Management of patients with chronic abdominal pain due to disorders of gut-brain interaction. Review

Abstract

Disorders of gut‑brain interaction (DGBI), including irritable bowel syndrome (IBS), functional dyspepsia (FD), and centrally‑mediated abdominal pain (CMAP), are present in more than 40 % of the worldwide population. At the first stages, most of the DGBI patients receive treatment with therapeutic agents aimed at visceral stimuli, such as eating and bowel movements. Unfortunately, a large subset of DGBI patients continue to experience chronic abdominal pain, which adversely affects health‑related quality of life and often leads to excessive unwarranted diagnosis and treatment, including surgery. Management of patients with abdominal pain who do not respond to first‑line therapy for visceral stimuli is complex and involves exposure to a number of cognitive, affective, and behavioral factors, including education, pain expectations, and other psychosocial modifiers such as mood disorders and anxiety disorders. Effective treatment of pain requires establishing a trusting relationship between the patient and the physician and avoiding medications that patients may abuse, such as opioids. Management options include both non‑pharmacological methods and pharmacological therapy. The paper presents an updated clinical review prepared by experts from the American Gastroenterological Association, focusing on the management of patients with DGBI in whom pain does not decrease under the influence of first‑line therapy aimed at visceral stimuli. This review is presented in the form of best clinical advice, although it does not discuss the use of additional non‑traditional or alternative therapies, such as marijuana, and does not cover the treatment of abdominal wall or pelvic pain syndromes.