487 Use of Central Neuromodulators by Gastroenterologists in the Treatment of IBS: A Pilot Survey

Abstract

INTRODUCTION: Central neuromodulators (CN) include antidepressants and other CNS-targeted medications. They are effective in providing symptom relief in Irritable Bowel Syndrome (IBS) and other chronic abdominal pain disorders. However, little is known about gastroenterologists' practices, attitudes and knowledge regarding the use of these medications. METHODS: A 44-question survey designed by two national experts in functional gastrointestinal disorders (FGID) and a GI fellow was distributed via email to 7 experts in FGID and the GI faculty and alumni at UC-Los Angeles. Responses were reported using simple proportions and descriptive statistics. RESULTS: Characteristics of the 46 GIs that participated in the survey (response rate = 19.2%) are described in Table 1. 64.4% considered the use of CN extremely or very important in their management of IBS patients (Table 2) and 46.7% believed that CN were effective in at least half of their patients (Table 3). However, 37.9% prescribed CN to ≤20% of their IBS patients. 42.2% rated their competency in prescribing CN as ≥4 on a 5-point scale (5 = most competent). 97.8% of respondents used TCA, 63.6% used SSRI and 53.3% used SNRI. Respondents were more comfortable prescribing TCA than SSRI (100% vs. 59.5%; P < 0.01) and SNRI (100% vs. 60.0%; P < 0.01), however, their knowledge about the side effects of TCA (68.9%), SSRI (68.9%) and SNRI (64.4%) was similar (P = 0.87). The most common reasons GIs provided for not prescribing CN was concern about side effects (65.9%). 57.7% of respondents estimated that >20% of their patients refused treatment with a CN, most commonly due to psychiatric stigma (80.0%) and potential side effects (57.8%). FGID experts had higher mean scores for self-assessed confidence (4.3 vs. 2.3; P < 0.01) and competence (4.6 vs. 3.2; P < 0.01) in prescribing CN when compared to non-experts. While experts were more likely than non-experts to feel comfortable prescribing CN for IBS patients' psychiatric symptoms (P < 0.01), there was no difference in their comfort prescribing CN for patients' IBS symptoms (P = 0.32). CONCLUSION: Many surveyed gastroenterologists infrequently prescribe CN to their patients with IBS even though most consider them important in managing these patients. Perceived lack of competence and concern about CN side effects may be significant barriers to prescribing these medications. In particular, non-TCA CN such as SSRI and SNRI may be underutilized. These results warrant further study in a larger population of gastroenterologists.