Functional Abdominal Pain Syndrome Research Articles

S1146 No Effect of Gut-Directed Hypnotherapy On Rectal Sensitivity in Children with Functional Abdominal Pain and Irritable Bowel Syndrome

S1146 No Effect of Gut-Directed Hypnotherapy On Rectal Sensitivity in Children with Functional Abdominal Pain and Irritable Bowel Syndrome

S1147 Gastrointestinal (GI) Permeability Is Associated with Trait Anxiety in Children with Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS)

S1147 Gastrointestinal (GI) Permeability Is Associated with Trait Anxiety in Children with Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS)

Hypnosis for Functional Abdominal Pain & Irritable Bowel Syndrome

Gastroenterology| March 01 2008 Hypnosis for Functional Abdominal Pain & Irritable Bowel Syndrome AAP Grand Rounds (2008) 19 (3): 25–26. https://doi.org/10.1542/gr.19-3-25 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Hypnosis for Functional Abdominal Pain & Irritable Bowel Syndrome. AAP Grand Rounds March 2008; 19 (3): 25–26. https://doi.org/10.1542/gr.19-3-25 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chronic functional abdominal pain, hypnosis, irritable bowel syndrome Source: Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, et al. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133(3):1430–1436; doi:10.1053/j.gastro.2007.08.072 The purpose of this study, conducted in the Netherlands, was to examine the effectiveness of hypnotherapy compared to standard medical care in a pediatric population with functional abdominal pain (FAP) or irritable bowel syndrome (IBS). Patients ages 8–18 years with either FAP (n=31) or IBS (n=22) were randomized to either hypnotherapy or standard medical care. Hypnotherapy was conducted at a site distant from the academic center by a registered nurse with years of training and experience in hypnotherapy. The hypnotherapy intervention consisted of six age-appropriate 50-minute sessions over a three-month period. The goal of the hypnotherapy was to provide suggestions for general relaxation, sleep improvement, and “ego-strengthening.” Standard medical care consisted of physician-directed education, dietary advice, extra dietary fiber, and pain medication in addition to six half-hour sessions of “supportive therapy” conducted over a three-month period. Patients in both groups maintained a pain diary card on which they recorded the daily frequency and intensity of abdominal pain and other somatic symptoms such as headache. Outcomes were assessed at baseline, one, four, eight, and 12 weeks after randomization and again six and 12 months post-therapy. Gastrointestinal pain scores decreased significantly in both groups during and after treatment but reductions were significantly greater in the hypnotherapy group than in the standard medical care group. At one-year follow-up, there was an 85% remission among those in the hypnotherapy group compared to 25% in the standard medical care group. The response to hypnotherapy was similar in patients with IBS and FAP. Younger patients (<14 years) responded significantly better during and up to six months after treatment; however, these differences were not significant one year after treatment. The authors conclude that, similar to adult studies,1 gut-directed hypnotherapy is an effective treatment of functional gastrointestinal disorders in children. Drs. Lobato and LeLeiko have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Despite common images of hypnosis as a technique for inducing embarrassing behavior in comedy clubs, the serious use of psychological suggestion and trance states to alleviate human suffering can be traced back to ancient religious rituals and ceremonies. Using modern scientific methods, investigators have not only delineated a relationship between psychological state and physical illness, they have also demonstrated the effectiveness of psychologically-based interventions to treat a variety of physical symptoms in adults and children.2 Hypnotherapy is a treatment wherein suggestions are delivered after a patient is inducted into a hypnotic trance. Hypnotic trance is a deep state of psychological and physiological relaxation which leaves the patient more receptive to new ideas or therapeutic suggestion (eg, your stomach ache will go away). Hypnotherapy has been successfully used to treat symptoms such as hysterical coughing and hiccups, asthma, and dermatologic disorders such as eczema and warts.... You do not currently have access to this content.

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomised controlled trial

Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomised controlled trial

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.

Coping with Chronic Pain in Gastroenterology Patients

Coping with Chronic Pain in Gastroenterology Patients

Treatment options for chronic abdominal pain in children and adolescents

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS.

FUNCTIONAL GASTROINTESTINAL DISORDERS

Introduction: Abdominal pain related to functional gastrointestinal disorders (FGID) is frequent in children and can be of variable severity. Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are associated with rectal hypersensitivity. Our aim was to test the hypothesis that, in children with IBS or FAP, the rectal sensory threshold for pain (RSTP) is correlated with symptoms severity. Methods: 52 patients (37 girls, mean age 13 years, range 8.5 to 17 y) with IBS (n = 30) and with FAP (n = 22), according to Rome II criteria, underwent a series of rectal isobaric balloon distensions using an electronic barostat to determine their RSTP. The patients completed the Questionnaire on Pediatric Gastrointestinal Symptoms in Children underlining symptoms of importance such as pain frequency and duration, missed days of school and missed activities with friends due to pain. Results: The mean RSTP of IBS patients (19 mmHg ± 10) was not significantly different from that of the FAP patients (23 mmHg ± 11; P = 0.2). 85% of the patients had a RSTP ≤ 30 mmHg which represents the 5th percentile of our control population and were considered hypersensitive. 81% reported abdominal pain for more than one year and 91% once a week or more. 52% and 37% respectively reported missing school and social activities at least once a week. No significant association was found between RSTP and pain frequency, duration of pain, missed days of school and missed social activities in the total population (multiple logistic regression, p > 0.20). The subset of patients with hypersensitive values of RSTP similarly did not demonstrate any relation with the same variables (multiple linear regression, P > 0.25). Conclusions: In our population, rectal hypersensitivity, as measured by RSTP, was not proportional to the gravity of symptoms in children with IBS and FAP, suggesting that symptoms severity in FGID is not only under dependence of visceral hypersensitivity but is also influenced by other factors.

Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome

A reduced rectal perceptual threshold has been reported in patients with irritable bowel syndrome (IBS), but this phenomenon may be induced by a comorbid psychological state. We evaluated the rectal pain threshold at baseline and after conditioning (repetitive rectal painful distention: RRD) in patients with IBS or functional abdominal pain syndrome (FAPS), which is an abdominal pain disorder, and in healthy controls, and determined whether rectal hypersensitivity is a reliable marker for IBS. The rectal sensory threshold was assessed by a barostat. First, a ramp distention of 40 ml/min was induced, and the threshold of pain and the maximum tolerable pressure (mmHg) were measured. Next, RRD (phasic distentions of 60-s duration separated by 30-s intervals) was given with a tracking method until the subjects had complained of pain six times. Finally, ramp distention was induced again, and the same parameters were measured. The normal value was defined by calculating the 95% confidence intervals of controls. Five or six of the seven IBS patients showed a reduced rectal pain threshold or maximum tolerable pressure, respectively, at baseline. In all patients with IBS, both thresholds were reduced after RRD load, but they were reduced in none of the patients with FAPS. RRD significantly reduced both thresholds in the IBS group (P < 0.05), but it had no effect in the control or FAPS groups. Rectal hypersensitivity induced by RRD may be a reliable marker for IBS. Conditioning-induced visceral hypersensitivity may play a pathophysiologic role in IBS.

Functional Abdominal Pain Syndrome

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient. The diagnosis of FAPS is made on the basis of positive symptom criteria and a longstanding history of symptoms; in the absence of alarm symptoms, an extensive diagnostic evaluation is not required. Management is based on a therapeutic physician-patient relationship and empirical treatment algorithms using various classes of centrally acting drugs, including antidepressants and anticonvulsants. The choice, dose, and combination of drugs are influenced by psychiatric comorbidities. Psychological treatment options include psychotherapy, relaxation techniques, and hypnosis. Refractory FAPS patients may benefit from a multidisciplinary pain clinic approach.

Functional Gallbladder and Sphincter of Oddi Disorders

The functional disorder of the gallbladder (GB) is a motility disorder caused initially either by metabolic abnormalities or by a primary motility alteration. The functional disorders of the sphincter of Oddi (SO) encompass motor abnormalities of either the biliary or the pancreatic SO. Dysfunction of the GB and/or biliary SO produce similar patterns of pain. The pain caused by a dysfunction of the pancreatic SO can be similar to that of acute pancreatitis. The symptom-based diagnostic criteria of motility dysfunction of the GB and biliary SO are episodes of moderate to severe steady pain located in the epigastrium and right upper abdominal quadrant that last at least 30 minutes. GB motility disorder is suspected after gallstones and other structural abnormalities have been excluded. This diagnosis should then be confirmed by a decreased GB ejection fraction induced by cholecystokinin at cholescintigraphy and after disappearance of the recurrent biliary pain after cholecystectomy. Symptoms of biliary SO dysfunction may be accompanied by features of transient biliary obstruction, and those of pancreatic SO dysfunction are associated with elevation of pancreatic enzymes and even pancreatitis. Biliary-type SO dysfunction is more frequently recognized in postcholecystectomy patients. SO manometry is valuable to select patients with sphincter dysfunction; however, because of the high incidence of complications, these patients should be referred to an expert unit for such assessment. Thus invasive tests should be performed only in the presence of compelling clinical evidence and after noninvasive testing has yielded negative findings. The committee recommends that division of the biliary or pancreatic sphincters only be considered when the patient has severe symptoms, meets the required criteria, and other diagnoses are excluded.

Functional Bowel Disorders

Employing a consensus approach, our working team critically considered the available evidence and multinational expert criticism, revised the Rome II diagnostic criteria for the functional bowel disorders, and updated diagnosis and treatment recommendations. Diagnosis of a functional bowel disorder (FBD) requires characteristic symptoms during the last 3 months and onset > or =6 months ago. Alarm symptoms suggest the possibility of structural disease, but do not necessarily negate a diagnosis of an FBD. Irritable bowel syndrome (IBS), functional bloating, functional constipation, and functional diarrhea are best identified by symptom-based approaches. Subtyping of IBS is controversial, and we suggest it be based on stool form, which can be aided by use of the Bristol Stool Form Scale. Diagnostic testing should be guided by the patient's age, primary symptom characteristics, and other clinical and laboratory features. Treatment of FBDs is based on an individualized evaluation, explanation, and reassurance. Alterations in diet, drug treatment aimed at predominant symptoms, and psychotherapy may be beneficial.

Functional Gastrointestinal Disorders in African American Children in Primary Care

To determine the prevalence of functional gastrointestinal disorders (FGIDs) in a primary care setting and to assess the usefulness of pediatric Rome criteria. The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) assessing the pediatric Rome criteria was administered to 243 school-age children visiting a general pediatric clinic for annual school physicals. Pearson chi statistics were used to determine the association of various demographic factors with FGIDs. All children were African American, 47.7% were girls, and the mean +/- standard deviation age of the group was 10.7 +/- 3.9 years. QPGS detected 52 children (21.4%) with FGID. Diagnoses included aerophagia (6), abdominal migraine (1), cyclic vomiting syndrome (2), functional dyspepsia (2), functional abdominal pain syndrome (1), functional constipation (39) and functional fecal retention (1). Thorough clinical evaluation identified 47 (19.3%) children with FGIDs. Five of the children (2.1%) identified as having FGID on QPGS were felt not to have FGID by the examining physician. Children with FGIDs were not different from healthy children in age, insurance, parent's education, employment or number of children in the family. FGIDs were more common in girls (29/47 girls, P = 0.028). Children with FGIDs tended to live in single-parent households and miss school more often than children without FGIDs (P = 0.08). Functional gastrointestinal disorders are common among African American children and adolescents in a primary care setting and predominantly affect girls. Symptom-based criteria are useful in the diagnosis of pediatric FGIDs.

From the bench to the ‘crib’‐side: implications of scientific advances to paediatric neurogastroenterology and motility

Paediatric gastrointestinal motility disorders may present in the neonatal period as the result of a congenital insult that occurred during embryonic development or as a manifestation of an abnormal genetic background. Functional gastrointestinal and motility disorders may also be acquired and present during childhood as the first presentation of a condition that can persist or re-occur throughout adolescence and adulthood. These disorders can have a significant psychological and financial impact on the lives of the affected children and their families. Recently, enteric neuroscience research has advanced the understanding of the pathogenesis and treatment of uncommon congenital or developmental gastrointestinal motility disorders such as Hirschsprung disease and chronic intestinal pseudo-obstruction. In addition, research has contributed to improvements in the understanding of more prevalent functional gastrointestinal disorders in children, such as chronic constipation and functional abdominal pain syndromes. The purpose of this review is to highlight these advances with particular regard to the clinical impact they have in the understanding and management of disorders in the field of paediatric neurogastroenterology and motility.

Validation of the Pediatric Rome II Criteria for Functional Gastrointestinal Disorders Using the Questionnaire on Pediatric Gastrointestinal Symptoms

To validate the pediatric Rome II criteria for functional gastrointestinal disorders (FGIDs) using the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS). Subjects were 315 consecutive new patients, 4 to 18 years of age, seen in a tertiary care clinic and classified by pediatric gastroenterologists as having a functional problem. Patients and parents separately completed the QPGS before medical consultation. Diagnoses were derived using computer algorithms reflecting the Rome II criteria for pediatric FGIDs. Convergent validity was assessed by prevalence of diagnoses and internal validity using factor analysis to confirm symptom clusters of the criteria. Separate analyses were performed for 4 to 9 and 10 to 18 year olds, and for diagnoses based on parent and child reports. In both age groups, the most prevalent diagnoses were irritable bowel syndrome (IBS) (22.0%, 35.5%), functional constipation (19.0%, 15.2%), and functional dyspepsia (FD) (13.6%, 10.1%). Parent-child concordance on diagnoses was generally poor. Factor analyses supported the internal validity of FD and of IBS symptoms except for relief with defecation. Although functional abdominal pain syndrome and abdominal migraine occurred rarely, symptom clustering within each diagnosis supports their validity. Among patients with abdominal pain, duration was of at least 3 months in most, and pain was of long duration and severe in at least one third. More than half of patients classified as having a functional problem met at least one pediatric Rome II diagnosis for FGIDs. This study offers initial support for the validity of several of the criteria.

Severe irritable bowel and functional abdominal pain syndromes: Managing the patient and health care costs

Severe irritable bowel and functional abdominal pain syndromes: Managing the patient and health care costs

Clinical outcomes measurement: Gut feelings: The impact of symptom-specific anxiety in pain

Disease-specific anxiety measures have demonstrated potential utility for clinical assessment, treatment outcome studies, and mechanistic studies of the role of anxiety in disease presentation. Recently a gastrointestinal(GI)-specific measure of anxiety (Visceral Sensitivity Index, VSI) has been developed and validated for the assessment of symptom-specific anxiety in Irritable Bowel Syndrome (IBS), the most common functional abdominal pain syndrome. Replicate the psychometric properties of the VSI in a population based, non-clinic sample of IBS. Examine the relationship between VSI and general anxiety in IBS, controls and subjects with somatic pain. Using a population survey design, the notion of GI-symptom specific anxiety as measured by the VSI was assessed in several known-groups of young adults: non-pain controls, IBS (meeting Rome II diagnostic criteria), and somatic pain (experiencing some non-abdominal pain on a regular basis in the past 6 months) groups. Analyses addressed the relative importance of GI-specific anxiety after controlling for general anxiety, depression, neuroticism, and vitality. The results from a diverse sample of 312 university students (35% male, 65% female) provided further support for the reliability (á=.93) and the discriminant validity of the VSI. Subjects meeting IBS criteria (N=31) had significantly higher mean levels of GI-specific anxiety, p<.001, and neuroticism than controls (N=281), p<.05. Individuals endorsing non-abdominal pain (N=185) had higher levels of anxiety but lower levels of neuroticism than their non-pain counterparts (N=127), p's<001). Logistic regression of group status onto the psychological and vitality variables indicated GI-specific anxiety was the dominant and most relevant predictor for presence of IBS but not somatic pain. Instead general anxiety levels were more relevant for the presence of somatic pain. Results provide further support for the psychometric properties of the VSI and its relevance to assessment of GI-specific anxiety. The findings further support the importance of disease-specific measures of anxiety.

Validation of Rome II criteria for functional gastrointestinal disorders by factor analysis of symptoms in Asian patient sample.

It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria. A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the '12 weeks out of 12 months' criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria. Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor. Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification.

Chronic narcotic use in inflammatory bowel disease patients: Prevalence and clinical characteristics

Narcotic addiction can be a significant problem in inflammatory bowel disease (IBD). However, there are few published reports about this problem. All patients prescribed narcotics chronically in the absence of demonstrable organic pathology were identified on the computerized Brisbane IBD Research Group database (n=332 patients with informative data as of 1 January 1999). Individual case records were reviewed with regard to clinical, psychiatric and social characteristics of these patients, and the prevalence of psychiatric disorders were compared with a control group of IBD patients. Eleven patients were identified. Nine had complete datasets, eight with Crohn's disease (CD), of which six had previous stricturing ileal disease, and one patient had ulcerative colitis, making a prevalence of 2.7% of IBD patients and 5.1% of CD patients. A 67% prevalence of a psychiatric disorder in narcotic users was significantly greater than the 8% prevalence in the control group of IBD patients (odds ratio 22, 95% CI 3.24-177). A significant proportion of IBD patients without demonstrable organic pathology were chronic narcotic users. Psychiatric disorders are common in this subgroup, as with chronic functional abdominal pain syndromes. It is suggested that inappropriate narcotic use in IBD patients can be reduced by appreciating that narcotics are a temporary therapy only for IBD patients, and awareness of pre-existing social and psychiatric disorders, which not only impact on clinical presentation of pain, but also help define the subgroup of patients who are at risk of narcotic misuse.