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Burgell RE, Hoey L, Norton K, Fitzpatrick J. Treating disorders of brain-gut interaction with multidisciplinary integrated care. Moving towards a new standard of care. JGH Open 2024; 8:e13072. [PMID: 38770352 PMCID: PMC11103762 DOI: 10.1002/jgh3.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/06/2024] [Accepted: 04/13/2024] [Indexed: 05/22/2024]
Abstract
Disorders of brain-gut interaction (DGBI) are highly prevalent in our community with a negative burden on the quality of life and function. Symptoms are frequently food-induced, and psychological disorders are commonly co-morbid and contribute greatly to symptom severity and healthcare utilization, which can complicate management. Pathophysiological contributors to the development and maintenance of DGBI are best appreciated within the biopsychosocial model of illness. Established treatments include medical therapies targeting gastrointestinal physiology, luminal microbiota or visceral sensitivity, dietary treatments including dietary optimization and specific therapeutic diets such as a low-FODMAP diet, and psychological interventions. The traditional "medical model" of care, driven predominantly by doctors, poorly serves sufferers of DBGI, with research indicating that a multidisciplinary, integrated-care approach produces better outcomes. This narrative review explores the current evidence for multidisciplinary care and provides the best practice recommendations for physicians and healthcare systems managing such patients.
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Affiliation(s)
- Rebecca Elizabeth Burgell
- Gastroenterologist Functional GI Disorders ServiceAlfred Health and Monash UniversityMelbourneAustralia
| | - Louisa Hoey
- Clinical PsychologistFunctional GI Disorders service, Alfred HealthMelbourneAustralia
| | - Kate Norton
- Clinical Nurse SpecialistFunctional GI Disorders service, Alfred Health MelbourneMelbourneAustralia
| | - Jessica Fitzpatrick
- DietitianFunctional GI Disorders service, Alfred Health and Monash UniversityMelbourneAustralia
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2
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Slouha E, Mohamed A, Patel B, Razeq Z, Clunes LA, Kollias TF. The Use of Psychotherapy for Refractory Irritable Bowel Syndrome: A Systematic Review. Cureus 2024; 16:e54138. [PMID: 38487115 PMCID: PMC10938188 DOI: 10.7759/cureus.54138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a common yet debilitating and chronic condition that consists of disturbances in bowel habits and abdominal pain that is frequently relieved with defecation. While the first line of treatment for IBS is pharmacological treatment, this has been shown to fail, leading to the patient being classified as having refractory IBS. The quality of life (QOL) of these patients is greatly hindered; in this case, there are rarely moments of relief. Additional modalities of treatment have been employed in classical cases of IBS, such as psychotherapy, and research has started to evaluate its effectiveness with refractory IBS. Both cognitive behavioral therapy (CBT) and gut-directed hypnotherapy (GDH) are effective in treating classical IBS as they restructure and bring a state of meditation to the patient, allowing them to work through the symptoms. The question is whether it remains successful in refractory cases. This systematic review was conducted with strict adherence to PRISMA guidelines with an initial inquiry resulting in 28,978 publications through PubMed, ScienceDirect, and ProQuest databases. Through automatic and manual screening processes, articles that were peer-reviewed experimental or observation publications done between 2003 and 2023 were included in this study, resulting in 21 publications. Across all studies evaluating CBT, it was consistently found to be successful in improving symptom severity and frequency, QOL, and extracolonic symptoms such as anxiety and depression. When broken down into delivery methods, minimal contact CBT was found to be just as, if not superior, to standard contact. Within this, telephone-delivered CBT was superior to web-delivered CBT. GDH and biofeedback therapy were found to also significantly improve all domains of IBS with no difference between them. Acceptance and commitment therapy were found only to improve associated symptoms. However, there was no significant improvement in their QOL, whereas integrative group therapy found no significant improvement in any domain. Because IBS is so common and crippling to those affected, its crucial to continuously improve QOL through advancement in treatment modalities. Further research should focus more on other modes of therapy as success has been shown in standard therapeutic techniques.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Ahmed Mohamed
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Bansari Patel
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Ziyad Razeq
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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3
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Bardon C, Guillemette A, Rioux ME, Rivard M. Group intervention programs and their impact on well-being and quality-of-life for adults living with a rare or orphan disease - realist review of literature. Disabil Rehabil 2022:1-11. [PMID: 35979809 DOI: 10.1080/09638288.2022.2104943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Adults living with a rare or orphan diseases (ROD) experience common psychosocial difficulties that are often poorly addressed in usual care. This realist literature review aims to inform the development, evaluation and implementation of evidence based group therapy programs adapted to shared needs of patients living with various ROD. METHOD The review is based on an analysis of Context-Mechanism-Outcome configurations. It included 21 primary studies published between 2010 and April 2022 and used a PRISMA process for study selection and inclusion. RESULTS Our results show that group psychosocial interventions can help reduce perception of symptoms and psychological impacts of disease, improve social functioning and support and quality of life in patients. CONCLUSION Group therapy programs seem promising for ROD-patients and should be considered within comprehensive treatment and support plans. However, more comprehensive studies of group therapies in context should aim to identify core active components of these interventions with ROD-patients. Implications for Rehabilitation:Rare or Orphan Diseases are varied, difficult to diagnose and have a major impact on all aspects of the patients' lives (physical, emotional, psychological, social, professional).Psychosocial support is a key but underdeveloped component to support the recovery trajectory for these patients.In this review of group interventions, we identified a few promising practices adaptable to patients living with Rare or Orphan Diseases (Acceptance and commitment therapy, cognitive behavioural therapies, psychoeducational programs).Patients who received psychosocial group interventions are likely to experience improvement in their quality of life.
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Affiliation(s)
- Cécile Bardon
- Psychologie, Université du Québec à Montréal, Montréal, Canada
| | | | - Marie-Eve Rioux
- Psychologie, Université du Québec à Montréal, Montréal, Canada
| | - Mélina Rivard
- Psychologie, Université du Québec à Montréal, Montréal, Canada
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Bray NA, Koloski NA, Jones MP, Do A, Pang S, Coombes JS, McAllister S, Campos J, Arthur L, Stanley P, DeMaria K, Chao CY, Catague R, Whaley A, Talley NJ, Holtmann GJ. Evaluation of a Multidisciplinary Integrated Treatment Approach Versus Standard Model of Care for Functional Gastrointestinal Disorders (FGIDS): A Matched Cohort Study. Dig Dis Sci 2022; 67:5593-5601. [PMID: 35362835 PMCID: PMC9652261 DOI: 10.1007/s10620-022-07464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions. AIMS To assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden. METHODS A matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Mixed models estimated the within ICC change in SAGIS total as -9.7 (95% CI -13.6, -5.8; p < 0.0001), compared with -1.7 (95% CI -4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, -7.6 (95% CI -11.4, -3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001). CONCLUSION This matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care.
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Affiliation(s)
- Nicola A. Bray
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Natasha A. Koloski
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia ,College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Michael P. Jones
- grid.1004.50000 0001 2158 5405School of Psychological Sciences, Macquarie University, Ryde, NSW Australia
| | - Anh Do
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Siong Pang
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jeff S. Coombes
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Sarah McAllister
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jane Campos
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Leela Arthur
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Paul Stanley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Katherine DeMaria
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Che-yung Chao
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Rachel Catague
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Amanda Whaley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Nicholas J. Talley
- College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Gerald J. Holtmann
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia ,grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
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Engel F, Stadnitski T, Stroe-Kunold E, Berens S, Schäfert R, Wild B. Temporal Relationships Between Abdominal Pain, Psychological Distress and Coping in Patients With IBS - A Time Series Approach. Front Psychiatry 2022; 13:768134. [PMID: 35911239 PMCID: PMC9329557 DOI: 10.3389/fpsyt.2022.768134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Irritable bowel syndrome (IBS) is a chronic disease leading to abdominal pain that is often related to psychological distress. The aim of the study was to investigate the temporal relationships between abdominal pain and psychological variables in patients with IBS. METHODS This longitudinal diary study included eight patients from a waiting group, recruited in the frame of a pilot intervention study. During their waiting time of 3 months the patients answered questions daily regarding somatic and psychological variables using an online diary. All patients were considered and analyzed as single cases. The temporal dynamics between the time series of psycho-somatic variables were analyzed using a vector autoregressive (VAR) modeling approach. RESULTS For all patients, positive same-day correlations between somatic and psychological time series were observed. The highest same-day correlations were found between somatic symptoms and pain-related discomfort (r = 0.40 to r = 0.94). Altogether, n = 26 significant lagged relationships were identified; n = 17 (65%) indicated that somatic values were predictive of psychological complaints on the following days. N = 9 (35%) lagged relationships indicated an opposite relationship in that psychological complaints were predictive of somatic symptoms. Three patients showed a significant positive same-day correlation between abdominal pain and use of a positive coping strategy. However, significant lagged relationships in two patients showed that for these patients the use of positive thinking as a coping strategy was unhelpful in reducing pain on the following days. CONCLUSIONS In patients with IBS abdominal symptoms appear to be closely related to psychological symptoms. For some patients, somatic complaints predict psychological complaints, in other patients the directionality is opposite. The impact of coping strategies on somatic symptoms varies among patients, therefore their role for a possible reduction of pain should be further explored. The results suggest the need of characterizing patientsindividually for effective health interventions. Individual time series analyses provide helpful tools for finding reasonable person-level moderators.
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Affiliation(s)
- Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | | | - Esther Stroe-Kunold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Rainer Schäfert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.,Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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6
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Gillan C. Review article: the effectiveness of group and self-help hypnotherapy for irritable bowel syndrome and the implications for improving patients' choice and access to treatment. Aliment Pharmacol Ther 2021; 54:1389-1404. [PMID: 34591988 DOI: 10.1111/apt.16623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individual hypnotherapy (IH) is a recognised treatment for irritable bowel syndrome (IBS). However, it is not widely available to patients due to its resource-intensive nature, lack of adequately trained therapists, and scepticism about hypnosis. Non-individualised hypnotherapy approaches, such as group and self-help hypnotherapy, could maximise existing therapist resources by treating more patients at the same time, thus widening patient access to treatment without incurring additional expenditure. AIMS To investigate the research literature for non-individualised approaches to hypnotherapy for IBS and to determine their effectiveness for reducing symptom severity and/or providing adequate relief. METHODS A literature review of published peer-reviewed studies was conducted. Quantitative research was selected to determine the effectiveness of the interventions. RESULTS Ten studies were eligible for inclusion. Three delivered group hypnotherapy, three integrated hypnosis within a group concept, and four utilised a self-help home hypnotherapy treatment using audio recordings. Both group hypnotherapy for adults and the self-help home hypnotherapy treatment for children were effective interventions that may be non-inferior to IH for patients with mild-to-moderate symptoms. Treatment benefits were long-lasting. The evidence for the integrative group concept and home treatment for adults was less compelling. CONCLUSIONS Group hypnotherapy for adults, and self-help hypnotherapy for children, may be cost-effective treatments that can widen access for patients with milder IBS in primary care settings. Further research is needed to determine the effectiveness of group hypnotherapy for patients with severe, refractory IBS.
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Affiliation(s)
- Carolyn Gillan
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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7
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Berens S, Schaefert R, Ehrenthal JC, Baumeister D, Gauss A, Eich W, Tesarz J. The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints. J Clin Gastroenterol 2021; 55:e66-e76. [PMID: 33780221 DOI: 10.1097/mcg.0000000000001505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND GOAL The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics. STUDY This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients. RESULTS About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits. CONCLUSIONS Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.
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Affiliation(s)
- Sabrina Berens
- Institute of Psychology
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University
| | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University
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Engel F, Stadnitski T, Stroe-Kunold E, Berens S, Schaefert R, Wild B. Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report. BMC Gastroenterol 2021; 21:309. [PMID: 34344311 PMCID: PMC8336402 DOI: 10.1186/s12876-021-01879-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) appears to have a bidirectional interaction with both depressive and anxiety-related complaints. However, it remains unclear how exactly the psychological complaints, at the individual level, are related to somatic symptoms on a daily basis. This single case study investigates how somatic and psychological variables are temporally related in a patient with irritable bowel syndrome. CASE REPORT The patient was a woman in her mid-twenties with an IBS diagnosis. She reported frequent soft bowel movements (5-6 times per day), as well as flatulence and abdominal pain. She resembled a typical IBS patient; however, a marked feature of the patient was her high motivation for psychosomatic treatment as well as her willingness to try new strategies regarding the management of her symptoms. As an innovative approach this single case study used a longitudinal, observational, time series design. The patient answered questions regarding somatic and psychological variables daily over a period of twelve weeks with an online diary. The diary data was analysed using an autoregressive (VAR) modeling approach. Time series analyses showed that in most variables, strong same-day correlations between somatic (abdominal pain, daily impairment) and psychological time series (including coping strategies) were present. The day-lagged relationships indicated that higher values in abdominal pain on one day were predictive of higher values in the psychological variables on the following day (e.g. nervousness, tension, catastrophizing, hopelessness). The use of positive thinking as a coping strategy was helpful in reducing the pain on the following days. CONCLUSION In the presented case we found a high correlation between variables, with somatic symptoms temporally preceding psychological variables. In addition, for this patient, the use of positive thoughts as a coping strategy was helpful in reducing pain.
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Affiliation(s)
- Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Tatjana Stadnitski
- Department of Quantitative Methods in Psychology, University of Ulm, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Esther Stroe-Kunold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, 4031, Basel, Switzerland
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, Agrawal A, Aziz I, Farmer AD, Eugenicos MP, Moss-Morris R, Yiannakou Y, Ford AC. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70:1214-1240. [PMID: 33903147 DOI: 10.1136/gutjnl-2021-324598] [Citation(s) in RCA: 204] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.
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Affiliation(s)
- Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Peter A Paine
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Gastroenterology, Salford Royal Foundation Trust, Salford, UK
| | - Christopher J Black
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Lesley A Houghton
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hazel A Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Maura Corsetti
- Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Anurag Agrawal
- Gastroenterology, Doncaster and Bassetlaw Hospitals NHS Trust, Armthorpe Road, Doncaster, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Adam D Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Maria P Eugenicos
- Department of Gastroenterology, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Rona Moss-Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yan Yiannakou
- Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK .,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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10
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Georghiades A, Eiroa-Orosa FJ. A systematic review outlining the impact of education on patients and physicians in gastroenterology. PSYCHOL HEALTH MED 2021; 27:1468-1481. [PMID: 33632021 DOI: 10.1080/13548506.2021.1890158] [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] [Indexed: 10/22/2022]
Abstract
Functional gastrointestinal symptoms (FGIDs) refer to a noticeable change in the body that is reported by the patient as being different from normal. FGIDs can have a significant impact on the patient's quality of life by interfering with daily functioning. The primary objective of the current paper was to identify short-term educational interventions for patients diagnosed with FGIDs and medically unexplained symptoms. This is with the aim of assessing its effectiveness on patient's quality of life and symptom severity. The second objective was to establish the current educational programmes and training opportunities available for physicians working with this subgroup of patients. This is in order to ascertain if these could change negative physician beliefs and attitudes. Databases such as PubMed and Google Scholar were searched from November to February 2018. A total of eight interventions were found which were evaluated using the Behavioural Change Techniques Taxonomy. Short-term educational programmes combining the use of lectures and practical sessions were found to be the most effective in improving patient quality of life and symptom severity. Managing patient exposure through the use of problem-based learning was considered the most effective teaching method for trainee physicians and could help to prevent the internalisation of negative attitudes. Definite conclusions about the effectiveness of patient and physician interventions are difficult to ascertain due to the small number of studies found and the high risk of bias. Future research should focus on providing a more unified approach to the management of this subgroup of patients.
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Affiliation(s)
- Alicia Georghiades
- Section of Personality, Evaluation and Psychological Treatment; Department of Clinical Psychology and Psychobiology; School of Psychology; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Francisco José Eiroa-Orosa
- Section of Personality, Evaluation and Psychological Treatment; Department of Clinical Psychology and Psychobiology; School of Psychology; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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11
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Krouwel M, Farley A, Greenfield S, Ismail T, Jolly K. Systematic review, meta-analysis with subgroup analysis of hypnotherapy for irritable bowel syndrome, effect of intervention characteristics. Complement Ther Med 2021; 57:102672. [PMID: 33508441 DOI: 10.1016/j.ctim.2021.102672] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypnotherapy has been shown to be effective at relieving global gastrointestinal symptoms (GGS) in irritable bowel syndrome (IBS). This study examines the impact of hypnotherapy delivery and participant characteristics on IBS outcomes. METHODS This systematic review searched CINAHL, Cochrane Library, Conference Citation Index, Embase, PubMed, PsycARTICLES, PsychINFO, Science Citation index-expanded, Social Science Citation Index. Titles and abstracts, then full-text articles were screened against inclusion criteria: trials with a concurrent comparator of hypnotherapy in adults with IBS diagnosed using Manning or ROME criteria, which provided symptom data. Included studies were extracted and assessed for bias using Cochrane Collaboration 2011 guidance. Random-effects meta-analysis was conducted with sub-group analysis to assess the impact of delivery characteristics on outcomes. RESULTS Twelve trials were included, 7 in the meta-analyses. Hypnotherapy reduced the risk of GGS, but this was not statistically significant, (standardised mean difference (SMD) 0.24, [-0.06, 0.54], I2 66 %). Higher frequency of sessions (≥1/week) reduced GGS (SMD 0.45 [0.23,0.67] I2 0 %), as did higher volumes of intervention (≥8 sessions with ≥6 h of contact) (SMD 0.51 [0.27,0.76] I2 0 %) and group interventions (SMD 0.45 [0.03, 0.88] I2 62 %). Only volume of intervention produced a significant effect between the subgroups. CONCLUSION This review suggests that high volume hypnotherapy is more beneficial than low and should be adopted for GDH. Both high frequency and group interventions are effective in reducing GGS in IBS. However, the sample size is small and more studies are needed to confirm this.
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Affiliation(s)
- Matthew Krouwel
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Tariq Ismail
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Black CJ, Thakur ER, Houghton LA, Quigley EMM, Moayyedi P, Ford AC. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut 2020; 69:1441-1451. [PMID: 32276950 DOI: 10.1136/gutjnl-2020-321191] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty. DESIGN We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score. RESULTS We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated. CONCLUSIONS Several psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term. TRIAL REGISTRATION NUMBER The study protocol was published on the PROSPERO international prospective register of systematic reviews (registration number CRD 42020163246).
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Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, West Yorkshire, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, West Yorkshire, UK
| | - Elyse R Thakur
- Department of Psychiatry and Behavioural Sciences, Baylor College of Medicine, Houston, Texas, USA.,Division of Gastroenterology and Hepatology, Atrium Health, Charlotte, North Carolina, USA
| | - Lesley A Houghton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, West Yorkshire, UK
| | - Eamonn M M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA
| | - Paul Moayyedi
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, West Yorkshire, UK .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, West Yorkshire, UK
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13
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Berens S, Engel F, Gauss A, Tesarz J, Herzog W, Niesler B, Stroe-Kunold E, Schaefert R. Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic. Gastroenterol Res Pract 2020; 2020:9086340. [PMID: 32411207 PMCID: PMC7204123 DOI: 10.1155/2020/9086340] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/18/2019] [Accepted: 01/11/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients' health status. This study is aimed at analyzing the differences between patients with multiple as compared to one single FGID. METHODS A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n = 294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed. RESULTS Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 [23.0] years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 [126] and 232 [163] in patients with >1 and 1 FGID, respectively (p < .001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities. CONCLUSIONS Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.
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Affiliation(s)
- Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Annika Gauss
- Department of Gastroenterology, Infectious Diseases and Intoxications, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Beate Niesler
- Institute of Human Genetics, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, D-69120 Heidelberg, Germany
| | - Esther Stroe-Kunold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
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Halmos EP, Gibson PR. Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome. J Gastroenterol Hepatol 2019; 34:1134-1142. [PMID: 30945376 DOI: 10.1111/jgh.14650] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
Since its first trial showing evidence of efficacy for managing symptoms of irritable bowel syndrome, the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet has been gaining popularity but not without criticism. Application of the diet has changed from a rigid list of "allowed" and "not allowed" foods to a structured program of initial FODMAP restriction followed by food reintroduction and finally personalization so that patients are empowered to adjust their diet themselves to achieve good predictability of symptoms. Safety concerns of the diet have centered around its initial elimination leading to compromise of nutritional and psychological health, but careful patient assessment and management, preferably through a FODMAP-trained dietitian, will reduce the risk of such negative health outcomes. Most negative attention for the FODMAP diet has been the notion that it will ruin the microbiota. Controlled studies have indicated that reducing FODMAP intake has no effects on bacterial diversity but will reduce total bacterial abundance, and higher FODMAP intakes will increase health-promoting bacteria, supporting the concept of the full FODMAP program, including attaining a minimal "maintenance" level of FODMAP restriction. This review addresses all these concerns in detail and how to overcome them, including the use of a "FODMAP-gentle" diet, describing restriction of a select few foods very concentrated in FODMAPs. This version of the diet is commonly applied in practice by experienced FODMAP-trained dietitians but is not clearly described in literature. Careful direction and assessment of response or nonresponse will decrease the risks of over-restriction and under-restriction of diet.
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Affiliation(s)
- Emma P Halmos
- Department of Gastroenterology, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
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McDonald E, Teets R, Ortiz C, Gilchrist C, Waltermaurer E, Perez E, Kligler B. A Randomized Trial of a Group-Based Integrative Medicine Approach Compared to Waitlist Control on Irritable Bowel Syndrome Symptoms in Adults. Explore (NY) 2018; 14:406-413. [PMID: 30243949 DOI: 10.1016/j.explore.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder that affects a large proportion of the general population. Dietary and mind-body approaches have shown some effectiveness in reducing IBS symptoms. OBJECTIVES The purpose of this project was to test the feasibility of a low cost, group-oriented integrative medicine approach to IBS, and to explore whether such an approach improves participant outcomes. METHODS This was a randomized-controlled trial involving a 4-week group-oriented treatment intervention combining dietary intervention and mind-body therapies followed by 8-weeks of telephonic health coaching. Differences between the intervention and control groups on IBS-specific measures were examined at baseline, 4, 8, and 12-week. RESULTS Fifty-two participants completed the study, 30 in the control group and 22 in the intervention group. On the IBS Symptom Severity Score, at 4 weeks the intervention group showed statistically significant improvement compared to the control group (p < .02), which was sustained at the 8 and 12-week data points as well, with the proportion of the intervention group experiencing moderate to severe symptoms decreasing from 81.3% at baseline to 45% at week 4 and 54.5% at week 12. A statistically significant improvement was also seen on the CES-D measure of depression between baseline and week 12 in the intervention group compared to controls. On the IBS Quality of Life measure we did not observe a statistically significant difference between the groups. CONCLUSIONS This low-cost, group-oriented intervention approach offers a strategy to address the challenge of access to this type of integrative approach for patients of low socioeconomic status or limited means.
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Affiliation(s)
- Elizabeth McDonald
- Mount Sinai Beth Israel, Department of Integrative Medicine, 245 Fifth Avenue 2nd Floor, New York, NY 10016, USA
| | - Raymond Teets
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai and Institute for Family Health, 16 east 16th street, New York, NY 10003, USA
| | - Caroline Ortiz
- Mount Sinai Beth Israel, Department of Integrative Medicine, 245 Fifth Avenue 2nd Floor, New York, NY 10016, USA
| | - Christine Gilchrist
- Mount Sinai Beth Israel, Department of Integrative Medicine, 245 Fifth Avenue 2nd Floor, New York, NY 10016, USA
| | - Eve Waltermaurer
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai and Institute for Family Health, 16 east 16th street, New York, NY 10003, USA
| | - Elidania Perez
- Mount Sinai Beth Israel, Department of Integrative Medicine, 245 Fifth Avenue 2nd Floor, New York, NY 10016, USA
| | - Benjamin Kligler
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai and Institute for Family Health, 16 east 16th street, New York, NY 10003, USA.
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