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Butt MF, Groen J, Jonker CAL, Burton-Murray H, Carrington EV, Chang L, Di Lorenzo C, Ellis J, Escher JC, Gorter RR, Jewell S, Karrento K, Koster EC, Nurko S, Rosen R, van Tilburg MAL, Zarate-Lopez N, Corsetti M, Benninga MA. Pediatric to adult transition care in neurogastroenterology and motility: A position paper from the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility. Neurogastroenterol Motil 2024:e14869. [PMID: 39038114 DOI: 10.1111/nmo.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
Transition services-programs that support adolescents and young adults (AYAs) as they move from a child-centered to a more autonomous, adult-orientated healthcare system-have been associated with improved short- and long-term healthcare outcomes. Unfortunately, there is a paucity of evidence exploring transition services within the neurogastroenterology and motility (NGM) field. The overall aim of this article, endorsed by the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility, is to promote a discussion about the role of transition services for patients with NGM disorders. The AYAs addressed herein are those who have: (a) a ROME positive disorder of gut-brain interaction (DGBI), (b) a primary or secondary motility disorder (including those with motility disorders that have been surgically managed), or (c) an artificial feeding requirement (parenteral or enteral tube feeding) to manage malnutrition secondary to categories (a) or (b). The issues explored in this position paper include the specific physical and psychological healthcare needs of patients with NGM disorders; key healthcare professionals who should form part of a secondary care NGM transition service; the triadic relationship between healthcare professionals, caregivers, and patients; approaches to selecting patients who may benefit most from transition care; methods to assess transition readiness; and strategies with which to facilitate transfer of care between healthcare professionals. Key areas for future research are also addressed, including the construction of NGM-specific transition readiness questionnaires, tools to assess post-transfer healthcare outcomes, and educational programs to train healthcare professionals about transition care in NGM.
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Affiliation(s)
- Mohsin F Butt
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jip Groen
- Emma Children's Hospital-Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Charlotte A L Jonker
- Emma Children's Hospital-Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Helen Burton-Murray
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Emma V Carrington
- Department of Surgery and Cancer, Imperial College NHS Trust, London, UK
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress at University of California, Los Angeles, Los Angeles, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jacob Ellis
- Department of Child and Adolescent Psychological Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Katja Karrento
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emma C Koster
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Samuel Nurko
- Division of Gastroenterology, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Rachel Rosen
- Division of Gastroenterology, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Miranda A L van Tilburg
- Graduate Medical Education, Cape Fear Valley Health, Fayetteville, North Carolina, USA
- Joan C Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
- Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Natalia Zarate-Lopez
- Department of Gastroenterology and Gastrointestinal Physiology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Maura Corsetti
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marc A Benninga
- Emma Children's Hospital-Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
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Raghuraman N, White JN, Watson L, Belleï-Rodriguez CÉ, Shafir R, Wang Y, Colloca L. Neuropsychological mechanisms of observational learning in human placebo effects. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06608-7. [PMID: 38743108 DOI: 10.1007/s00213-024-06608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
Scientific evidence indicates that placebo effects are psychoneurobiological events involving the contribution of distinct central nervous systems and peripheral physiological mechanisms that influence pain perception and other symptoms. Placebo effects can occur without formal conditioning and direct prior experience because crucial information can be acquired through observational learning. Observation of benefits in another person results in placebo effects of a magnitude like those induced by directly experiencing an analgesic benefit. Understanding the psychological mechanisms of observationally induced placebo effects is a complex and multifaceted endeavor. While previous reviews have highlighted various frameworks and models to understand these phenomena, the underlying biological mechanisms have been overlooked. We summarize critically current understanding of its behavioral and neural mechanisms. Understanding the neural mechanisms of hypoalgesia driven by observation can serve as a foundation for future development of novel theoretical and methodological approaches and ultimately, applications.
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Affiliation(s)
- Nandini Raghuraman
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Epidemiology and Human Genetics, University of Maryland School of Medicine, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Jewel N White
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | - Lakota Watson
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | | | - Roni Shafir
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA.
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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Koen LW, Ravensbergen SJ, Schoormans D, Hoogendijk WJG, Grootendorst-van Mil NH. The association between parental chronic physical illness and adolescent functional somatic symptoms. J Affect Disord 2023; 338:262-269. [PMID: 37308000 DOI: 10.1016/j.jad.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/23/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems. METHODS In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects. RESULTS Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores. LIMITATIONS The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification. CONCLUSION Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.
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Affiliation(s)
- Lotte W Koen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Susan J Ravensbergen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dounya Schoormans
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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van Tilburg MAL, Levy RL, Stoner S, Romano JM, Murphy TB, Abdullah B, Mancl L, Feld AD. Mediation of outcomes for cognitive behavioral therapy targeted to parents of children with Functional Abdominal Pain Disorders. J Psychosom Res 2021; 150:110618. [PMID: 34598050 PMCID: PMC8526395 DOI: 10.1016/j.jpsychores.2021.110618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There is a large body of evidence for the efficacy of Cognitive Behavioral Therapy (CBT) in treating Functional Abdominal Pain Disorders (FAPD) in children. In most CBT interventions for FAPD, parents participate together with their children. However, only one study to date has examined targeting parents alone for treatment. The aim of the current study was to examine mediators of a parent-only CBT treatment incorporating social learning (SLCBT) for FAPD in children. METHODS We examined mediators of child outcomes in an existing randomized controlled trial (n = 316) of parent-only social learning CBT compared to an education condition. Hypothesized mediators (parental protectiveness, perceived threat of pain, catastrophizing) were assessed at 3 months post-treatment, and outcomes (parent ratings of disability, quality of life, school absences, and health care visits) were assessed at 6 months post-treatment. Mediation analyses were performed using Hayes' PROCESS macro. RESULTS Pain catastrophizing significantly mediated treatment effects for all outcomes (B ranged from -1.65 to 2.22). Reduction in pain threat was a significant mediator for all outcomes (B ranged from -1.84 to 3.13) except school absences and health care visits. Decrease in parental protectiveness mediated effects on disability and missed school (B ranged from -1.47 to 1.34). Mediation effects did not differ by in-person or remote delivery of SLCBT. CONCLUSION Changes in maladaptive parental thoughts and behaviors following parent-only SLCBT intervention appeared to mediate the effects of the intervention. Parental catastrophizing appears to be a particularly important target given that decreases in that variable mediated all outcomes.
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Affiliation(s)
- Miranda A L van Tilburg
- School of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States of America; School of Social Work, University of Washington, Seattle, WA, United States of America; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Susan Stoner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, United States of America
| | - Joan M Romano
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Tasha B Murphy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Bisher Abdullah
- CHI Franciscan, Prime Health Clinic, Tacoma, WA, United States of America
| | - Lloyd Mancl
- Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Andrew D Feld
- Division of Gastroenterology, Washington Permanente Medical Group, University of Washington, Seattle, WA, United States of America
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Murphy LK, de la Vega R, Kohut SA, Kawamura JS, Levy RL, Palermo TM. Systematic Review: Psychosocial Correlates of Pain in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:697-710. [PMID: 32458966 DOI: 10.1093/ibd/izaa115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pain is a common symptom in pediatric inflammatory bowel disease (IBD) and is associated with poor health outcomes, yet additional knowledge about the psychosocial correlates of pain is needed to optimize clinical care. The purpose of this study is to systematically review the psychosocial factors associated with pain and pain impact in youth diagnosed with IBD within a developmentally informed framework. METHODS Manual and electronic searches yielded 2641 references. Two authors conducted screening (98% agreement), and data extraction was performed in duplicate. Average study quality was rated using the National Institutes of Health Quality Assessment Tool. RESULTS Ten studies (N = 763 patients; N = 563 Crohn disease, N = 200 ulcerative/ indeterminate colitis) met the inclusion criteria. Findings showed consistent evidence that higher levels of child depression symptoms and child pain catastrophizing were associated with significantly greater pain and pain impact (magnitude of association ranged from small to large across studies). Greater pain and pain impact were also associated with higher levels of child anxiety symptoms, child pain threat, child pain worry, and parent pain catastrophizing. Within the included studies, female sex and disease severity were both significantly associated with pain and pain impact. Study quality was moderate on average. CONCLUSIONS There is evidence that child psychosocial factors are associated with pain and pain impact in pediatric IBD; more studies are needed to examine parent- and family-level psychosocial factors. Youth with IBD should be routinely screened for pain severity, pain impact, and psychosocial risk factors such as anxiety/depression.
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Affiliation(s)
- Lexa K Murphy
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Rocio de la Vega
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Sara Ahola Kohut
- Department of Psychology and Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joy S Kawamura
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Rona L Levy
- Department of Social Work, University of Washington, Seattle, Washington, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Psychogastroenterology: A Cure, Band-Aid, or Prevention? CHILDREN-BASEL 2020; 7:children7090121. [PMID: 32899111 PMCID: PMC7552785 DOI: 10.3390/children7090121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
Abstract
Psychogastroenterology is a field that focuses on the brain–gut connection. Many children with gut disorders also struggle with psychological and social factors that affect their disease outcomes. Psychological factors have been suggested to be a cure, a band-aid, or a prevention. This article examines the underlying models of disease and health that determine how we understand and treat psychosocial factors in gut diseases. The biomedical and biopsychosocial models are presented and applied to pediatric gut disorders. This article should familiarize clinicians as well as children and their families to the challenges and opportunities for addressing psychosocial factors in gut disease. Psychogastroenterology is best thought of as a cog in a complex treatment machine.
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Understanding the Psychosocial and Parenting Needs of Mothers with Irritable Bowel Syndrome with Young Children. CHILDREN-BASEL 2020; 7:children7080093. [PMID: 32784536 PMCID: PMC7463880 DOI: 10.3390/children7080093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
Women of childbearing age experience the highest prevalence of irritable bowel syndrome (IBS), yet little is known about their psychosocial and parenting needs, which may influence their children’s experience of future gastrointestinal or pain-related conditions. The aims of this study were to conduct qualitative interviews to understand the psychosocial and parenting needs of mothers with IBS who have young school-age children, and to assess mothers’ potential interest in and acceptability of a preventive parenting intervention program. Ten mothers with IBS who have young (age 5–10), healthy children were interviewed. Interviews were coded with thematic analysis and three themes were identified: (1) Guilt about how IBS impacts children, (2) Worry that children will develop IBS, and (3) Already on high alert for children’s health. All mothers expressed interest in an Internet-based preventive intervention and identified tools and strategies they would want included. Results demonstrate that mothers experience guilt about how IBS has impacted their children in their daily lives, concern that they need to pay attention to children’s early signs and symptoms that could indicate gastrointestinal problems, and worry about children developing IBS in the future—suggesting that a preventive intervention may address important concerns for this population.
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Steutel NF, Zeevenhooven J, Scarpato E, Vandenplas Y, Tabbers MM, Staiano A, Benninga MA. Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers. J Pediatr 2020; 221:107-114. [PMID: 32446468 DOI: 10.1016/j.jpeds.2020.02.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands. STUDY DESIGN Children were enrolled if they were age 0-48 months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12 months and for toddlers age 13-48 months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria. RESULTS In total 2751 children were included: 1698 infants age 0-12 months and 1053 children age 13-48 months. The prevalence of any FGID in infants age 0-12 months and 13-48 months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P = .030) and formula feeding (P = .045) were associated with the prevalence of any FGID among infants. Country (Italy) (P = .033) and parents subjected to domestic violence (P = .035) were associated with the prevalence of any FGID in toddlers age 13-48 months. CONCLUSIONS FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.
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Affiliation(s)
- Nina F Steutel
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Clinical Epidemiology, Bioinformatics and Biostatistics, Amsterdam, The Netherlands
| | - Judith Zeevenhooven
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - Elena Scarpato
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
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Jones MP, Faresjö Å, Beath A, Faresjö T, Ludvigsson J. Abdominal Pain in Children Develops With Age and Increases With Psychosocial Factors. Clin Gastroenterol Hepatol 2020; 18:360-367.e1. [PMID: 31009796 DOI: 10.1016/j.cgh.2019.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Functional gastrointestinal disorders are highly prevalent, cause significant suffering, and are costly to society. Pain is a central feature of 2 of the most common functional gastrointestinal disorders: irritable bowel syndrome and functional dyspepsia. Although these disorders have been well studied in adults, their etiology is poorly understood. We sought to identify early life factors associated with the development of abdominal pain in children (age, 2-12 y). METHODS We collected data from the All Babies in Southeast Sweden study of 1781 children, born from October 1, 1997, through October 31, 1999, whose families answered questions about abdominal pain and risk factors at birth, 1 year, 2.5 years, 5 years, 8 years, and 10 to 12 years. We used latent growth curve models to evaluate risk factors for development of abdominal pain. The primary outcomes were prevalence of abdominal pain and associated factors. RESULTS The prevalence of abdominal pain increased linearly with age in the study cohort, increasing by approximately 6% per year. Psychosocial variables associated with slope of the growth curve included lower emotional control at age 2 years (P = .005), parental concern for the child at age 2 years (P = .02), and measures of parental stress (P = .004). Nonvaginal birth was associated with a reduced slope of the growth curve (P = .03). CONCLUSIONS In a study of children in Sweden, we found early psychosocial environment and mode of delivery at birth was associated with development of childhood abdominal pain. Factors associated with development of the early immune system, identified in previous recall-based research, were not supported by data from this study. These findings have important implications for the prevention of abdominal pain in children and later in life.
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Affiliation(s)
- Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia.
| | - Åshild Faresjö
- Division of Community Medicine, Department of Medical Health and Science, Linköping University, Linköping, Sweden
| | - Alissa Beath
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia
| | - Tomas Faresjö
- Division of Community Medicine, Department of Medical Health and Science, Linköping University, Linköping, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Division of Pediatrics, Crown Princess Victoria Children's Hospital, Region Östergötland, Linköping, Sweden
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Observe to get pain relief: current evidence and potential mechanisms of socially learned pain modulation. Pain 2019; 158:2077-2081. [PMID: 29035916 DOI: 10.1097/j.pain.0000000000000943] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Parental Factors in Pediatric Functional Abdominal Pain Disorders: A Cross-sectional Cohort Study. J Pediatr Gastroenterol Nutr 2019; 68:e20-e26. [PMID: 30289821 DOI: 10.1097/mpg.0000000000002163] [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] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Parental factors are suggested to play a role in pediatric irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) and may influence treatment. Since studies on parental factors mainly focus on mothers, this study aims to compare physical health, psychological distress, personality dimensions, and parenting behavior of both parents of children with IBS or FAP-NOS to parents of controls. METHODS Parents of 91 children with IBS or FAP-NOS were included in this explorative cross-sectional cohort study. Parents of 74 age-matched healthy children were used as controls. Questionnaires were used to measure demographics, physical health, psychological distress and symptoms, personality dimensions, and child-rearing practices. RESULTS A total of 59 mothers and 52 fathers of 61 children with IBS/FAP-NOS (response rate 61.0%) and 56 mothers and 49 fathers of 59 controls completed the study (response rate 70.9%). Mothers of children with IBS/FAP-NOS reported more physical problems. Psychological distress and symptoms, personality dimensions, and child-rearing practices did not differ between mothers of both groups. Fathers of children with IBS/FAP-NOS had significantly lower scores on the child-rearing practice subscale of ignoring of unwanted behavior. In the IBS/FAP-NOS group, fathers were more depressed and less agreeable than mothers. No differences on all assessed outcomes were found between parents of children with IBS and children with FAP-NOS. CONCLUSIONS Mothers of children with IBS/FAP-NOS and healthy peers differ with respect to physical health. Fathers in both groups differ with respect to child-rearing style. Clinicians should be aware of these differences when treating children with these disorders.
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Barber Garcia BN, Gray LS, Simons LE, Logan DE. Development of the Parent Responses to School Functioning Questionnaire. THE JOURNAL OF PAIN 2017; 18:1277-1286. [DOI: 10.1016/j.jpain.2017.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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Norton C, Czuber-Dochan W, Artom M, Sweeney L, Hart A. Systematic review: interventions for abdominal pain management in inflammatory bowel disease. Aliment Pharmacol Ther 2017; 46:115-125. [PMID: 28470846 DOI: 10.1111/apt.14108] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/22/2016] [Accepted: 03/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under-treated symptom. AIM To systematically review evidence on interventions (excluding disease-modifying interventions) for abdominal pain management in IBD. METHODS Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) were searched (February 2016). Two researchers independently screened references and extracted data. RESULTS Fifteen papers were included: 13 intervention studies and two cross-sectional surveys. A variety of psychological, dietary and pharmacological interventions were reported. Four of six studies reported pain reduction with psychological intervention including individualised and group-based relaxation, disease anxiety-related Cognitive Behavioural Therapy and stress management. Both psychologist-led and self-directed stress management in inactive Crohn's disease reduced pain compared with controls (symptom frequency reduction index=-26.7, -11.3 and 17.2 at 6-month follow-up, respectively). Two dietary interventions (alcoholic drinks with high sugar content and fermentable carbohydrate with prebiotic properties) had an effect on abdominal pain. Antibiotics (for patients with bacterial overgrowth) and transdermal nicotine patches reduced abdominal pain. Current and past cannabis users report it relieves pain. One controlled trial of cannabis reduced SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). These results must be treated with caution: data were derived from predominantly small uncontrolled studies of moderate to low quality. CONCLUSIONS Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD.
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Affiliation(s)
- C Norton
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - W Czuber-Dochan
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - M Artom
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - L Sweeney
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - A Hart
- St Mark's Hospital, London, UK
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Bonvanie IJ, Janssens KAM, Rosmalen JGM, Oldehinkel AJ. Life events and functional somatic symptoms: A population study in older adolescents. Br J Psychol 2016; 108:318-333. [DOI: 10.1111/bjop.12198] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 04/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Irma J. Bonvanie
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE); University of Groningen; University Medical Center Groningen; The Netherlands
| | - Karin A. M. Janssens
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE); University of Groningen; University Medical Center Groningen; The Netherlands
| | - Judith G. M. Rosmalen
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE); University of Groningen; University Medical Center Groningen; The Netherlands
| | - Albertine J. Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE); University of Groningen; University Medical Center Groningen; The Netherlands
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van Tilburg MAL, Levy RL, Walker LS, Von Korff M, Feld LD, Garner M, Feld AD, Whitehead WE. Psychosocial mechanisms for the transmission of somatic symptoms from parents to children. World J Gastroenterol 2015; 21:5532-41. [PMID: 25987776 PMCID: PMC4427675 DOI: 10.3748/wjg.v21.i18.5532] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/19/2014] [Accepted: 12/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To examine familial aggregation of irritable bowel syndrome (IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to stress. METHODS Mothers of children between the ages of 8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget Sound. Mothers completed questionnaires, including the Child Behavior Checklist (child psychological distress), the Family Inventory of Life Events (family exposure to stress), SCL-90R (mother psychological distress), and the Pain Response Inventory (beliefs about pain). Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire (beliefs about pain), Pain Response Inventory (coping) and Child Symptom Checklist [gastrointestinal (GI) symptoms]. In addition, health care utilization data was obtained from the automated database of Group Health Cooperative. Mothers with IBS (n = 207) and their 296 children were compared to 240 control mothers and their 335 children, while controlling for age and education. RESULTS Hypothesis 1: reinforcement of expression of GI problems is only related to GI symptoms, but not others (cold symptoms) in children. There was no significant correlation between parental reinforcement of symptoms and child expression of GI or other symptoms. Hypothesis 2: modeling of GI symptoms is related to GI but not non-GI symptom reporting in children. Children of parents with IBS reported more non-GI (8.97 vs 6.70, P < 0.01) as well as more GI (3.24 vs 2.27, P < 0.01) symptoms. Total health care visits made by the mother correlated with visits made by the child (rho = 0.35, P < 0.001 for cases, rho = 0.26, P < 0.001 for controls). Hypothesis 3: children learn to share the methods of coping with illness that their mothers exhibit. Methods used by children to cope with stomachaches differed from methods used by their mothers. Only 2/16 scales showed weak but significant correlations (stoicism rho = 0.13, P < 0.05; acceptance rho = 0.13, P < 0.05). Hypothesis 4: mothers and children share psychological traits such as anxiety, depression, and somatization. Child psychological distress correlated with mother's psychological distress (rho = 0.41, P < 0.001 for cases, rho= 0.38, P < 0.001 for controls). Hypothesis 5: stress that affects the whole family might explain the similarities between mothers and their children. Family exposure to stress was not a significant predictor of children's symptom reports. Hypothesis 6: the intergenerational transmission of GI illness behavior may be due to multiple mechanisms. Regression analysis identified multiple independent predictors of the child's GI complaints, which were similar to the predictors of the child's non-GI symptoms (mother's IBS status, child psychological symptoms, child catastrophizing, and child age). CONCLUSION Multiple factors influence the reporting of children's gastrointestinal and non-gastrointestinal symptoms. The clustering of illness within families is best understood using a model that incorporates all these factors.
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. Repeated primary care consultations for non-specific physical symptoms in children in UK: a cohort study. BMC FAMILY PRACTICE 2014; 15:195. [PMID: 25477255 PMCID: PMC4261613 DOI: 10.1186/s12875-014-0195-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-specific physical symptoms (NSPS), such as headache and abdominal pain, are common reasons for children to consult primary care. NSPS represent a significant burden not only on society, but also on health care services, through frequent physician consultations and referrals to secondary care. Research evidence suggests a positive relationship between health and consulting behavior of parents and their children, but research on whether repeated physician consultations for NSPS in children is influenced by parental consultations for NSPS is lacking. The aim was to measure the frequency of repeated physician consultations for NSPS in children, and investigate whether this is influenced by maternal consultations for NSPS. METHODS A cohort study of children registered with primary care practices contributing to the Consultation in Primary Care Archive database. Participants were child-mother pairs registered between January 2007 and December 2010. The cohort comprised all children (n = 1437) aged 2 to 16 years who consulted a physician for NSPS in 2009. Mothers' consultations for NSPS were measured between 2007 and 2008. Main outcome measures were repetition and frequency of consultations for NSPS in children (consultations for NSPS in both 2009 and 2010). RESULTS Overall, 27% of children had repeated consultations for NSPS. The three most common repeated consultations were for back pain, constipation and abdominal pain. Exposure to maternal consultation for NSPS was associated with 21% increase in consultation frequency for NSPS (adjusted incidence rate ratio 1.21; 95% CI 1.12, 1.31). After adjusting for child age and maternal age, maternal consultation for NSPS was associated with an increased risk of repeated consultations for NSPS in children (relative risk 1.41; 95% CI 1.16, 1.73). This association was also significant for specific NSPS groups including painful, gastrointestinal, and neurologic symptoms. CONCLUSIONS Repeated consultation for NSPS is common among children. It is important for primary care physicians and secondary care clinicians, managing children referred from primary care for NSPS, to be aware that consultation for NSPS in mothers is a risk factor for repeated consultations for NSPS among children. More research is needed to uncover exactly how parental health influences health and consulting behavior of children.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. .,Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, USA. .,Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA.
| | | | | | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
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Nakagawa Y, Chiba K. Role of microglial m1/m2 polarization in relapse and remission of psychiatric disorders and diseases. Pharmaceuticals (Basel) 2014; 7:1028-48. [PMID: 25429645 PMCID: PMC4276905 DOI: 10.3390/ph7121028] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022] Open
Abstract
Psychiatric disorders such as schizophrenia and major depressive disorder were thought to be caused by neurotransmitter abnormalities. Patients with these disorders often experience relapse and remission; however the underlying molecular mechanisms of relapse and remission still remain unclear. Recent advanced immunological analyses have revealed that M1/M2 polarization of macrophages plays an important role in controlling the balance between promotion and suppression in inflammation. Microglial cells share certain characteristics with macrophages and contribute to immune-surveillance in the central nervous system (CNS). In this review, we summarize immunoregulatory functions of microglia and discuss a possible role of microglial M1/M2 polarization in relapse and remission of psychiatric disorders and diseases. M1 polarized microglia can produce pro-inflammatory cytokines, reactive oxygen species, and nitric oxide, suggesting that these molecules contribute to dysfunction of neural network in the CNS. Alternatively, M2 polarized microglia express cytokines and receptors that are implicated in inhibiting inflammation and restoring homeostasis. Based on these aspects, we propose a possibility that M1 and M2 microglia are related to relapse and remission, respectively in psychiatric disorders and diseases. Consequently, a target molecule skewing M2 polarization of microglia may provide beneficial therapies for these disorders and diseases in the CNS.
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Affiliation(s)
- Yutaka Nakagawa
- Research Strategy and Planning Department, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama 227-0033, Japan.
| | - Kenji Chiba
- Advanced Medical Research Laboratories, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama 227-0033, Japan.
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. The association between GP consultations for non-specific physical symptoms in children and parents: a case-control study. PLoS One 2014; 9:e108039. [PMID: 25251344 PMCID: PMC4176724 DOI: 10.1371/journal.pone.0108039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences. OBJECTIVE To investigate associations between GP consultations for NSPS in parents and their children. METHODS Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354). PRIMARY OUTCOME MEASURE child consultation status for NSPS. RESULTS Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms. CONCLUSIONS Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
- Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
- Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | | | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
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19
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Internet-delivered cognitive behavior therapy for adolescents with functional gastrointestinal disorders — An open trial. Internet Interv 2014. [DOI: 10.1016/j.invent.2014.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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20
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GP consultations for medically unexplained physical symptoms in parents and their children: a systematic review. Br J Gen Pract 2014; 63:e318-25. [PMID: 23643229 PMCID: PMC3635577 DOI: 10.3399/bjgp13x667178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is evidence of an association of medically unexplained physical symptoms (MUPS) between parents and children, but it is unclear whether this association is also present for GP consultations. AIM To review the literature investigating the association of GP consultations for MUPS between parents and children. DESIGN OF STUDY Systematic review. METHOD Systematic search of MEDLINE(®), Embase, CINAHL, and PsycINFO databases from their inception to October 2012. Observational studies examining the association of GP consultations for MUPS between parents and children were included. RESULTS Eight studies were included in the review. Three studies found significant associations between GP consultations for multiple MUPS between parents and children. Two studies reported significant associations between irritable bowel syndrome diagnosis in parents and multiple MUPS in children. One study showed no significant associations between multiple MUPS in mothers and functional abdominal pain in children. Two studies investigated the association of non-specific low back pain in parents and children; one study showed a significant association, whereas the other study found no significant association. Formal pooling of the results was not performed owing to a high degree of study heterogeneity. CONCLUSION This review provides evidence of an association between GP consultations for MUPS in parents and children, although the evidence is limited by some potential biases and study heterogeneity. GPs need to be aware of this association, which has implications for management of children presenting with MUPS. More longitudinal research focusing on all common MUPS in children, which relies on more precise sources of data, is needed to further investigate this association.
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Schurman JV, Hunter HL, Danda CE, Friesen CA, Hyman PE, Cocjin JT. Parental illness encouragement behavior among children with functional gastrointestinal disorders: a factor analysis with implications for research and clinical practice. J Clin Psychol Med Settings 2013; 20:255-61. [PMID: 22945665 DOI: 10.1007/s10880-012-9327-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of the current study was to assess the factor structure of the Illness Behavior Encouragement Scale (IBES) by Walker and Zeman (1992) among children with functional gastrointestinal disorders (FGIDs). Two hundred seventy nine children (63 % female), and 135 primary caregivers (90.8 % mothers), recruited from a large Midwestern children's hospital completed the IBES, a 12-item measure of parental behavior in response to abdominal pain episodes. Findings suggested the IBES possesses two conceptually distinct scales that are invariant across parent self- and child-report, and are consistent with previous factor analysis in a Dutch sample of children with headaches. Different types of parental behaviors exist that naturally cluster and diverge in reliable ways. Future research is warranted to determine if these different types of parental behavior may differentially influence illness outcomes among children with FGIDs.
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22
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Triantafillidis JK, Merikas E, Gikas A. Psychological factors and stress in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2013; 7:225-38. [PMID: 23445232 DOI: 10.1586/egh.13.4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The role of psychological distress and personality as predisposing factors for the development of inflammatory bowel disease (IBD) remains controversial. Attempts to investigate the role of psychological factors in IBD exhibited rather conflicting results. Among the studies concerning the effects of stress or depression on the course of IBD, the majority suggest that stress worsened IBD, the rest giving either negative or inconclusive results. However, application of strategies, including avoidance of coping and training patients in problem solving or emotion-oriented, could influence the course of IBD. Large controlled clinical trials are needed in order to clarify the impact of psychological interventions on the quality of life and the course of disease.
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Affiliation(s)
- John K Triantafillidis
- Department of Gastroenterology, Center for Inflammatory Bowel Disease, Saint Panteleimon General Hospital, Nicea, Greece.
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23
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El-Salhy M. Irritable bowel syndrome: Diagnosis and pathogenesis. World J Gastroenterol 2012; 18:5151-63. [PMID: 23066308 PMCID: PMC3468846 DOI: 10.3748/wjg.v18.i37.5151] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/18/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome III criteria. A combination of the Rome III criteria, a physical examination, blood tests, gastroscopy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS: heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following: genetic factors, dietary intake, intestinal flora, or low-grade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI- and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut.
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25
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Darlington AS, Verhulst F, De Winter A, Ormel J, Passchier J, Hunfeld J. The influence of maternal vulnerability and parenting stress on chronic pain in adolescents in a general population sample: The TRAILS study. Eur J Pain 2012; 16:150-9. [DOI: 10.1016/j.ejpain.2011.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - F.C. Verhulst
- Department of Child and Adolescent Psychiatry; Erasmus MC-Sophia; Rotterdam; The Netherlands
| | - A.F. De Winter
- Department of Health Sciences; Community and Occupational Medicine; University Medical Centre Groningen; Groningen; The Netherlands
| | - J. Ormel
- Department of Psychiatry; University Medical Centre Groningen; Groningen; The Netherlands
| | - J. Passchier
- Department of Clinical Psychology; VU University Amsterdam; Amsterdam; The Netherlands
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26
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Too sick for school? Parent influences on school functioning among children with chronic pain. Pain 2011; 153:437-443. [PMID: 22169177 DOI: 10.1016/j.pain.2011.11.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022]
Abstract
Parental responses to children with chronic pain have been shown to influence the extent of the child's functional disability, but these associations have not been well studied in relation to children's pain-related school functioning. The current study tests the hypothesis that parental pain catastrophizing and parental protective responses to child pain influence the extent of school impairment in children with chronic pain. A mediational model was tested to determine whether parental protective behaviors serve a mediating role between parental pain catastrophizing and child school impairment. Study participants were a clinical sample of 350 children ages 8-17 years with chronic pain and their parents. Measures of pain characteristics, demographic characteristics, child depressive symptoms, school attendance rates, overall school functioning, parental pain catastrophizing, and parental protective responses to pain were collected. Results show that, controlling for the known influences of pain intensity and child depressive symptoms, parental pain catastrophizing and parental protective responses to child pain each independently predict child school attendance rates and reports of overall school impairment. Parental protectiveness was found to mediate the association between parental cognitions (i.e., parent pain catastrophizing) and child school functioning outcomes. These findings underscore the importance of intervening with parents to foster parental responses to child pain that help children engage and succeed in the school environment despite pain.
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Helgeland H, Van Roy B, Sandvik L, Markestad T, Kristensen H. Paediatric functional abdominal pain: significance of child and maternal health. A prospective study. Acta Paediatr 2011; 100:1461-7. [PMID: 21557765 DOI: 10.1111/j.1651-2227.2011.02349.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM First, to what extent do general paediatric outpatients with functional abdominal pain experience other somatic and mental health symptoms compared with children in a population-based sample? Second, to what extent are such symptoms in both patients and their mothers associated with persistent child abdominal pain and functional disability? METHODS Ninety-four referred patients [mean age (SD) 11.1 (1.9) years, 62% girls] were assessed by questionnaires and a paediatric consultation at baseline and at follow-up after 6-9 months (94% follow-up participation). At baseline, somatic and mental health symptoms in the patients were compared with a population-based sample of 14,000 school children. Outcome at follow-up was patient self-reported abdominal pain and disability. Prognostic factors explored included patient and maternal somatic and mental health symptoms. RESULTS The patients experienced significantly more somatic [e.g. headache (OR: 9.2; 95% CI: 5.9-14.6)] and emotional symptoms than the school children. Patient's older age and peer problems at baseline were significantly associated with more abdominal pain at follow-up, whereas patient's older age, emotional symptoms, prosocial behaviour and maternal somatic symptoms were associated with disability. CONCLUSION Our results highlight the importance of focusing wider than just the patient's symptoms of abdominal pain in clinical practice and research.
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Affiliation(s)
- Helene Helgeland
- Department of Child and Adolescent Psychiatry, Innlandet Hospital Trust, Gjovik, Norway.
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Van Der Veek SM, Derkx H, De Haan E, Benninga MA, Plak RD, Boer F. Do Parents Maintain or Exacerbate Pediatric Functional Abdominal Pain? A Systematic Review and Meta-analysis. J Health Psychol 2011; 17:258-72. [DOI: 10.1177/1359105311410513] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Parents may maintain or exacerbate functional abdominal pain (FAP) in children through modeling of physical symptoms and solicitous responses to the child’s complaints. This systematic review and meta-analysis aimed to examine these relationships. Parents of children with FAP reported more physical symptoms than parents of healthy children (effect size d = .36). As all studies were cross-sectional or retrospective, the causal direction was unclear. For parental responses to child complaints, not enough studies were available to perform a meta-analysis. We conclude that the present literature is unfit to establish whether parents maintain or exacerbate pediatric FAP through the processes investigated.
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Affiliation(s)
| | | | - Else De Haan
- Academic Medical Center, Amsterdam, The Netherlands
| | | | - Rachel D. Plak
- De Bascule, Academic Center for Child and Adolescent Psychiatry, The Netherlands
| | - Frits Boer
- Academic Medical Center, Amsterdam, The Netherlands
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Abstract
OBJECTIVES The aim of the study was to identify prognostic factors for the persistence of chronic abdominal pain (CAP) in children. MATERIALS AND METHODS For this systematic review, MEDLINE, EMBASE, and PsycINFO were searched up to June 2008 for prospective follow-up studies of pediatric CAP as defined by the criteria of Apley, von Baeyer, or the Rome committee. The outcome measure of interest was persistence of CAP. Persistent CAP was considered only when the abdominal pain of children with CAP persisted during follow-up at the same level of frequency and severity. For each study the risk for bias was assessed. The evidence for prognostic factors was summarized according to a best-evidence synthesis. RESULTS Eight studies, which examined 17 prognostic factors, were included. Moderate evidence was found that having a parent with gastrointestinal symptoms predicts the persistence of CAP. Strong evidence was found for no association between female sex and the duration of CAP, and moderate evidence that the severity of abdominal pain does not predict persistence of CAP. There is conflicting evidence as to whether psychological factors prevent, or have no relation with, persistence of CAP. CONCLUSIONS Because there are few prognostic follow-up studies on pediatric CAP, the evidence for prognostic factors is limited. Physicians should ask about parental gastrointestinal problems because this is a risk factor for persistence of CAP in children. The hypothesis that psychological factors of the child predict persistence of CAP is not supported by evidence from the follow-up studies.
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Helgeland H, Sandvik L, Mathiesen KS, Kristensen H. Childhood predictors of recurrent abdominal pain in adolescence: A 13-year population-based prospective study. J Psychosom Res 2010; 68:359-67. [PMID: 20307703 DOI: 10.1016/j.jpsychores.2009.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 10/13/2009] [Accepted: 10/20/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate maternal and child emotional symptoms, physical health problems, and negative life events measured at children's age 18 months and 12 years as potential predictors for self-reported recurrent abdominal pain (RAP) in adolescents (14 years). METHODS A population-based prospective study conducted at child health clinics (preventive health care) in Norway followed a cohort of 916 mothers with children from children's age 18 months until adolescence. Child self-report was obtained from 12 years of age. Outcome measure was adolescent self-reported RAP. RESULTS Of 456 adolescents, 58 (13%) reported RAP. Of these, 36 (62%) were girls. By multivariate analyses, the following maternal factors predicted RAP in adolescence: psychological distress at children's age 18 months (OR, 2.5; 95% CI, 1.3-4.8) and a maternal history of psychological distress at children's age 12 years (OR, 3.2; 95% CI, 1.7-6.2). The following child factors measured at age 12 years predicted RAP in adolescence: abdominal (OR, 2.5; 95% CI, 1.3-4.9) and extraintestinal pain (OR, 2.3; 95% CI, 1.2-4.4) by maternal report, self-reported frequent extraintestinal pain (OR, 2.9; 95% CI, 1.4-5.9), and self-reported depressive symptoms (OR, 2.4; 95% CI, 1.1-5.1). Negative life events and physical health in mothers and toddlers did not predict RAP. CONCLUSIONS This is the first cohort study that finds maternal psychological distress in early childhood to predict RAP in their offspring 13 years later. Our results support that maternal psychological distress and preadolescent children's depressive and somatic symptoms may play a role in the development of RAP.
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Affiliation(s)
- Helene Helgeland
- Department of Child and Adolescent Psychiatry, Innlandet Hospital Trust, Gjovik, Norway.
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Prise en charge des douleurs abdominales secondaires aux désordres fonctionnels gastro-intestinaux. Arch Pediatr 2009; 16:858-60. [DOI: 10.1016/s0929-693x(09)74180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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