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Interviewer: Lauri R. Graham; Interviewee: Laurie Keefer, PhD August 14, 2017
Medscape spoke with Laurie Keefer, PhD, associate professor in the departments of medicine and gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City, about the brain-gut connection and its influence on digestive health. We discussed how the use of hypnotherapy can be an effective alternative treatment for patients, one that is backed by scientific evidence and is now being offered at medical centers and via telemedicine throughout the United States. A leader in the development of effective behavioral therapies for gastrointestinal disorders, Dr Keefer's extensive research focuses primarily on gastroesophageal reflux disease (GERD) and other esophageal disorders, irritable bowel syndrome, and inflammatory bowel disease, including Crohn disease and ulcerative colitis.
A Bidirectional Pathway
Medscape: What do we know about how the mind-gut connection influences our health?
Dr Keefer: The pathway between the mind (or the brain) and the gut is bidirectional. A lot of times people forget that. There are a lot of processes that happen symptomatically in the gut that go up to the brain, and vice versa. I think GERD is one of those, where shifts in acid exposure may be perceived by the brain, and so the gut is essentially telling the brain that something is going wrong. When treating patients with brain-gut therapies, I think it helps them to know that while we're working on the brain, we're also taking into account input from the gut.
When treating patients with brain-gut therapies, I think it helps them to know that while we're working on the brain, we're also taking into account input from the gut.
Medscape: Much of the research around hypnotherapy for digestive health has focused on irritable bowel syndrome (IBS). For what other gastrointestinal (GI) conditions has hypnotherapy been shown to be effective?
Dr Keefer: The research is very robust in IBS but then drops off after that. IBS happened to be the test case, partly because it is so common and refractory. For many of us, though, we believe that if hypnosis has been validated and shown to be effective in IBS and we're targeting the same processes, then it should work for other GI conditions. IBS is brain-gut dysregulation. GERD is brain-gut dysregulation. Inflammatory bowel disease (IBD) has an element of brain-gut dysregulation. While we categorize diseases and say that hypnosis hasn't been tested in this disease or that disease, we do know that symptoms of brain-gut dysregulation are improved with hypnosis.
Medscape: In regard to IBD, has any of the research borne out whether hypnotherapy is more effective for ulcerative colitis versus Crohn disease?
Dr Keefer: I believe that there have been only two studies,[1,2] and both are in ulcerative colitis because it is much easier to demonstrate the brain-gut process in ulcerative colitis. Clinically I do not necessarily differentiate, though. I see a lot of patients with Crohn disease who are in remission but have ongoing abdominal pain and bloating or overlap with IBS, and so it brings us back to hypnotherapy.1234
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