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Orock A, Johnson A, Mohammadi E, Greenwood-Van Meerveld B. Environmental enrichment reverses stress-induced changes in the brain-gut axis to ameliorate chronic visceral and somatic hypersensitivity. Neurobiol Stress 2024; 28:100590. [PMID: 38075024 PMCID: PMC10698671 DOI: 10.1016/j.ynstr.2023.100590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction Behavioral therapies, including cognitive behavioral therapy, hypnotherapy and stress management activities, have emerged as effective treatments for irritable bowel syndrome (IBS), a female predominant disorder of the brain-gut axis. IBS, affecting over 10% of the global population, typically presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While the mechanisms underlying how behavioral therapies treat IBS are still elusive, we had previously shown that chronic stress alters gene expression in brain regions critical for stress processing and nociception. We found that exposure to an enriched environment (EE), the rodent analogue of behavioral therapies, prior to and during the stressor was sufficient to prevent stress-induced changes in glucocorticoid receptor (GR) expression in the central nucleus of the amygdala (CeA) and hippocampus. Pre-exposure to EE also inhibited stress-induced increased colonic permeability and was able to block the induction of stress-induced visceral and somatic hypersensitivity. However, it remains unknown if EE can reverse chronic viscerosomatic hypersensitivity that persists following exposure to stress. We hypothesized that EE after chronic stress would be sufficient to reverse stress-induced changes in i) GR expression in the CeA and hippocampus, ii) ameliorate stress-induced colonic hyperpermeability and iii) restore normal visceral and somatic sensitivity in male and female rats. Methods Male and female rats were exposed to daily water avoidance stress (WAS). After confirming the rats had developed visceral hypersensitivity, 50% of the animals were housed in EE for 2 weeks while the other 50% remained in standard housing (SH). At the end of this period, we assessed visceral and somatic sensitivity. We also collected colon tissue to measure colonic permeability. Micro-punches of tissue from the CeA and hippocampus were isolated to measure GR expression. Control animals not exposed to WAS were kept in SH for the duration of the study (n = 8 per group). Results In both male and female rats, EE reversed stress-induced visceral (p < 0.001) and somatic (p < 0.01) hypersensitivity when compared to WAS animals housed in SH to levels comparable to control animals. EE exposure also reversed changes in GR expression in both the hippocampus (p < 0.01) and CeA (p < 0.01), normalizing GR expression to control levels. EE exposure ameliorated stress-induced colonic hyperpermeability in both male (p < 0.01) and female (p < 0.01) rats compared to WAS rats in SH. Conclusion Our findings suggest that behavioral therapies are viable therapeutic options for IBS as they can counter the stress-induced pathophysiology underlying IBS symptoms including visceral hypersensitivity, increased colonic permeability and altered gene expression.
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Affiliation(s)
- A. Orock
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - A.C. Johnson
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
| | - E. Mohammadi
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - B. Greenwood-Van Meerveld
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
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Law M, Pickering I, Bartlett E, Sebaratnam G, Varghese C, Gharibans A, O'Grady G, Andrews CN, Calder S. Cognitive behavioural therapy-based interventions for gastroduodenal disorders of gut-brain interaction: A systematic review. J Psychosom Res 2023; 175:111516. [PMID: 37832277 DOI: 10.1016/j.jpsychores.2023.111516] [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: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs. METHODS Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible. RESULTS Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later. CONCLUSIONS This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.
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Affiliation(s)
- Mikaela Law
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Isabella Pickering
- Alimetry Ltd., Auckland, New Zealand; The Department of Psychological Medicine, The University of Auckland, New Zealand
| | | | | | - Chris Varghese
- The Department of Surgery, The University of Auckland, New Zealand
| | - Armen Gharibans
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Greg O'Grady
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd., Auckland, New Zealand; The Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Canada
| | - Stefan Calder
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand.
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Benzo RM, Moreno PI, Noriega-Esquives B, Otto AK, Penedo FJ. Who benefits from an eHealth-based stress management intervention in advanced prostate cancer? Results from a randomized controlled trial. Psychooncology 2022; 31:2063-2073. [PMID: 35851976 PMCID: PMC10472415 DOI: 10.1002/pon.6000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Conduct a secondary analysis to examine the effects of a tablet-delivered, group-based cognitive-behavioral stress management (CBSM) intervention for reducing symptom burden among men with advanced prostate cancer (APC) and elevated baseline levels of symptom burden. METHODS A total of 192 men with APC were randomized to either a CBSM or a health promotion condition and followed for one year. Six analytical samples were included in our study, each including participants who reported elevated levels of burden for the corresponding outcome at baseline. Outcomes included five domains of symptom-related quality of life (urinary incontinence n = 98; urinary irritation n = 61; bowel function n = 43; sexual function n = 177; and hormonal function n = 149) and depression (n = 31). Repeated measures mixed models were used to detect within- and between-group changes in outcomes. RESULTS Regardless of condition, participants with elevated symptom burden or mild-to-severe depression showed short-term (6-month) improvements in urinary irritation, bowel function, hormonal function, and depression scores. Only participants in the CBSM condition showed short-term (6-month) improvements in urinary incontinence, and long-term (12-month) improvements in urinary irritation, bowel function, hormonal function, and depression scores. CONCLUSIONS Our findings suggest that targeting a web-based CBSM intervention to recipients most likely to benefit (elevated levels of symptom burden) can improve several domains of symptom-related quality of life and depressive symptoms in men with APC.
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Affiliation(s)
- Roberto M. Benzo
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Patricia I. Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Blanca Noriega-Esquives
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amy K. Otto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Frank J. Penedo
- Department of Psychology, University of Miami, Miami, Florida, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Tome J, Kamboj AK, Sweetser S. A Practical 5-Step Approach to Nausea and Vomiting. Mayo Clin Proc 2022; 97:600-608. [PMID: 35246289 DOI: 10.1016/j.mayocp.2021.10.030] [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] [Received: 07/15/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Nausea and vomiting (N/V) are common presenting complaints in the outpatient and inpatient settings. These symptoms can be associated with high morbidity and poor quality of life, particularly in those with chronic symptoms. The clinical approach to N/V can be challenging, given the numerous possible underlying causes as well as the vast array of diagnostic and therapeutic options. In this concise review, we provide a practical 5-step approach to the clinical evaluation and treatment of N/V, suitable for application in the primary care and subspecialty settings. The 5-step approach includes (1) defining what the patient means by N/V, (2) determining whether symptoms are acute or chronic, (3) considering medication or toxin adverse effects, (4) using the patient's presentation, severity of symptoms, and physical examination findings to formulate a differential diagnosis and to guide evaluation, and (5) directing treatment on the basis of knowledge of neurotransmitters and receptors involved in the emetic pathways. We discuss the pathophysiology (neuronal pathways and neurotransmitters), differential diagnosis (medication and toxin adverse effects, neurologic causes, gastrointestinal diseases, metabolic and endocrine conditions, and psychogenic disorders), initial evaluation and risk stratification, and management and treatment options. Management of symptoms that are acute in onset or mild in severity may involve an empirical trial of antiemetics without extensive testing. In contrast, when symptoms are chronic or moderate-severe, testing for an underlying cause should be performed, and medication adverse effects, neurologic causes, gastrointestinal diseases, metabolic or endocrine conditions, and psychogenic disorders should be considered in particular.
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Affiliation(s)
- June Tome
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Kim H, Oh Y, Chang SJ. Effects of Internet-delivered Cognitive Behavioral Therapy in Patients with Irritable Bowel Syndrome: Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2021; 24:e35260. [PMID: 35687389 PMCID: PMC9233255 DOI: 10.2196/35260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. Objective This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. Methods This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. Results The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] –0.633; 95% CI –0.861 to –0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (–0.372; 95% CI –0.704 to –0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD –0.391; 95% CI –0.560 to –0.221), and long-term follow-up (SMD –0.357; 95% CI –0.541 to –0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. Conclusions This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future.
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Affiliation(s)
- Hyunjung Kim
- School of Nursing, Research Institute of Nursing Science, Hallym University, Chuncheon, Republic of Korea
| | - Younjae Oh
- School of Nursing, Research Institute of Nursing Science, Hallym University, Chuncheon, Republic of Korea
| | - Sun Ju Chang
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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Orock A, Louwies T, Ligon CO, Mohammadi E, Greenwood-Van Meerveld B. Environmental enrichment prevents stress-induced epigenetic changes in the expression of glucocorticoid receptor and corticotrophin releasing hormone in the central nucleus of the amygdala to inhibit visceral hypersensitivity. Exp Neurol 2021; 345:113841. [PMID: 34390704 DOI: 10.1016/j.expneurol.2021.113841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Stress is a known trigger for the symptoms of irritable bowel syndrome (IBS), a gastrointestinal (GI) disorder that presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While behavioral therapies have been used to attenuate IBS symptoms, the underlying mechanisms by which these therapies interact with stress-induced pathology remains to be delineated. Here we use a rat model to test the hypothesis that exposure to environmental enrichment (EE) inhibits stress-induced changes within the brain-gut axis to prevent visceral and somatic hypersensitivity and colonic hyperpermeability. METHODS Female rats (n = 8/group) were housed in EE one week before and one week during exposure to water avoidance stress (WAS) while controls were housed in standard cages (SH). One day after the final WAS exposure, colonic and somatic sensitivity were assessed by the visceromotor response (VMR) to colorectal distension (CRD) and withdrawal threshold elicited by an electronic von Frey on the hind paw of the rats respectively. All rats were returned to SH for 3 weeks before colonic and somatic sensitivity were reassessed on day 28. The rats were then immediately euthanized and the spinal cord was collected to assess changes in neuronal activation (assessed via ERK phosphorylation) in response to noxious CRD. A separate cohort of animals (n = 8/group) that did not undergo behavioral assessments was euthanized the day after the final WAS exposure and the central nucleus of the amygdala (CeA) was collected to investigate WAS and EE induced epigenetic changes at the glucocorticoid receptor (GR) and corticotrophin releasing hormone (CRH) promoter. The colon from these rats was also collected to assess colonic permeability via changes in transepithelial electrical resistance (TEER) in vitro. RESULTS Exposure to stress persistently increased VMR to CRD (P < 0.01) and decreased the hind paw withdrawal threshold (P < 0.001) in female rats. WAS also decreased TEER in the colon tissue of female rats (p = 0.05). In the CeA, WAS induced a decrease in histone acetylation at the GR promoter but increased histone acetylation at the CRH promoter and reduced GR-CRH interactions in the CeA. Analysis of the spinal cord showed that WAS increased CRD-evoked ERK phosphorylation in the dorsal horn. Exposure to EE prevented WAS-induced changes in the CeA, dorsal horn and colon respectively to prevent visceral and somatic hypersensitivity. CONCLUSION Our data reveals that behavioral therapies can produce long lasting molecular and epigenetic changes that can prevent stress-induced pathologies even after completion of the therapy. These results highlight the potential mechanisms by which behavioral therapies may ameliorate visceral pain associated stress-related pathologies such as the irritable bowel syndrome.
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Affiliation(s)
- A Orock
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America.
| | - T Louwies
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - C O Ligon
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - E Mohammadi
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - B Greenwood-Van Meerveld
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; Department of Veterans Affairs Health Care System, Oklahoma City, OK, United States of America
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Walsh S, Jones M, Gray RJ, Gillam M, Gunn KM, Barker T, Eshetie T, Moseley GL. Use of behavioural activation to manage pain: a scoping review protocol. BMJ Open 2021; 11:e041036. [PMID: 34083325 PMCID: PMC8183225 DOI: 10.1136/bmjopen-2020-041036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chronic pain is a distressing condition and often poorly treated and managed. Psychological therapies are considered first-line intervention for people with chronic pain. Common psychological therapies require extensive clinician training and specialist qualifications. One approach that does not need lengthy training nor specialist qualification, but has empirical support in other health domains, is behavioural activation (BA). BA seeks to increase engagement in behaviours that are valued by the person and progress through behaviours that can increase mood and develop skills that build satisfying routines. BA can help people to manage their condition through scheduling behaviours, promoting routine and mastery over their condition. The extent to which BA has been used to support people living with chronic pain is not clear. METHODS AND ANALYSIS This scoping review aims to identify published studies describing the application of BA to support people living with chronic pain. To map the evidence regarding BA and chronic pain, including the study type and the associated evidence, a scoping review was adopted. The search will be conducted in bibliographic databases, clinical trial registries and grey literature. No date limits will be applied to the search strategy. Screening of titles and abstracts, and full-text screening, will be independently undertaken by two investigators using Covidence software. Any disagreement between investigators will be resolved by a third investigator. Data from included publications will be extracted using a customised data extraction tool. ETHICS AND DISSEMINATION The scoping review is an analysis of existing data and therefore ethics approval is not required. The findings of this scoping review will further our understanding of how BA has been used to support people living with chronic pain and inform future training and education programmes in this area.
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Affiliation(s)
- Sandra Walsh
- Department of Rural Health, University of South Australian - Whyalla Campus, Whyalla Norrie, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Richard John Gray
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Mt Barker, South Australia, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Trevor Barker
- Allied Health & Human Performance, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Tesfahun Eshetie
- Department of Rural Health, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Orock A, Yuan T, Greenwood-Van Meerveld B. Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance. FRONTIERS IN PAIN RESEARCH 2021; 1:609292. [PMID: 35295688 PMCID: PMC8915633 DOI: 10.3389/fpain.2020.609292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic visceral pain represents a major unmet clinical need with the severity of pain ranging from mild to so severe as to prevent individuals from participating in day-to-day activities and detrimentally affecting their quality of life. Although chronic visceral pain can be multifactorial with many different biological and psychological systems contributing to the onset and severity of symptoms, one of the major triggers for visceral pain is the exposure to emotional and physical stress. Chronic visceral pain that is worsened by stress is a hallmark feature of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Current pharmacological interventions for patients with chronic visceral pain generally lack efficacy and many are fraught with unwanted side effects. Cognitive behavioral therapy (CBT) has emerged as a psychotherapy that shows efficacy at ameliorating stress-induced chronic visceral pain; however, the molecular mechanisms underlying CBT remain incompletely understood. Preclinical studies in experimental models of stress-induced visceral pain employing environmental enrichment (EE) as an animal model surrogate for CBT are unraveling the mechanism by which environmental signals can lead to long-lasting changes in gene expression and behavior. Evidence suggests that EE signaling interacts with stress and nociceptive signaling. This review will (1) critically evaluate the behavioral and molecular changes that lead to chronic pain in IBS, (2) summarize the pharmacological and non-pharmacological approaches used to treat IBS patients, and (3) provide experimental evidence supporting the potential mechanisms by which CBT ameliorates stress-induced visceral pain.
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Affiliation(s)
- Albert Orock
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Tian Yuan
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma City VA Health Care System, Oklahoma City, OK, United States
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Beverley Greenwood-Van Meerveld
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Jin S, Li YF, Qin D, Luo DQ, Guo H, Gao XH, Yue L, Zheng H. Non-pharmacological treatments for irritable bowel syndrome: study protocol of an umbrella review of systematic review and meta-analyses. BMJ Open 2019; 9:e027778. [PMID: 30898835 PMCID: PMC6475190 DOI: 10.1136/bmjopen-2018-027778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Non-pharmacological treatments are used in the management of irritable bowel syndrome, and their effectiveness has been evaluated in multiple meta-analyses. The robustness of the results in the meta-analyses was not evaluated. We aimed to assess whether there is evidence of diverse biases in the meta-analyses and to identify the treatments without evidence of risk of bias. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and CINAHL Plus for meta-analyses that evaluate the effectiveness of non-pharmacological treatments. The time of publication will be limited from inception to December 2018. The credibility of the meta-analyses will be evaluated by assessing between-study heterogeneity, small-study effect and excess significance bias. The between-study heterogeneity will be assessed using the Cochrane's Q test, and the extent of the heterogeneity will be classified using the I2 statistics. The existence of a small-study effect in a meta-analysis will be evaluated using the funnel plot method and confirmed by Egger's test. Excess significance bias will be evaluated by comparing the expected number of clinical studies with positive findings with the observed number. ETHICS AND DISSEMINATION No formal ethical approval is required since we will use publicly available data. We will disseminate the findings of the umbrella review through publication in a peer-reviewed journal and conference presentations. PROSPERO REGISTRATION NUMBER CRD42018111516.
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Affiliation(s)
- Song Jin
- Teaching Hospital/Clinical Medicine Department, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yi-Fan Li
- Sichuan 2nd Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Di Qin
- The 3rd Teaching Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dan-Qing Luo
- Teaching Hospital/Clinical Medicine Department, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hong Guo
- Teaching Hospital/Clinical Medicine Department, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiu-Hua Gao
- Teaching Hospital/Clinical Medicine Department, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Yue
- The 3rd Teaching Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Zheng
- The 3rd Teaching Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Abstract
Nausea and vomiting result from complex interactions between afferent and efferent pathways of the gastrointestinal tract, central nervous system, and autonomic nervous system. Afferent pathways from the vagus nerve, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius, which in turn relays signals to the central pattern generator to initiate multiple downstream pathways resulting in symptoms of nausea and vomiting. There is increasing evidence that the central pathway of chronic nausea is different from that of acute nausea and vomiting-and closely resembles that of neuropathic pain. This improved understanding of chronic nausea has resulted in a paradigm shift with regard to management strategy. Although conventional therapies such as antiemetics and prokinetics are commonly used to manage acute nausea and vomiting, they are historically not as effective in treating chronic nausea. Recently, neuromodulator agents, such as tricyclic antidepressants, gabapentin, olanzapine, mirtazapine, and benzodiazepines, and cannabinoids have been shown to be efficacious in the treatment of nausea and vomiting, and may be useful in the treatment of chronic symptoms. There is a need to study these agents, especially in the management of chronic functional nausea. Improved understanding of the central and peripheral circuitry of nausea and vomiting symptoms will allow for enhanced utilization of the currently available medications, and the development of novel therapeutic options.
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Tayama J, Saigo T, Ogawa S, Takeoka A, Hamaguchi T, Inoue K, Okamura H, Yajima J, Matsudaira K, Fukudo S, Shirabe S. Effect of attention bias modification on event-related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho-behavioral study. Neurogastroenterol Motil 2018; 30:e13402. [PMID: 30062816 DOI: 10.1111/nmo.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS. METHODS Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing. KEY RESULTS A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group. CONCLUSIONS AND INFERENCES Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.
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Affiliation(s)
- J Tayama
- Graduate School of Education, Nagasaki University, Nagasaki, Japan
| | - T Saigo
- School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
| | - S Ogawa
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - A Takeoka
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - T Hamaguchi
- Department of Occupational Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - K Inoue
- Center for the Study of Higher Education and Global Admissions, Osaka University, Suita, Japan
| | - H Okamura
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - J Yajima
- Faculty of Literature, Beppu University, Beppu, Japan
| | - K Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo-Hospital, Tokyo, Japan
| | - S Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Shirabe
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
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12
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Fournier A, Mondillon L, Dantzer C, Gauchez AS, Ducros V, Mathieu N, Faure P, Canini F, Bonaz B, Pellissier S. Emotional overactivity in patients with irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13387. [PMID: 29856118 DOI: 10.1111/nmo.13387] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients' vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters. METHODS We assessed the emotional facial expressions (EMFACS), psychological (anxiety, depression, alexithymia), and neurophysiological (cortisol, heart rate variability (HRV)) parameters of 25 IBS patients and 26 healthy controls (HC) while they watched fear-eliciting movie extracts. KEY RESULTS Overall, the task elicited an increase in state anxiety and consistent HRV responses. However, IBS patients differed from HC as they displayed more sadness and tended to display more rage. Contrary to HC, IBS patients showed an increase in heart rate and a decrease in parasympathetic regulation, reflecting an enhanced responsiveness corroborated by higher scores in depression and state anxiety. Consistent with their higher difficulty in identifying feelings, a component of alexithymia positively correlated with their expressions of rage, they were not aware of their increase in anxiety during the task, whereas HC were. No linear relationship between patients' expressions and their neurophysiological responses was found. CONCLUSIONS & INFERENCES Irritable bowel syndrome patients displayed greater emotional expressiveness with negative prevalence. This reflects an emotional vulnerability potentially related to low regulation skills and underscores the importance of considering the central dysregulation hypothesis in IBS as a promising avenue of research.
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Affiliation(s)
- A Fournier
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - L Mondillon
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - C Dantzer
- Laboratory of Psychology, Bordeaux University, Bordeaux, France
| | - A-S Gauchez
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - V Ducros
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - N Mathieu
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France
| | - P Faure
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France
| | - F Canini
- Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France
| | - B Bonaz
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France.,Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France.,Grenoble Institute of Neurosciences (GIN), INSERM, University Grenoble Alpes, Grenoble, France
| | - S Pellissier
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
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13
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Erfan A, Noorbala AA, Karbasi Amel S, Mohammadi A, Adibi P. The Effectiveness of Emotional Schema Therapy on the Emotional Schemas and Emotional Regulation in Irritable Bowel Syndrome: Single Subject Design. Adv Biomed Res 2018; 7:72. [PMID: 29862221 PMCID: PMC5952533 DOI: 10.4103/abr.abr_113_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Positive and negative emotional states are the most important factors in treatment and prevention process of psychosomatic diseases. This research aimed to investigate the effectiveness of emotional schemas' therapy on emotional schemas' modification and difficulties of emotion regulation in women with irritable bowel syndrome (IBS). Materials and Methods: This research was implemented in the framework of single-subject experimental design using step-wise multiple baselines plan. Five patients with IBS were selected as convenience sampling on the base of their willingness to participate and then they received emotional schema therapy (EST). Research tools included ROME III scale, SCID interview, emotional schemas questionnaire, and difficulties of emotional regulation. The analysis of data was done using visual analysis charts, recovery percentage, and reliable change index. Results: The results showed a decrease of scores in some maladaptive schemas and increase of some adaptive schemas than baseline in patients who received EST (P ≤ 0.05). Furthermore, this treatment decreased scores of some emotion regulation difficulty components (P ≤ 0.05). Conclusion: It seems that EST is an appropriate option for treatment of these patients because it is effective in improvement of emotional schemas and difficulties of emotional regulation.
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Affiliation(s)
- Arefeh Erfan
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Karbasi Amel
- Department of Education and Psychology, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
| | - Abolfazl Mohammadi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology 2018; 154:1140-1171.e1. [PMID: 29274869 DOI: 10.1053/j.gastro.2017.11.279] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Central neuromodulators (antidepressants, antipsychotics, and other central nervous system-targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut-brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations. METHODS The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee. RESULTS The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6-12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient-provider relationship. CONCLUSIONS Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, Chapel Hill, North Carolina.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom
| | - Eva Szigethy
- Departments of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hans Törnblom
- Departments of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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15
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Szigethy E, Knisely M, Drossman D. Opioid misuse in gastroenterology and non-opioid management of abdominal pain. Nat Rev Gastroenterol Hepatol 2018; 15:168-180. [PMID: 29139482 PMCID: PMC6421506 DOI: 10.1038/nrgastro.2017.141] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Opioids were one of the earliest classes of medications used for pain across a variety of conditions, but morbidity and mortality have been increasingly associated with their chronic use. Despite these negative consequences, chronic opioid use is increasing worldwide, with the USA and Canada having the highest rates. Chronic opioid use for noncancer pain can have particularly negative effects in the gastrointestinal and central nervous systems, including opioid-induced constipation, narcotic bowel syndrome, worsening psychopathology and addiction. This Review summarizes the evidence of opioid misuse in gastroenterology, including the lack of evidence of a benefit from these drugs, as well as the risk of harm and negative consequences of opioid use relative to the brain-gut axis. Guidelines for opioid management and alternative pharmacological and nonpharmacological strategies for pain management in patients with gastrointestinal disorders are also discussed. As chronic pain is complex and involves emotional and social factors, a multimodal approach targeting both pain intensity and quality of life is best.
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Affiliation(s)
- Eva Szigethy
- Departments of Psychiatry and Medicine, University of Pittsburgh, 3708 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
| | - Mitchell Knisely
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, Pennsylvania 15261, USA
| | - Douglas Drossman
- Center for Functional GI & Motility Disorders, University of North Carolina, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, North Carolina 27599, USA
- Drossman Gastroenterology PLLC, 901 Kings Mill Road, Chapel Hill, North Carolina 27517, USA
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16
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Guadagnoli L, Taft TH, Keefer L. Stigma perceptions in patients with eosinophilic gastrointestinal disorders. Dis Esophagus 2017; 30:1-8. [PMID: 28475723 PMCID: PMC5770239 DOI: 10.1093/dote/dox014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Indexed: 12/11/2022]
Abstract
This study aims to evaluate the presence of perceived stigma in people diagnosed (self-reported) with an eosinophilic gastrointestinal disorder and examine the relationship to the patient's health-related quality of life and additional psychosocial patient-reported outcomes. One hundred forty-nine patients diagnosed for a minimum of 6 months participated in the study. Eligible participants completed questionnaires to assess perceived stigma, psychological functioning, and health-related quality of life. Perceived stigma was moderately associated with a decrease in total health-related quality of life and perceived treatment efficacy. Additionally, greater perceived stigma was positively correlated with an increase in anxiety, depression, and healthcare utilization. The study demonstrates the influence of perceived stigma on several aspects of health-related quality of life in patients with these illnesses. As such, it is important for health professionals to be aware of stigma in patients diagnosed with an eosinophilic gastrointestinal disorder.
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Affiliation(s)
- L. Guadagnoli
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology and Hepatology, Chicago, Illinois, USA
| | - T. H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology and Hepatology, Chicago, Illinois, USA
| | - L. Keefer
- Icahn School of Medicine, Mount Sinai Medical Center, Susan and Leonard Feinstein IBD Center, New York, New York, USA
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17
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Edebol-Carlman H, Ljótsson B, Linton SJ, Boersma K, Schrooten M, Repsilber D, Brummer RJ. Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms. Gastroenterol Res Pract 2017; 2017:8915872. [PMID: 28210270 PMCID: PMC5292189 DOI: 10.1155/2017/8915872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a gastrointestinal disorder linked to disturbances in the gut-brain axis. Visceral hypersensitivity and pain are hallmarks of IBS and linked to the physiological and psychological burden and to the nonadaptive coping with stress. Cognitive-behavioral therapy (CBT) for IBS has proven effective in reducing gastrointestinal and psychiatric symptoms in IBS by means of coping with stress. The present pilot study evaluated for the first time whether CBT for IBS affected visceral sensitivity and pain. Individual CBT was performed for 12 weeks in 18 subjects with IBS and evaluated in terms of visceral sensitivity and pain during rectal distensions using the barostat method and self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms. Visceral discomfort, urge, and pain induced by the barostat were not affected by CBT but were stable across the study. However, the level of self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms decreased after the intervention. Central working mechanisms and increased ability to cope with IBS-symptoms are suggested to play a key role in the alleviation of IBS symptoms produced by CBT.
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Affiliation(s)
- Hanna Edebol-Carlman
- Nutrition-Gut-Brain Interactions Research Centre, Örebro University, 701 82 Örebro, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Steven J. Linton
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Martien Schrooten
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Dirk Repsilber
- Nutrition-Gut-Brain Interactions Research Centre, Örebro University, 701 82 Örebro, Sweden
| | - Robert J. Brummer
- Nutrition-Gut-Brain Interactions Research Centre, Örebro University, 701 82 Örebro, Sweden
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18
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Thomas LV, Jenkins G, Belton J, Clements S, Jacob C, Johnson N, Joy D, Low J, Munson E, Sheppard J. Nutritional advice for community patients: insights from a panel discussion. Br J Community Nurs 2016; 21:130-7. [PMID: 26940615 DOI: 10.12968/bjcn.2016.21.3.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.
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Affiliation(s)
| | | | - Julie Belton
- Operational & Strategic Director, Cuckoo Lane Surgery, Hanwell, UK
| | - Suzie Clements
- Education Lead & Associate Trainer, Hertfordshire Community NHS Trust, Welwyn Garden City, UK
| | - Ciara Jacob
- Practice Nurse in Centric Health and vice-Chair Irish Practice Nurse Association, Newbridge, Republic of Ireland
| | - Naomi Johnson
- Assistant Science Manager, Yakult UK Limited, South Ruislip, UK
| | - Deirdre Joy
- Senior Science Officer, Yakult Ireland, Dublin, Republic of Ireland
| | - Jennifer Low
- Consultant Registered Dietitian, JL Nutrition Clinic, Sevenoaks, Kent, UK
| | - Eileen Munson
- Senior Lecturer, University of South Wales, Pontypridd, Wales, UK
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19
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Moloney RD, Johnson AC, O'Mahony SM, Dinan TG, Greenwood‐Van Meerveld B, Cryan JF. Stress and the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome. CNS Neurosci Ther 2016; 22:102-17. [PMID: 26662472 PMCID: PMC6492884 DOI: 10.1111/cns.12490] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 02/06/2023] Open
Abstract
Visceral pain is a global term used to describe pain originating from the internal organs of the body, which affects a significant proportion of the population and is a common feature of functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS). While IBS is multifactorial, with no single etiology to completely explain the disorder, many patients also experience comorbid behavioral disorders, such as anxiety or depression; thus, IBS is described as a disorder of the gut-brain axis. Stress is implicated in the development and exacerbation of visceral pain disorders. Chronic stress can modify central pain circuitry, as well as change motility and permeability throughout the gastrointestinal (GI) tract. More recently, the role of the gut microbiota in the bidirectional communication along the gut-brain axis, and subsequent changes in behavior, has emerged. Thus, stress and the gut microbiota can interact through complementary or opposing factors to influence visceral nociceptive behaviors. This review will highlight the evidence by which stress and the gut microbiota interact in the regulation of visceral nociception. We will focus on the influence of stress on the microbiota and the mechanisms by which microbiota can affect the stress response and behavioral outcomes with an emphasis on visceral pain.
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Affiliation(s)
- Rachel D. Moloney
- Laboratory of NeurogastroenterologyAPC Microbiome InstituteUniversity College CorkCorkIreland
- Present address:
Oklahoma Center for NeuroscienceUniversity of Oklahoma Health Science CenterOklahoma CityOKUSA
| | - Anthony C. Johnson
- Oklahoma Center for NeuroscienceUniversity of Oklahoma Health Science CenterOklahoma CityOKUSA
| | - Siobhain M. O'Mahony
- Laboratory of NeurogastroenterologyAPC Microbiome InstituteUniversity College CorkCorkIreland
- Department of Anatomy and NeuroscienceUniversity College CorkCorkIreland
| | - Timothy G. Dinan
- Laboratory of NeurogastroenterologyAPC Microbiome InstituteUniversity College CorkCorkIreland
- Department of Psychiatry and Neurobehavioural ScienceUniversity College CorkCorkIreland
| | - Beverley Greenwood‐Van Meerveld
- Oklahoma Center for NeuroscienceUniversity of Oklahoma Health Science CenterOklahoma CityOKUSA
- V.A. Medical CenterOklahoma CityOKUSA
| | - John F. Cryan
- Laboratory of NeurogastroenterologyAPC Microbiome InstituteUniversity College CorkCorkIreland
- Department of Anatomy and NeuroscienceUniversity College CorkCorkIreland
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20
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De Gucht V. Illness perceptions mediate the relationship between bowel symptom severity and health-related quality of life in IBS patients. Qual Life Res 2015; 24:1845-56. [PMID: 25663636 PMCID: PMC4493794 DOI: 10.1007/s11136-015-0932-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Irritable bowel syndrome (IBS) is a functional bowel disorder with a large negative impact on HRQOL. The present study examines whether severity of bowel symptoms is directly related to HRQOL, and/or indirectly, mediated by the patients' illness perceptions. METHODS Patients were recruited from an IBS support group (N = 123), and data were collected online. HRQOL was measured with the Quality of Life Measure for Persons with IBS and illness perceptions with the brief Illness Perception Questionnaire. Mediation models were tested using the bootstrapping procedure developed by Hayes. RESULTS Irritable bowel syndrome symptom severity is directly related to total HRQOL and its subscales; after entering the mediator variables (i.e. the patients' illness perceptions) into the model, this direct association remained only significant for total HRQOL. The relationship between bowel symptom severity and total HRQOL was partially mediated by illness perceptions, and its relationship with each of the HRQOL subscales was fully mediated by the patients' illness perceptions. Perceived consequences were a mediator of the relationship between bowel symptom severity, total HRQOL as well as its subscales, with the exception of Sexuality. CONCLUSIONS Bowel symptom severity not only has a direct relationship with HRQOL, but also an indirect relationship via the patients' cognitive and emotional representations of their illness. In order to better understand this relationship, future research should not only include illness perceptions but also assess cognitive and behavioural coping responses. Clinicians wanting to improve patients' HRQOL should not only focus on the patients' symptoms, but also on their illness beliefs and coping responses.
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Affiliation(s)
- Véronique De Gucht
- Health Psychology Unit, Faculty of Social Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, PO BOX 9555, 2300 RB, Leiden, The Netherlands,
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