Implementing psychological therapies for gastrointestinal disorders in pediatrics

ABSTRACT

Introduction

The brain-gut axis refers to complex and reciprocal interactions that impact symptom presentation and disease course within the GI tract. Psychological therapies included in the treatment of functional gastrointestinal disorders (FGIDs) as well as chronic gut disorders including inflammatory bowel disease (IBD) address environmental and psychological factors impacting patients’ symptoms and overall functioning.

Areas covered

Employing a biopsychosocial approach, this review focuses on the evidence for and implementation of psychological therapies across pediatric gastrointestinal disorders.

Expert opinion

By developing a working knowledge of evidence-based psychological therapies applicable to pediatric gastrointestinal disorders, clinicians have the opportunity to comprehensively treat patients’ symptoms and distress. Regular communication and coordination between pediatric gastroenterology clinicians and providers of psychological therapies offers the greatest likelihood for successfully implementing psychological therapies into treatment plans.

KEYWORDS:

• Psychological intervention
• gastrointestinal
• IBD
• functional disorders
• brain-gut axis

Article highlights

• Across pediatric gastrointestinal disorders, comprehensive treatment plans increasingly include psychological therapies as a core component.

• Evidence supports psychological therapies targeting processes common across gastrointestinal disorders, including alterations in pain perception, maladaptive cognitions, physiological hyperarousal, and behavioral avoidance.

• Psychological therapies with strongest evidence base address current functioning and how interactions between psychosocial factors and gastrointestinal symptoms work to maintain symptoms.

• A basic tenet of a brain-gut conceptualization of gastrointestinal disorders is acceptance that symptoms are the result of interactions between psychosocial, gastrointestinal, and biomedical processes.

• Established therapies to treat pediatric gastrointestinal disorders include cognitive behavioral therapy, gut-directed hypnotherapy, and biofeedback-assisted relaxation training.

• To strengthen the evidence base for psychological therapies in the treatment of gastrointestinal disorders, there is a need for controlled trials evaluating effects on emotional and behavioral functioning as well as disease parameters and overall daily functioning.

Declaration of interest

Dr van Tilburg is a consultant for Mahana Therapeutics. B Reed receives funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health. M van Tilburg is a consultant for Mahana Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number K23DK122115 awarded to the first author.