What Does the Research Say About Treating Functional Gastrointestinal Disorders?

There is a growing body of research that addresses functional gastrointestinal disorders (FGIDs) and their treatment. These are some of the studies I have found helpful as I continue my work with children, adolescents, and young adults with these conditions.

A large trial that focused on children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) showed a significant placebo response but no substantial improvement from amitriptyline, an antidepressant.1 This medication is one of the most commonly prescribed for these GI issues, yet despite this study’s findings, it is still routinely used today, particularly by many of the patients I see in my office.

In another study by the Cochrane Review (the organization that studies studies and determines whether medical research is truly valid) on the use of antidepressants for patients with FGIDs, researchers reported:2

“Clinicians must be aware that for the majority of antidepressant medications, no evidence exists that supports their use for the treatment of abdominal pain–related FGIDs in children and adolescents. The existing randomized controlled evidence is limited to studies on amitriptyline and revealed no statistically significant differences between amitriptyline and placebo for most efficacy outcomes. Amitriptyline does not appear to provide any benefit for the treatment of functional gastrointestinal disorder in children and adolescents.” 

And anecdotally, I can tell you that even at a low dose, parents are not wildly enthusiastic about treating their children with an anti-depressant medication. Which leaves me wondering, why would you want to expose your child to the risk of side effects to a medicine when it has been shown not to work any better than a placebo?

So let’s continue reviewing the research.

In 2007, a pioneering study was done in the Netherlands where standard medical treatment (SMT) was used in one group, and the other group received six sessions of hypnotherapy (HT) over three months. The results were quite impressive. After just one week, there was significant improvement in pain frequency and intensity in the HT compared to the SMT. And, after one year, there was an 85% improvement in the HT group compared to 11% in the SMT group.3 What’s more, five years later, 20% of the SMT group were still doing well, compared to 68% of the HT group.4

In 2017, another study compared in-person treatment with experienced pediatric hypnosis gastrointestinal therapists with an identical script that the patients listened to at home. At the one-year follow-up, 71% of the in-person group were doing well, compared to 62% of the home CD group. The differences in these results were felt not to be statistically significant, meaning both treatment settings produced significant and lasting results.5

What these studies show us is that medications are not as effective as the combination of hypnotherapy and cognitive-behavioral therapy (CBT). It also demonstrates that at-home treatment programs can be a very effective way to deliver treatment for functional gastrointestinal disorders.

These facts support my approach to treating patients with my online video program, Controlling Your Gut Feelings—as do the people who are finding healing through it.

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References
1. Saps, M., Youssef, N., Miranda, A., Nurko, S., Hyman, P., Cocjin, J., et al. (2009). Multicenter randomized placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders. Gastroenterology, 137(4), 1261–1269.

2. Kaminski, A., Kamper, A., Thaler, K., Chapman, A., & Gartlehner, G. (2011). Antidepressants for the treatment of abdominal pain‐related functional gastrointestinal disorders in children and adolescents. The Cochrane Database of Systematic Reviews, 6(7).

3. Vlieger, A.M., Menko-Frankenhuis, C., Wolfkamp, S.C., Tromp, E. & Benninga, M.A. (2007). Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: A randomized controlled trial. Gastroenterology, 133(5), 1430–1436.

4. Vlieger, A.M., Rutten J.M., Govers, A.M., Frankenhuis, C., & Benninga, M.A. (2012). Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. The American Journal of Gastroenterology, 107(4), 627–631.

5. Rutten, J.M.T.M., Vlieger, A.M., Frankenhuis, C., George, E.K., Groeneweg, M., Norbruis, O.F., et al. (2017). Home-based hypnotherapy self- exercises vs. individual hypnotherapy with a therapist for treatment of pediatric irritable bowel syndrome, functional abdominal pain, or functional abdominal pain syndrome: A randomized clinical trial. JAMA Pediatrics, 171(5), 470–477.

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