1
|
Mullin K, Rentea RM, Appleby M, Reeves PT. Gastrointestinal Ostomies in Children: A Primer for the Pediatrician. Pediatr Rev 2024; 45:210-224. [PMID: 38556505 DOI: 10.1542/pir.2023-006195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Despite the advancement of medical therapies in the care of the preterm neonate, in the management of short bowel syndrome and the control of pediatric inflammatory bowel disease, the need to create fecal ostomies remains a common, advantageous treatment option for many medically complex children.
Collapse
Affiliation(s)
- Kaitlyn Mullin
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital-Kansas City, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Patrick T Reeves
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
2
|
David JG, Sejkora E, Michel HK, Mackner L. Pediatric GI Health Care Professionals' Perceptions of and Engagement With Psychosocial Providers in Pediatric IBD Care. JPGN REPORTS 2023; 4:e305. [PMID: 37200719 PMCID: PMC10187836 DOI: 10.1097/pg9.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/23/2023] [Indexed: 05/20/2023]
Abstract
Multidisciplinary care is recommended for optimal pediatric inflammatory bowel disease (IBD) care, including psychosocial providers (eg, psychologists). However, health care professionals' (HCPs) perceptions of and engagement with psychosocial providers in pediatric IBD is lacking. Methods Cross-sectional REDCap surveys were completed by HCPs (eg, gastroenterologists) across American ImproveCareNow (ICN) centers. Demographics and self-reported perceptions of and engagement with psychosocial providers were collected. Data were analyzed at participant and site levels through descriptives, frequencies, an independent t test, and exploratory analyses of variance. Results A total of 101 participants from 52% of ICN sites participated. Participants were 88% gastrointestinal physicians, 49% identifying as female, 94% non-Hispanic, and 76% Caucasian. Of ICN sites, 75% and 94% of sites reported outpatient and inpatient psychosocial care, respectively. Participants referred for various clinical reasons to psychosocial providers (eg, illness adjustment). At the participant level, 92% of HCPs reported psychosocial care was very important and 64% reported their clinical thresholds shifted to engage psychosocial providers earlier in care. Barriers to psychosocial care included limited psychosocial providers (92%), psychosocial providers availability (87%), and IBD patients' lack of openness to psychosocial care (85%). One-way analyses of variance by HCP length of experiences were not statistically significant on perceived understanding of psychosocial providers or perceived changes in clinical threshold over time. Conclusion HCPs overall reported positive perceptions of and frequent engagement with psychosocial providers in pediatric IBD. Limited psychosocial providers and other notable barriers are discussed. Future work should continue interprofessional education of HCPs and trainees and efforts to improve access to psychosocial care in pediatric IBD.
Collapse
Affiliation(s)
- Jennie G David
- From the Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | | | | | - Laura Mackner
- Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
3
|
Winnick JB, Chancey L, Buzenski J, Sukumar K, Focht DR, Kuhn BR, Tabani S, Zahka NE, Williams SE. Telehealth for Pediatric Disorders of Gut-Brain Interaction During the COVID-19 Pandemic. J Pediatr Gastroenterol Nutr 2023; 76:447-450. [PMID: 36580889 PMCID: PMC10012839 DOI: 10.1097/mpg.0000000000003687] [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: 06/10/2022] [Accepted: 11/11/2022] [Indexed: 12/31/2022]
Abstract
A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with a disorder of gut-brain interaction including functional abdominal pain and irritable bowel syndrome. Cognitive behavioral therapy (CBT) was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 22 youth (mean age = 14.36 years) who received CBT via telehealth between February and September of 2021, after completing an initial evaluation between February and July of 2021. Patients completed reliable and valid self-report measures of functional disability and pain during treatment. A unique CBT model was employed with an initial focus on psychoeducation and function regardless of level of severity of functional impairment. Consistent with study hypotheses, nonparametric statistical analyses demonstrated statistically significant reductions in functional disability and pain following implementation of the CBT model via telehealth. Contrary to predictions, there was no relation found between severity of functional impairment and duration of treatment.
Collapse
Affiliation(s)
- Joel B. Winnick
- From Geisinger Commonwealth School of Medicine, Scranton, PA
- the Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA
| | | | | | - Kritika Sukumar
- From Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Dean R. Focht
- From Geisinger Commonwealth School of Medicine, Scranton, PA
- the Department of Pediatrics, Pediatric Gastroenterology, Geisinger, Danville, PA
| | - Benjamin R. Kuhn
- From Geisinger Commonwealth School of Medicine, Scranton, PA
- the Department of Pediatrics, Pediatric Gastroenterology, Geisinger, Danville, PA
| | - Saniya Tabani
- From Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Nicole E. Zahka
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Sara E. Williams
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
4
|
Wang H, Liu WJ, Wang XY, Chen XQ, Cai RL, Zhang MT, Wang HT, He GW, Zhang Z, Shen GM. A central amygdala input to the dorsal vagal complex controls gastric motility in mice under restraint stress. Front Physiol 2023; 14:1074979. [PMID: 36875016 PMCID: PMC9975572 DOI: 10.3389/fphys.2023.1074979] [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] [Received: 10/20/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Background/aims: Psychological and physiological stress can cause gastrointestinal motility disorders. Acupuncture has a benign regulatory effect on gastrointestinal motility. However, the mechanisms underlying these processes remain unclear. Methods: Herein, we established a gastric motility disorder (GMD) model in the context of restraint stress (RS) and irregular feeding. The activity of emotional center-central amygdala (CeA) GABAergic neurons and gastrointestinal center-dorsal vagal complex (DVC) neurons were recorded by electrophysiology. Virus tracing and patch clamp analysis of the anatomical and functional connection between the CeAGABA → dorsal vagal complex pathways were performed. Optogenetics inhibiting or activating CeAGABA neurons or the CeAGABA → dorsal vagal complex pathway were used to detect changes in gastric function. Results: We found that restraint stress induced delayed gastric emptying and decreased gastric motility and food intake. Simultaneously, restraint stress activated CeA GABAergic neurons, inhibiting dorsal vagal complex neurons, with electroacupuncture (EA) reversing this phenomenon. In addition, we identified an inhibitory pathway in which CeA GABAergic neurons project into the dorsal vagal complex. Furthermore, the use of optogenetic approaches inhibited CeAGABA neurons and the CeAGABA → dorsal vagal complex pathway in gastric motility disorder mice, which enhanced gastric movement and gastric emptying, whereas activation of the CeAGABA and CeAGABA → dorsal vagal complex pathway mimicked the symptoms of weakened gastric movement and delayed gastric emptying in naïve mice. Conclusion: Our findings indicate that the CeAGABA → dorsal vagal complex pathway may be involved in regulating gastric dysmotility under restraint stress conditions, and partially reveals the mechanism of electroacupuncture.
Collapse
Affiliation(s)
- Hao Wang
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China.,Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, Anhui, China
| | - Wen-Jian Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi-Yang Wang
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Xiao-Qi Chen
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Rong-Lin Cai
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Meng-Ting Zhang
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Hai-Tao Wang
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Guang-Wei He
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, Anhui, China
| | - Zhi Zhang
- Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui, China
| | - Guo-Ming Shen
- College of Integrated Chinese and Western Medicine (School of Life Sciences), Anhui University of Chinese Medicine, Hefei, Anhui, China
| |
Collapse
|
5
|
Rexwinkel R, Vlieger AM, Saps M, Tabbers MM, Benninga MA. A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. Eur J Pediatr 2022; 181:2603-2617. [PMID: 35460383 PMCID: PMC9192445 DOI: 10.1007/s00431-022-04459-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Disorders of the gut-brain interaction negatively impact quality of life and carry a substantial socioeconomic burden. Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common functional abdominal pain disorders in childhood. The pathophysiology is not fully understood, and high-quality intervention trials and international guidelines are missing. Therefore, the management of these disorders remains challenging. This review aims to provide an up-to-date overview of therapeutic possibilities for pediatric IBS or FAP-NOS and recommends management strategies. To prevent unnecessary referrals and extensive costs, it is fundamental to make a positive diagnosis of IBS or FAP-NOS in children with chronic abdominal pain with only minimal investigations. A tailor-made approach for each patient, based on the accompanying physical and psychological symptoms, is proposed to date. CONCLUSION Shared decision-making including non-pharmacological and pharmacological interventions should be considered and discussed with the family. WHAT IS KNOWN • Irritable bowel syndrome and functional abdominal pain-not otherwise specified are common in childhood. • Although the number of treatment options has grown recently, managing these disorders can be challenging and unsatisfactory, and no evidence-based international management guidelines are available. WHAT IS NEW • We suggest using a stepwise individualized approach to management, where after first-line management, both non-pharmacological and pharmacological interventions should be discussed.
Collapse
Affiliation(s)
- Robyn Rexwinkel
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands.
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, University of Miami, Miami, FL, USA
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
| |
Collapse
|
6
|
Utilization of Pediatric Psychology Services in Outpatient Pediatric Gastroenterology Within a Rural Health System. J Pediatr Gastroenterol Nutr 2022; 75:52-55. [PMID: 35621993 DOI: 10.1097/mpg.0000000000003468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Increased utilization of pediatric psychology services has been demonstrated following integration into urban pediatric gastroenterology clinics; however, examination within rural health systems is lacking. Utilization of pediatric psychology services was assessed through a retrospective analysis of Electronic Health Record data contrasting referrals occurring six months pre- and post-integration of pediatric psychology in an outpatient pediatric gastroenterology clinic within a rural setting. Significant increases in the number of referrals to pediatric psychology and number of billed initial visits were observed after integration, as was a significant decrease in time to be seen. Patients with public insurance were 3.1 times more likely to complete a billed initial visit compared with patients with nonpublic insurance. The current findings support the integration of pediatric psychology within rural outpatient pediatric gastroenterology clinics to increase utilization and allow more traditionally underserved families to benefit from these services.
Collapse
|
7
|
“The tonic’s not always in a bottle”: a qualitative study investigating a heart rate variability biofeedback coherence intervention for individuals with gastrointestinal disorders. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2022. [DOI: 10.21595/chs.2021.22069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
8
|
Friesen C, Colombo JM, Deacy A, Schurman JV. An Update on the Assessment and Management of Pediatric Abdominal Pain. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:373-393. [PMID: 34393542 PMCID: PMC8354769 DOI: 10.2147/phmt.s287719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Chronic abdominal pain is very common in children and adolescent and results in high personal and social costs. Most youth with chronic abdominal pain fulfill criteria for a functional abdominal pain disorder (FAPD) as defined by Rome criteria. These are complex conditions with a wide array of biological, psychological, and social factors contributing to the experience of pain. The purpose of the current review is to provide an overview of the pathophysiology of FAPDs and an up-to-date summary of the literature related to FAPDs in children and adolescents, with additional focus on several areas (eg, diet and probiotics) where patients and families frequently have questions or implement self-directed care. We also provide an approach to the assessment and treatment of pediatric FAPDs focusing on the robust literature regarding psychological interventions and much sparser literature regarding medication treatment.
Collapse
Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Deacy
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
9
|
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.
Collapse
|