D0215 - The Clinical Value of Complementary Approaches in Foregut Disorders of Gut-Brain Interaction

Malika Gill, MD¹, Edward F. Hurtte, MD², Benjamin Rogers, MD¹, C. Prakash Gyawali, MD, MRCP^1
1Washington University in St. Louis, St. Louis, MO; ²Washington University in St. Louis School of Medicine/ Barnes Jewish Hospital, St. Louis, MO

Introduction: Complementary therapy is often utilized as an adjunct to pharmaco-therapeutics and cognitive/behavioral therapy (CBT) in symptomatic disorders of gut-brain interaction (DGBI), but specific value of each approach remains unclear. We evaluated the clinical value of complementary approaches in foregut DGBI that persisted despite standard management.

Methods: Study subjects were identified from a cohort of patients with established DGBI managed at a tertiary clinic. Use of complementary therapy (ginger, peppermint oil, turmeric, acupuncture, dietary modifications, exercise, and probiotics) was identified from review of electronic medical records. Concurrent neuromodulator therapy and/or CBT was not an exclusion. Symptom frequency and severity was quantified using a 100 mm visual analog scale (VAS) and averaged, while health related quality of life was evaluated using the BEST questionnaire; both were administered at initial presentation and upon follow up. Data were analyzed to determine 30% improvement in symptom burden collectively and within each symptomatic cohort.

Results: Over a 26-month period, 163 DGBI patients (median age 59.0 years, 66.9% F, BMI 26.1 kg/m²) were included, and 68 (41.7%) had foregut symptoms (heartburn, regurgitation, chest pain, bloating, belching, cough, nausea). Neuromodulators (151, 92.6%) and CBT 35 (21.5%) were standard therapy. Among complementary therapy, peppermint oil was utilized most often (41, 25.2%), followed by dietary modifications (35, 21.5%), probiotics (30, 18.4%) and exercise (25, 15.3%). BEST scores improved in 60 (36.8%), and VAS in 57 (35.0%). Overall symptom change was similar with and without complementary approaches; CBT provided an overall trend toward improvement (p=0.06). Within foregut symptom groups, overall symptoms on VAS trended toward improvement with exercise (75.0% vs. 38.6%, p=0.067). BEST score improved with ginger extract in patients with nausea (100% vs. 42.7%, p=0.037), and with peppermint oil in patients with esophageal symptoms (heartburn, regurgitation, chest pain, belching) (100.0% v. 18.2%, p=0.027). VAS improved more often with anxiety (53.2%) and depression (50.0%) compared to multiple (20.9%) or no (31.6%) psychiatric comorbidities (p=0.009). BEST score improvement was higher in patients with anxiety (54.8%) and depression (50.0%) compared to multiple psychiatric abnormalities (26.3%, p=0.057).

Discussion: In foregut DGBI, complementary therapeutic approaches are most beneficial when tailored to presenting symptoms.



Disclosures:


Malika Gill, MD¹, Edward F. Hurtte, MD², Benjamin Rogers, MD¹, C. Prakash Gyawali, MD, MRCP¹. D0215 - The Clinical Value of Complementary Approaches in Foregut Disorders of Gut-Brain Interaction, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.