This month’s cover story (page 14) brings to the forefront the need for us, as physicians and especially as gastroenterologists, to incorporate mental health and the emerging focus of neurogastroenterology into our practice to better serve our patients.
The efficacy of neuromodulators in treating irritable bowel syndrome has been well demonstrated in various studies, so we need to better explain this to patients. Patients should not question if we are taking on the role of psychologist and diagnosing them with depression. Instead, we need to explain how these medications interact with the gut and nervous system.
We should say to them, “We aren’t prescribing a tricyclic or SSRI because we think you’re depressed and anxious and this is what is causing your symptoms. We’re prescribing these drugs which are known to affect the way the enteric nerves talk to each other.”
In that vein, though, a key to having patients accept treatments outside the norm is to train psychologists who can also approach GI disorders with cognitive behavioral therapy. Involving psychologists in one’s daily practices opens not only your fellow physicians to the efficacy of these techniques, but also shows your patients that you support these methods and see the value in the holistic approach to treating GI disorders.
I look forward to seeing how Laurie Keefer, PhD, and Sarah Kinsinger, PhD, accelerate this already exciting area of GI research and treatment. I expect that their examples will bring along the next generation of neurogastroenterology leaders.
Recently, I saw a patient with refractory ulcerative colitis who was moderately active endoscopically, enough to be causing blood loss and iron deficiency. This patient was extremely reluctant to go on biologics or immunosuppressants, for fear of side effects. After evaluation, the patient decided to seek out a psychologist who administered hypnotherapy. Her symptoms improved. When I saw her a year later, she was in complete endoscopic remission. Though the patient had subsequent issues with polypoid dysplasia and further flare ups, and this is a purely anecdotal, “n of 1” experience, the experience showed me the potential of hypnotherapy in treating IBD. I hope further studies offer more backing for physicians to present these options to patients, especially those reluctant to pursue pharmacotherapy.
On the other hand, we should remember that not all symptoms are attributable to mental health. I have had converse situations in which I connected a patient’s anxiety, depression, etc. to his or her symptoms, only to see them go into clinical remission on a biologic treatment.
In the IBD-IBS patient, it’s even more challenging sometimes figuring out the direct cause of disease. Still, we will have greater success acting as a team – gastroenterologist and neurogastroenterologist – for the best holistic treatment of our patients.
As always, please share your thoughts and personal stories about neurogastroenterology with us on Twitter: @HealioGastro or @EdwardLoftus2.
Edward V. Loftus Jr., MD
Chief Medical Editor
Healio Gastroenterology and Liver Disease
Disclosure: Loftus reports no relevant financial disclosures.