A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction

Author: Laurie Keefer1, Sarah K Ballou2, Douglas A Drossman3, Gisela Ringstrom4, Sigrid Elsenbruch5, Brjánn Ljótsson6
1 Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: laurie.keefer@mssm.edu.
2 Beth Israel Deaconess Medical Center, Boston, Massachusetts.
3 Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
4 Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
5 Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany; Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
6 Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Conference/Journal: Gastroenterology
Date published: 2022 Jan
Other: Volume ID: 162 , Issue ID: 1 , Pages: 300-315 , Special Notes: doi: 10.1053/j.gastro.2021.09.015. , Word Count: 251

Background and aims:
This Rome Foundation Working Team Report reflects the consensus of an international interdisciplinary team of experts regarding the use of behavioral interventions, specifically brain-gut behavior therapies (BGBTs), in patients with disorders of gut-brain interaction (DGBIs).

The committee members reviewed the extant scientific literature and, when possible, addressed gaps in this literature through the lens of their clinical and scientific expertise. The Delphi method was used to create consensus on the goals, structure, and framework before writing the report. The report is broken into 5 parts: 1) definition and evidence for BGBT, 2) the gut-brain axis as the mechanistic basis for BGBT, 3) targets of BGBTs, 4) common and unique therapeutic techniques seen in BGBT, and 5) who and how to refer for BGBT.

We chose to not only review for the reader the 5 existing classes of BGBT and their evidence, but to connect DGBI-specific behavioral targets and techniques as they relate directly, or in some cases indirectly, to the gut-brain axis. In doing so, we expect to increase gastrointestinal providers' confidence in identifying and referring appropriate candidates for BGBT and to support clinical decision making for mental health professionals providing BGBT.

Both gastrointestinal medical providers and behavioral health providers have an opportunity to optimize care for DGBIs through a collaborative integrated approach that begins with an effective patient-provider relationship, thoughtful communication about the brain-gut axis and, when appropriate, a well communicated referral to BGBT.

Keywords: Gut-brain axis; behavioral interventions; cognitive behavior therapy; gut-directed hypnotherapy; irritable bowel syndrome.

PMID: 34529986 DOI: 10.1053/j.gastro.2021.09.015