Advertisement

Applied Psychophysiology and Biofeedback

, Volume 39, Issue 3–4, pp 287–291 | Cite as

HRV Biofeedback for Pediatric Irritable Bowel Syndrome and Functional Abdominal Pain: A Clinical Replication Series

  • Mark J. Stern
  • Robert A. F. Guiles
  • Richard Gevirtz
Article

Abstract

Irritable bowel syndrome (IBS) and Functional Abdominal Pain (FAP) are among the most commonly reported Functional Gastrointestinal Disorders. Both have been associated with varying autonomic dysregulation. Heart Rate Variability Biofeedback (HRVB) has recently begun to show efficacy in the treatment of both IBS and FAP. The purpose of this multiple clinical replication series was to analyze the clinical outcomes of utilizing HRVB in a clinical setting. Archival data of twenty-seven consecutive pediatric outpatients diagnosed with IBS or FAP who received HRVB were analyzed. Clinical outcomes were self-report and categorized as full or remission with patient satisfaction, or no improvement. Qualitative reports of patient experiences were also noted. Full remission was achieved by 69.2 % and partial remission was achieved by 30.8 % of IBS patients. Full remission was achieved by 63.6 % and partial remission was achieved by 36.4 % of FAP patients. No patients in either group did not improve to a level of patient satisfaction or >50 %. Patient’s commonly reported feeling validated in their discomfort as a result of psychophysiological education. Results suggest that HRVB is a promising intervention for pediatric outpatients with IBS or FAP. Randomized controlled trials are necessary to accurately determine clinical efficacy of HRVB in the treatment of IBS and FAP.

Keywords

Clinical replication series Heart rate variability Biofeedback Irritable bowel syndrome Functional abdominal pain 

References

  1. Adeyemi, E., Desai, K., Towsey, M., & Ghista, D. (1999). Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies. The American Journal of Gastroenterology, 94(3), 816–823.PubMedCrossRefGoogle Scholar
  2. Aggarwal, A., Cutts, T., Abell, T., Cardoso, S., Familoni, B., Bremer, J., et al. (1994). Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology, 106(4), 945–950.PubMedGoogle Scholar
  3. Akehurst, R. L., Brazier, J. E., Mathers, N. N., O’Keefe, C. C., Kaltenthaler, E. E., & Morgan, A. A. (2002). Health-related quality of life and cost impact of irritable bowel syndrome in a UK primary care setting. Pharmacoeconomics, 20(7), 455–462.PubMedCrossRefGoogle Scholar
  4. Barlow, D. H., Hayes, S. C., & Nelson, R. O. (1984). The scientist practitioner: Research and accountability in clinical and education settings. Elmsford: Pergamon Press.Google Scholar
  5. Brandt, L., Chey, W., Foxx-Orenstein, A., Schiller, L., Schoenfeld, P., & Spiegel, B. (2009). An evidence-based position statement on the management of irritable bowel syndrome. The American Journal of Gastroenterology, 104(Suppl 1), S1–S35. doi: 10.1038/ajg.2008.122.PubMedGoogle Scholar
  6. Chelimsky, G., Boyle, J., Tusing, L., & Chelimsky, T. (2001). Autonomic abnormalities in children with functional abdominal pain: Coincidence or etiology? Journal of Pediatric Gastroenterology and Nutrition, 33(1), 47–53.PubMedCrossRefGoogle Scholar
  7. Dobbin, A., Dobbin, J., Ross, S., Graham, C., & Ford, M. (2013). Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients with refractory irritable bowel syndrome. The Journal of the Royal College of Physicians of Edinburgh, 43(1), 15–23. doi: 10.4997/JRCPE.2013.104.PubMedCrossRefGoogle Scholar
  8. Drossman, D. (2006). The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 130(5), 1377–1390.PubMedCrossRefGoogle Scholar
  9. Drossman, D. A., Li, Z., Andruzzi, E., Temple, R. D., Talley, N. J., & Thompson, W. (1993). U.S. householder survey of functional gastrointestinal disorders. Digestive Diseases and Sciences, 38(9), 1569–1580.PubMedCrossRefGoogle Scholar
  10. Gevirtz, R. (2000). Resonant frequency training to restore autonomic homeostasis for treatment of psycho physiologic disorders. Biofeedback, 27(1), 7–9.Google Scholar
  11. Goyal, R., & Hirano, I. (1996). The enteric nervous system. The New England Journal of Medicine, 334(17), 1106–1115.PubMedCrossRefGoogle Scholar
  12. Grover, M., & Drossman, D. (2010). Functional abdominal pain. Current gastroenterology reports, 12(5), 391–398. doi: 10.1007/s11894-010-0125-0.PubMedCrossRefGoogle Scholar
  13. Heitkemper, M., Burr, R., Jarrett, M., Hertig, V., Lustyk, M., & Bond, E. (1998). Evidence for autonomic nervous system imbalance in women with irritable bowel syndrome. Digestive Diseases and Sciences, 43(9), 2093–2098.PubMedCrossRefGoogle Scholar
  14. Jänig, W. (2006). The integrative action of the autonomic nervous system: Neurobiology of homeostasis. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  15. Jørgensen, L., Christiansen, P., Raundahl, U., Ostgaard, S., Christensen, N., Fenger, M., et al. (1993). Autonomic nervous system function in patients with functional abdominal pain. An experimental study. Scandinavian Journal of Gastroenterology, 28(1), 63–68.PubMedCrossRefGoogle Scholar
  16. Karling, P., Nyhlin, H., Wiklund, U., Sjöberg, M., Olofsson, B., & Bjerle, P. (1998). Spectral analysis of heart rate variability in patients with irritable bowel syndrome. Scandinavian Journal of Gastroenterology, 33(6), 572–576.PubMedCrossRefGoogle Scholar
  17. Koloski, N., Talley, N., & Boyce, P. (2000). The impact of functional gastrointestinal disorders on quality of life. The American Journal of Gastroenterology, 95(1), 67–71.PubMedCrossRefGoogle Scholar
  18. Lee, H., Choi, Y., & Choi, M. (2014). The efficacy of hypnotherapy in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Journal of Neurogastroenterology and Motility, 20(2), 152–162. doi: 10.5056/jnm.2014.20.2.152.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology & Biofeedback, 25(3), 177–191.CrossRefGoogle Scholar
  20. Maxion-Bergemann, S., Thielecke, F., Abel, F., & Bergemann, R. (2006). Costs of irritable bowel syndrome in the UK and US. Pharmacoeconomics, 24(1), 21–37.PubMedCrossRefGoogle Scholar
  21. Mazur, M., Furgała, A., Jabłoński, K., Madroszkiewicz, D., Ciećko-Michalska, I., Bugajski, A., et al. (2007). Dysfunction of the autonomic nervous system activity is responsible for gastric myoelectric disturbances in the irritable bowel syndrome patients. Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society, 58(Suppl), 3131–3139.Google Scholar
  22. McAllister, C., McGrath, F., & Fielding, J. (1990). Altered skin temperature and electromyographic activity in the irritable bowel syndrome. Biomedicine & Pharmacotherapy, 44(8), 399–401.CrossRefGoogle Scholar
  23. McOmber, M. A., & Shulman, R. J. (2008). Pediatric functional gastrointestinal disorders. Nutrition in Clinical Practice, 23(3), 268–274. doi: 10.1177/0884533608318671.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Neff, D. F., & Blanchard, E. B. (1987). A multi-component treatment for irritable bowel syndrome. Behavior Therapy, 18(1), 70–83. doi: 10.1016/S0005-7894(87)80052-7.CrossRefGoogle Scholar
  25. Nozu, T., & Okumura, T. (2011). Visceral sensation and irritable bowel syndrome; with special reference to comparison with functional abdominal pain syndrome. Journal of Gastroenterology and Hepatology, 26, 122–127. doi: 10.1111/j.1440-1746.2011.06636.x.PubMedCrossRefGoogle Scholar
  26. Orr, W., Elsenbruch, S., & Harnish, M. (2000). Autonomic regulation of cardiac function during sleep in patients with irritable bowel syndrome. The American Journal of Gastroenterology, 95(10), 2865–2871.PubMedCrossRefGoogle Scholar
  27. Palsson, O., & Whitehead, W. (2013). Psychological treatments in functional gastrointestinal disorders: A primer for the gastroenterologist. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, 11(3), 208. doi: 10.1016/j.cgh.2012.10.031.CrossRefGoogle Scholar
  28. Pellissier, S., Dantzer, C., Canini, F., Mathieu, N., & Bonaz, B. (2010). Psychological adjustment and autonomic disturbances in inflammatory bowel diseases and irritable bowel syndrome. Psychoneuroendocrinology, 35(5), 653–662. doi: 10.1016/j.psyneuen.2009.10.004.PubMedCrossRefGoogle Scholar
  29. Puzanovova, M., Arbogast, P. G., Smith, C. A., Anderson, J., Diedrich, A., & Walker, L. S. (2009). Autonomic activity and somatic symptoms in response to success versus failure on a cognitive task: A comparison of chronic abdominal pain patients and well children. Journal of Psychosomatic Research, 67(3), 235–243. doi: 10.1016/j.jpsychores.2009.02.007.PubMedCentralPubMedCrossRefGoogle Scholar
  30. Schuster, M. (2001). Defining and diagnosing irritable bowel syndrome. The American Journal of Managed Care, 7(8 Suppl), S246–S251.PubMedGoogle Scholar
  31. Sowder, E., Gevirtz, R., Shapiro, W., & Ebert, C. (2010). Restoration of vagal tone: A possible mechanism for functional abdominal pain. Applied Psychophysiol Biofeedback. Google Scholar
  32. Sperber, A., & Drossman, D. (2010). Functional abdominal pain syndrome: Constant or frequently recurring abdominal pain. The American Journal of Gastroenterology, 105(4), 770–774. doi: 10.1038/ajg.2010.68.PubMedCrossRefGoogle Scholar
  33. Thompson, W., Irvine, E., Pare, P., Ferrazzi, S., & Rance, L. (2002). Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Digestive Diseases and Sciences, 47(1), 225–235.PubMedCrossRefGoogle Scholar
  34. Waring, W., Chui, M., Japp, A., Nicol, E., & Ford, M. (2004). Autonomic cardiovascular responses are impaired in women with irritable bowel syndrome. Journal of Clinical Gastroenterology, 38(8), 658–663.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mark J. Stern
    • 1
  • Robert A. F. Guiles
    • 1
  • Richard Gevirtz
    • 1
  1. 1.Clinical Psychology PhD ProgramCalifornia School of Professional PsychologySan DiegoUSA

Personalised recommendations