A global epidemiological study of functional GI disorders • 73,076 adults surveyed (33 countries, 6 continents) • Data collection: By Internet (24 countries), by household interview (7 countries), or both methods (China and Turkey, green).
Diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys and 20.7% of persons who completed the household surveys
FGIDs were associated with lower quality of life and more frequent doctor visits
My take: In industrialized countries, about 40% have functional GI disorders.
From 2007–2015, approximately 36.9 million (95% CI, 31.4–42.4) weighted visits in patients of non-federally employed physicians for chronic symptomatic FBDs were sampled. There was an annual weighted average of 2.7 million (95% CI, 2.3–3.2) visits for symptomatic irritable bowel syndrome/chronic abdominal pain, 1.0 million (95% CI, 0.8–1.2) visits for chronic constipation, and 0.7 million (95% CI, 0.5–0.8) visits for chronic diarrhea. Pharmacologic therapies were prescribed in 49.7% (95% CI, 44.7–54.8) of visits compared to nonpharmacologic interventions in 19.8% (95% CI, 16.0–24.2) of visits (P < .001). Combination treatment strategies were more likely to be implemented by primary care physicians and in patients with depression or obesity. The direct annual cost of ambulatory clinic visits alone for chronic symptomatic FBDs is approximately US$358 million
This article is a useful and up-to-date review on the role of psychology to treat children with gastrointestinal disorders, particularly targeting functional GI disorders as well as children with inflammatory bowel disease. Also, I want to recognize Bonney and Jessica who have been so helpful for so many of our patients.
Cognitive behavioral therapy (CBT)
Biofeedback-assisted relaxation training
Emerging therapies: Mindfulness, and Acceptance and Commitment therapy
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According to a recent study (M Saps et al. JPGN 2018; 66: 387-90), joint hypermobility is not associated with an increased risk of functional gastrointestinal disorders (FGIDs).
From a school-based study of 654 children from a public school in Cali, Columbia, 148 (22.6%) were identified as having an FGID. Among this group, 136 children participated in the study along with 136 age/sex-matched healthy controls. Joint laxity was assessed to establish a Beighton score.
There was no significant difference in joint laxity between the FGID group and the control group, with OR of 1.03.
The implication of this study is that previous associations between joint hypermobility (JH) and FGIDs could be due to selection bias at tertiary care centers. Alternatively, “it is possible that the association between FGIDs and JH exists, but it is only limited to a subset of patients that consult at specialized clinics.”
My take: This article challenges the idea that JH increases the risk of FGID. Based on this study, if JH is a risk factor, it is hard to detect in a general population.
A recent commentary explains why “functional” pain is such a lousy term (JAMA Pediatr. Published online June 02, 2014. doi:10.1001/jamapediatrics.2014.530 –thanks to Ben Gold for this reference). In pediatric GI practice, functional gastrointestinal disorders (FGIDs) constitute a large part of clinical work.
The author, Neil Schechter from the Chronic Pain Program in Boston, makes several important observations:
“There is general dissatisfaction with the terminology.” This stems from the fact that “in common parlance today, functional disorders are typically assumed to be a product of psychological distress.” Yet, parents/patients are “not ready to accept a strictly psychological explanation.”
The idea that functional pain is solely a psychological disturbance is inaccurate. Though, anxiety and depression are common associated problems which often contribute to symptoms. He states that “hyperexcitability” of the nervous system is “the core biological link and final common pathway for the creation of functional pain disorders.”
This category should be labeled dysfunctional pain. “In effect, calling pain ‘functional’ is like calling disease, ‘ease.'”
These disorders frequently respond to centrally acting therapies including antidepressants, anticonvulsants, exercise, cognitive behavioral therapy, and acupuncture.
“The search for an appropriate term for these pain problems is far more than semantic…[a patient’s] understanding of their illness is clearly linked to their compliance with medical advice…it may stem their desire for additional costly investigation.”
Dr. Schechter proposes the term “primary pain disorder.” “Unlike Shakespeare’s rose, functional pain would benefit from a new name.”
Take-home message: I wish I had written this commentary. Explaining “functional” pain and “irritable bowel syndrome” are Sisyphean tasks. Better nomenclature could ease the burden. Join me in abandoning the use of the word “functional.”
In the same issue, an editorial on the “Role of Celiac Disease Screening for Children with Functional Gastrointestinal Disorders” (JAMA Pediatr. 2014;168(6):514-515. doi:10.1001/jamapediatrics.2013.5418) comments on a study (JAMA Pediatr. 2014; 168(6):555-60) in the same issue which reports a 4-fold higher prevalence of celiac disease among children who meet clinical criteria for irritable bowel syndrome. The study reports the results from a cohort of 992 children identified with recurrent abdominal pain in a primary care setting. In the editorial, the authors note: “When grouped together, the prevalence rate of celiac disease among all children with FGIDs (IBS included) approaches 2%. Celiac disease screening in this population would result in a positive tTG-IgA test result in 4%…However, 53% of all positive test results would be falsely elevated.” As such the editorial advocates in favor of screening for celiac disease in children with IBS but not all FGIDs.