When Treating Functional GI Disorders, It’s Never One Size Fits All
Children and adolescents with chronic abdominal pain and nausea often feel they are suffering from a mystery disease that doctors are not able to diagnose, much less treat. Those who seek care at the Cincinnati Children’s Functional Gastrointestinal Disorders (FGID) Clinic typically experience symptom relief, as well as something greater: hope.
The clinic, led by pediatric gastroenterologist Neha R. Santucci, MD, MBBS, began in 2018 and sees about 160 new patients a year. The care team recently expanded to include a new pediatric GI specialist, Kahleb Graham, MD, and a dedicated psychologist. Both Drs. Santucci and Graham have training and expertise in neurogastroenterology and specifically in FGIDs. The initial consult includes time with a physician, the psychologist and a dietitian as part of the clinic’s multidisciplinary care model.
The need for effective FGID treatment is significant. Nearly 30% of all motility consults at Cincinnati Children’s involve FGID, a group of GI disorders with symptoms that cannot be attributed to any organic disease. FGIDs include irritable bowel syndrome, functional nausea, functional dyspepsia, abdominal migraine, cyclic vomiting, rumination and functional abdominal pain. Refractory symptoms can be disabling and severely affect a patient’s quality of life.
A Multimodal Approach
“In the era of personalized care, one size doesn’t fit all,” says Santucci. “There are many subtypes of FGIDs, and each patient presents differently. Some have overlapping pain conditions, dizziness or autonomic arousal or they can’t sleep, or they have Ehlers-Danlos syndrome contributing to their symptoms. We try to understand the different pathophysiologies in play and treat each patient with a multimodal approach.”
Research has shown that adults with FGID who seek care from a gastroenterologist and have cognitive behavioral therapy (CBT) experience better outcomes than those who only receive GI care. Santucci has observed the same thing in pediatric patients.
“Our psychologists sometimes use biofeedback to help patients visualize the extent to which pain and anxiety are affecting them physically,” she says. “With six to eight weeks of CBT, patients can learn how to block pain and nausea signals that travel from the belly to the brain.”
Raising Expectations
Santucci adds that the team may offer multiple therapies in synergy in hopes that the cumulative effect will result in sustained symptom control, lower pain scores and improve functioning.
“Many patients doing CBT say they feel it isn’t working at first, so we may offer endoscopic therapies like pyloric Botox injection or pyloric dilation for patients with dyspepsia to decrease severity of the symptoms,” Santucci says. “The treatment helps the patient feel better and start to think it’s possible to feel better still. This improves participation in CBT and leads to more lasting outcomes.”
The care team provides other treatment modalities for FGID, including medications (such as neuromodulators or antispasmodic agents), sleep hygiene recommendations, phytotherapy, dietary changes, other integrative therapies and percutaneous electrical nerve field stimulation (PENFS). Cincinnati Children’s is one of very few pediatric institutions in the United States offering PENFS, which treats visceral hypersensitivity seen in FGIDs by modulating vagal nerve pathways connecting the brain and gut.
“We discuss treatment options and tailor them to each person’s needs,” Santucci explains. “It’s truly a patient-first model, and children are responding well to it.”
The FGID Clinic takes place twice a week. Most patients are between the ages of 10 and 18 and from surrounding states, although some travel from other parts of the country for care.
To learn more or refer a patient to the FGID Clinic, contact Robin Garrett, intake coordinator.
(Published November 2020)
