For years, chronic abdominal pain and nausea have generally
been diagnosed after an extensive workup and a series of inconclusive tests.
For those who suffer from these symptoms, there is nothing more frustrating
than having a vague answer, and ultimately no clear solution. Symptoms can be
managed with medications, but this can lead to increased dependence on these
medications, and is ultimately not treating the root cause of the problem.
Although this article discusses this in the context of pediatric patients, I
believe that the same ideas apply to adult patients.
In looking at abdominal issues, neurogastroenterologists are now
considering what is called the “second brain.” These are millions of neurons innervating
the gastrointestinal tract that act as one cohesive unit, sending important messages
to the primary brain. If these neurons are not functioning properly, they can send
defective signals to the primary brain, meaning that patients might feel pain even if
they have no clinical source of pain.
Treatments targeting the second brain are not a series of medications, but rather a series of
lifestyles changes. These include reduction in stress levels, ascertaining an appropriate amount of
exercise, and getting sufficient sleep. Differences in these habits can all manifest in the gut, and often negatively do so. In
addition, 95% of serotonin production takes place in the gut. This means that
raising serotonin levels in patients with depression can also relieve gastrointestinal
problems.
Although other organ systems do not have a second brain like
the GI tract, I believe that a similar theme still applies to each organ system.
Reducing levels of stress and anxiety can have downstream effects on various
health conditions. Unfortunately, I think that many patients are unwilling to admit
that stress and other lifestyle differences could play a role in some medical
conditions. Furthermore, I think that fewer patients would be open to this type
of solution of making lifestyle changes because it is not a quick and easy solution such as a medical or
surgical intervention. Making lifestyle changes to reduce stress and anxiety
requires discipline and patience, which is certainly antagonistic to the
American lifestyle.
This issue is important to me because it touches on the idea
of treating patients holistically. While ruling out infection and other acute causes
of abdominal pain and nausea is crucial, evaluating other components like
mental influences is equally important. Issues like this one cannot be viewed as one that is simply fixed with medication or surgery. This is a great example of why physicians must evaluate their patients holistically.
References:
Hello Sara,
ReplyDeleteThank you for posting this interesting blog. The idea of a "second brain" is intriguing. From what I read, the term "second brain" comes from the vast number of neurons associated with the gastrointestinal tract which, together, constitute the enteric nervous system. I read that the enteric nervous system is often considered to operate separately from the visceral motor system and is often found to function without direct sympathetic or parasympathetic supervision (Purves, et al., 2001)! As you mentioned, disruption in the enteric nervous system is often linked to emotional disruptions and is implicated in irritable bowel syndrome (IBS) and even constipation, diarrhea, and general abdominal pain. This link between emotional disruption and abdominal dysfunction, has lead to the exploration of mind-body therapies such as cognitive behavioral therapy to treat IBS and bowel-disorders (Johns Hopkins Medicine, 2017). This is very interesting! Thank you for posting.
References:
Purves D., Augustine GJ., Fitzpatrick D., et al., editors. Neuroscience. 2nd editions. Sunderland (MA): Sinauer Associates (2001). The enteric nervous system. https://ncbi.nlm.nih.gov/gov/books/NBK11097
John Hopkins Medicine (2017). The brain-gut connection. Retrieved from: www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection
I work in a hospital and see quite a lot of patients who come in with nausea and abdominal pain and ultimately get diagnosed with chronic abdominal pain. Their frustration is clear to see and it is disappointing that there isn’t much that can be done for these patients.
ReplyDeleteWhile reading this article and your blog post, I kept thinking about the vagus nerve. This is the cranial nerve which has some effect on abdominal areas, innervating many muscles and organs here. I was curious if this “second brain” mentioned was neurons stemming from this vagus nerve. This article http://www.brainprotips.com/vagus-nerve-symptoms/ talks about how a malfunctioning vagus nerve can lead to stomach pain and cramping and nausea through a variety of mechanisms. Your linked article seems to have been meant for an audience unfamiliar with technical terms, so I’m curious if they are alluding to this vagus nerve without mentioning it specifically.
Thanks for your interesting post!