Biofeedback and behavioral approaches to disorders of the gastrointestinal tract

Paradoxical Intention and Exposure In vivo in the Treatment of Psychogenic Nausea: Report of Two Cases

Two patients suffering from long-standing psychogenic nausea were treated by paradoxical intention and exposure in vivo within an A–BC–B–BC single case experimental design. Each received six treatment sessions. At the six month follow-up, both patients had improved substantially. Contrary to what was expected, paradoxical intention produced adverse outcome; both patients because nauseous and even vomited a few times while practicing the technique. Exposure in vivo gave better results.

Association of the -1438 G/A and 102 T/C polymorphism of the 5-Ht2A receptor gene with irritable bowel syndrome 5-Ht2A gene polymorphism in irritable bowel syndrome

GOALS

The aim of this study is to investigate whether there were any association between the 102 T/C and -1438 G/A polymorphisms of the 5-HT2A receptor gene and IBS, and abdominal pain, anxiety and depression.

BACKGROUND

Genes involved in serotonin (5-HT) metabolism are good candidates for the pathogenesis of irritable bowel syndrome (IBS). Recently, a silent polymorphism in the 5-HT2A receptor gene was identified that is defined by a T to C transition at position 102. Also, a novel G to A base change at position -1438 of the promoter region has been detected in 5-HT2A receptor gene.

STUDY

Fifty-four patients with IBS diagnosed according to the Rome 1 criteria and 107 healthy individuals were included in the study. PCR was used to amplify a 468-bp (G-->A) and 342-bp (T-->C) fragment of genomic DNA containing the polymorphism. Hospital anxiety and depression scale was used to assess the risk of depression and anxiety. Severity of chronic abdominal pain was determined by visual analogue scale (VAS).

RESULTS

It was shown that there was a high incidence of homozygote C allele of the 102T/C polymorphism (%22.2; OR: 7.89, P = 0.04) and homozygote A allele of the -1438 G/A promoter region (%%37; OR: 11.14, P = 0.01) in patients with IBS. The risk of having an anxiety disorder was 83.3% in patients with C/C genotype, which was higher than other allele carrying patients, and overall mean (%52.7). (chi = 8.56, P = 0.014). The patients with T/T genotype had a VAS score of 54.93 +/- 2.59 mm, which was significantly higher than that of the patients with other genotypes (p1 = 0.02, p2 = 0.001).

CONCLUSION

This study suggests that the patients with homozygote C allele of the 102 T/C polymorphisms or homozygote A allele of the -1438 G/A polymorphism of the 5-HT2A receptor gene, have a high risk of IBS. On the other hand, T/T genotype of 102 T/C polymorphism may be associated with more severe pain in patient with IBS.

Treatment of faecal incontinence in a child with sacral agenesis: the use of biofeedback training

The case of a 14-year-old girl is presented who was born with sacral agenesis and severe, chronic constipation not responding to laxative treatment. Biofeedback was employed in the treatment of the constipation and soiling. After six treatment sessions over four months, the constipation and soiling ceased and there was no relapse during follow-up of 12 months. Although this child had an absence of S3-S5 and the coccyx, with possible innervation abnormalities, this case illustrates that biofeedback training might be a useful adjunct to existing therapies.

Problematic gagging: principles of treatment

The causes of problematic gagging are discussed and a behavioral method for its treatment is recommended. Four case studies illustrating the application of this approach are presented.

The irritable bowel syndrome

The clinical characteristics and putative pathogenetic mechanisms of the irritable bowel syndrome are described. The complex inter-relationships between stressful life situations, psychoneurotic and somatic factors involved in the production, maintenance and management of alimentary symptoms are discussed using a behavioural model and catastrophe theory.