Pharmacologic neuromodulation for bloating

Abstract

Background: Though bloating is a common and highly distressing symptom among patients with disorders of gut-brain interaction (DGBI), few targeted treatment options exist. In this study, we examined the use and efficacy of pharmacologic neuromodulators to treat bloating specifically.

Methods: In a retrospective study of consecutively referred patients with a DGBI (N = 77; ages 18-74, 87% female) to a tertiary neurogastroenterology clinic who were prescribed a neuromodulator for a primary complaint of bloating in 2016-2022, the degree of patient-reported bloating response (0-100%) to the maximum dose of a prescribed neuromodulator was examined using multivariable logistic regression, adjusted for key covariates.

Results: Forty-seven (61.0%) patients reported any response (>0%) to neuromodulation and 28 (36.4%) met the a priori responder definition (≥50% improvement). Duloxetine was the most commonly prescribed neuromodulator (n = 52, 67.5%). On multivariable analysis, only younger age was associated with an increased odds of neuromodulator response (OR 1.04, 95% CI [1.08, 1.01]).

Conclusions: Pharmacologic neuromodulators may show promise as a tool for the treatment of bloating, and further research is warranted.

Keywords: Brain-Gut axis; constipation; functional dyspepsia; functional gastrointestinal disorders; irritable bowel syndrome; pharmacology.