What Becomes of the Frequent Hospital Attenders with Centrally Mediated Gastrointestinal Pain Syndrome?

Abstract

Objective: Centrally mediated gastrointestinal pain syndrome (CAPS) is an infrequently diagnosed functional condition. A small number of patients do, however, become heavy service users due to difficulty in controlling severe symptoms. We aim to review the outcomes of patients who required frequent hospitalisation with CAPS. Methods: Medical records of patients with multiple CAPS presentations during 2015 (n = 18) were further analysed and reviewed until January 1st, 2019. Results: Patients (female 15; male 3) had a median age of 33 (IQR 12) years. Gastrointestinal co-diagnosis was common (88.9%), most frequently irritable bowel syndrome (50%), cyclical vomiting syndrome (27.8%) or gastro-oesophageal reflux disease (16.7%). 66.7% were prescribed regular opiate analgesics. Psychiatric co-morbidity was present in almost all: depression (88.9%); anxiety/panic disorders (38.9%) and post-traumatic stress disorder (27.8%). Social stressors were cited in 33.3%. 27.8% were employed, frequently in healthcare. Over the 4-year study period, 18 identified patients accounted for 2,048 nights in hospital and 672 A+E attendances. In 2015, these patients spent a median of 19 (IQR 34) nights in hospital each with median hospitalisations of between 7 and 10 nights over the following 3 years. Median A+E attendance was 8 per patient (IQR 8) in 2015, remaining relatively constant between 5 and 6 A+E presentations per patient per subsequent year. Conclusion: CAPS is a complicated heterogenous condition resulting from an interplay of physical stimuli with cognitive and emotional factors. As such, management is difficult and requires a multidisciplinary approach with considerable patient ownership of the condition, which is often difficult to achieve.