Eucker, Stephanie A.

Luck, Nora

Shahamatdar, Soroush

English

George Washington University: Health Sciences Research Commons (HSRC)

Himmelfarb Health Sciences Library, The George Washington University Health Sciences Research Commons URGENT Matters School of Medicine and Health Sciences 8-16-2023 Bridging the Gaps in DGBI: The Mind Body Approach to Abdominal Pain Nora Luck George Washington University Soroush Shahamatdar George Washington University Stephanie A. Eucker Duke University Follow this and additional works at: https://hsrc.himmelfarb.gwu.edu/smhs_URGENT_Matters  Part of the Medicine and Health Sciences Commons Recommended Citation Luck, Nora; Shahamatdar, Soroush; and Eucker, Stephanie A., "Bridging the Gaps in DGBI: The Mind Body Approach to Abdominal Pain" (2023). URGENT Matters. Paper 26. https://hsrc.himmelfarb.gwu.edu/smhs_URGENT_Matters/26 This News Article is brought to you for free and open access by the School of Medicine and Health Sciences at Health Sciences Research Commons. It has been accepted for inclusion in URGENT Matters by an authorized administrator of Health Sciences Research Commons. For more information, please contact hsrc@gwu.edu. Bridging the Gaps in DGBI: The Mind Body Approach to Abdominal PainNora Luck, Soroush Shahamatdar, Stephanie A. Eucker, MD, PhD08/16/2023Abdominal pain is the most common chief complaint in US EDs, representing over sevenmillion annual visits. Yet, despite intensive ED work-ups, approximately 25% of these patientsleave the ED with a diagnosis of “nonspecific abdominal pain.” While infections, inflammation,surgical processes, and cancer-related gastrointestinal (GI) conditions are often readilydiagnosable through standard testing, many causes of abdominal pain cannot be clearly identifiedthrough traditional diagnostic methods. Many of these causes fall under the umbrella ofDisorders of Gut-Brain Interaction (DGBI), formerly known as “functional abdominal pain.”DGBI are disorders that affect more than a third of the U.S. population. The underlyingetiologies remain poorly defined but are likely due to a combination of various factors, includingmotility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gutmicrobiota, and/or altered central nervous system processing.Because these disorders are rarely life-threatening, there is a lack of awareness andeffective research regarding both the diagnosis and treatment of DGBI in the ED. Effectivetreatment likely includes a recognition of the associated biological, psychological and socialfactors and their complex interactions, termed “biopsychosocial” factors, contributing to thedisease process. Diagnosis is complicated because DGBIs share similarities that overlap withseveral distinct GI diseases featuring well-defined structural causes; for example, a DGBI suchas functional dyspepsia can exhibit symptoms that overlap with gastroparesis; a DGBI such asirritable bowel syndrome can manifest similarities with inflammatory bowel diseases, e.g.,Crohn’s disease and ulcerative colitis.The reason that DGBI are important to emergency medicine practitioners is that thechronic and relapsing nature of DGBI symptoms lead to multiple ED visits, multiple negative CTscans, and contribute to a significant burden on the emergency healthcare system as well aspatient dissatisfaction with treatment. Abdominal pain has been identified as the top primarycomplaint among “superutilizers” – a term that refers to patients who visit the ED four or moretimes annually. These recurrent visits result in repeated diagnostic investigations, where patientsare subject to unnecessary and extensive imaging and testing, posing an increased risk ofradiation exposure. Multiple CT scans not only have adverse effects on patients but are alsocostly. The time required to perform and interpret imaging results can impact ED patient flowand concurrently increase financial strain on the patient, sometimes costing as much as $9,000for a single CT scan.The end result of these intensive diagnostic efforts for most patients with DGBIs is theabsence of a clear diagnosis. Moreover, these patients are often prescribed opioid analgesics forsymptom management, exposing them to a greater risk of developing an opioid use disorder. In astudy with U.S. veterans, the likelihood of patients with DGBI to be prescribed with opioidswere shown to be 40% higher than those with structural GI diagnoses. Opioid prescriptions forGI conditions have increased despite the clinical guidelines update from the AmericanGastroenterological Association discouraging opioid prescriptions for chronic abdominal painsecondary to DGBI. This contributes to the perpetual cycle of failure to resolve symptoms,recurrent healthcare visits, ED overcrowding, increased ED wait times, and increased length ofstay for all patients.To address these challenges, the first multicenter prospective observational study of EDpatients with suspected DGBIs was launched at The George Washington University Hospital(DC), Duke University Hospital (NC), and Henry Ford Hospital (MI). Patients eligible for thestudy include those who present to the ED with undifferentiated abdominal pain with a frequencyof at least one painful episode per week for at least 8 weeks, hence meeting Rome criteria for aDGBI. The study queries various biopsychosocial factors, including abdominal paincharacteristics, sleeping habits, anxiety, depression, and social determinants of health. Theoverall aims of the study are to:1. Identify ED patients with undiagnosed DGBIs2. Assess the impact of undiagnosed DGBIs on ED utilization and other economic implications3. Characterize the biopsychosocial features of ED patients with suspected DGBIs to guide thedevelopment of targeted interventions4. Evaluate the role of evidence-based pain management strategies based on thebiopsychosocial approach for treating ED patients with suspected DGBIs.Stay tuned for more information on this topic as the study progresses. Until then, EDsshould consider DGBIs in patients with recurrent abdominal pain, multiple ED visits, andnegative and/or inconclusive diagnostic work-ups.The authors have no conflicts to report.

Bridging the Gaps in DGBI: The Mind Body Approach to Abdominal Pain

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1025&context=smhs_URGENT_Matters

Bridging the Gaps in DGBI: The Mind Body Approach to Abdominal Pain

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