Nuances of the psychogastroenterology patient: A predictive model for gastrointestinal quality of life improvement

Neurogastroenterol Motil. 2019 Sep;31(9):e13663. doi: 10.1111/nmo.13663. Epub 2019 Jun 17.


Background: Gastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brain-gut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. This study aimed to identify features associated with improvements in GI-specific quality of life scores following behavioral health interventions (BHI). The second aim was to create a psychogastroenterology referral care pathway incorporating identified characteristics for greatest benefit from GI-specific behavioral therapy.

Methods: We performed a prospective observational study of 101 (63 women; median age, 45 years) gastroenterology patients referred for psychogastroenterology consultation at a single center. Patients attended an average of seven sessions with a single GI psychologist where evidence-based brain-gut psychotherapies were employed. GI-specific quality of life (IBS-QOL) and psychological distress (BSI-18) were assessed before and after BHI. Patients completed self-reported questionnaires. We performed a multivariable analysis to determine predictors associated with IBS-QOL score improvement.

Key results: A total of 53 (52.5%) patients experienced improvement in IBS-QOL score. Patients with improved IBS-QOL scores had significantly higher baseline BSI general domain T-scores (61.9 vs. 56.9, P = 0.002). Female gender (odds ratio [OR], 3.2), pretreatment BSI somatization T-score ≥63 (OR, 3.7), and a diagnosis of depression (OR, 4.2) were associated with greater odds of IBS-QOL score improvement following BHI.

Conclusions and inferences: We identified factors associated with response to GI-specific BHI to aid in optimizing the utilization of psychogastroenterology services and provide referring providers with information to inform treatment recommendations. Female patients with disorders of gut-brain interaction (DGBIs), high somatization, and depression should be considered a priority for brain-gut psychotherapies.

Keywords: cognitive behavioral therapy; disorders of gut-brain interaction; gut-directed hypnotherapy; inflammatory bowel disease; psychogastroenterology.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cognitive Behavioral Therapy / methods
  • Female
  • Gastrointestinal Diseases / epidemiology
  • Gastrointestinal Diseases / psychology*
  • Gastrointestinal Diseases / therapy*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality of Life / psychology*
  • Self Report
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology*
  • Stress, Psychological / therapy*
  • Young Adult