A symptom severity questionnaire for patients suffering from functional gastrointestinal disorder: FGI-Checklist

Patient-Reported Outcomes in Disorders of Gut-Brain Interaction

Disorders of gut-brain interaction are characterized by chronic gastrointestinal symptoms in the absence of abnormal endoscopic or radiologic findings or objective biomarkers that can be identified during routine clinical evaluation. The assessment of the symptom pattern and severity, therefore, is the key modality to evaluate the presence, impact, and evolution of these conditions, for both clinical and regulatory purposes. Patient-reported outcomes are structured symptom assessment questionnaires designed to evaluate symptom patterns, quantify severity of symptoms, and evaluate response to treatment at follow-up. This review provides an overview of currently available patient-reported outcomes for evaluating the main disorders of gut-brain interaction, specifically, functional dyspepsia; irritable bowel syndrome; and chronic constipation. It summarizes their content, level of validation for clinical practice and for research, and the regulatory approach to these conditions. Expected future developments and need for further research on patient-reported outcomes for these and other disorders of gut-brain interaction are highlighted.

Patient-reported outcome measures in functional dyspepsia: a systematic review and COSMIN analysis

BACKGROUND

Functional dyspepsia (FD) as a type of disorders of brain-gut interaction (DBGI), patient self-reporting of its symptoms becomes an important component of clinical outcome assessment. We performed a systematic review using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines to identify the best available patient-reported outcome measure (PROM) of FD.

METHODS

The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched four databases with no date limit, looking for previously confirmed PROMs for evaluating FD symptoms. An overall rating was then assigned based upon COSMIN guidelines, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the level of evidence for psychometric properties of included PROMs.

RESULTS

Thirty articles covering outcome indicators of 24 patient reports were included. The Leuven Postprandial Distress Scale (LPDS) showed adequate content validity and moderate quality evidence of adequate internal consistency to generate an A recommendation.

CONCLUSION

LPDS is currently the most recommended PROM for patient self-reported FD symptoms. However, it fails to assess two important areas of cross-cultural validity/ measurement invariance and measurement error. Future research can be continuously improved on this basis.

Efficacy of Cognitive Behavioral Therapy With Local Wisdom and Web-Based Counseling on Generalized Anxiety Disorders and Functional Gastrointestinal Disorders in Adolescent College Girls: Protocol for a Randomized Controlled Trial

BACKGROUND

The high academic demands experienced by students will often have an impact on the quality of their mental and physical health. The most common health problems reported are gastrointestinal disorders. This condition tends to manifest in the emergence of generalized anxiety disorders (GADs) and reduces the quality of life and productivity. The population that experiences this disorder the most is female adolescents, and this condition occurs in both South African and Indonesian populations. The use of drugs, especially benzodiazepines, often causes psychological conditions as side effects. For this reason, it is necessary to have a solution in the form of a targeted and efficient approach to reduce psychological symptoms that arise from functional gastrointestinal disorders (FGIDs) in the form of anxiety.

OBJECTIVE

The purpose of this study is to produce and implement a counseling intervention model to assist female students with GADs caused by FGID factors using an approach combining cognitive behavioral therapy (CBT), web-based counseling, and local wisdom in Indonesian and South African populations.

METHODS

The research subjects will comprise 118 female adolescent students from Indonesia and 118 female adolescent students from South Africa, making a total sample of 236 participants, and the study will use a prospective, parallel randomized controlled trial design. The recruitment process will begin in July 2023, and the trial will begin in August 2023. The posttest assessment data gathering will take place by November 2023. Questionnaires that will be used in this study include the Functional Gastrointestinal Disorder Checklist (FGI-Checklist) to collect data related to FGIDs and the Generalized Anxiety Disorder 7-item (GAD-7) to measure the anxiety conditions experienced by respondents.

RESULTS

By adopting the intention-to-treat principle, there will be significant mean changes in GAD scores and FGID scores after exposure to this combined approach in the Indonesian and South African populations. Implementing this comprehensive intervention will improve the students' psychological symptoms related to FGIDs and ultimately enhance their overall well-being.

CONCLUSIONS

This study will develop and implement a model of counseling intervention for female students with GADs obtained from FGIDs using a combination approach to CBT, web-based counseling, and local wisdom in both the Indonesian and South African populations. The trial findings will contribute to our understanding of the effects of CBT combined with local wisdom and web-based counseling approaches that mental health counselors can use to treat GAD-affected adolescent girls who have FGIDs.

TRIAL REGISTRATION

UMIN Clinical Trial Registry UMIN000051386; https://tinyurl.com/yjwz8kht.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50316.

Standardized system and App for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation

BACKGROUND

Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications.

METHODS

The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a diverse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4 h after a test meal. Individual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients.

KEY RESULTS

App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (r_S  =0.68), early satiation (r_S  =0.55), bloating (r_S  =0.48), heartburn (r_S  =0.47), upper gut pain (r_S  =0.40), and excessive fullness (r_S  =0.40); all p < 0.001 (n = 79). The total App-reported Gastric Symptom Burden Score correlated positively with PAGI-SYM (r_S  =0.56; convergent validity; p < 0.001), and negatively with PAGI-QOL (r_S  = -0.34; concurrent validity; p = 0.002). Interviews demonstrated that the pictograms had adequate face and content validity.

CONCLUSIONS AND INFERENCES

The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-h post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.

Unaltered Brain GABA Concentrations and Resting fMRI Activity in Functional Dyspepsia With and Without Comorbid Depression

BACKGROUND

GABA-deficit characterizes depression (MDD), which is highly comorbid with Functional Dyspepsia (FD). We examined brain GABA concentrations and resting activities in post-prandial distress subtype FD (FD-PDS) patients with and without MDD.

METHODS

24 female age/education-matched FD-PDS with comorbid MDD (FD-PDS-MDD), non-depressed FD-PDS, and healthy controls each were compared on GABA concentrations, resting fMRI (fALFF) in bilateral pregenual anterior cingulate (pgACC), left dorsolateral prefrontal cortex (DLPFC), insula, and somatosensory cortex (SSC).

RESULTS

FD-PDS-MDD patients had mild though elevated depressive symptoms. FD-PDS patients had generally mild dyspeptic symptoms. No significant between-group differences in GABA or fALFF were found. No significant correlations were found between GABA and depressive/dyspeptic symptoms after Bonferroni correction. In patients, GABA correlated positively with left insula fALFF (r = 0.38, Bonferroni-corrected p = .03).

CONCLUSION

We did not find altered GABA concentrations or brain resting activity in FD-PDS or its MDD comorbidity. The neurochemical link between MDD and FD remains elusive.