Recently Dr. DiLorenzo gave our group a brilliant lecture. I have taken some notes and shared some slides. There may be inadvertent omissions and mistakes in my notes. This is part 2 of my summary.

Key points (intermixed with slides):

• Improving Physical activity, Diet and Sleep Often Helps DGBI symptoms
• Excess use of smartphones can be detrimental. There are issues with FOMO (fear of missing out), cyberbullying, effects on sleep, and effects on interpersonal skills
• Displacement, or replacing important activities (including physical activity) with time spent on social media, is a significant concern

• Working with pain psychologists is an important part of treatment for many children and adolescents
• Lots of celebrities have been open about their mental health challenges: Lady Gaga, Ariana Grande, Kristen Bell, Selena Gomez, Ryan Reynolds, and Dwayne “The Rock” Johnson
• For more serious mental health concerns, referral to psychiatry is more appropriate

• Gut-Brain neuromodulators can be effective.
• Despite their good safety profile, they are underutilized
• Dr. DiLorenzo uses more citalopram than omeprazole
• Amitriptyline is often used for abdominal pain in the absence of anxiety. Variable results have been published

• Psychotropic medications: Amitriptyline is useful for pain predominant IBS, Citalopram often is effective for FAP/IBS with anxiety, Buspirone is helpful in dyspepsia with anxiety, and Mirtazapine is a good choice in the setting of dyspepsia with with weight loss. Generally, start with a low dose and slowly titrate with each medication
• Safety: Despite black box warning, recent studies have suggested SSRIs may lower the risk of suicidality overall

• Other treatments: PENFS (see also: Auricular Stimulation Associated with Less Pain, Less Disability, and Better Sleep)

• Don’t be the doctor who only tells patients things they want to hear. (Don’t be afraid of online rating)

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