Ethics & Leadership in Health Care

Functional Gastrointestinal Diseases (FGID) are a family disorders that are characterized by gastrointestinal symptoms in the absence of readily identifiable organic pathology. Examples of FGID include irritable bowel syndrome (IBS), functional dyspepsia, abdominal migraine, functional abdominal pain, and functional abdominal pain syndrome. These disorders are classically thought to stem from dysfunction of the enteric nervous system. However, there is a growing recognition that multiple factors play a role in the genesis of FGIDs. This idea is encapsulated by the “biopsychosocial” model of disease, and is supported by a body of literature which has identified higher rates of FGID in patients with anxiety, depression, post-traumatic stress disorder, agoraphobia, and other pychosocial dysfunction.

Recurrent Abdominal Pain (RAP) and IBS are major causes of pediatric morbidity. Over a third of children and adolescents report recurrent abdominal pain, and the overall prevalence of non-organic abdominal pain has been noted to be over 75% (Hyams, Treem, Justinich, Davis, Shoup, & Burke, 1995; Schwille, Giel, Ellert, Zipfel, & Enck, 2009). A large subset of these children report symptoms that are consistent with irritable bowel syndrome. Management of these children is complex and includes medical, dietary, and behavioral interventions. Medical therapy often revolves around the use of antispasmodics, probiotics, and antidepressants. The data supporting their use, however, has been mixed.

Over the last twenty years behavioral therapies such as cognitive behavioral therapy (CBT) and hypnotherapy (HT) have come to light as major treatment modalities for functional gastrointestinal disease. In a large multicenter randomized controlled trial, Levy et al. (2010) compared 3-session CBT to a control intervention and noted significant improvements in pain and functioning in children. Similar results have been published in multiple smaller trials (Duarte, Penna, Andrade, Cancela, Neto, & Barbosa, 2006; Gros, Antony, McCabe, & Lydiard, 2011; Mahvi-Shirazi, Fathi-Ashtiani, Rasoolzade-Tabatabaei, & Amini, 2012; Robins, Smith, Glutting, & Bishop, 2005; Youssef et al., 2004). Likewise, Vlieger and colleagues (2007) compared hypnotherapy to standard medical therapy in 53 children with irritable bowel syndrome. They found that, while both interventions resulted in improved pain scores, the hypnotherapy group demonstrated lasting clinical improvement at 1 year follow-up. Five year follow-up data has recently been published and revealed that significantly more of the hypnotherapy group remained in remission without any further intervention (Vlieger, Rutten, Govers, Frankenhuis, & Benninga, 2012). A growing body of literature is available validating the use of hypnotherapy in irritable bowel syndrome in adults, and pain syndromes more generally (Calvert, Houghton, Cooper, Morris, & Whorwell, 2002; Rutten, Reitsma, Vlieger, & Benninga, 2012; Lindfors et al., 2012; Whorwell, Prior, & Faragher, 1984).

CBT and HT can be viewed as complementary to one another. CBT involves a very deliberate conscious understanding of one’s disease process and triggers and focuses on successful pain mitigation measures. HT recruits the imagination with utilization of therapeutic imagery to down regulate inappropriate pain responses. Our center has developed a collaborative approach, utilizing both CBT and HT for the treatment of refractory IBS. To our knowledge no work has been done assessing the efficacy of such a collaborative approach using both CBT and HT in children with functional gastrointestinal disease.

Finally, telehealth is a growing field aimed at reducing barriers to effective treatments. Telehealth allows specialty treatments to reach patients who are in need (Sato, Clifford, Silverman, & Davies, 2009). Telehealth is defined as the utilization of technology that allows providers and patients the opportunity to interact with one another from a distance (McGeary, McGeary, & Gatchel, 2012). Even though CBT via videoconferencing is an acceptable alternative to face-to-face CBT, the authors are unaware of any study that has compared the two different modes of treatment in addressing FGIDs in youth (Sato et al., 2009). Further, while previous research suggests that hypnosis can be effectively delivered via telehealth in adults (Appel, Bleiberg, & Noiseux, 2002; Simpson et al., 2002), this has yet to be examined for youth.

No specific qualifications. Must send resume to drheckler@seton.org and participate in an interview. Must be organized and dependable.

Ongoing, beginning in the fall of 2016

data and project management within a multidisciplinary pediatric GI clinic. The clinic day is Thursday, so must be available on this day.