Using Central Neuromodulators and Psychological Therapies to Manage Patients with Disorders of Gut-Brain Interaction: A Clinical Guide

191 Pages·2019·1.647 MB·English

by  W. Harley Sobin

Using Central
Neuromodulators
and Psychological
Therapies to Manage
Patients with Disorders
of Gut-Brain Interaction
A Clinical Guide
W. Harley Sobin
Editor
123
Using Central
Neuromodulators
and Psychological Therapies
to Manage Patients with
Disorders of Gut-Brain
Interaction
W. Harley Sobin
Editor
Using Central
Neuromodulators
and Psychological
Therapies to
Manage Patients
with Disorders of
Gut-Brain Interaction
A Clinical Guide
Editor
W. Harley Sobin
Pleasant Prairie, WI
USA
ISBN 978-3-030-18217-5 ISBN 978-3-030-18218-2 (eBook)
https://doi.org/10.1007/978-3-030-18218-2
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Foreword
Disorders of Gut-Brain Interaction: A Coming
of Age for the Clinician
Perhaps, one of the great advances over the last decade within
gastroenterology has been the biopsychosocial realignment
in our understanding of what has typically been called func-
tional GI disorders (FGIDs) to the more scientifically based
disorders of gut-brain interaction (DGBI). As FGIDs, clini-
cians and scientists gave them no credit; they were under-
stood as the absence of organic disease or possibly due to
“psychiatric” difficulties. Then, as the field of neurogastroen-
terology emerged and has begun to thrive, early adapters
began to study these disorders because they were now seen
as not only legitimate but interesting and relevant. This has
led to the rapid growth of the study of gut-brain interactions,
neurophysiology of GI function, brain imaging, and central
treatments. Because DGBIs relate to dysregulation of the
gut-brain axis, the treatments that work are the central neu-
romodulators and behavioral methods that help to reestab-
lish normality within this system and patients benefit.
Furthermore, the aficionados who use these treatments also
learn that by employing these treatments for a sufficient
amount of time, the vicious cycle of pain and GI dysfunction
may actually dissipate, via gut-brain neurogenesis.
I am one of a small number of academicians and clinicians
who have made a career of promoting this new knowledge.
Yet to date, I almost feel that this understanding is one of the
best-kept secrets in our field. I say that because the areas of
v
vi Foreword
biopsychosocial care, neurogastroenterology, psychopharma-
cology, and gut-brain interactions are applied by only a select
few academicians who do the research but have limited prac-
tices. Presently, this new knowledge may seem to clinicians in
practice as not relevant, “over their head,” or belonging to the
realm of behaviorists. So how can we disseminate this knowl-
edge to clinicians in order to benefit our patients?
I met Dr. Harley Sobin less than 3 years ago and was
struck by his passion for this area of work as a clinical gastro-
enterologist. He empirically learned that acquiring the latest
understanding of these disorders, properly communicating
this knowledge to his patients, and prescribing the correct
treatments really work. Dr. Sobin is an early adapter who
uses this knowledge successfully in his practice, and this has
positively reinforced his desire to teach others.
The product of his desire to teach others is demonstrated
in this, much needed, book. I believe its greatest value
relates to Dr. Sobin’s ability to reach clinicians through his
personal experience as a gastroenterologist: one who applies
the science he has learned into everyday practice. The book
is practically organized to meet the needs of the clinician. It
begins with a chapter on the meaning of gut-brain interac-
tions, offers a practical guide to how to use central neuro-
modulators based on the dominant symptom features
confronting the clinician, and includes the practical applica-
tion of behavioral interactions including how to refer and
why. There are also helpful guidelines about how to approach
this topic to patients and much more. The book is written in
a no-nonsense manner with case examples, practical knowl-
edge from his own experience, and when needed relevant
attributions of knowledge from others linked to the proper
citations.
I highly recommend this book to clinicians seeking to go
beyond gut-related treatments to care for patients with disorders
Foreword vii
of gut-brain interaction, with chronic GI pain, or with psychiatric
comorbidities. Applying this knowledge will help practitioners
and their patients.
Douglas A. Drossman, MD
President, Rome Foundation, Professor Emeritus of
Medicine and Psychiatry, UNC Center for Functional GI
and Motility Disorders, Center for the Education and
Practice of Biopsychosocial Care and Drossman
Gastroenterology
Chapel Hill, NC, USA
Preface
This text is designed to discuss central therapies for managing
patients with disorders of gut-brain interaction (DGBI)
which replaces the older terminology – functional gastroin-
testinal disorders (FGIDs). It investigates the use of central
neuromodulators and psychological therapies for treating
these patients.
While there are many books that address the treatment of
DGBI, particularly IBS, most of them concern themselves with
treatments that focus specifically on gut-directed therapy.
However, the more challenging patients with recalcitrant
DGBI will benefit from central therapies. That is the focus of
this text. There are chapters, written by a gastroenterologist,
on how central neuromodulators can help disordered gut
function. There are specifics on choices of drugs for different
disorders, along with dosages, and recommendations on their
use. There are chapters, written by psychologists, that outline
the use of cognitive behavioral therapy and exposure therapy
in treating some of these patients. There is also a chapter,
written by psychiatrists, that presents a tutorial on how inter-
nal medicine physicians should approach the use of psychiat-
ric medications.
We feel that there is a niche that needs to be served. There
are a limited number of texts that address the use of central
therapies in treating the more challenging patients with
DGBI.
Hopefully, this text will be seen as a significant adjunct in
managing these patients.
Pleasant Prairie, WI, USA W. Harley Sobin
ix
Contents
1 The Gut-Brain Connection and Its Significance
to Gastroenterologists .......................... 1
W. Harley Sobin
2 How to Use Central Neuromodulators (CNs)
to Help Manage Patients with Disorders of
Gut- Brain Interaction (DGBI) ................. 15
W. Harley Sobin
3 A Psychopharmacology Guide by Psychiatrists
for Non-psychiatrists .......................... 41
Thomas W. Heinrich, Julie Ruth Owen,
and Deepa S. Pawar
4 Discussion on the Use of Psychiatric Medications:
Questions by W. Harley Sobin MD Answers by
Thomas W. Heinrich MD ...................... 89
Thomas W. Heinrich
5 Cognitive-Behavioral Therapy for Irritable Bowel
Syndrome ................................... 95
Melissa G. Hunt
6 Exposure Therapy for Functional GI Disorders ... 143
Karen Lynn Cassiday
7 A Personalized Approach to the Patient Requiring
Central Therapies ............................ 175
W. Harley Sobin
Index .......................................... 181
xi
Contributors
Karen  Lynn  Cassiday The Anxiety Treatment Center of
Greater Chicago, Deerfield, IL, USA
Thomas  W.  Heinrich Medical College of Wisconsin,
Department of Psychiatry and Behavioral Medicine,
Department of Family and Community Medicine, Milwaukee,
WI, USA
Melissa G. Hunt University of Pennsylvania, Department of
Psychology, Philadelphia, PA, USA
Julie Ruth Owen Medical College of Wisconsin, Department
of Psychiatry and Behavioral Medicine, Milwaukee, WI, USA
Deepa S. Pawar Medical College of Wisconsin, Department
of Psychiatry and Behavioral Medicine, Milwaukee, WI, USA
W. Harley Sobin Pleasant Prairie, WI, USA
xiii