The feasibility of guided imagery treatment for abdominal discomfort in pediatric patients with quiescent inflammatory bowel disease.

Abstract

BACKGROUND: Pediatric patients with quiescent inflammatory bowel diseases (IBD) commonly experience abdominal discomfort similar to patients with functional gastrointestinal disorders such as Irritable Bowel Syndrome (IBS). Guided imagery is a highly effective therapy for functional abdominal discomfort but has not been tested in patients with quiescent IBD [Pediatrics 2009; 124:1-10]. SPECIFIC AIM: To determine the feasibility of audio-recorded guided imagery therapy in pediatric IBD patients in remission experiencing IBS-associated symptoms, specifically abdominal discomfort. METHODS: IBD patients in remission but still experiencing abdominal discomfort were recruited from the UNC Pediatric IBD clinic. Patients received a previously established audio-recorded guided imagery treatment for the treatment of abdominal discomfort, which could be used in the child's home. The patients' primary caregiver completed questionnaires regarding disease-related quality of life, functional disability, and abdominal pain. RESULTS: 10 patients ages 9-17 (mean: 14.6 + 2.7 years; 30% male, 70% female), were enrolled. Caregivers reported a mean frequency of abdominal pain in the last two weeks of 3-6 days. The mean frequency of disease related problems effecting quality of life in the past 7 days was "almost never" and mean disease-related functional disability was "little to none". One patient finished the complete treatment and 4 patients completed part of the treatment; in addition, 2 patients discontinued treatment due to IBD exacerbation, and 3 patients were lost to follow-up. Of those enrolled, 2/3 of all patients had a diagnosed psychiatric illness CONCLUSION: In this pilot study, home-based guided imagery therapy was not feasible in pediatric IBD patients with quiescent disease who had abdominal discomfort due to IBS. There may be various explanations for this. Treatment material was considered not age appropriate for older adolescents; thus, they may benefit more from adult-based treatments. In addition, functional abdominal pain was high in this patient population, but decreased quality of life and functional disability were almost non-existent. Lack of perceived significant impairment differentiates these patients from pediatric patients with functional abdominal pain and likely reduces willingness to comply with guided imagery exercises daily. Finally, most IBD patients suffered from significant anxiety which is associated with poor treatment outcomes in behavioral trials. Of note, all medical providers reported that they liked guided imagery programs since it decreased parental/patient reluctance to seek psychological treatment for patient anxiety. Further efforts to address the need for treatment of functional gastrointestinal symptoms, with or without associated psychological co-morbidity, may benefit children with IBD