Department of Medicine and Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, University of North Carolina, Chapel Hill, NC, USA.
Aliment Pharmacol Ther. 2021 Aug;54(3):281-291. doi: 10.1111/apt.16467. Epub 2021 Jun 20.
Central neuromodulators are an effective treatment for irritable bowel syndrome (IBS) but may be used less frequently than other therapies.
To survey gastroenterologists in the United States (US) about their use of neuromodulators in patients with IBS.
A 23-question survey was distributed to gastroenterologists in the United States. Comparisons in prescribing practices were conducted between (a) gastroenterologists who were "high prescribers" versus "low prescribers" of neuromodulators in patients with IBS and (b) gastroenterologists and "gastroenterology experts" in the use of neuromodulators using descriptive statistics and multivariable logistic regression analyses.
The 525 gastroenterologists who were surveyed used neuromodulators for a median range of 21%-30% of their patients with IBS. Neuromodulators were described as extremely/very important in managing IBS by 55% of clinicians. Significant predictors of high-prescribing behaviour were academic versus clinical practice setting (odds ratio [OR] 2.60 [95% CI 1.61-4.20]), disorders of brain-gut interaction focused practice (OR 4.80 [2.60-8.84]), and greater perceived effectiveness of neuromodulators (OR 2.75 [1.30-5.84]). Compared to gastroenterologists, experts prescribed neuromodulators to a higher percentage of their patients with IBS (41%-50% vs 21%-30%; P = 0.019) and more frequently found neuromodulators effective (70% vs 27%; P = 0.003). However, concern about side effects was the most common barrier to neuromodulator use (59%).
The majority of US gastroenterologists believe central neuromodulators are important in treating IBS, and 27% believe they are effective in most patients. High prescribers are in academic practice, focus in IBS and perceive central neuromodulators as effective. Education is needed to improve gastroenterologists' prescribing behaviour.
中枢神经调节剂是治疗肠易激综合征（IBS）的有效方法，但它们的使用可能不如其他疗法频繁。
调查美国胃肠病学家对 IBS 患者使用神经调节剂的情况。
向美国胃肠病学家分发了一份 23 个问题的调查问卷。通过描述性统计和多变量逻辑回归分析，比较了（a）IBS 患者中神经调节剂的“高处方医生”与“低处方医生”之间的处方实践，以及（b）神经调节剂的使用情况，比较了胃肠病学家和“胃肠病学专家”。
接受调查的 525 名胃肠病学家将神经调节剂用于其 IBS 患者的中位数范围为 21%-30%。55%的临床医生认为神经调节剂在治疗 IBS 方面非常/非常重要。高处方行为的显著预测因素包括学术与临床实践环境（优势比[OR]2.60[95%可信区间1.61-4.20]）、专注于脑-肠相互作用障碍的实践（OR 4.80[2.60-8.84]）和对神经调节剂更高的疗效感知（OR 2.75[1.30-5.84]）。与胃肠病学家相比，专家为更高比例的 IBS 患者开具了神经调节剂（41%-50%比 21%-30%；P=0.019），并认为神经调节剂更有效（70%比 27%；P=0.003）。然而，担心副作用是使用神经调节剂的最常见障碍（59%）。
大多数美国胃肠病学家认为中枢神经调节剂对治疗 IBS 很重要，27%的人认为它们对大多数患者有效。高处方医生在学术实践中，专注于 IBS 并认为中枢神经调节剂有效。需要进行教育以改善胃肠病学家的处方行为。
