“Physicians are not aware of many of the newer methods for managing the FGIDs and feel poorly trained in the use of these medications, ” Dr. Drossman explained. “The Rome Foundation is looking to increase this understanding and we are beginning to see a major change in the acceptance and value of these treatments.”

Dr. Drossman offers insight below on the new research published online in Gastroenterology, Neuromodulators for Functional GI Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report.

1. What’s new and/or what are the research highlights?

Drossman: This is the first and most comprehensive review of the use of central neuromodulators for painful functional gastrointestinal disorders (FGIDs) like irritable bowel syndrome (IBS), centrally mediated abdominal pain and other painful symptoms.  It is the culmination of an 18-month project (a Rome Working Team) where we did an evidenced-based review of the literature and consensus of experts to come up with recommendations.  One key point is that we are changing the use of antiquated terminology of “antidepressants” and “antipsychotics” which were developed originally to treat psychiatric disorders, and replacing with the term neuromodulators.  The new term reflects better our understanding that these are disorders of gut-brain interaction (Rome IV).

In that context, we are treating a dysfunctional brain-gut axis with these medications, often in doses lower than for treating major psychiatric disorders.  Some of the major findings are that tricyclic antidepressants (TCAs) and SNRIs do work for pain.  However, if a single medication does not work or has side effects, we employ the concept of augmentation (combining two or more treatments) to help those that don’t initially respond.  Also, patients are kept on them for a year or more for relapse prevention.  It is a way to provide ample time to reverse the dysfunctional circuitry causing the FGID problem in the first place, and it may reverse the neurodegeneration that occurs over time. Finally, if there are frequent side effects or a failure to respond we recommend doing pharmacogenomic testing, a new method to evaluate how patients genetically metabolize these medications.  Also, it’s important to realize that the ways in which we employ these treatments for FGIDs is different from how psychiatrists treat psychiatric disorders.  In fact, psychiatrists are not well versed in these methods.