Multidisciplinary Care Helps Kids With Chronic GI Pain

The Disorders of the Gut-Brain Interaction (DGBI) program, part of the Neurogastroenterology and Motility Disorders specialty at Cincinnati Children’s, is one of the only programs of its kind in the United States. It brings together multiple disciplines, including psychology and nutrition, to improve care for patients with complex gastrointestinal (GI) needs.

An estimated 50% of visits to pediatric gastroenterologists are because of DGBI. Think functional dyspepsia and irritable bowel syndrome—conditions that cause chronic abdominal pain—and others, such as cyclic vomiting syndrome, functional nausea and rumination.

“Our goal for our clinic has been helping patients who haven’t always received a clear diagnosis or effective treatment,” says DGBI program director Neha Santucci, MD, MBBS. “They have a lot of other comorbid conditions and can get lost in the system. They’re seeing a neurologist. They’re seeing a cardiologist. They’re scared and asking, ‘What’s wrong with me?’”

Santucci continues, “Outreach in the community has been a big part of our work. We’re educating trainees, primary care providers and other specialists to provide the best level of care for these higher-needs patients.”

Multidisciplinary Treatment Model Improves Clinical Care

The DGBI program specializes in DGBI treatment, especially with percutaneous electrical nerve field stimulation and other non-pharmacologic modalities. A big part of what makes the program unique is the collaboration across disciplines. The intake team and the neurogastroenterology nurses strive to make this process as smooth as possible.

“We want to spread awareness and be able to clinically improve care,” explains Santucci. “That’s why we have this multidisciplinary clinic—where we bring everyone to the patient. They don’t have to go to specialists on different days. Instead, we collaborate to streamline care.”

Santucci and Kahleb Graham, MD are the neurogastroenterologists in the outpatient DGBI clinic. They also are working closely with mental health and other teams to create a partial day and inpatient Mind-Body Disorder program. The initiative will integrate mental health and other biopsychosocial support to treat the complex physical needs of patients with DGBI, especially those who fail regular outpatient treatment.

Cutting-Edge Research Results in Center of Excellence Distinction

Along with current treatments, the DGBI program supports several innovative research projects, with the goal of benefitting the larger community. Drs. Khalil El-Chammas and Ajay Kaul are integral parts of the research team. Research areas look at the effects of non-invasive vagal neuromodulation, the role of risk factors like sleep disturbances, autonomic functioning and feeding intolerance, social determinants of health, transition of care for DGBI patients, and the overlap of DGBI and other organic GI disorders.

“The idea is to bring new treatments to the bedside that address what patients are struggling with based on our clinical and bench experience,” Santucci says. “We hope to integrate new treatments—especially non-pharmacologic treatments—because a lot of DGBI patients don’t always get better with medications that come with side effects.”

Recent research milestones include:

• In August 2024, Cincinnati Children’s became a Center of Excellence for research related to auricular percutaneous electrical nerve field stimulation (PENFS), a type of pain management.
  
  
• Collaborating with other researchers through the Pediatric Pain Research Center, the DGBI team helped host a conference in October to teach trainees about the clinical and research aspects of pain management.
  
  
• Through an NIH K23 research grant, Santucci and her team are studying sleep disturbances, circadian rhythm and autonomic changes in children with functional abdominal pain disorders and in healthy children. They also are looking at changes with neurostimulation.
  
  
• In June, DGBI became part of the Health Equity Network, looking at the racial disparities in DGBI care. Through this quality improvement partnership with primary care providers, the DGBI team will develop a better way to care for minority children. They’ll work with communities, including schools, to discuss and navigate some of the challenges that come with DGBI disorders, such as chronic absenteeism, stigma, mental health concerns and other school barriers.

Educational Tools Help Providers Manage DGBI

A big part of DGBI program work is educating others about the research, treatment model and successful patient outcomes. The team is partnering with integrative medicine to provide more non-pharmacologic therapies that are currently under-used when treating chronic abdominal pain and nausea. They’ve also developed community support tools to educate pediatricians on managing DGBI.

“Outreach in the community has been a big part of our work,” says Santucci. “We’re educating trainees, primary care providers and other specialists to provide the best level of care for these higher-needs patients.”

(Published October 2024)

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