J Neurogastroenterol Motil 2024; 30(4): 385-386  https://doi.org/10.5056/jnm24125
Clinicians’ Knowledge, Attitudes, and Practices Towards Neuromodulators and Psychological Treatment in Functional Gastrointestinal Disorders - Do They Know?
Yonghoon Choi
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
Correspondence to: *Yonghoon Choi, MD
Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Korea
Tel: +82-31-787-7088, E-mail: 89796@snubh.org

Article: Clinicians’ knowledge, attitudes, and practices regarding the management of functional gastrointestinal disorders with neuromodulators and psychological treatment
Shin SY, Lee JY, Jung SW, et al
(J Neurogastroenterol Motil 2024;30:480-490)
Received: August 23, 2024; Accepted: September 10, 2024; Published online: October 30, 2024
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Body

Dysfunction of the brain–gut axis is considered to be the core of the complex biological mechanisms of functional gastrointestinal disorders (FGIDs), that is characterized by any combination of motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered CNS processing.1 Recent evidences revealed that the CNS can communicate with the gut through neuronal pathways, immune system signaling, and chemical signaling based via neurotransmitters and associated metabolites.1

This concept also presented a new alternative to the treatment of FGIDs, that the role of the medications acting within the brain–gut axis system has begun to be emphasized. The Rome Foundation recently have proposed a relabel of these drugs as “gut-brain neuromodulators,” to improve understanding of their pharmacologic value, reduce stigma, and improve treatment adherence.1,2 Considering the effectiveness and importance of these drugs in treating FGIDs, most recent guidelines also recommend the use of neuromodulators including tricyclic antidepressants or serotonergic agents.3-5 In addition, psychotherapies and referral to psychiatry are recommended in cases of refractory cases with severe, long-lasting symptoms, or ineffective in standard medical treatment in the latest guidelines.3-6

However, it is difficult to apply these treatments in practice since gastroenterologists are not usually familiar with them. Further, the clinical application of these agents is driven more by empiric evidence, and there is lack of well-designed investigations targeted to these particular disorders.1,7,8 Adding this, it is difficult to apply the results of overseas research as it is since there are differences in guidelines for FGIDs among countries, and the extent to which these treatments are actually being applied in clinical practice in Korea remains unclear.

In this issue of the Journal of Neurogastroenterology and Motility, a prospective, cross-sectional study was reported.9 This study covers a wide range of clinicians from primary care to tertiary hospitals, and is an interesting one to find out the views and positions of neuromodulators of physicians treating FGIDs in the real clinical field. Surprisingly, a large discrepancy was discovered, that although most of the respondents answered positively to the need for neuromodulators and psychiatric treatment, about one-third of them did not prescribe neuromodulators with unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. In addition, the difference among respondents according to the type of medical institution affiliated was remarkable, that primary care clinicians prescribed neuromodulators less frequently than gastroenterologists at tertiary hospitals, and the rate of referral to psychiatry by primary care clinicians was also lower than that of gastroenterologists at tertiary hospitals.

This result emphasizes the existing difference in the knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians, and showed that knowledge and intimacy with these treatments directly affect actual prescription and treatment practices. Furthermore, the observed differences according to the type of medical institution affiliated suggested the need for education on proper use of neuromodulators and supplementation of national guidelines to fill the gap.

This study collected more than 400 responses from all over the country, and confirmed that there still is a gap between the knowledge of neuromodulators and psychiatric treatments and the actual practice, although it has limitations as an online-based survey study, that certain demographic groups such as those who are interested in FGIDs may have been overrepresented, and it was difficult to confirm whether the respondent fully understood the intention of the questionnaire. The authors concluded that unfamiliarity with these treatment modalities and lack of knowledge led to a passive attitude towards them and the limitation of their use. These results will must be considered in order to move forward to appropriate treatment of FGIDs in Korea in the future, and studies on the perception of neuromodulators should be conducted in other countries.

Financial support

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Conflicts of interest

None.

References
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