A survey of gastroenterologists in the United States on the use of central neuromodulators for treating irritable bowel syndrome

Abstract

Summary Background Central neuromodulators are an effective treatment for irritable bowel syndrome (IBS) but may be used less frequently than other therapies. Aims To survey gastroenterologists in the United States (US) about their use of neuromodulators in patients with IBS. Methods A 23‐question survey was distributed to gastroenterologists in the United States. Comparisons in prescribing practices were conducted between (a) gastroenterologists who were “high prescribers” versus “low prescribers” of neuromodulators in patients with IBS and (b) gastroenterologists and “gastroenterology experts” in the use of neuromodulators using descriptive statistics and multivariable logistic regression analyses. Results The 525 gastroenterologists who were surveyed used neuromodulators for a median range of 21%‐30% of their patients with IBS. Neuromodulators were described as extremely/very important in managing IBS by 55% of clinicians. Significant predictors of high‐prescribing behaviour were academic versus clinical practice setting (odds ratio [OR] 2.60 [95% CI 1.61‐4.20]), disorders of brain‐gut interaction focused practice (OR 4.80 [2.60‐8.84]), and greater perceived effectiveness of neuromodulators (OR 2.75 [1.30‐5.84]). Compared to gastroenterologists, experts prescribed neuromodulators to a higher percentage of their patients with IBS (41%‐50% vs 21%‐30%; P = 0.019) and more frequently found neuromodulators effective (70% vs 27%; P = 0.003). However, concern about side effects was the most common barrier to neuromodulator use (59%). Conclusions The majority of US gastroenterologists believe central neuromodulators are important in treating IBS, and 27% believe they are effective in most patients. High prescribers are in academic practice, focus in IBS and perceive central neuromodulators as effective. Education is needed to improve gastroenterologists' prescribing behaviour.

Gastroenterology Trainees’ Attitudes and Knowledge towards Patients with Disorders of Gut‐Brain Interaction

“…Perceived and internalized stigma can adversely affect patient outcomes 6,7 . A recent survey found that 28% of practicing gastroenterologists cited a lack of competence as a barrier to prescribing neuromodulators with another study finding than less than a quarter of gastroenterologists wrote more than 10 neuromodulator prescriptions to patients annually, despite ample evidence supporting their efficacy across a variety of DGBI conditions 8,9 …”

“…6,7 A recent survey found that 28% of practicing gastroenterologists cited a lack of competence as a barrier to prescribing neuromodulators with another study finding than less than a quarter of gastroenterologists wrote more than 10 neuromodulator prescriptions to patients annually, despite ample evidence supporting their efficacy across a variety of DGBI conditions. 8,9 Gastroenterology fellowship is the formative period to develop competence as measured by knowledge milestones and to learn how to cultivate a therapeutic patient-physician relationship prior to entering independent practice. Both components are essential in improving satisfaction and health outcomes in patients with DGBI.…”

Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial

“…Neuromodulators could attenuate visceral nociception and exert profound effects on peripheral nervous system (e.g., GI tract), and has been proven to be effective in the treatment of rFD ( 6 ). However, concerns about side effects and ADS were the most common barriers to neuromodulator use ( 10 , 13 ). Gastroenterologists are concerned about ADS and side effects of LC therapy and the insufficiency of efficacy of SC therapy in rFD.…”

“…With the increasing use of neuromodulators in DGBI, side effects associated with neuromodulators have emerged, which are reported to be the most common barriers to neuromodulator use ( 10 ). Besides, currently used neuromodulators are mainly slow-acting agents requiring at least 6–8 weeks for their actions, which might lead to stigma attributed to antidepressant and treatment non-adherence ( 11 ).…”

Neuromodulators in the Brain-Gut Axis: their Role in the Therapy of the Irritable Bowel Syndrome

“…The interest in the therapy with neuromodulators in IBS is reflected by the emergence of a new subspeciality called psychogastroenterology [26,27]. It is also reflected in the prescription practice of gastroenterologists [28]. Therefore, the aim of this review is to present an update on the use of neuromodulators in IBS.…”