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The digestive system and the nervous system are two separate aspects of the human body, right? The gut and brain are actually in constant communication, but sometimes their relationship can turn dysfunctional, with confused signals that disrupt the lives of children who have disorders of gut-brain interaction (DGBI).

Dr. Lily Barash, a pediatric gastroenterologist and Assistant Professor of Clinical Pediatrics at AV���, says these disorders occur when communication between the digestive and nervous systems is disrupted.

DGBI is a big category, she says, but “the most common are functional constipation, irritable bowel syndrome (IBS) and functional dyspepsia.” Here, “functional” means a condition in which an organ or system behaves abnormally with no apparent structural injury, damage or infection at the root of the problem.

Dr. Barash witnesses, diagnoses and treats children with one or more DGBI. These disorders are surprisingly prevalent among children and adults alike. About 25 percent of the North American population have at least one DGBI, while up to 7 percent have IBS.

Keep reading to learn more about the causes, symptoms and treatment of a group of disorders that can be challenging to diagnose but often responsive to individualized approaches to treatment.

What causes DGBI?

A combination of genetic, environmental and psychological factors can cause DGBI. Various stressors, prior infection, sleep disturbances and early life events also can predispose a child to developing one or more of these conditions.

What makes the gut uniquely vulnerable to pain and dysfunction?

The gut isn’t exclusively about digestion. It even has its own nervous system, and it’s home to a wealth of muscles, nerves, hormones and enzymes. It even produces 95 percent of the body’s serotonin, a neurotransmitter that regulates mood, sleep, bone health and wound healing, among other key bodily functions. Think of the gut as a second brain.

Symptoms and triggers

The symptoms of DGBI tend to be chronic and recurrent, says Dr. Barash, and they can last for months or years. “It’s possible for a child to outgrow a DGBI, but symptoms may recur during periods of increased stress, travel or infection. The good news is that we can help you know what to do when and if they recur.”

In addition to pain and constipation, symptoms may include:

• migraines
• nausea
• dyspepsia (indigestion)
• bloating
• diarrhea

How do you diagnose DGBI?

Unfortunately, there’s no stool or blood test that can confirm a DGBI diagnosis. It can’t be seen during an endoscopy. So how do specialists like Dr. Barash make a DGBI diagnosis?

“We look at the pattern of a child’s symptoms, take a detailed individual and family history and perform a physical exam. In some cases, we also need to exclude other GI conditions, like celiac disease and IBD (inflammatory bowel disease).

“The treatment of DGBI is highly individualized,” Dr. Barash continues. “But whatever your child’s symptoms, a pediatric GI can help in making the diagnosis, exclude other conditions when necessary, and develop an evidence-based treatment plan that addresses both symptoms and quality of life.”

Pediatric gastroenterologists like Dr. Barash also work with interdisciplinary teams, drawing on the expertise of social workers, psychologists, dietitians, neurologists and other specialists as needed for both diagnosis and treatment.

Her goal is to help families understand their child’s symptoms and cope with the challenges they face. “Unfortunately, these disorders can affect a child’s quality of life. Frequent medical visits and sick days mean missing out on activities with friends and, of course, assignments at school. Fortunately, though, there are many treatment options.”

Medication

Medications tend to be symptom-specific. Dr. Barash may prescribe a laxative for functional constipation, fiber for diarrhea, or an anti-spasmodic or neuromodulator for pain. Although still experimental, there’s a growing body of evidence showing that certain medications for migraine relief may help children with DGBI.

She sometimes recommends certain herbals, including peppermint oil. It all depends on the symptom or pattern of symptoms. What works for one child may have a negligible effect on the next one.

Mental health component

Mental health issues and DGBI often work in tandem and reinforce each other. The disorder itself can be stressful, which leads to general anxiety and a lower quality of life.

In addition, there’s another type of anxiety, called symptom anxiety. Children and adolescents with symptom anxiety can experience more intense pain, poor sleep and an overall worsening of their gut health.

“Let’s say a child develops anxiety around nausea, fearing it will lead to vomiting, which can become a self-fulfilling prophecy.” The pattern has a name: symptom catastrophizing.

Cognitive behavioral therapy (CBT) can interrupt the pathway and stop the escalation of symptoms.

“Even without a mental health diagnosis,” she says, “CBT can be effective in helping patients change the way their thoughts exacerbate their symptoms.”

Dr. Barash has also used another type of therapy with her young patients: gut-directed hypnotherapy (GDH). It’s an approach that relies on hypnosis and the deep relaxation it fosters to achieve symptom-free digestion and elimination. Clinicians who use this type of therapy with their DGBI patients report overwhelmingly positive results.

A couple of other treatment options

Acupuncture, an alternative treatment from the perspective of western medicine, has limited evidence in children with DGBI but positive results on an individual level.

Some children may benefit from percutaneous nerve stimulation in the form of a device worn on the ear that targets abdominal pain and the pathways that drive it.

When it comes to treatment, she says, trust your gut! If exam week is coming and your stress levels and symptoms increase, remember what your body responded to earlier and pursue these treatments again.

“DGBI symptoms won’t disappear overnight, but with treatment, your quality of life will improve, and that, in turn, can improve your symptoms. Over time, your pain will go down from 10 to 5 and then down to 3. That’s something to celebrate!”

Can DGBI lead to disordered eating?

In a misguided but understandable attempt to control the food they consume, children and teens with DGBI may decide to limit or even eliminate certain foods they believe are triggers. It’s called restrictive eating, and Dr. Barash never recommends adopting that approach, as it could result in excessive weight loss and even lead to an eating disorder. Instead, she and the dietitians she works with advise patients and families to emphasize a varied, healthy diet based on whole foods.

Is a visit to the Emergency Room ever warranted?

If your child has severe pain, difficulty swallowing, repeated vomiting or blood in their stool, a visit to the ER is definitely called for.

Precision medicine: A glimpse into the future

Dr. Barash looks forward to a future in which DGBI are far better characterized and understood; a future shaped by precision medicine, in which medical treatment is tailored to an individual’s unique genes, risk factors, habits and influences.

Here’s an example of what that could mean. The microbiome is known to play a role in DGBI, as well as in other digestive diseases, and it’s being studied intensely. The microbiome is the totality of the microbes—viruses, bacteria and fungi, among other tiny organisms—that inhabit your gut. These vary from individual to individual.

“Some studies have confirmed the value of certain probiotics, such as lactobacillus rhamnosus GG. The research is still limited, but we’re looking toward a future when an individual’s microbiome can be analyzed and understood, and the appropriate treatment, including pre- and probiotics, can be tailored accordingly.”

That’s a future we’d all welcome!

Key takeaways

• Disorders of gut-brain interaction (DGBI) occur when communication between the digestive and nervous systems is disrupted.
• The most common DGBI are functional constipation, irritable bowel syndrome functional abdominal pain and functional dyspepsia
• A child can outgrow a DGBI, but symptoms may recur, caused by stress, travel or infection.
• To diagnose DGBI, a pediatric gastroenterologist studies the pattern of a child’s symptoms.
• Treatment of DGBI is highly individualized
• DGBI can affect a child’s quality of life, but there are many treatment options, including medication, cognitive behavioral therapy and gut-directed hypnotherapy, as well as acupuncture and other alternative treatments.
• Restricted eating is not recommended, as it could lead to an eating disorder.
• The individual child’s microbiome is believed to play an important role in DGBI, but that relationship remains to be clarified, with the help of precision medicine— the medicine of the future.

Make an appointment with a pediatric gastroenterologist here.