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'Comprehensive approach' needed for pediatric functional GI disorders
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A multidisciplinary treatment approach that combined gastrointestinal, pain and psychologic factors helped improve symptoms in children with functional gastrointestinal disorders, according to research published in Clinical Gastroenterology and Hepatology.
Samuel Nurko, MD, MPH, of the Center for Gastrointestinal and Functional Disorders at Boston Children’s Hospital, and colleagues wrote that functional gastrointestinal disorders (FGID) can create a poorer quality of life for pediatric patients by regularly forcing them to miss school and to undergo extensive testing.
“FGIDs result from a complex interplay between genetic pre-disposition, biological and psychosocial triggers, and are best explained by the biopsychosocial model,” they wrote.
To demonstrate why these factors indicate the need for a multidisciplinary approach, Nurko and colleagues conducted a retrospective observational cohort study with patients from Boston Children’s Hospital. The study comprised patients with functional abdominal pain or irritable bowel syndrome observed between 2010 and 2014 (n = 67; mean age = 15.5 years; pain duration = 2.3 years).
Researchers distributed questionnaires to assess baseline characteristics, pain, disability and quality of life among the patients, and created an individualized treatment plan for each patient.
The plan centered on treating disorders through both medical and psychological therapies.
“We focus on changing the framework away from the medical model, in which pain is interpreted as an alarm sign representing an underlying illness, toward the understanding pain itself as the illness,” the researchers wrote. “Testing was only suggested as a means to identify triggers, not the cause of pain.”
The primary outcome of the study was improvement in abdominal pain or functional disability index scores of at least 30% using validated scales, as well as subjective improvement in pain or function using a five-point Likert scale.
Of 46 patients who completed follow-up, 78% reported significant improvement in functioning (21.7% normal; 37% significant; 19.6% some; 13% no improvement; 2.3% worse), and 69.6% reported significant improvement of abdominal pain (4.3% asymptomatic; 43.5% significant, 21.7% some, 26.1% no improvement; 4.3% worse).
Nurko and colleagues believe their results show the promise of a multidisciplinary approach in treating pediatric FGIDs.
“Our patients had seen multiple physicians prior to their evaluation with us, and it is notable that our team recommended many similar pharmacologic and non-pharmacologic interventions that had been unsuccessful previously,” they wrote. “We postulate that our multipronged approach, with its strong emphasis on a biopsychosocial explanation for FGIDs may have an additive effect and enable recommendations previously not perceived as helpful to be successfully incorporated into a new package of interventions.” – by Alex Young
Disclosures: The authors reported no relevant financial disclosures.
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