that have been published on different therapeutic agents. TAKE HOME MESSAGE Before starting medical treatment, a careful physical examination should exclude 'alarm symptoms'. Laboratory data, ultrasound and endoscopy are recommended in patients older than 45 - 55 years (depending on the guidelines being used). In areas with a high prevalence of Helicobacter pylori, the initial strategy includes 'test and treat' for H. pylori in addition to empiric acid suppressive therapy. Many studies have focused on the role of gastrointestinal dysmotility and hypersensitivity for dyspepsia with inconclusive results. Further therapeutic medical strategies include prokinetics, herbal preparations and psycho-/neurotopic drugs as well as additional psycho- or hypnotherapy.
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Affiliation(s)
- Arne Kandulski
- Otto-von-Guericke University Magdeburg, Department of Gastroenterology, Hepatology and Infectious Diseases, Germany
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83
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Jee SR, Jung HK, Min BH, Choi KD, Rhee PL, Kang YW, Lee SI. [Guidelines for the treatment of functional dyspepsia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:67-81. [PMID: 21350319 DOI: 10.4166/kjg.2011.57.2.67] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.
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Affiliation(s)
- Sam Ryong Jee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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84
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Grover M, Drossman DA. Centrally acting therapies for irritable bowel syndrome. Gastroenterol Clin North Am 2011; 40:183-206. [PMID: 21333907 DOI: 10.1016/j.gtc.2010.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders typically defy traditional diagnostic methods based on structural abnormalities, and has led to the emergence of the discipline of neurogastroenterology or the study of the "brain-gut axis," which is based on dysregulation of neuroenteric pathways as a key pathophysiological feature of IBS. Centrally acting treatments can influence these pathways and improve the clinical manifestations of pain and bowel dysfunction associated with this disorder. To successfully implement these treatment strategies, it is important to recognize their dual effects on brain and gut, understanding the nature and severity of the GI symptoms and their psychosocial concomitants, and applying them within the context of the patient's understanding of their value.
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Affiliation(s)
- Madhusudan Grover
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Soo S, Moayyedi P, Deeks JJ, Delaney B, Lewis M, Forman D. WITHDRAWN: Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2011; 2011:CD002301. [PMID: 21328255 PMCID: PMC6885039 DOI: 10.1002/14651858.cd002301.pub5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Studies have also shown that non-ulcer dyspepsia (NUD) patients have higher scores of anxiety, depression, neurotism, chronic tension, hostility, hypochondriasis and tendency to be more pessimistic when compared with the community controls. However, the role of psychological interventions in NUD remains uncertain. OBJECTIVES This review aims to determine the effectiveness of psychological interventions including psychotherapy, psychodrama, cognitive behavioural therapy, relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores in patients with NUD. SEARCH STRATEGY Trials were identified by searching the Cochrane Controlled Trials Register (Issue 3-1999), MEDLINE (1966-99), EMBASE (1988-99), PsycLIT (1987-1999) and CINAHL (1982-99). Bibliographies of retrieved articles were also searched and experts in the field were contacted. Searches were updated on 10 December 2002 and 21 January 2004. The searches were re-run on 24 January 2005 and 9 January 2006 and no new trials were found SELECTION CRITERIA All randomised controlled trials (RCTs) or quasi-randomised studies assessing the effectiveness of psychological interventions (including psychotherapy, psychodrama, cognitive behavioural therapy, relaxation therapy and hypnosis) for non-ulcer dyspepsia (NUD) were identified. DATA COLLECTION AND ANALYSIS Data collected included both individual and global dyspepsia symptom scores and quality of life (QoL) scores. MAIN RESULTS We identified only four trials each using different psychological interventions; three presented results in a manner that did not allow synthesis of the data to form a meta-analysis. All trials suggested that psychological interventions benefit dyspepsia symptoms and this effect persists for one year. However, all trials used statistical techniques that adjusted for baseline differences between groups. This should not be necessary for a randomised trial that is adequately powered suggesting that the sample size was too small. Unadjusted data was not statistically significant. The other problems of psychological intervention included low recruitment and high drop out rate, which has been shown to be greater in patients receiving group therapy. AUTHORS' CONCLUSIONS There is insufficient evidence from this review to confirm the efficacy of psychological intervention in NUD.
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Affiliation(s)
- Shelly Soo
- South Tyneside District HosiptalDepartment of Medicine/GastroenterologyHarton LaneSouth ShieldsUKNE34 0PL
| | - Paul Moayyedi
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1200 Main Street WestRoom 4W8EHamiltonOntarioCanadaL8N 3Z5
| | - Jonathan J Deeks
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Brendan Delaney
- King's College LondonDivision of Health and Social Care Research7th Floor Capital House42 Weston StreetLondonUKSE1 3QD
| | - Maxine Lewis
- St Joseph's HospitalDepartment of PsychiatryHamiltonOntarioCanada
| | - David Forman
- International Agency for Research on Cancer150 cours Albert‐ThomasLyonFrance69372
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86
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Hsu WY, Huang SS, Chiu NY. Escitalopram for psychogenic nausea and vomiting: a report of two cases. J Formos Med Assoc 2011; 110:62-6. [PMID: 21316015 DOI: 10.1016/s0929-6646(11)60010-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 08/27/2008] [Accepted: 10/22/2008] [Indexed: 01/13/2023] Open
Abstract
Psychogenic nausea and vomiting is defined as vomiting without any obvious organic pathology or vomiting with a psychological etiology. The treatment for such a condition is a challenge in clinical practice. The first patient was a 46-year-old married factory worker who was repeatedly hospitalized for recurring bouts of nausea and vomiting. After consultation, she was diagnosed with major depressive disorder. The frequency of nausea and vomiting decreased after treatment with daily doses of 10-20 mg escitalopram. The second patient was a 37-year-old married teacher who had bouts of nausea and vomiting and was also hospitalized repeatedly. She was diagnosed with mixed anxiety-depressive disorder. After treatment with 10 mg/day escitalopram, her episodes of nausea and vomiting decreased. Escitalopram may be an effective treatment for psychogenic nausea and vomiting associated with depression.
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Affiliation(s)
- Wen-Yu Hsu
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, Changhua, Taiwan
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87
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Marc I, Pelland-Marcotte MC, Ernst E. Do standards for the design and reporting of nonpharmacological trials facilitate hypnotherapy studies? Int J Clin Exp Hypn 2011; 59:64-81. [PMID: 21104485 DOI: 10.1080/00207144.2011.522896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The design and quality of 30 recent hypnotherapy trials (years 2000-2008) were assessed using the checklist for evaluating a report of nonpharmacological treatment (CLEAR NPT). Randomization was adequately reported in 53% of studies. The masking of participants and care providers is not feasible in hypnotherapy studies. Assessor masking is rarely introduced in randomized, controlled trials (27%). Reporting and quality of published hypnotherapy trials need to be improved. Investigators may consider using CLEAR NPT to evaluate study quality but attention should be paid to document intervention adherence, standardization of cointerventions, participant and care-provider expectations and beliefs, and, finally, hypnotizability.
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Affiliation(s)
- Isabelle Marc
- Centre de recherche, CHUQ, Laval University, Québec City, Canada.
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88
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Abstract
The paper by Xiao et al. in this issue of American Journal of Gastroenterology reports that patients with functional dyspepsia (FD) complaining of epigastric burning have a higher probability to present abnormal gastroesophageal acid reflux, as well as response to proton pump inhibitor therapy than those complaining of epigastric pain, bothersome postprandial fullness, or early satiety. No differences in the above parameters were detected when comparing patients with epigastric pain syndrome and postprandial distress syndrome, as proposed by the Rome III classification of FD. If confirmed, these results contribute to clarify the relationship between FD and gastroesophageal reflux disease and, at the same time, highlight the importance of analyzing individual symptoms rather than clusters of symptoms, when managing patients complaining of upper gastrointestinal symptoms.
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89
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Miwa H, Kondo T, Oshima T, Fukui H, Tomita T, Watari J. Esophageal sensation and esophageal hypersensitivity - overview from bench to bedside. J Neurogastroenterol Motil 2010; 16:353-62. [PMID: 21103417 PMCID: PMC2978388 DOI: 10.5056/jnm.2010.16.4.353] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/13/2010] [Accepted: 08/19/2010] [Indexed: 12/19/2022] Open
Abstract
Noxious stimuli in the esophagus activate nociceptive receptors on esophageal mucosa, such as transient receptor potential, acid-sensing ion channel and the P2X family, a family of ligand-gated ion channels responsive to ATP, and this generates signals that are transmitted to the central nervous system via either spinal nerves or vagal nerves, resulting in esophageal sensation. Among the noxious stimuli, gastric acid and other gastric contents are clinically most important, causing typical reflux symptoms such as heartburn and regurgitation. A conventional acid penetration theory has been used to explain the mechanism of heartburn, but much recent evidence does not support this theory. Therefore, it may be necessary to approach the causes of heartburn symptoms from a new conceptual framework. Hypersensitivity of the esophagus, like that of other visceral organs, includes peripheral, central and probably psychosocial factor-mediated hypersensitivity, and is known to play crucial roles in the pathoegenesis of nonerosive reflux disease, functional heartburn and non-cardiac chest pain. There also are esophagitis patients who do not perceive typical symptoms. This condition is known as silent gastroesophageal reflux disease. Although the pathogenesis of silent gastroesophageal reflux disease is still not known, hyposensitivity to reflux of acid may possibly explain the condition.
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Affiliation(s)
- Hiroto Miwa
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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90
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Kiebles JL, Kwiatek MA, Pandolfino JE, Kahrilas PJ, Keefer L. Do patients with globus sensation respond to hypnotically assisted relaxation therapy? A case series report. Dis Esophagus 2010; 23:545-53. [PMID: 20459447 DOI: 10.1111/j.1442-2050.2010.01064.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Globus sensation is a bothersome and difficult symptom to treat. The aims of this study were to evaluate the acceptability and utility of hypnotically-assisted relaxation (HAR) in decreasing the perception of globus sensation and the effect of HAR on interdeglutitive upper esophageal sphincter (UES) pressure. Sixteen subjects with persistent globus sensation unresponsive to therapy for reflux disease and with normal esophageal/laryngeal imaging studies were invited to participate in a 7-session clinical protocol. Before and after HAR, subjects completed standard questionnaires including the esophageal symptoms questionnaire. High-resolution manometric assessment of respiratory augmentation and average resting UES pressure were assessed before and after HAR. Ten of the 16 subjects agreed to participate in the protocol. All participants were women with median age 51.5 (range 30-72 years). The participants found HAR acceptable and completed the entire 7-session trial. Globus symptom severity varied widely pre-treatment (median=52.5, range 16-72), and 9 of 10 subjects reported a reduction in globus symptomatology following treatment (median=14.0, range 3-19; P=.007). Only 1 subject exhibited abnormal respiratory augmentation of UES pressure (>27 mm Hg) prior to treatment and was normal following treatment (9.9 mm Hg). Resting UES pressure was normal in all subjects (<118 mm Hg). Group respiratory augmentation and average resting UES pressure were unaffected by HAR (P=.48, .89). This case series suggests that HAR can provide a substantial improvement in globus sensation irrespective of cause. UES function was unaffected. We suggest that HAR therapy is an acceptable and useful intervention for patients with globus sensation.
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Affiliation(s)
- J L Kiebles
- Center for Psychosocial Research in GI, and Esophageal Disorders Research Center, Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL, USA
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91
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Ford AC, Marwaha A, Lim A, Moayyedi P. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8:401-9. [PMID: 19631762 DOI: 10.1016/j.cgh.2009.07.020] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 07/07/2009] [Accepted: 07/11/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Dyspepsia and irritable bowel syndrome (IBS) are common conditions that can coexist in patients. We performed a systematic review and meta-analysis to estimate prevalence of IBS in dyspepsia. METHODS Relevant articles published through August 2008 were identified from MEDLINE and EMBASE literature searches (23,457 citations). Eligible studies included adults recruited from the community, the workplace, blood donation or screening clinics, and family physician offices or internal medicine clinics. Selected studies reported prevalence of dyspepsia and IBS within the same population. The prevalence of IBS in subjects with and without dyspepsia was pooled for all studies and compared. Odds ratios (OR) and confidence intervals (CI) were calculated. The degree of overlap between dyspepsia and IBS was determined. RESULTS Of 239 papers evaluated, 150 reported prevalence of dyspepsia and 19 (involving 18,173 subjects) reported the proportion of subjects with IBS within the same population. The prevalence of dyspepsia was 27% (95% CI, 23%-31%). The prevalence of IBS in subjects with dyspepsia was 37% (95% CI, 30%-45%) compared with 7% (95% CI, 5%-10%) in those without. The pooled OR for IBS in subjects with dyspepsia was 8 (95% CI, 5.74-11.16). The degree of overlap between the 2 conditions varied from 15% to 42%, depending on diagnostic criteria used for each. CONCLUSIONS Individuals with dyspepsia have an 8-fold increase in prevalence of IBS compared with the population. The strength of the association suggests common pathogenic mechanisms. Dyspeptic patients should be assessed routinely for IBS.
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Affiliation(s)
- Alexander C Ford
- Gastroenterology Division, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
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92
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Abstract
Dyspepsia is a common term used for a heterogeneous group of abdominal symptoms. Functional dyspepsia (FD) is the focus of this review. The 2006 Rome III criteria defined FD and its subgroups, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). FD is a very common condition with a high prevalence throughout the world, adversely affecting the quality of life of patients. The pathophysiology of FD has been under investigation during the past two decades. Multiple mechanisms such as abnormal gastric emptying, visceral hypersensitivity, impaired gastric accommodation, and central nervous system factors are likely involved. Several tests are available for the assessment of various physiologic functions possibly involved in the pathogenesis of FD, and some of these could be used in clinical practice, helping to understand the abnormalities underlining patients' complaints. Currently, the possibilities of pharmacological therapy for FD are still limited, however, experience of using prokinetics, tricyclic antidepressants, selective serotonin-reuptake inhibitors (SSRIs), proton-pump inhibitors (PPIs), and several alternative techniques has been accumulated. The different combinations of alterations in physiologic gastrointestinal and central nervous system functions result in the very heterogeneous nature of FD so combined approaches to these patients could be beneficial in challenging cases.
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93
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Affiliation(s)
- Nicholas J Talley
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32082, USA
| | - Linda Herrick
- School of Nursing, University Of Minnesota, 300 University Square, 111 South Broadway, Rochester, MN 55904, USA; Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - G Richard Locke
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
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Goodhand JR, Wahed M, Rampton DS. Management of stress in inflammatory bowel disease: a therapeutic option? Expert Rev Gastroenterol Hepatol 2009; 3:661-79. [PMID: 19929586 DOI: 10.1586/egh.09.55] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is increasing evidence that psychological stress and associated mood disorders are linked with, and can adversely affect the course of, inflammatory bowel disease (IBD). Unfortunately, owing to methodological difficulties inherent in undertaking appropriately targeted and blinded trials, there are limited high-quality data regarding the effects on IBD of interventions aimed to ameliorate stress and mood disorders. Nevertheless, patients want psychological intervention as well as conventional medical strategies. Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there are no strong data as of yet to indicate that stress management has a beneficial effect on the activity or course of IBD. As yet, which, when and how interventions targeted at psychological stress and mood disturbances should be offered to individual patients with IBD is not clear.
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Affiliation(s)
- James R Goodhand
- Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
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95
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Is there a role for lifestyle education in the management of gastro-oesophageal reflux disease? Eur J Gastroenterol Hepatol 2009; 21:1229-40. [PMID: 19839082 DOI: 10.1097/meg.0b013e32832a7d87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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96
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Talley NJ, Choung RS. Whither dyspepsia? A historical perspective of functional dyspepsia, and concepts of pathogenesis and therapy in 2009. J Gastroenterol Hepatol 2009; 24 Suppl 3:S20-8. [PMID: 19799694 DOI: 10.1111/j.1440-1746.2009.06067.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Functional dyspepsia is a highly prevalent but heterogeneous disorder; multiple pathogenetic mechanisms are likely involved but the underlying causal pathways in functional dyspepsia remain obscure. The term functional dyspepsia was popularized by the famed Walter Alvarez at the Mayo Clinic early last century. Prominent Australian gastroenterologists who have contributed to our understanding of functional dyspepsia include Peter Baume, Barry Marshall, Douglas Piper, Nick Talley, John Kellow, and Gerald Holtmann. Specific dyspeptic symptoms have not generally correlated very well with any particular physiologic disturbance, although gastric disaccommodation and duodenal eosinophilia have been linked to early satiety in this condition. Genetic markers have been tentatively identified, and functional dyspepsia can follow bacterial gastroenteritis. No objective diagnostic tools for functional dyspepsia are currently agreed upon, although meal induction of symptoms appears reproducible and may have diagnostic utility. The symptomatic criteria for functional dyspepsia (Rome III criteria) are based on expert consensus and the exclusion of organic causes. Various therapeutic modalities for functional dyspepsia have been explored; however, empirical approaches are still employed for the treatment of functional dyspepsia. Better approaches for functional dyspepsia are likely to follow an improved understanding of the underlying pathophysiological abnormalities.
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97
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Abstract
Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.
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Affiliation(s)
- Vivien Miller
- University of Manchester, Manchester, United Kingdom
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98
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Ammoury RF, Pfefferkorn MDR, Croffie JM. Functional gastrointestinal disorders: past and present. World J Pediatr 2009; 5:103-12. [PMID: 19718531 DOI: 10.1007/s12519-009-0021-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 02/03/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic abdominal pain is a common complaint in childhood and adolescence. Despite decades of clinical observations and research, it still poses a challenge to pediatric health care professionals. The aim of this review is to highlight the epidemiology of pediatric chronic abdominal pain and to describe the pathogenesis of this disorder, its clinical manifestations, evaluation and therapeutic options. DATA SOURCES Articles on chronic abdominal pain in the recent years from PubMed, MEDLINE, and reference textbooks were reviewed. RESULTS Chronic abdominal pain, a functional gastrointestinal disorder (FGID), is a multifactorial condition that results from a complex interaction between psychosocial and physiologic factors via the brain-gut axis. A thorough history coupled with a complete physical examination and normal screening studies rule out an organic cause in 95% of the cases. It is highly important for the physician to establish a trusting relationship with the child and parents because successful treatment including modification of physical and psychological stress factors, dietary changes, and drug therapy depends greatly on education, reassurance and active psychological support. CONCLUSIONS FGIDs are a cause of great anxiety, distress and morbidity in children as well as adults. As our understanding of these conditions improves, our therapeutic interventions will progress not only to overcome them but also to intervene early in the disease course so as to limit long-term impact.
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Affiliation(s)
- Rana Fayez Ammoury
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine, Indianapolis, IN, USA.
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99
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Carruthers HR, Miller V, Morris J, Evans R, Tarrier N, Whorwell PJ. Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy. Int J Clin Exp Hypn 2009; 57:162-73. [PMID: 19234964 DOI: 10.1080/00207140802665401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A medical artist asked 109 patients if they had an image of their IBS pre- and posthypnotherapy, making precise watercolor paintings of any images described. Results were related to treatment outcome, symptoms, anxiety, depression, and absorption (hypnotizability); 49% of patients had an image, and a wide variety were recorded and painted. Imagery was significantly associated with gender (p < .05), anxiety (p < .05), noncolonic symptomatology (p < .05), and absorption (p = .001); 57.8% of responders compared with 35.5% of nonresponders to hypnotherapy had an image of their disease (p < .05) before treatment, and color images were associated with better outcomes (p = .05) than monochrome ones. All images changed in responders, often becoming more nonspecific in nature. Inquiring about IBS imagery helps to identify potential responders and nonresponders to hypnotherapy and may also provide insights into how patients think about their illness.
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100
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Miwa H, Oshima T, Sakurai J, Tomita T, Matsumoto T, Iizuka S, Koseki J. Experimental oesophagitis in the rat is associated with decreased voluntary movement. Neurogastroenterol Motil 2009; 21:296-303. [PMID: 19126182 DOI: 10.1111/j.1365-2982.2008.01221.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Growing interest has arisen regarding the mechanism of dyspeptic symptom generation. However, no evaluation system of these symptoms in animals has been developed. In this study, we examined whether voluntary movement of rats could be a measure to assess visceral symptoms of reflux oesophagitis. A chronic acid reflux oesophagitis model was made using rats, and the size of erosions was measured. Omeprazole was administered to the oesophagitis rats for 10 days. The amount of voluntary movement was measured by an infrared sensor. Intracellular spaces in oesophageal epithelium were also measured using a emission electron microscope. NP-40 soluble and insoluble fractions of claudins were examined by Western blot. Voluntary movement was significantly lower in the oesophagitis model rats than in the sham-operated rats (P < 0.01). Although omeprazole reduced the size of erosions, it did not significantly affect the total amount of voluntary movement (r = -0.033, P = 0.916). Intracellular spaces were significantly dilated in the oesophagitis model rats and claudin-3 showed a significantly lower relative quantity in the NP-40 insoluble fraction. Omeprazole significantly increased voluntary movement of oesophagitis model rats and the relative quantity of claudin-3 in the insoluble fraction (P < 0.05). Dilated intercellular spaces and the lower level of claudin-3 may relate to the voluntary movement of oesophagitis model rats. Decreases in voluntary movement of oesophagitis model rats may reflect visceral symptoms and be able to serve as an index of chronic abdominal symptoms.
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Affiliation(s)
- H Miwa
- Division of Upper Gastroenteroelogy, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
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