Skip to main content

How to Use Central Neuromodulators (CNs) to Help Manage Patients with Disorders of Gut-Brain Interaction (DGBI)

  • Chapter
  • First Online:
Using Central Neuromodulators and Psychological Therapies to Manage Patients with Disorders of Gut-Brain Interaction
  • 321 Accesses

Abstract

This article instructs on the use of central neuromodulators to manage patients with chronic functional gastrointestinal disorders that are incompletely responding to dietary changes or peripherally acting gastrointestinal drugs. The use of various psychopharmacologic agents, including SSRIs, SNRIs, TCAs, other antidepressants, and second-generation antipsychotics, is reviewed. The benefit of these agents in managing chronic abdominal pain, nausea, dyspepsia, and altered bowel function is discussed. Case studies are provided. Dosages of the agents and potential side effects are discussed. In addition, a set of questions and answers to drive home salient clinical points is included, as an addendum.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Clouse RE, Lustman PJ. Use of psychopharmacological agents for functional gastrointestinal disorders. Gut. 2005;54(9):1332–41. https://doi.org/10.1136/gut.2004.048884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Dekel R, Drossman DA, Sperber AD. The use of psychotropic drugs in irritable bowel syndrome. Expert Opin Investig Drugs. 2013;22(3):329–39. https://doi.org/10.1517/13543784.2013.761205.

    Article  CAS  PubMed  Google Scholar 

  3. Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for functional gastrointestinal disorders (disorders of gut−brain interaction): a Rome foundation working team report. Gastroenterology. 2018;154:1140–1171.e1. https://doi.org/10.1053/j.gastro.2017.11.279.

    Article  PubMed  Google Scholar 

  4. Grover M, Drossman DA. Psychopharmacologic and behavioral treatments for functional gastrointestinal disorders. Gastrointest Endosc Clin N Am. 2009;19(1):151–70. https://doi.org/10.1016/j.giec.2008.12.001.

    Article  PubMed  Google Scholar 

  5. Van Oudenhove L, Levy RL, Crowell MD, et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology. 2016;150(6):1355–1367.e2. https://doi.org/10.1053/j.gastro.2016.02.027.

    Article  Google Scholar 

  6. Kim SE, Chang L. Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms? Neurogastroenterol Motil. 2012;24(10):895–913. https://doi.org/10.1111/j.1365-2982.2012.01993.x.

    Article  CAS  PubMed  Google Scholar 

  7. Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381–96. https://doi.org/10.1146/annurev-med-012309-103958.

    Article  CAS  PubMed  Google Scholar 

  8. Keefer L, Drossman DA, Guthrie E, et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology. 2016;150(6):1408–19. https://doi.org/10.1053/j.gastro.2016.02.034.

    Article  Google Scholar 

  9. Stahl SM. Stahl’s essential psychopharmacology. 4th ed. Cambridge: Cambridge University Press; 2013.

    Google Scholar 

  10. Schatzberg AF, DeBattista C. Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing; 2015. https://books.google.com/books?hl=en&lr=&id=zT22CAAAQBAJ&pgis=1. Accessed 26 Nov 2015.

    Book  Google Scholar 

  11. Creed F. How do SSRIs help patients with irritable bowel syndrome? Gut. 2006;55(8):1065–7. https://doi.org/10.1136/gut.2005.086348.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Grover M, Drossman DA. Psychotropic agents in functional gastrointestinal disorders. Curr Opin Pharmacol. 2008;8(6):715–23. https://doi.org/10.1016/j.coph.2008.07.012.

    Article  CAS  PubMed  Google Scholar 

  13. Grover M, Drossman DA. Centrally acting therapies for irritable bowel syndrome. Gastroenterol Clin N Am. 2011;40:183–206. https://doi.org/10.1016/j.gtc.2010.12.003.

    Article  Google Scholar 

  14. Törnblom H, Drossman DA. Centrally targeted pharmacotherapy for chronic abdominal pain. Neurogastroenterol Motil. 2015;27(4):455–67. https://doi.org/10.1111/nmo.12509.

    Article  PubMed  Google Scholar 

  15. Drossman DA, Toner BB, Whitehead WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125(1):19–31. http://www.ncbi.nlm.nih.gov/pubmed/12851867. Accessed 26 Nov 2015.

    Article  Google Scholar 

  16. Tack J, Ly HG, Carbone F, et al. Efficacy of mirtazapine in patients with functional dyspepsia and weight loss. Clin Gastroenterol Hepatol. 2016;14(3):385–392.e4. https://doi.org/10.1016/j.cgh.2015.09.043.

    Article  CAS  PubMed  Google Scholar 

  17. Jiang SM, Jia L, Liu J, Shi MM, Xu MZ. Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss. World J Gastroenterol. 2016;22:5260–6. https://doi.org/10.3748/wjg.v22.i22.5260.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Tack J, Janssen P, Masaoka T, Farré R, Van Oudenhove L. Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Clin Gastroenterol Hepatol. 2012;10(11):1239–45. https://doi.org/10.1016/j.cgh.2012.06.036.

    Article  CAS  PubMed  Google Scholar 

  19. Coss-Adame E, Erdogan A, Rao SSC. Treatment of esophageal (noncardiac) chest pain: an expert review. Clin Gastroenterol Hepatol. 2014;12(8):1224–45. https://doi.org/10.1016/j.cgh.2013.08.036.

    Article  PubMed  Google Scholar 

  20. Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial. Gastroenterology. 1987;92(4):1027–36. http://www.ncbi.nlm.nih.gov/pubmed/3549420. Accessed 26 Nov 2015.

    Article  CAS  Google Scholar 

  21. Grover M, Dorn SD, Weinland SR, Dalton CB, Gaynes BN, Drossman DA. Atypical antipsychotic quetiapine in the management of severe refractory functional gastrointestinal disorders. Dig Dis Sci. 2009;54(6):1284–91. https://doi.org/10.1007/s10620-009-0723-6.

    Article  CAS  PubMed  Google Scholar 

  22. Sobin WH, Heinrich TW, Drossman DA. Central neuromodulators for treating functional GI disorders: a primer. Am J Gastroenterol. 2017;112:693–702. https://doi.org/10.1038/ajg.2017.57.

    Article  CAS  PubMed  Google Scholar 

  23. Sperber AD, Drossman DA. Review article: the functional abdominal pain syndrome. Aliment Pharmacol Ther. 2011;33:514–24. https://doi.org/10.1111/j.1365-2036.2010.04561.x.

    Article  CAS  PubMed  Google Scholar 

  24. Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2007;27(1):31–40. https://doi.org/10.1111/j.1365-2036.2007.03541.x.

    Article  PubMed  Google Scholar 

  25. Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(6):811–9. https://doi.org/10.1038/ajg.2014.82.

    Article  CAS  PubMed  Google Scholar 

  26. Richter JA, Patrie JT, Richter RP, et al. Bleeding after percutaneous endoscopic gastrostomy is linked to serotonin reuptake inhibitors, not aspirin or clopidogrel. Gastrointest Endosc. 2011;74(1):22–34.e1. https://doi.org/10.1016/j.gie.2011.03.1258.

    Article  PubMed  Google Scholar 

  27. Thiwan S, Drossman DA, Morris CB, et al. Not all side effects associated with tricyclic antidepressant therapy are true side effects. Clin Gastroenterol Hepatol. 2009;7(4):446–51. https://doi.org/10.1016/j.cgh.2008.11.014.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sobin, W.H. (2019). How to Use Central Neuromodulators (CNs) to Help Manage Patients with Disorders of Gut-Brain Interaction (DGBI). In: Sobin, W. (eds) Using Central Neuromodulators and Psychological Therapies to Manage Patients with Disorders of Gut-Brain Interaction. Springer, Cham. https://doi.org/10.1007/978-3-030-18218-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-18218-2_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18217-5

  • Online ISBN: 978-3-030-18218-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics