Mental health conditions are becoming increasingly common and can trigger gut-brain axis (GBA) disorders, and the number of people being diagnosed with these disorders has increased in recent years.
An important reminder of the overlapping roles between these diseases Recent internet research.
Researchers questioned 54,127 adult participants (49.1% female, mean age 44.3 years) from 26 countries around the world using Rome IV criteria. Researchers determined that an astonishing 37.5% of respondents exhibited clinically relevant severity of psychological distress and/or physical symptoms. These responders also had a 4.45-fold increased risk of suffering from a GBA disorder compared to people without physical symptoms or psychological distress.
In the United States, the two most common functional gastrointestinal (GI) disorders of GBA are: irritable bowel syndrome (IBS) and functional dyspepsia.
Mind-body-oriented therapy (“mindfulness”) for IBS and functional dyspepsia has been shown to be effective and long-lasting. These include gut-directed hypnotherapy (GDH), relaxation techniques (such as yoga or tai chi), behavioral therapy, and/or psychotherapy.
These alternative methods have not yet been widely adopted among gastroenterologists, despite promising evidence. However, this situation may begin to change with the publication of two new studies highlighting the use of a mindfulness approach for IBS and functional dyspepsia.
Digital hypnotherapy for IBS
recent research The study by Chey et al. is the first randomized trial to evaluate the use of all-digital GDH in patients with IBS. Application of this technique, although shown to be safe and effective in previous studies, has been very limited due to the lack of trained hypnotherapists in most fields. .
The study compared an all-digital program (Regulora) delivered via video call with a parallel group using a digital progressive muscle relaxation program administered through a mobile app.
Regulola consists of a proprietary script that is approximately 30 minutes long and is approved by the U.S. Food and Drug Administration (FDA), but it is not specifically targeted at intestinal symptoms. This study aimed to determine whether the beneficial results could be generalized to other his GDH symptoms.
A total of 378 patients were randomly assigned (79.8% female, mean age 42.5 years), and IBS subtypes were evenly distributed between groups.
Patients received a total of seven treatment sessions biweekly during the 12-week treatment period. They were also allowed access to daily practice sessions for as many days as they chose. All sessions were conducted remotely from the patient’s home.
Compliance was good, with 87.5% in the GDH group and 92.3% in the muscle relaxation group completing at least 5 of 7 sessions. There was no significant difference in the primary endpoint (abdominal pain) between the two groups. Results were also comparable between groups for the endpoints of stool consistency and frequency, IBS quality of life score, absenteeism time, and willingness to recommend.
There were no serious safety events in either group.
The relative equivalence of the GDH and muscle relaxation groups highlights the role that psychological factors such as stress and anxiety play in patients with IBS symptoms.
However, this study was characterized by a notable lack of sleep disturbances as a result, which may be influenced by these psychological factors and the occurrence of adverse events as a result of decreased sensory thresholds. has a significant impact on
Virtual reality to treat functional dyspepsia
Currently, there are no drugs approved by the FDA for functional dyspepsia; national guidelines We recommend a variety of treatments, including acid suppressants, antidepressants, prokinetic drugs, and cognitive behavioral therapy.
This makes the results even more important. new research A study by Cangemi et al. evaluated the safety and effectiveness of a virtual reality (VR) intervention for functional dyspepsia.
In the first randomized trial between active VR and sham-controlled VR in functional dyspepsia, researchers used a method to distract patients from real-world awareness and processing of noxious stimuli that engage patients’ somatic functions. The purpose was to evaluate the ability of VR to function as multisensory information. Recognition of discomfort.
Forty patients were enrolled (2:1 in favor of valid vs. sham). All participants were given headsets, the active group received a 3D immersive audiovisual program (RelieVRx) designed to reduce pain, and the sham group watched her 2D nature videos. Both groups used the headsets at least daily for two weeks.
Symptoms were assessed using the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index.
Although the researchers observed no significant improvement between the groups on symptom severity indices, there was greater improvement in individual symptoms for patients in the active VR group, with the exception of abdominal pain and bloating. .
Incorporating mindfulness into your treatment approach
These first randomized controlled trials for GBA disorders show that a mindfulness approach distracts from somatic input by intensively immersing brain centers to downregulate noxious stimuli. This indicates that it appears to be targeted. This is consistent with the gating theory of pain, which states that there are neural pathways that transmit or block pain signals in the central nervous system, thereby modulating pain perception.
There is growing data supporting the addition of mindfulness-oriented treatments for functional gastrointestinal disorders, and these GBA disorders are clearly bidirectional.
As a result, therapeutic approaches need to be expanded beyond traditional therapeutic approaches centered on antispasmodics, dietary fiber, and a FODMAP (fermentable oligosaccharide, disaccharide, monosaccharide, polyol) diet. New approaches focusing on gut-brain interactions can be effective and complement more standard interventions.
Tools are increasingly becoming available to help patients access these resources.Great options available GI on demand by the American College of Gastroenterology, which offers patients and health care providers an extensive menu of telehealth connections, including access to nutritionists and psychologists, and gut mindfulness therapies such as Nerva gut hypnotherapy. .
Customizing mindfulness approaches for each patient will go a long way toward accelerating the more global goal of personalized medicine, which treats patients as individuals rather than disease categories.
A regular Medscape contributor, David A. Johnson, MD, is a professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, and a past president of the American College of Gastroenterology. His primary focus is clinical gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, focusing on the effects of sleep and the microbiome on esophageal and colonic diseases, and more recently on gastrointestinal health and disease.
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