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Kristensen MS, Kjærulff TM, Ersbøll AK, Green A, Hallas J, Thygesen LC. The Influence of Antidepressants on the Disease Course Among Patients With Crohn's Disease and Ulcerative Colitis-A Danish Nationwide Register-Based Cohort Study. Inflamm Bowel Dis 2019; 25:886-893. [PMID: 30551218 PMCID: PMC6458526 DOI: 10.1093/ibd/izy367] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psychiatric comorbidity might modify the disease course adversely in patients with inflammatory bowel disease (IBD). Treatment options include antidepressants, which, apart from improving mood, have anti-inflammatory properties that might modify the disease course. This nationwide study aimed to examine the influence of antidepressants on the disease course among patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS Patients registered with an incident diagnosis of CD or UC in the Danish National Patient Register (2000-2017) were included. Information on antidepressant use and proxy measures of disease activity (health care and drug utilization) was extracted from national population registers. Poisson regression was performed to estimate disease activity rates by antidepressant use adjusted for confounders. Furthermore, the analyses were performed stratified by IBD subtype and type of antidepressants. RESULTS A total of 42,890 patients were included (UC: 69.5%; CD: 30.5%). When adjusted for confounders, a lower incidence rate of disease activity was found among antidepressant users compared with nonusers in both CD (incidence rate ratio [IRR], 0.75; 95% confidence interval [CI], 0.68-0.82) and UC (IRR, 0.90; 95% CI, 0.84-0.95) patients. Further, markedly lower rates of disease activity were found among CD (IRR, 0.51; 95% CI, 0.43-0.62) and UC (IRR, 0.67; 95% CI, 0.59-0.75) patients with no use of antidepressants before IBD onset. CONCLUSIONS In this nationwide study, antidepressant use was found to be beneficial on the disease course among patients with UC and CD, particularly in patients with no use of antidepressants before IBD onset. Randomized controlled trials are warranted to investigate the potential of antidepressants being an adjunct treatment to conventional IBD therapy.
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Affiliation(s)
- Marie Skov Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Address correspondence to: Marie Skov Kristensen, MSc, RN, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 2nd floor, 1455 Copenhagen K, Denmark ()
| | - Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anders Green
- OPEN (Odense Patient data Explorative Network), Odense University Hospital/University of Southern Denmark, Odense, Denmark
- Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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102
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Kilgallon E, Vasant DH, Green D, Shields PL, Hamdy S, Lal S, Paine P. Chronic continuous abdominal pain: evaluation of diagnostic features, iatrogenesis and drug treatments in a cohort of 103 patients. Aliment Pharmacol Ther 2019; 49:1282-1292. [PMID: 30950110 DOI: 10.1111/apt.15241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/23/2018] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic continuous abdominal pain (CCAP) is characteristic of centrally mediated gastrointestinal pain disorders. It consumes significant healthcare resources yet is poorly understood, with minimal cohort-specific data in the literature. AIMS To examine in a large cohort of CCAP patients, (a) diagnostic features, (b) iatrogenic impact of opioids and surgery, (c) drug treatment effects and tolerance. METHODS Consecutive tertiary CCAP referrals to a neurogastroenterology clinic (2009-2016) were reviewed for Rome IV and neuropathic pain criteria. Medical, surgical and drug histories, interventions and outcomes were correlated with clinical diagnosis and associated opioid use. RESULTS Of 103 CCAP patients (mean age 40 ± 14, 85% female), 50% had physiological exacerbations precluding full Rome IV Centrally Mediated Abdominal Pain Syndrome criteria. However, there were no significant differences between patients who satisfied Rome IV criteria and those who did not. Overall, 81% had allodynia (a nonpainful stimulus evoking pain sensation). Opioid use was associated with allodynia (P = 0.003). Prior surgery was associated with further operations post CCAP onset (P < 0.001). Although 68% had undergone surgical interventions, surgery did not resolve pain in any patient and worsened pain in 35%. Whilst duloxetine was the most effective neuromodulator (P = 0.003), combination therapy was superior to monotherapy (P = 0.007). CONCLUSIONS This is currently the largest cohort CCAP dataset that supports eliciting neuropathic features, including allodynia, for a positive clinical diagnosis, to guide treatment. Physiological exacerbation of CCAP may represent visceral allodynia, and need not preclude central origin. Use of centrally acting neuromodulators, and avoidance of detrimental opioids and surgical interventions appear to predict favourable outcomes.
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Affiliation(s)
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Darren Green
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | - Shaheen Hamdy
- Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Simon Lal
- Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Peter Paine
- Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Mikocka‐Walus A, Prady SL, Pollok J, Esterman AJ, Gordon AL, Knowles S, Andrews JM. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database Syst Rev 2019; 4:CD012680. [PMID: 30977111 PMCID: PMC6459769 DOI: 10.1002/14651858.cd012680.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD. OBJECTIVES The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD. SEARCH METHODS We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched. SELECTION CRITERIA Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included. DATA COLLECTION AND ANALYSIS Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle-Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, pain, hospital admissions, surgery, and need for steroid treatment. QoL was assessed using the WHO-QOL-BREF questionnaire. We calculated the risk ratio (RR) and corresponding 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) with 95% CI. A fixed-effect model was used for analysis. MAIN RESULTS We included four studies (188 participants). Two studies were double-blind RCTs, one was a non-randomised controlled trial, and one was an observational retrospective case-matched study. The age of participants ranged from 27 to 37.8 years. In three studies participants had quiescent IBD and in one study participants had active or quiescent IBD. Participants in one study had co-morbid anxiety or depression. One study used duloxetine (60 mg daily), one study used fluoxetine (20 mg daily), one study used tianeptine (36 mg daily), and one study used various antidepressants in clinical ranges. Three studies had placebo controls and one study had a no treatment control group. One RCT was rated as low risk of bias and the other was rated as high risk of bias (incomplete outcome data). The non-randomised controlled trial was rated as high risk of bias (random sequence generation, allocation concealment, blinding). The observational study was rated as high methodological quality, but is still considered to be at high risk of bias given its observational design.The effect of antidepressants on anxiety and depression is uncertain. At 12 weeks, the mean anxiety score in antidepressant participants was 6.11 + 3 compared to 8.5 + 3.45 in placebo participants (MD -2.39, 95% -4.30 to -0.48, 44 participants, low certainty evidence). At 12 months, the mean anxiety score in antidepressant participants was 3.8 + 2.5 compared to 4.2 + 4.9 in placebo participants (MD -0.40, 95% -3.47 to 2.67, 26 participants; low certainty evidence). At 12 weeks, the mean depression score in antidepressant participants was 7.47 + 2.42 compared to 10.5 + 3.57 in placebo participants (MD -3.03, 95% CI -4.83 to -1.23, 44 participants; low certainty evidence). At 12 months, the mean depression score in antidepressant participants was 2.9 + 2.8 compared to 3.1 + 3.4 in placebo participants (MD -0.20, 95% -2.62 to 2.22, 26 participants; low certainty evidence).The effect of antidepressants on AEs is uncertain. Fifty-seven per cent (8/14) of antidepressant participants group reported AEs versus 25% (3/12) of placebo participants (RR 2.29, 95% CI 0.78 to 6.73, low certainty evidence). Commonly reported AEs include nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood/anxiety, dry mouth, muscle spasms and hot flushes. None of the included studies reported any serious AEs. None of the included studies reported on pain.One study (44 participants) reported on QoL at 12 weeks and another study (26 participants) reported on QoL at 12 months. Physical, Psychological, Social and Environmental QoL were improved at 12 weeks compared to placebo (all low certainty evidence). There were no group differences in QoL at 12 months (all low certainty evidence). The effect of antidepressants on maintenance of clinical remission and endoscopic relapse is uncertain. At 12 months, 64% (9/14) of participants in the antidepressant group maintained clinical remission compared to 67% (8/12) of placebo participants (RR 0.96, 95% CI 0.55 to 1.69; low certainty evidence). At 12 months, none (0/30) of participants in the antidepressant group had endoscopic relapse compared to 10% (3/30) of placebo participants (RR 0.14, 95% CI 0.01 to 2.65; very low certainty evidence). AUTHORS' CONCLUSIONS The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow-up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy.
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Affiliation(s)
- Antonina Mikocka‐Walus
- Deakin University GeelongSchool of Psychology221 Burwood HighwayBurwood, VICVictoriaAustralia3025
| | - Stephanie L Prady
- University of YorkDepartment of Health SciencesSeebohm Rowntree Area 2YorkUKYO10 5DD
| | - Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Andrea L Gordon
- University of South AustraliaSchool of Pharmacy and Medical SciencesAdelaideAustralia
| | - Simon Knowles
- Swinburne University of TechnologyDepartment of Psychological SciencesATC1041 Hawthorn campusVictoriaAustralia
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Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol 2019; 2:6-29. [PMID: 31294724 PMCID: PMC6507291 DOI: 10.1093/jcag/gwy071] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS. METHODS A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient. RESULTS Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments. CONCLUSIONS Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.
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Affiliation(s)
- Paul Moayyedi
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | | | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lesley Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Kvern
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Louis Liu
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - William G Paterson
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sacha Sidani
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Vanner
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
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105
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Carpinelli L, Bucci C, Santonicola A, Zingone F, Ciacci C, Iovino P. Anhedonia in irritable bowel syndrome and in inflammatory bowel diseases and its relationship with abdominal pain. Neurogastroenterol Motil 2019; 31:e13531. [PMID: 30628137 DOI: 10.1111/nmo.13531] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anhedonia is the lowered ability to experience pleasure from rewarding or enjoyable activities and is considered a symptom of depression. Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are frequently accompanied by psychiatric disorders such as depression. However, to our knowledge, studies have yet to investigate the anhedonia in these patients. Our aim was to study the level of anhedonia in patients with IBD and IBS in comparison with healthy controls (HC), and to relate anhedonia levels with the severity of abdominal pain. METHODS We consecutively recruited IBD and IBS patients. All patients fulfilled the Snaith-Hamilton Pleasure Scale (SHAPS), a self-rating scale consisting of 14 items that cover the domains of social interaction, food, and drink, sensory experiences, achievement and pastimes, and the Beck Depression Inventory-II (BDI-II) to screen for depression. Moreover, we calculated abdominal pain on a (0-100) Visual Analog Scale (VAS) in all patients. KEY RESULTS We enrolled 120 patients (64 IBD and 56 IBS) and 81 HC. Among IBD patients, 34 had Crohn's disease and 30 ulcerative colitis. All patients as a whole had significantly higher SHAPS and BDI-II scores than HC (1.3 ± 1.5 vs 0.8 ± 0.1; P = 0.01 and 10.4 ± 7.5 vs 5.9 ± 4.9; P < 0.001, respectively), while no significant differences were found among groups. SHAPS score showed a significant correlation in only a few statements of BDI-II. In our cohort, a multivariate regression analysis showed that SHAPS score was significantly related to current abdominal pain (0-100 VAS) (P = 0.03) independent of gender and age. CONCLUSIONS AND INFERENCES The level of anhedonia was higher in all patients compared to healthy controls. The more the subject is anhedonic, the higher the VAS scale for abdominal pain. This study suggests that anhedonia would need to be very carefully weighed in IBD and IBS patients.
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Affiliation(s)
- Luna Carpinelli
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Cristina Bucci
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Antonella Santonicola
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Carolina Ciacci
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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106
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Windgassen S, Moss-Morris R, Goldsmith K, Chalder T. Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. J Psychosom Res 2019; 118:73-82. [PMID: 30522750 DOI: 10.1016/j.jpsychores.2018.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterised by abdominal pain and altered bowel movements. Cognitive behavioural therapy (CBT) has been shown to be effective in reducing symptom severity in IBS and enhancing quality of life/functioning. The present study sought to identify how CBT achieves change in these outcomes. METHOD Secondary analysis was conducted on 149 patients with irritable bowel syndrome who had been randomised to cognitive behavioural therapy plus an antispasmodic medication or antispasmodic alone. Single and sequential mediation was modelled using structural equation modelling. Gastrointestinal (GI) related avoidance behaviour, safety behaviour, cognitions and general anxiety were included as mediators. RESULTS GI safety behaviours, cognitions and general anxiety mediated treatment effect on the outcomes of symptom severity and work and social adjustment. Avoidance behaviour was not a significant mediator for either outcome. Sequential mediation models indicated that unhelpful GI related cognitions reduced before anxiety did, and this sequential path (R➔GI related cognitions➔anxiety➔outcome) was significant for both symptom severity (b = -0.22, CI [-0.40 to -0.90], p = .005) and work and social adjustment (b = -0.26, CI [-0.44 to -0.11], p = .003) where 'R' is randomisation. Reduction in GI safety behaviours also preceded reduction in anxiety. This sequence (R ➔GI safety behaviours➔anxiety➔outcome) was significant for both symptom severity (b = -0.11, CI [-0.24 to -0.01], p = .049) and work and social adjustment (b = -0.12, CI [-0.23 to -0.03], p = .03). CONCLUSION Results suggest that it is important for psychological treatments to target IBS specific factors for change.
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Affiliation(s)
- Sula Windgassen
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Rona Moss-Morris
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Kimberley Goldsmith
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AZ, United Kingdom.
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Internet-Delivered Cognitive Behavior Therapy for Young Taiwanese Female Nursing Students with Irritable Bowel Syndrome-A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050708. [PMID: 30818837 PMCID: PMC6427663 DOI: 10.3390/ijerph16050708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Irritable Bowel Syndrome (IBS) is prevalent within the general population. Studies have shown that stress and anxiety co-exist with IBS. Young Taiwanese women commonly exhibit physical and psychological health problems caused by academic stress. The purpose of our current study was to evaluate the efficacy of short-term Internet-delivered cognitive-behavioral therapy (ICBT) on female nursing students in practicum. We performed a cluster randomized controlled trial comprised of 160 participants who met the inclusion criteria, which were divided into three groups: (1) ICBT, (2) expressive writing (EW), and (3) wait-list control. Treatment interventions lasted for 6 weeks. Levels of anxiety, depression, and IBS symptoms were assessed at four time points, baseline assessment at T0, 2 weeks after T0 (T1), at the end of practicum (T2), and at 3-month follow-up (T3). The results showed that ICBT and EW groups exhibited a significant, yet small, reduction in anxiety and depression at T2 and T3 compared to the wait-list control group. The EW group exhibited significantly greater reduction in anxiety and depression compared to the ICBT group at T2. However, the ICBT group demonstrated greater improvements in alleviating anxiety and depression at T3 compared to the EW group. These data indicate that ICBT and EW groups exhibited small effects on anxiety and depression reduction at T2 and T3 compared to the wait-list control group, with no effects on IBS symptoms in young Taiwanese female nursing students.
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108
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How do people with refractory irritable bowel syndrome perceive hypnotherapy: Qualitative study protocol. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol 2019; 114:21-39. [PMID: 30177784 DOI: 10.1038/s41395-018-0222-5] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain-gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective. METHODS We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidepressants versus placebo, or psychological therapies versus control therapy or "usual management" were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). RESULTS The search strategy identified 5316 citations. Fifty-three RCTs, reported in 51 separate articles, were eligible for inclusion: 17 compared antidepressants with placebo, 35 compared psychological therapies with control therapy or "usual management", and one compared both psychological therapy and antidepressants with placebo. Four of the trials of psychological therapies, and one of the RCTs of antidepressants, were identified since our previous meta-analysis. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57-0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs, although with heterogeneity between RCTs of the latter (I(2) = 49%, P = 0.07). The RR of symptoms not improving with psychological therapies was 0.69 (95% CI 0.62-0.76). Cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy were all beneficial when data from two or more RCTs were pooled. There was significant heterogeneity between studies (I(2) = 69%, P < 0.001) and significant funnel plot asymmetry. There were also issues regarding trial design, including lack of blinding. CONCLUSIONS Antidepressants are efficacious in reducing symptoms in IBS patients. Psychological therapies also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result.
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Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Lucinda A Harris
- Division of Gastroenterology and Hepatology, Mayo School of Medicine, Scottsdale, AZ, USA
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | - Paul Moayyedi
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
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Kim JH, Jee SR. Irritable Bowel Syndrome. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:84-91. [DOI: 10.4166/kjg.2019.73.2.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Jae Hak Kim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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111
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Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, Whorwell PJ, de Wit NJ. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4:20-31. [DOI: 10.1016/s2468-1253(18)30310-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022]
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Vork L, Mujagic Z, Drukker M, Keszthelyi D, Conchillo JM, Hesselink MAM, van Os J, Masclee AAM, Leue C, Kruimel JW. The Experience Sampling Method-Evaluation of treatment effect of escitalopram in IBS with comorbid panic disorder. Neurogastroenterol Motil 2019; 31:e13515. [PMID: 30460734 PMCID: PMC7379179 DOI: 10.1111/nmo.13515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Confirming treatment response in clinical trials for irritable bowel syndrome (IBS) is challenging, due to the lack of biomarkers and limitations of the currently available symptom assessment tools. The Experience Sampling Method (ESM) might overcome these limitations by collecting digital assessments randomly and repeatedly during daily life. This study evaluated differences in change in abdominal pain between real-time (ie, ESM) and retrospective (ie, Gastrointestinal Symptom Rating Scale [GSRS] and an end-of-day symptom diary) measurements, using data of an RCT on escitalopram vs placebo in patients with IBS and comorbid panic disorder. METHODS Twenty-nine IBS patients with comorbid panic disorder were included in a 6-month RCT. The GSRS, diary, and ESM were completed at baseline (t = 0) and after 3 (t = 3) and 6 months (t = 6). Linear mixed models were used. KEY RESULTS Experience Sampling Method analyses revealed a significant interaction between escitalopram and time, and ESM abdominal pain scores were 1.4 points lower in the escitalopram group compared to placebo at t = 6 (on a 1-to-7 scale; P = 0.021). When including the interaction with momentary anxiety, the reduction in abdominal pain scores in escitalopram vs placebo was even more pronounced for higher levels of anxiety. Average GSRS- and end-of-day abdominal pain scores were not significantly different between escitalopram and placebo at t = 3 and 6. CONCLUSIONS & INFERENCES Real-time ESM has the potential to capture treatment response more sensitively compared to a retrospective end-of-day GI symptom diary and the GSRS, by taking into account day-to-day symptom variability as well as momentary factors that might moderate treatment effect, such as anxiety.
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Affiliation(s)
- Lisa Vork
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Marjan Drukker
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - José M. Conchillo
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Martine A. M. Hesselink
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Jim van Os
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands,Department of PsychiatryBrain Centre Rudolf Magnus, Utrecht University Medical CenterUtrechtThe Netherlands,King's College London, King's Health PartnersDepartment of Psychosis StudiesInstitute of PsychiatryLondonUK
| | - Ad A. M. Masclee
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Carsten Leue
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Joanna W. Kruimel
- Division of Gastroenterology‐Hepatology, Department of Internal MedicineNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical CenterMaastrichtThe Netherlands
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113
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Palsson OS. Is hypnotherapy helpful for irritable bowel syndrome in primary and secondary care? Lancet Gastroenterol Hepatol 2019; 4:2-3. [PMID: 30473201 DOI: 10.1016/s2468-1253(18)30344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Olafur S Palsson
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27515, USA.
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114
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Camilleri M. Management Options for Irritable Bowel Syndrome. Mayo Clin Proc 2018; 93:1858-1872. [PMID: 30522596 PMCID: PMC6314474 DOI: 10.1016/j.mayocp.2018.04.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS) is associated with diverse pathophysiologic mechanisms. These mechanisms include increased abnormal colonic motility or transit, intestinal or colorectal sensation, increased colonic bile acid concentration, and superficial colonic mucosal inflammation, as well as epithelial barrier dysfunction, neurohormonal up-regulation, and activation of secretory processes in the epithelial layer. Novel approaches to treatment include lifestyle modification, changes in diet, probiotics, and pharmacotherapy directed to the motility, sensation, and intraluminal milieu of patients with IBS. Despite recent advances, there is a need for development of new treatments to relieve pain in IBS without deleterious central or other adverse effects.
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Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program and Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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115
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Cheong PK, Ford AC, Cheung CKY, Ching JYL, Chan Y, Sung JJY, Chan FKL, Wu JCY. Low-dose imipramine for refractory functional dyspepsia: a randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2018; 3:837-844. [DOI: 10.1016/s2468-1253(18)30303-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
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116
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Ford AC. Intending to Treat Patients With Irritable Bowel Syndrome With Cognitive-Behavioral Therapy. Gastroenterology 2018; 155:2024. [PMID: 30240662 DOI: 10.1053/j.gastro.2018.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital and Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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117
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Black CJ, Burr NE, Quigley EMM, Moayyedi P, Houghton LA, Ford AC. Efficacy of Secretagogues in Patients With Irritable Bowel Syndrome With Constipation: Systematic Review and Network Meta-analysis. Gastroenterology 2018; 155:1753-1763. [PMID: 30144426 DOI: 10.1053/j.gastro.2018.08.021] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Several secretagogues have been approved for the treatment of irritable bowel syndrome with constipation (IBS-C). However, their relative efficacy is unclear because there have been no head-to-head randomized controlled trials. We conducted a network meta-analysis to compare their efficacies in patients with IBS-C. METHODS We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials through June 2018 to identify randomized controlled trials assessing the efficacy of secretagogues in adults with IBS-C. Trials included in the analysis reported a dichotomous assessment of overall response to therapy, and data were pooled using a random-effects model. Efficacy and safety of secretagogues were reported as a pooled relative risk with 95% confidence interval to summarize the effect of each comparison tested, and treatments were ranked according to their P score. RESULTS We identified 15 eligible randomized controlled trials of secretagogues that included 8462 patients. Linaclotide, lubiprostone, plecanatide, and tenapanor were superior to placebo for the treatment of IBS-C. Linaclotide (290 μg once daily) was ranked first in efficacy based on the end point recommended by the Food and Drug Administration for trials in IBS-C, the primary end point used in each trial, abdominal pain, and complete spontaneous bowel movements. Tenapanor (50 mg twice daily) was ranked first for decreasing bloating. Total numbers of adverse events were significantly larger with linaclotide (290 and 500 μg once daily) and plecanatide (3 mg once daily) compared with placebo. However, plecanatide 6 mg once daily ranked first for safety. Diarrhea was significantly more common with all drugs, except lubiprostone (8 μg twice daily). Nausea was significantly more common in patients who received lubiprostone. CONCLUSIONS In a network analysis of randomized controlled trials of secretagogues for IBS-C, we found all drugs to be superior to placebo. Efficacy was similar among individual drugs and dosages for most end points. However, data were extracted at the 12-week time point, so the long-term relative efficacy of these drugs is unknown.
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Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Nicholas E Burr
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Paul Moayyedi
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Lesley A Houghton
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
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118
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Abstract
This article provides an overarching view of what is currently known about the physiology of the brain-gut axis in both health and disease and how these concepts apply to irritable bowel syndrome, the most common functional gastrointestinal disorder in pediatrics.
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Affiliation(s)
- Julie Khlevner
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH 17, New York, NY 10032, USA
| | - Yeji Park
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH 17, New York, NY 10032, USA
| | - Kara Gross Margolis
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH 17, New York, NY 10032, USA.
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119
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Han BY, Shao QF, Cong Y, Guo S, Mao XY, Wei RH, Wei W. Transcutaneous electric nerve stimulation over acupoints for patients with diarrhea-predominant irritable bowel syndrome: Protocol for systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13267. [PMID: 30572430 PMCID: PMC6320180 DOI: 10.1097/md.0000000000013267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND At present, drug therapy for diarrhea-predominant irritable bowel syndrome (IBS-D) has made great progress; however, it does not often produce a satisfying curative effect. Transcutaneous electric nerve stimulation over acupoints (Acu-TENS) might be more effective in improving patient's symptoms and producing fewer side-effects as a result.Although with a great progress of the drug therapy for IBS-D, it is often hard to achieve its satisfactory curative effect. Acu-TENS that may be effective to improve patients' symptoms and fewer side-effects will be sought. There is no systematic review concerning the efficacy of Acu-TENS for IBS-D published. Therefore, this review aims to systematically evaluate the efficacy of Acu-TENS on IBS-D. METHODS Four English (PubMed, EMBASE, The Cochrane Library, Web of Science) and 4 Chinese electronic databases (Biomedical Literature Database, CNKI, VIP, Wanfang Database) will be searched from their inception to November 26, 2018. Randomized controlled trials that evaluated the effect of Acu-TENS on patients with IBS-D will be included. The primary outcome measures will include average weekly stool frequency, visual analog scale (VAS), and the Bristol scale. The secondary outcome measures will include the MOS 36-item short-form health survey (SF-36), IBS Quality of Life Questionnaire (IBS-QOL), severity of IBS symptoms (IBS-SSS), and rectal perception. Quality evaluation and data extraction will be independently undertaken, respectively. The data from the eligible trials will be analyzed by RevMan5.3. RESULTS For patients with IBS-D, this systematic review will provide evidences related to the efficacy of Acu-TENS in these evaluation aspects, stool frequency, VAS and the Bristol scale, SF-36, IBS-QOL, IBS-SSS, and rectal perception. CONCLUSION This evidence may be useful to medical workers with regard to the use of Acu-TENS in the treatment of IBS-D.PROSPERO registration number: PROSPERO CRD442018109294.
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Affiliation(s)
- Bo-yu Han
- Dongzhimen Hospital, Beijing University of Chinese Medicine
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qian-Feng Shao
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Cong
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Song Guo
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin-Yong Mao
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ru-Han Wei
- Cleveland State University, Cleveland, OH
| | - Wei Wei
- Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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120
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Peter J, Tran US, Michalski M, Moser G. The structure of resilience in irritable bowel syndrome and its improvement through hypnotherapy: Cross-sectional and prospective longitudinal data. PLoS One 2018; 13:e0202538. [PMID: 30419026 PMCID: PMC6231615 DOI: 10.1371/journal.pone.0202538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 07/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Resilience refers to a class of variables that are highly relevant to wellbeing and coping with stress, trauma, and chronic adversity. Despite its significance for health, resilience suffers from poor conceptual integration. Irritable bowel syndrome (IBS) is a functional disorder with altered psychological stress reactivity and a brain-gut-microbiota axis, which causes high levels of chronic strain. Gut-directed Hypnotherapy (GHT) is a standardized treatment for IBS aimed at improving resilience. An improvement of resilience as a result of GHT has been hypothesized but requires further investigation. The aims of the study were to validate the construct and develop an integrational measure of various resilience domains by dimensional reduction, and to investigate changes in resilience in IBS patients after GHT. METHOD A total of N = 74 gastroenterology outpatients with IBS (Rome III criteria) were examined in 7 resilience domains, quality of life, psychological distress and symptom severity. Of these, n = 53 participated in 7 to 10 GHT group sessions (Manchester protocol). Post-treatment examinations were performed on average 10 months after last GHT session. RESULTS Resilience factors proved to be unidimensional in the total sample. Greater resilience (composite score of resilience domains) and quality of life, and lower symptom severity and psychological distress were found after treatment (n = 16). Similar differences were present in cross-sectional comparisons of n = 37 treated vs. n = 37 untreated patients. CONCLUSION Resilience factors share a common psychological dimension and are functionally connected. The absence of maladaptive behaviours contributes to resilience. Improvements in resilience after hypnotherapy with parallel increases in quality of life and reduced psychological distress and symptom severity were observed. Independent replications with larger sample sizes and randomized controlled trials are needed.
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Affiliation(s)
- Johannes Peter
- Gastroenterology and Hepatology Division, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ulrich S. Tran
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
| | - Maria Michalski
- Gastroenterology and Hepatology Division, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gabriele Moser
- Gastroenterology and Hepatology Division, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Abstract
BACKGROUND Previous research suggests benefits of targeting beliefs about the unacceptability of emotions in treatment for irritable bowel syndrome (IBS). AIMS The current study developed and tested an intervention focusing on beliefs and behaviours around emotional expression. METHOD Four participants with IBS attended five group sessions using cognitive behavioural techniques focusing on beliefs about the unacceptability of expressing emotions. Bi-weekly questionnaires were completed and a group interview was conducted. This study used an AB design with four participants. RESULTS Averages indicate that participants showed decreases in beliefs about unacceptability of emotions and emotional suppression during the intervention, although this was not reflected in any of the individual trends in Beliefs about Emotions Scale scores and was significant in only one individual case for Courtauld Emotional Control Scale scores. Affective distress and quality of life improved during follow-up, with only one participant not improving with regard to distress. Qualitative data suggest that participants felt that the intervention was beneficial, referencing the value in sharing their emotions. CONCLUSIONS This study suggests the potential for beliefs about emotions and emotional suppression to be addressed in cognitive behavioural interventions in IBS. That beliefs and behaviours improved before outcomes suggests they may be important processes to investigate in treatment for IBS.
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122
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Abstract
Purpose of Review The functional gastrointestinal disorders, or disorders of gut-brain interaction as defined by the Rome IV criteria, are the most common diagnostic entities in gastroenterology. Treatments that address the dysregulation of gut-brain interaction with these disorders are increasingly gaining interest as a better option than for example traditional analgesics, particularly opioids. Antidepressants, antianxiety and antipsychotic medications, and visceral analgesics, now termed neuromodulators, are included in this update addressing the evidence of treatment benefit in disorders of brain-gut interaction. Recent Findings By a careful selection based on a multidimensional clinical profile, a decreased symptom burden, particularly regarding abdominal pain, nausea, and vomiting, as well as improved social function and quality of life, can be obtained by use of neuromodulators. There is good evidence for the peripheral neuromodulators from studies in bowel disorders, and the central neuromodulators both from indirect evidence in chronic pain disorders as well as selected disorders of brain-gut interaction. Summary Basic knowledge about the pharmacologic properties and clinical use of neuromodulators in disorders of brain-gut interaction improves the treatment outcome and avoids use of traditional analgesics.
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Black CJ, Houghton LA, Ford AC. Insights into the evaluation and management of dyspepsia: recent developments and new guidelines. Therap Adv Gastroenterol 2018; 11:1756284818805597. [PMID: 30397412 PMCID: PMC6207968 DOI: 10.1177/1756284818805597] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 02/04/2023] Open
Abstract
Dyspepsia is a very common gastrointestinal (GI) condition worldwide. We critically examine the recommendations of recently published guidelines for the management of dyspepsia, including those produced jointly by the American College of Gastroenterology and the Canadian Association of Gastroenterology, and those published by the UK National Institute for Health and Care Excellence. Dyspepsia is a symptom complex, characterized by a range of upper GI symptoms including epigastric pain or burning, early satiety, and post-prandial fullness. Although alarm features are used to help prioritize access to upper GI endoscopy, they are of limited utility in predicting endoscopic findings, and the majority of patients with dyspepsia will have no organic pathology identified at upper GI endoscopy. These patients are labelled as having functional dyspepsia (FD). The Rome IV criteria, which are used to define FD, further subclassify patients with FD as having either epigastric pain syndrome or post-prandial distress syndrome, depending on their predominant symptoms. Unfortunately, the Rome criteria perform poorly at identifying FD without the need for upper GI endoscopy. This has led to the investigation of alternative diagnostic approaches, including whether a capsaicin pill or combined serum biomarkers can accurately identify patients with FD. However, there is insufficient evidence to support either of these approaches at the present time. Patients with FD should be tested for H. pylori infection and be prescribed eradication therapy if they test positive. If they continue to have symptoms following this, then a trial of treatment with a proton pump inhibitor (PPI) should be given for up to 8 weeks. In cases where symptoms fail to adequately respond to PPI treatment, a tricyclic antidepressant may be of benefit, and should be continued for 6 to 12 months in patients who respond. Prokinetics demonstrate limited efficacy for treating FD, but could be considered if other strategies have failed. However, there are practical difficulties due to their limited availability in some countries and the risk of serious side effects. Patients with FD who fail to respond to drug treatments should be offered psychological therapy, where available. Overall, with the exception of recommendations relating to H. pylori testing and the prescription of PPIs, which are made on the basis of high-quality evidence, the evidence underpinning other elements of dyspepsia management is largely of low-quality. Consequently, there are still many aspects of the evaluation and management of dyspepsia that require further research.
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Affiliation(s)
| | - Lesley A. Houghton
- Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, UK,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Alexander C. Ford
- Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, UK,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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124
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Simrén M, Tack J. New treatments and therapeutic targets for IBS and other functional bowel disorders. Nat Rev Gastroenterol Hepatol 2018; 15:589-605. [PMID: 29930260 DOI: 10.1038/s41575-018-0034-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Functional bowel disorders (FBDs) are a spectrum of disorders characterized by combinations of symptoms attributable to the lower gastrointestinal tract. Most current first-line therapies for IBS and other FBDs target the predominant symptom and mainly affect one symptom in the symptom complex. Additional broadly effective treatment alternatives targeting the entire symptom complex are needed. New drugs for FBDs (such as lubiprostone, linaclotide, plecanatide, prucalopride, eluxadoline and rifaximin) target key mechanisms in the pathophysiology of these disorders and improve both the abnormal bowel habit and other key symptoms, such as abdominal pain and bloating. The current development of new treatment alternatives is focusing on different aspects of the complex pathophysiology of IBS and other FBDs: gut microenvironment (via diet and modulation of gut microbiota), enterohepatic circulation of bile acids, gastrointestinal secretion, motility and sensation, gut-brain interactions, gut barrier function and the immune system within the gastrointestinal tract. Studies also suggest that personalized treatment of IBS and other FBDs is possible using various diagnostic markers.
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Affiliation(s)
- Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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125
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Tayama J, Saigo T, Ogawa S, Takeoka A, Hamaguchi T, Inoue K, Okamura H, Yajima J, Matsudaira K, Fukudo S, Shirabe S. Effect of attention bias modification on event-related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho-behavioral study. Neurogastroenterol Motil 2018; 30:e13402. [PMID: 30062816 DOI: 10.1111/nmo.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS. METHODS Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing. KEY RESULTS A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group. CONCLUSIONS AND INFERENCES Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.
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Affiliation(s)
- J Tayama
- Graduate School of Education, Nagasaki University, Nagasaki, Japan
| | - T Saigo
- School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
| | - S Ogawa
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - A Takeoka
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - T Hamaguchi
- Department of Occupational Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - K Inoue
- Center for the Study of Higher Education and Global Admissions, Osaka University, Suita, Japan
| | - H Okamura
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - J Yajima
- Faculty of Literature, Beppu University, Beppu, Japan
| | - K Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo-Hospital, Tokyo, Japan
| | - S Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Shirabe
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
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126
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Mohsenabadi H, Zanjani Z, Shabani MJ, Arj A. A randomized clinical trial of the Unified Protocol for Transdiagnostic treatment of emotional and gastrointestinal symptoms in patients with irritable bowel syndrome: evaluating efficacy and mechanism of change. J Psychosom Res 2018; 113:8-15. [PMID: 30190053 DOI: 10.1016/j.jpsychores.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this randomized controlled trial was to evaluate the efficacy of Unified Protocol (UP) for transdiagnostic treatment of psychological problems, such as anxiety, depression, and stress, and treating the intensity of gastrointestinal symptoms in individuals with Irritable Bowel Syndrome (IBS). Another aim of the study was to test whether emotion regulation mediates the effect of UP. METHODS Among 91 patients diagnosed with IBS (using ROME III criteria), 64 patients were eligible to participate in the study based on the inclusion/exclusion criteria. These patients were randomly assigned to either an intervention group (n = 32) that participated in 12 weekly UP treatment sessions or to a wait-list control group (n = 32). All patients completed the Depression, Anxiety, and Stress Scale (DASS-42), Emotion Regulation Questionnaire (ERQ), and Gastrointestinal Symptoms Rating Scale (GSRS) pre- and post-intervention. The data were analyzed with SPSS 20.0 software. RESULTS The results of intention-to-treat (ITT) analysis indicated a significant decrease in depression, anxiety, stress, and gastrointestinal symptoms, as well as significant improvements in emotion regulation scores in the intervention group post intervention. All results were significant at P < .001. Mediation analyses indicated that changes in emotion regulation mediated the effect of UP on changes in emotional and gastrointestinal symptoms. CONCLUSION UP was effective and influential in emotion regulation among the intervention group and caused a decline in emotional and gastrointestinal symptoms. Hence, this intervention is promising, but larger RCTs are needed to more investigate its efficacy. Future studies could also examine the efficacy of the UP in other medical conditions with co-occurring psychological conditions. The study is registered at the irct.ir database under registration number IRCT2017010431765N1.
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Affiliation(s)
- Hamid Mohsenabadi
- Department of Clinical Psychology, Medical Faculty, Kashan University of Medical Science, Kashan, Iran
| | - Zahra Zanjani
- Department of Clinical Psychology, Medical Faculty, Kashan University of Medical Science, Kashan, Iran.
| | - Mohammad Javad Shabani
- Department of Clinical Psychology, Medical Faculty, Kashan University of Medical Science, Kashan, Iran
| | - Abbas Arj
- Department of Gastroenterology, Kashan University of Medical Sciences, Kashan, Iran
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Liu Y, Tran DQ, Rhoads JM. Probiotics in Disease Prevention and Treatment. J Clin Pharmacol 2018; 58 Suppl 10:S164-S179. [PMID: 30248200 PMCID: PMC6656559 DOI: 10.1002/jcph.1121] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/17/2018] [Indexed: 12/17/2022]
Abstract
Few treatments for human diseases have received as much investigation in the past 20 years as probiotics. In 2017, English-language meta-analyses totaling 52 studies determined the effect of probiotics on conditions ranging from necrotizing enterocolitis and colic in infants to constipation, irritable bowel syndrome, and hepatic encephalopathy in adults. The strongest evidence in favor of probiotics lies in the prevention or treatment of 5 disorders: necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. Probiotic mechanisms of action include the inhibition of bacterial adhesion; enhanced mucosal barrier function; modulation of the innate and adaptive immune systems (including induction of tolerogenic dendritic cells and regulatory T cells); secretion of bioactive metabolites; and regulation of the enteric and central nervous systems. Future research is needed to identify the optimal probiotic and dose for specific diseases, to address whether the addition of prebiotics (to form synbiotics) would enhance activity, and to determine if defined microbial communities would provide benefit exceeding that of single-species probiotics.
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Affiliation(s)
- Yuying Liu
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Dat Q Tran
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - J Marc Rhoads
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
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Abstract
Irritable bowel syndrome is a chronic functional gastrointestinal disorder that presents with abdominal pain related to defecation accompanied by a change in stool frequency or form Despite its impact on a patient’s quality of life it has no effect on mortality A positive clinical diagnosis should be made if the characteristic symptoms are present and red flags are absent Red flags should prompt specialist referral Consultations should be provided in an empathetic manner addressing the concerns of the patient while providing reassurance Manipulating diet with the assistance of a dietitian is an appropriate initial treatment for irritable bowel syndrome A low-FODMAP diet is an effective therapy
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129
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Lacy BE. Review article: an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48:817-830. [PMID: 30194692 PMCID: PMC6667996 DOI: 10.1111/apt.14948] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/27/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder. AIM To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea-predominant IBS (IBS-D). METHODS Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS-D. RESULTS IBS-D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short-course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS-D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS-D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient. CONCLUSIONS Multiple treatment options are now available for patients with IBS-D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients' IBS-D symptoms.
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Affiliation(s)
- Brian E. Lacy
- Section of GastroenterologyMayo ClinicJacksonvilleFlorida
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130
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Kim YS, Kim N. Sex-Gender Differences in Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24:544-558. [PMID: 30347934 PMCID: PMC6175559 DOI: 10.5056/jnm18082] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/08/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
Because of the sex-gender differences that are shown in a diversity of physiological and psychological factors, it can be speculated that the clinical presentation of symptoms as well as treatment strategies in women and men with irritable bowel syndrome (IBS) may differ. Studies have revealed that IBS is more common in women than men. As for the IBS subtype, IBS with constipation is significantly more prevalent among women than men. Sex hormones and gender differences may play important roles in the pathophysiology of IBS. However, its pathophysiologic mechanisms still remain largely unknown, and therapeutic implications are limited. Moreover, women IBS patients have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men IBS patients. Furthermore, there has been evidence of differences in the appropriate treatment efficacy to IBS in men and women, although relatively few men are enrolled in most relevant clinical trials. A more sex-gender-oriented approach in the medical care setting could improve understanding of heterogeneous patients suffering from IBS. An individualized and multicomponent approach including sex and gender issues might help improve the treatment of IBS.
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Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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131
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Bonilla S, Nurko S. Focus on the use of antidepressants to treat pediatric functional abdominal pain: current perspectives. Clin Exp Gastroenterol 2018; 11:365-372. [PMID: 30310301 PMCID: PMC6166750 DOI: 10.2147/ceg.s146646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic abdominal pain is frequently encountered in pediatric practice. A large proportion of cases meet Rome criteria for abdominal pain-functional gastrointestinal disorders (AP-FGIDs). These disorders are costly and, in some cases, lead to impairment of daily functioning and overall quality of life. Pathophysiologic mechanisms include early stressful events, visceral hypersensitivity, dysmotility, changes in intestinal microbiota, and altered central nervous system processing. They are considered disorders of the brain-gut interaction. The diagnosis is made on clinical grounds using symptom-based criteria (Rome criteria). Anxiety and depressive symptoms are more prevalent in patients with AP-FGIDs. Therefore, attention has been directed to the use of neuromodulators as potential interventions for AP-FGIDs. Antidepressants are one type of neuromodulators, and one of the most studied drugs for the management of AP-FGIDs in adult and pediatric population. Data available in pediatric population have significant limitations including nonuniform methodology with different study designs and primary endpoints. Evidence of the efficacy of antidepressants in the management of pediatric AP-FGIDs is not consistent. There is an urgent need for well-designed randomized clinical trials using age-appropriate validated outcome measures. Careful consideration must be given to adverse effects, particularly increased suicidal ideation.
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Affiliation(s)
- Silvana Bonilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital. Boston, MA, USA,
| | - Samuel Nurko
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital. Boston, MA, USA,
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132
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Henningsen P, Zipfel S, Sattel H, Creed F. Management of Functional Somatic Syndromes and Bodily Distress. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:12-31. [PMID: 29306954 DOI: 10.1159/000484413] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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133
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Adriani A, Ribaldone DG, Astegiano M, Durazzo M, Saracco GM, Pellicano R. Irritable bowel syndrome: the clinical approach. Panminerva Med 2018; 60:213-222. [PMID: 30257542 DOI: 10.23736/s0031-0808.18.03541-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder which presents with abdominal pain associated with alteration of bowel habits. IBS is a common condition affecting 9-23% of the general population, being the 80% female, with considerable impact on quality of life and health care costs. The exact pathogenesis of IBS remains elusive, but is clearly multifactorial and includes environmental and host factors. Management of patients with IBS is challenging since diagnosis and treatment could require several approaches with unsatisfactory results. In any case, the diagnosis of IBS is based on the positive identification of symptoms consistent with this condition and by excluding an underling organic disease. Before choosing therapeutic options, a strong reassuring physician-patient relationship is crucial. The therapeutic approach of IBS may consist of both non-pharmacological therapies and pharmacotherapy and should be based on prevalent symptomatology. Lifestyle modifications such as stress reduction and increased physical activity seem to be useful to improve symptoms and should be encouraged. The same for dietary modifications that represent an important first-line therapeutic option. The pharmacological treatment should take into account the predominant symptom and test one drug at a time with a predefined time point for effectiveness evaluation and dosage adjustment. This clinical review offers an updated overview on epidemiology, pathogenesis, diagnosis and treatment of IBS.
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Affiliation(s)
| | - Davide G Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Marilena Durazzo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio M Saracco
- Unit of Gastroenterology, Molinette Hospital, Turin, Italy.,Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
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134
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Li C, Hou Z, Liu Y, Ji Y, Xie L. Cognitive-behavioural therapy in patients with inflammatory bowel diseases: A systematic review and meta-analysis. Int J Nurs Pract 2018; 25:e12699. [DOI: 10.1111/ijn.12699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/13/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Chenyang Li
- Tianjin University of Traditional Chinese Medicine; Tianjin China
| | - Zhenhua Hou
- Tianjin University of Traditional Chinese Medicine; Tianjin China
| | - Yanhui Liu
- Tianjin University of Traditional Chinese Medicine; Tianjin China
| | - Yunan Ji
- Tianjin University of Traditional Chinese Medicine; Tianjin China
| | - Lingli Xie
- Tianjin University of Traditional Chinese Medicine; Tianjin China
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135
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Pietrzak A, Skrzydło-Radomańska B, Mulak A, Lipiński M, Małecka-Panas E, Reguła J, Rydzewska G. Guidelines on the management of irritable bowel syndrome: In memory of Professor Witold Bartnik. PRZEGLAD GASTROENTEROLOGICZNY 2018; 13:259-288. [PMID: 30581501 PMCID: PMC6300851 DOI: 10.5114/pg.2018.78343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
These guidelines constitute an update of the previous "Recommendations on the management of irritable bowel syndrome" issued in 2008. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2008, the aetiology, epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of irritable bowel syndrome (IBS). The English-language acronym for the syndrome (IBS) has become popular in medical and popular scientific language. It is also widely recognized by patients who identify with this diagnosis. Therefore, in the discussed guidelines, this is what we will use.
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Affiliation(s)
- Anna Pietrzak
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Lipiński
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
- Department of the Prevention of Alimentary Tract Diseases, Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
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136
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Thakur ER, Shapiro J, Chan J, Lumley MA, Cully JA, Bradford A, El-Serag HB. A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study. Dig Dis Sci 2018; 63:2189-2201. [PMID: 29744772 DOI: 10.1007/s10620-018-5095-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychological treatments are efficacious for irritable bowel syndrome (IBS) in clinical trials; however, their effectiveness when conducted in gastroenterology practice settings is unclear. AIM To perform a systematic review of the types and effects of psychological treatments for IBS conducted in gastroenterology clinics. METHODS We searched PubMed, EMBASE, and Cochrane central register. Studies conducted in gastroenterology clinic settings with IBS patients who were clinically referred from gastroenterology were included. RESULTS We identified 3078 citations, of which only eight studies were eligible. Seven studies compared psychological treatments (average n = 25.7; range 12-43) to controls (average n = 25.4 patients; range 12-47), whereas one study compared two active "bonafide" interventions. Psychological treatments varied (cognitive-behavioral therapy, guided affective imagery, mindfulness, hypnosis, biofeedback, emotional awareness training). However, across approaches, short-term benefits were seen. IBS symptoms improved significantly among patients in cognitive and behavioral therapies, mindfulness-based stress reduction, guided affective imagery, and emotional awareness training compared with controls; there was a similar trend for gut-directed hypnotherapy. Similarly, IBS symptoms improved in a study of two active biofeedback and hypnosis treatments. CONCLUSIONS Evidence for the effectiveness of psychological treatment in gastroenterology practice is promising but limited. Study designs that involve a blending of efficacy and effectiveness components are needed.
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Affiliation(s)
- Elyse R Thakur
- VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Jordan Shapiro
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Johanna Chan
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Rm. 7204, 5057 Woodward Ave., Detroit, MI, 48202, USA
| | - Jeffrey A Cully
- VA South Central Mental Illness Research, Education and Clinical Center, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Andrea Bradford
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Hashem B El-Serag
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), Michel E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA
- Gastroenterology and Hepatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
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137
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Zhang QE, Wang F, Qin G, Zheng W, Ng CH, Ungvari GS, Yuan Z, Mei S, Wang G, Xiang YT. Depressive symptoms in patients with irritable bowel syndrome: a meta-analysis of comparative studies. Int J Biol Sci 2018; 14:1504-1512. [PMID: 30263003 PMCID: PMC6158731 DOI: 10.7150/ijbs.25001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/13/2018] [Indexed: 12/15/2022] Open
Abstract
Depression is common in patients with irritable bowel syndrome (IBS), but the reported prevalence across different studies is inconsistent. This meta-analysis systematically examined the presence and severity of depressive symptoms in patients with IBS. Two investigators independently performed a literature search. The pooled depressive symptom severity was calculated using a random effects model. Subgroup, sensitivity and meta-regression analyses were conducted to examine the moderating factors of the development of depressive symptoms. Twenty four studies (n=2,837) comparing depressive symptoms between IBS patients (n=1,775) and healthy controls (n=1,062) were identified; 14 (58.3%) studies were rated as high quality. Compared to healthy controls, IBS patients had more frequent (OR=9.21, 95%CI: 4.56-18.57, P<0.001; I2=76%) and more severe depressive symptoms (n=1,480, SMD=2.02, 95%CI: 1.56-2.48, P<0.001; I2=94%). Subgroup analyses revealed that patients with all IBS subtypes had more severe depressive symptoms than controls. In addition, versions of the Hamilton Depression Rating Scale (HAM-D) and IBS diagnostic criteria were significantly associated with depressive symptom severity. Meta-regression analyses revealed that female gender, younger age and small sample size were significantly associated with more severe depressive symptoms. In conclusion, meta-analytic data showed that IBS patients had more frequent and severe depressive symptoms than healthy controls. Adequate screening and treatment for depression should be developed and implemented in this patient population.
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Affiliation(s)
- Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Geng Qin
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chee H. Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S. Ungvari
- University of Notre Dame Australia, Perth, Australia
- Division of Psychiatry, University of Western Australia Medical School, Perth, Australia
| | - Zhen Yuan
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Songli Mei
- School of Public Health, Jilin University, Jilin province, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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138
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Hanlon I, Hewitt C, Bell K, Phillips A, Mikocka-Walus A. Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:244-259. [PMID: 29901820 DOI: 10.1111/apt.14840] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/08/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. AIMS To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. METHODS We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. RESULTS We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. CONCLUSION There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases.
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Affiliation(s)
- I Hanlon
- Department of Health Sciences, University of York, York, UK
| | - C Hewitt
- Department of Health Sciences, University of York, York, UK
| | - K Bell
- Department of Health Sciences, University of York, York, UK
| | - A Phillips
- Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Mikocka-Walus
- Department of Health Sciences, University of York, York, UK.,School of Psychology, Deakin University Geelong, Melbourne, Vic., Australia
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139
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Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care. Br J Gen Pract 2018; 68:e654-e662. [PMID: 30061195 PMCID: PMC6104876 DOI: 10.3399/bjgp18x698321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background Previous studies have identified issues with the doctor–patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms. Aim To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU). Design and setting This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fifty-two participants took part in semi-structured interviews post-treatment in UK primary and secondary care. Method Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data. Results Two key themes were identified: perceived paucity of GPs’ IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: reaching a ‘last-resort diagnosis’; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour. Conclusion In this refractory IBS group, specific doctor–patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.
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140
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Lackner JM, Jaccard J, Keefer L, Brenner D, Firth R, Gudleski GD, Hamilton F, Katz LA, Krasner SS, Ma CX, Radziwon C, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology 2018; 155:47-57. [PMID: 29702118 PMCID: PMC6035059 DOI: 10.1053/j.gastro.2018.03.063] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS There is an urgent need for safe treatments for irritable bowel syndrome (IBS) that relieve treatment-refractory symptoms and their societal and economic burden. Cognitive behavior therapy (CBT) is an effective treatment that has not been broadly adopted into routine clinical practice. We performed a randomized controlled trial to assess clinical responses to home-based CBT compared with clinic-based CBT and patient education. METHODS We performed a prospective study of 436 patients with IBS, based on Rome III criteria, at 2 tertiary centers from August 23, 2010, through October 21, 2016. Subjects (41.4 ± 14.8 years old; 80% women) were randomly assigned to groups that received the following: standard-CBT (S-CBT, n = 146, comprising 10 weekly, 60-minute sessions that emphasized the provision of information about brain-gut interactions; self-monitoring of symptoms, their triggers, and consequences; muscle relaxation; worry control; flexible problem solving; and relapse prevention training), or 4 sessions of primarily home-based CBT requiring minimal therapist contact (MC-CBT, n = 145), in which patients received home-study materials covering the same procedures as S-CBT), or 4 sessions of IBS education (EDU, n = 145) that provided support and information about IBS and the role of lifestyle factors such as stress, diet, and exercise. The primary outcome was global improvement of IBS symptoms, based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Ratings were performed by patients and board-certified gastroenterologists blinded to treatment allocation. Efficacy data were collected 2 weeks, 3 months, and 6 months after treatment completion. RESULTS A higher proportion of patients receiving MC-CBT reported moderate to substantial improvement in gastrointestinal symptoms 2 weeks after treatment (61.0% based on ratings by patients and 55.7% based on ratings by gastroenterologists) than those receiving EDU (43.5% based on ratings patients and 40.4% based on ratings by gastroenterologists) (P < .05). Gastrointestinal symptom improvement, rated by gastroenterologists, 6 months after the end of treatment also differed significantly between the MC-CBT (58.4%) and EDU groups (44.8%) (P = .05). Formal equivalence testing applied across multiple contrasts indicated that MC-CBT is at least as effective as S-CBT in improving IBS symptoms. Patients tended to be more satisfied with CBT vs EDU (P < .05) based on immediate posttreatment responses to the Client Satisfaction Questionnaire. Symptom improvement was not significantly related to concomitant use of medications. CONCLUSIONS In a randomized controlled trial, we found that a primarily home-based version of CBT produced significant and sustained gastrointestinal symptom improvement for patients with IBS compared with education. Clinicaltrials.gov no.: NCT00738920.
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Affiliation(s)
- Jeffrey M. Lackner
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - James Jaccard
- School of Social Work, New York University, New York, NY
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Darren Brenner
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rebecca Firth
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Gregory D. Gudleski
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Frank Hamilton
- Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD
| | - Leonard A. Katz
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Susan S. Krasner
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY,Department of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Chang-Xing Ma
- Department of Biostatistics, University at Buffalo, SUNY, Buffalo, NY
| | - Christopher Radziwon
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Michael D. Sitrin
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
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141
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Holmes HJ, Thakur ER, Carty JN, Ziadni MS, Doherty HK, Lockhart NA, Schubiner H, Lumley MA. Ambivalence over emotional expression and perceived social constraints as moderators of relaxation training and emotional awareness and expression training for irritable bowel syndrome. Gen Hosp Psychiatry 2018; 53:38-43. [PMID: 29751205 PMCID: PMC6086751 DOI: 10.1016/j.genhosppsych.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Psychological treatments are generally beneficial for patients with irritable bowel syndrome (IBS), but patients' responses vary. A prior randomized controlled trial found that both relaxation training (RT) and emotional awareness and expression training (EAET) were superior to a waitlist control condition for IBS symptoms, quality of life, depression, and anxiety among IBS patients (Thakur et al., 2017). METHOD We conducted secondary analyses on these data to examine potential moderators of treatment outcomes. Baseline measures of patients' ambivalence over emotional expression and perceived social constraints, which have been hypothesized to influence some treatments, were tested as possible moderators of the effects of RT and EAET, compared to the control condition. RESULTS Results indicated that these variables moderated the effects of RT but not EAET. The benefits of RT occurred for patients who reported higher ambivalence over emotional expression or perceived social constraints, whereas the benefits of EAET were not influenced by these factors. CONCLUSION These findings suggest that RT might be particularly helpful for people who tend to avoid emotional disclosure and expression, supporting the possible benefit of targeting treatments to patient characteristics and preferences, whereas EAET might be helpful for a broader range of patients with IBS.
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142
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Chen M, Tang TC, Wang Y, Shui J, Xiao XH, Lan X, Yu P, Zhang C, Wang SH, Yao J, Zheng H, Huang DQ. Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48:160-168. [PMID: 29856472 DOI: 10.1111/apt.14817] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/17/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tong-Xie-Yao-Fang (TXYF) is a Chinese herbal formula for treating chronic diarrhoea accompanied by abdominal pain. The results were inconsistent in previous trials examining its effect. AIM To study the efficacy of TXYF granules for treating diarrhoea-predominant irritable bowel syndrome (IBS-D). METHODS We performed a double-blind, placebo-controlled randomised trial and enrolled 160 participants with IBS-D. The participants had VAS scores ≥3 cm in IBS-D global symptoms and ≥2 days in a week with abdominal pain and loose stools (Bristol score 5, 6 or 7). They were randomly assigned to received TXYF or placebo during a treatment period of 4 weeks, and they were followed up for 8 weeks after treatment. The primary outcome was adequate relief of IBS-D global symptoms for at least 2 of 4 weeks during weeks 1-4. Secondary outcomes included mean weekly VAS scores of IBS-D major symptoms, mean weekly stool frequency, mean weekly Bristol score, and adverse events. RESULTS 155 of 160 patients completed the trial. We found a significantly higher rate of adequate relief of global symptoms in TXFY group during weeks 1 to 4 (57.5% vs 37.5%, χ2 = 5.6391, P = 0.017); logistic regression analysis showed a similar result (OR 2.2, 95% CI 1.2-4.4, P = 0.016). Most of the secondary outcomes showed superiority of TXYF over placebo in weekly assessment from week 3 to week 7. The adverse event rate was low in both groups (3.8% vs 3.8%, P = 1.000). CONCLUSION During a 4 week trial, TXFY granules were superior to placebo in controlling symptoms of IBS-D.
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Affiliation(s)
- M Chen
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - T-C Tang
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Y Wang
- Colorectal Department, Luzhou People's Hospital, Luzhou, Sichuan, China
| | - J Shui
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - X-H Xiao
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - X Lan
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - P Yu
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - C Zhang
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - S-H Wang
- Colorectal Department, Luzhou People's Hospital, Luzhou, Sichuan, China
| | - J Yao
- Colorectal Department, Luzhou People's Hospital, Luzhou, Sichuan, China
| | - H Zheng
- Acupuncture and Tuina School/3rd Teaching Hosptial, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - D-Q Huang
- Clinical Medicine College/Teaching hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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143
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Preston K, Krumian R, Hattner J, de Montigny D, Stewart M, Gaddam S. Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 improve quality-of-life and IBS symptoms: a double-blind, randomised, placebo-controlled study. Benef Microbes 2018; 9:697-706. [PMID: 29888656 DOI: 10.3920/bm2017.0105] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 was compared to placebo for relief of symptoms of irritable bowel syndrome (IBS). A total of 113 subjects at 3 clinical sites were randomised in a 2:1 ratio and followed for 12 weeks. Subjects ingested either 2 capsules of active study product, containing 50×109 cfu of live organisms, or 2 placebo capsules daily. Endpoints included improvement in abdominal pain, days of pain, distention, stool consistency and frequency, quality of life (QOL), and adequate relief (AR) of IBS symptoms. IBS subtypes constipation (IBS-C), diarrhoea (IBS-D), and mixed (IBS-M) were evaluated separately; the effect of gender was also examined. For all efficacy endpoints improvement of 30% or more vs placebo was considered clinically significant. With the exception of pain intensity and AR, the endpoints demonstrated a therapeutic advantage of active over placebo for IBS symptoms in at least some subject subgroups. The IBS-D and female subgroups showed the largest and most consistent effects. Stool frequency and consistency were evaluated in the IBS-C and IBS-D subgroups, and improvement of active vs placebo was noted in both. QOL improvement was seen overall and in specific domains. Adverse events (AEs) were limited to 7 subjects; all were of mild or moderate intensity except one, severe cramping. Four AEs in the same subject in the placebo group were judged to be related to study product; these resolved by the end of study. There were no serious AEs.
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Affiliation(s)
- K Preston
- 1 Westlake Medical Research, 550 St. Charles St., Ste. 208, Thousand Oaks, CA 91360, USA
| | - R Krumian
- 1 Westlake Medical Research, 550 St. Charles St., Ste. 208, Thousand Oaks, CA 91360, USA
| | - J Hattner
- 2 Sprim Americas, 254 Front St. Ph, New York, NY 10038, USA
| | - D de Montigny
- 3 Bio-K Plus International, Inc., 495 Blvd. Armand-Frappier, Laval, H7V 4B3, Canada
| | - M Stewart
- 2 Sprim Americas, 254 Front St. Ph, New York, NY 10038, USA
| | - S Gaddam
- 4 Digestive and Liver Disease Specialists, 11922 Seacrest Dr., Ste. A, Garden Grove, CA 92840, USA
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144
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Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol 2018; 24:2211-2235. [PMID: 29881232 PMCID: PMC5989237 DOI: 10.3748/wjg.v24.i21.2211] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
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145
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Brusaferro A, Farinelli E, Zenzeri L, Cozzali R, Esposito S. The Management of Paediatric Functional Abdominal Pain Disorders: Latest Evidence. Paediatr Drugs 2018; 20:235-247. [PMID: 29497992 PMCID: PMC5954057 DOI: 10.1007/s40272-018-0287-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recurrent abdominal pain (RAP) is one of the most common health complaints in both children and adults. Although RAP is considered a functional disorder rather than an organic disease, affected children and their families can still experience anxiety and concerns that can interfere with school, sports, and regular daily activities and lead to frequent attendances at pediatric emergency departments or pediatric gastroenterology clinics. Our review shows experts do not agree on a universally proven management that will work on every child presenting with functional abdominal pain (FAP). Treatment strategies include both non-pharmacological and pharmacological options. Non-pharmacological treatments are usually very well accepted by both children and their parents and are free from medication side effects. Nevertheless, they may be as effective as the pharmacological interventions; therefore, according to many experts and based on the majority of current evidence, a non-pharmacological approach should be the first intervention attempt in children with RAP. In particular, the importance of the bio-psychosocial approach is highlighted, as a majority of children will improve with counselling and reassurance that no serious organic pathologies are suspected, especially when the physician establishes a trustful relationship with both the child and their family. Placebo and pharmacological interventions could be attempted when the bio-psychosocial approach is not applicable or not efficacious. In some difficult cases, finding an effective treatment for FAP can be a challenge, and a number of strategies may need to be tried before symptoms are controlled. In these cases, a multidisciplinary team, comprising a pediatric gastroenterologist, dietician, psychologist, and psychotherapist, is likely to be successful.
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Affiliation(s)
- Andrea Brusaferro
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Edoardo Farinelli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Letizia Zenzeri
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Rita Cozzali
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
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146
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Ford AC, Moayyedi P, Chey WD, Harris LA, Lacy BE, Saito YA, Quigley EMM. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. Am J Gastroenterol 2018; 113:1-18. [PMID: 29950604 DOI: 10.1038/s41395-018-0084-x] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Paul Moayyedi
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - William D Chey
- Division of Gastroenterology, Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA.
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147
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Keefer L. Behavioural medicine and gastrointestinal disorders: the promise of positive psychology. Nat Rev Gastroenterol Hepatol 2018; 15:378-386. [PMID: 29651112 DOI: 10.1038/s41575-018-0001-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychosocial risk factors linked to brain-gut dysregulation are prevalent across the spectrum of gastrointestinal disorders and are associated with poor patient outcomes. Robust and reproducible data in the areas of behavioural intervention science and the brain-gut axis have led to major advances in patient care, including the routine use of brain-gut psychotherapies to manage digestive symptoms and optimize coping. The logical next step for the emerging field of psychogastroenterology is to develop a scientific framework that enables the identification of those individual characteristics and coping styles that buffer patients against the negative psychological effects of chronic gastrointestinal disorders. A shift towards a strength-based, positive psychological science of gastrointestinal disorders could facilitate the integration of early, effective psychological care into gastroenterology practice. In this Perspective, I discuss the potential role of three human strengths with relevance to gastrointestinal health - resilience, optimism and self-regulation - and how these three constructs can be cultivated through existing or emerging brain-gut psychotherapies.
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Affiliation(s)
- Laurie Keefer
- Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, NY, USA.
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148
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Weaver KR, Melkus GD, Fletcher J, Henderson WA. Perceived Stress, Its Physiological Correlates, and Quality of Life in Patients With Irritable Bowel Syndrome. Biol Res Nurs 2018; 20:312-320. [PMID: 29402137 PMCID: PMC5993079 DOI: 10.1177/1099800418756733] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is a chronic, common disorder of the gastrointestinal tract associated with high psychological comorbidity and diminished quality of life. Patients with IBS display a heightened sensitivity to stress, although the literature is inconsistent as to whether they have a dysregulated stress response. The purpose of the present investigation, a substudy of a larger research effort, was to examine physiological correlates of perceived stress in patients with IBS (cortisol and adrenocorticotropic hormone) and to explore associations between perceived stress and quality of life. A total of 101 participants (35 with IBS [predominant subtypes IBS-constipation and IBS-diarrhea] and 66 healthy controls [HCs]) completed self-report inventories regarding perceived stress and quality of life, and fasting peripheral blood was drawn. Participants with IBS did not differ from the HC in demographic or physiological measures but did differ in psychological measures, reporting significantly higher levels of perceived stress and lower levels of quality of life. Perceived stress and quality of life were not significantly associated in IBS participants. However, differential findings of the stress response were found within IBS participants by sex, race, and subtype. These findings illustrate the heterogeneity of the IBS patient population, underscore the necessity of evaluating larger sample sizes and increasing the diversity of such samples to include males and ethnic minorities, and demonstrate the importance of taking an individualized approach to evaluation and treatment in the IBS patient population.
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Affiliation(s)
- Kristen R. Weaver
- Johns Hopkins University, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Wendy A. Henderson
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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149
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Song KH, Jung HK, Kim HJ, Koo HS, Kwon YH, Shin HD, Lim HC, Shin JE, Kim SE, Cho DH, Kim JH, Kim HJ. Clinical Practice Guidelines for Irritable Bowel Syndrome in Korea, 2017 Revised Edition. J Neurogastroenterol Motil 2018; 24:197-215. [PMID: 29605976 PMCID: PMC5885719 DOI: 10.5056/jnm17145] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/11/2018] [Accepted: 02/27/2018] [Indexed: 12/12/2022] Open
Abstract
In 2011, the Korean Society of Neurogastroenterology and Motility (KSNM) published clinical practice guidelines on the management of irritable bowel syndrome (IBS) based on a systematic review of the literature. The KSNM planned to update the clinical practice guidelines to support primary physicians, reduce the socioeconomic burden of IBS, and reflect advances in the pathophysiology and management of IBS. The present revised version of the guidelines is in continuity with the previous version and targets adults diagnosed with, or suspected to have, IBS. A librarian created a literature search query, and a systematic review was conducted to identify candidate guidelines. Feasible documents were verified based on predetermined inclusion and exclusion criteria. The candidate seed guidelines were fully evaluated by the Guidelines Development Committee using the Appraisal of Guidelines for Research and Evaluation II quality assessment tool. After selecting 7 seed guidelines, the committee prepared evidence summaries to generate data exaction tables. These summaries comprised the 4 main themes of this version of the guidelines: colonoscopy; a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; probiotics; and rifaximin. To adopt the core recommendations of the guidelines, the Delphi technique (ie, a panel of experts on IBS) was used. To enhance dissemination of the clinical practice guidelines, a Korean version will be made available, and a food calendar for patients with IBS is produced.
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Affiliation(s)
- Kyung Ho Song
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon,
Korea
- Konyang University Myunggok Medical Research Institute Daejeon,
Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul,
Korea
- Correspondence: Hye-Kyung Jung, MD, PhD Department of Internal Medicine, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea, Tel: +82-2-2650-2874, Fax: +82-2-2655-2874, E-mail:
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University, College of Medicine, Jinju,
Korea
| | - Hoon Sup Koo
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon,
Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu,
Korea
| | - Hyun Duk Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan,
Korea
| | - Hyun Chul Lim
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan,
Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
| | - Dae Hyeon Cho
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Changwon,
Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul,
Korea
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150
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Keefer L, Palsson OS, Pandolfino JE. Best Practice Update: Incorporating Psychogastroenterology Into Management of Digestive Disorders. Gastroenterology 2018; 154:1249-1257. [PMID: 29410117 DOI: 10.1053/j.gastro.2018.01.045] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/13/2022]
Abstract
Chronic digestive diseases, including irritable bowel syndrome, gastroesophageal reflux disease, and inflammatory bowel diseases, cannot be disentangled from their psychological context-the substantial burden of these diseases is co-determined by symptom and disease severity and the ability of patients to cope with their symptoms without significant interruption to daily life. The growing field of psychogastroenterology focuses on the application of scientifically based psychological principles and techniques to the alleviation of digestive symptoms. In this Clinical Practice Update, we describe the structure and efficacy of 2 major classes of psychotherapy-cognitive behavior therapy and gut-directed hypnotherapy. We focus on the impact of these brain-gut psychotherapies on gastrointestinal symptoms, as well as their ability to facilitate improved coping, resilience, and self-regulation. The importance of the gastroenterologist in the promotion of integrated psychological care cannot be overstated, and recommendations are provided on how to address psychological issues and make an effective referral for brain-gut psychotherapy in routine practice.
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Affiliation(s)
- Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - John E Pandolfino
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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