Functional abdominal pain (centrally mediated abdominal pain syndrome) by Dr. Brian Lacy at @AmCollegeGastro #ACG2021
#GITwitter #GI #FGID #DGBI
#GITwitter #GI #FGID #DGBI
A common scenario!
Definitions
Associated with anxiety/depression and somatization syndromes
Pathophysiology: genetic predisposition ➕ insult to the gut (e.g., infection) ▶️ visceral hypersensitivity
Can't change predisposing factors, but can work on precipitating and perpetuating factors
Can't change predisposing factors, but can work on precipitating and perpetuating factors
Bidirectional gut-brain and brain-gut contributions to pain
📜HISTORY is 🔑
⚠️Don't forget to check Carnett's sign for abdominal wall pain!
⚠️Don't forget to check Carnett's sign for abdominal wall pain!
🔑 points
🔹assess psychological status
🔹ask about trauma
🔹assess psychological status
🔹ask about trauma
Differential diagnosis of CAPS
Physical examination
CAPS treatment: first and foremost, educate and reassure
Pharmacologic: neuromodulators (do NOT use opioids!)
Psychologic: CBT, hypnotherapy
Pharmacologic: neuromodulators (do NOT use opioids!)
Psychologic: CBT, hypnotherapy
Neuromodulators in CAPS
Since multiple pathways are likely involved in the pathophysiology of CAPS, drugs with multiple targets may be more effective
TCAs should be first line for CAPS
SNRIs can also be effective
SSRIs don't work directly on pain pathways, so while may help anxiety/depression, would not help much with pain in CAPS
Certain atypical antidepressants can also be helpful in CAPS
May need multiple agents in CAPS
CAPS summary from Dr. Lacy
• • •
Missing some Tweet in this thread? You can try to
force a refresh
