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Virtual Reality Reduces Abdominal Pain in Hospitalized Patients: Results of a Controlled Trial
498
AGA Abstracts
A SYNBIOTIC PARTIAL WHEY HYDROLYSATE WITH REDUCED LACTOSE DECREASES INFANTILE COLIC AND IMPROVES QUALITY OF LIFE SCORING; A RANDOMIZED OPEN PILOT STUDY Yvan Vandenplas, A Analitis, Ioannis Xinias Aim: The aim was to evaluate the efficacy of a formula containing partially hydrolyzed whey protein, reduced lactose, Bifidobacterium lactis (B lactis) and galacto-oligosaccharides (GOS)in formula fed infants presenting with infantile colic (IC), defined as episodes of unsoothable crying for more than three hours per day during more than three days a week without organic cause.. Patients and Methods: The efficacy of the study formula was evaluated during one month in 40 term born infants (mean age: 1.0 ± 0.4 months; range 20 days-3 months) presenting with IC. Twenty full-term formula fed infants with IC which were not offered any dietary intervention served as control. All parents completed the parent form of a Quality of Life (QoL) questionnaire, assessing the burden of IC on family life. Parents were also asked to report stool frequency and composition, and to rate the benefit of the formula at the follow-up visit. Results: The infants in the control group were slightly older than these in the intervention group. Crying time did not differ at inclusion. The test formula reduced crying time from 3.2 hours (P25-75 3.1 - 3.3) to 0.5 hours (0.3 - 0.8). Although the decrease in crying time was also significant in the control group (from 3.5 (3.2-4.5) to 2.0 (2.2-3.0), the difference in decreased crying time between the intervention and control group was statistically significant (2.7 versus 1.2 hours, or 1.5 hours/day less crying in the intervention group). Stool composition became looser only in the intervention group. Defecation frequency showed no statistically significant change in either group. Median scores of the QoL questionnaire obtained at inclusion, decreased after one month in both the intervention and the control group for the majority of the variables indicating improvement. More specifically, in the intervention group median scores improved significantly for all parameters. In the control group, all parameters improved as well except for the parent-child interaction and QoL related social interaction with friends and relatives. The median score changes for all the 7 QoL questionnaire variables between inclusion and after the intervention was significantly greater in the treatment group compared to the control group. The median score regarding the benefit of intervention versus no intervention was also statistically significant lower, i.e. better, in the intervention group. Conclusion: The test-formula significantly reduced the duration of crying episodes as well as the burden of the overall QoL.
Figure: Samsung Gear Virtual Reality Headset.
512 THE PREVALENCE AND IMPACT OF OVERLAPPING ROME IV FUNCTIONAL GASTROINTESTINAL DISORDERS ON SOMATISATION, QUALITY OF LIFE, AND HEALTHCARE UTILISATION: RESULTS FROM A THREE-COUNTRY GENERAL POPULATION STUDY Imran Aziz, Olafur S. Palsson, Hans Törnblom, Ami D. Sperber, William E. Whitehead, Magnus Simren Background: The population prevalence of Rome IV functional gastrointestinal disorders (FGIDs) and their cumulative effect on health impairment is unknown. We used data from a large cross-sectional study of the general population to address this, and compared somatisation, quality of life, and healthcare utilisation in those fulfilling Rome IV FGID criteria with non-GI and organic GI-disease controls. Methods: An internet-based healthcare survey was completed by 6300 general population adults from three English-speaking countries (2100 each from United States, Canada, and United Kingdom). Quota based sampling was used to ensure equal proportion of sex (50%/50%) and age groups (40% aged 18-39, 40% aged 40-64, 20% aged 65+) across countries, and to control education distributions (30% maximum with college degree or equivalent). The survey included questions on demographics, doctor-diagnosed organic GI-disease, criteria for the Rome IV FGIDs, the patient health questionnaire (PHQ)-12 somatisation measure, the Short Form-8 (SF-8) quality of life questionnaire, and questions on GI-related medication and surgical history. Results: Data was available for analysis from 5931 subjects (49.2% female; mean age 47.4 years, range 18-92) after having eliminated 369 (5.9%) inconsistent responders. The number of subjects having symptoms compatible with a FGID was 2060 (34.7%) compared to 3444 (58.1%) healthy and 427 (7.2%) organic GI-disease controls. Per organ region, the bowel disorders were the most predominant FGIDs (n=1651, 27.8%), followed by gastroduodenal (n=627, 10.7%), anorectal (n=440, 7.4%), esophageal (n=383, 6.5%), and gallbladder disorders (n=10, 0.2%). On average, the 2060 individuals who met FGID criteria qualified for 1.5 FGID diagnoses, and 728 of them (35.3%) qualified for FGID diagnoses in more than one organ region. The presence of FGIDs in multiple organ regions correlated with increasing somatic symptom (PHQ-12) scores, worse mental and physical quality of life, greater consumption of GI-related medical therapies and a higher prevalence of abdominal surgeries (all p<0.001; table 1). Of note, the overlap of FGIDs was associated with worse somatisation and quality of life scores than organic GI-disease controls. Conclusion: Roughly a third of the general adult population have GI symptoms that fulfil diagnostic criteria for a Rome IV FGID. In a third of this subset multiple organ regions are involved and this overlap is associated with increased somatisation, poorer quality of life, and greater healthcare utilisation. Study support: The Rome Foundation
511 VIRTUAL REALITY REDUCES ABDOMINAL PAIN IN HOSPITALIZED PATIENTS: RESULTS OF A CONTROLLED TRIAL Vartan C. Tashjian, Sasan Mosadeghi, Mark W. Reid, Amber Howard, Mayra Lopez, Brennan Spiegel Background: Improvements in software, design, and cost reduction have made virtual reality (VR) a practical tool for immersive, 3-dimensional (3D), multi-sensory experiences that distract patients from painful stimuli. Although VR is known to reduce somatic pain and is increasingly used as a drug-free alternative to analgesics, less is known about the effect of VR for visceral pain. As part of a larger, controlled trial of VR in hospitalized patients with diverse types of acute pain, we analyzed the impact of a one-time 3D VR intervention on abdominal pain vs. a 2D distraction video. Methods: We performed a comparative cohort study in a large, urban teaching hospital, to test VR for acute pain in inpatients with an average pain score of ≥3/10 from any cause including, but not limited to, abdominal pain. Patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, epilepsy, and in isolation were excluded. Patients in the intervention group viewed a 3D VR experience designed to reduce pain using the Samsung Gear Oculus VR headset (Figure); control patients viewed a high-definition 2D nature video on a 14" bedside screen. Pre- and postintervention pain scores were recorded. Difference-in-difference (DID) scores were compared between groups. We performed bivariate and multivariable regression analyses to evaluate whether the effect of VR varied for patients with abdominal pain vs. somatic pain. Results: There were N=100 subjects in the overall study (50 per study group), of which 33 had abdominal pain (11 in VR group; 22 controls) from an acute GI diagnosis (including IBD, IBS, functional abdominal pain, pancreatitis, post-surgical GI pain, bowel obstruction, perforation, diverticulitis, GI malignancy, other). Across all patients in the study, the mean pain reduction in the VR cohort was greater than in controls (-1.3 vs. -0.6 points, respectively; p=0.008). In the sub-group of GI patients, the mean pain reduction in the VR cohort dropped significantly (pre=5.72, post=4.18; p=0.016) with a similar effect size as observed in the overall population. In multivariable regression analysis adjusting for age, race, ethnicity, and gender, VR remained a significant predictor of pain reduction independent of whether the pain was abdominal or somatic in origin (β coefficient=-0.65 points; 95% confidence intervals=1.3 to 0; P=0.05). There were no adverse events reported from VR. Conclusion: Use of VR in hospitalized patients significantly reduces pain vs. a control distraction condition - this effect is similar for pain of both abdominal and somatic origin. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting for diverse patients with abdominal pain; future randomized trials should confirm benefit with different visualizations and exposure periods in larger GI populations.
AGA Abstracts
S-116
AGA Abstracts
A SYNBIOTIC PARTIAL WHEY HYDROLYSATE WITH REDUCED LACTOSE DECREASES INFANTILE COLIC AND IMPROVES QUALITY OF LIFE SCORING; A RANDOMIZED OPEN PILOT STUDY Yvan Vandenplas, A Analitis, Ioannis Xinias Aim: The aim was to evaluate the efficacy of a formula containing partially hydrolyzed whey protein, reduced lactose, Bifidobacterium lactis (B lactis) and galacto-oligosaccharides (GOS)in formula fed infants presenting with infantile colic (IC), defined as episodes of unsoothable crying for more than three hours per day during more than three days a week without organic cause.. Patients and Methods: The efficacy of the study formula was evaluated during one month in 40 term born infants (mean age: 1.0 ± 0.4 months; range 20 days-3 months) presenting with IC. Twenty full-term formula fed infants with IC which were not offered any dietary intervention served as control. All parents completed the parent form of a Quality of Life (QoL) questionnaire, assessing the burden of IC on family life. Parents were also asked to report stool frequency and composition, and to rate the benefit of the formula at the follow-up visit. Results: The infants in the control group were slightly older than these in the intervention group. Crying time did not differ at inclusion. The test formula reduced crying time from 3.2 hours (P25-75 3.1 - 3.3) to 0.5 hours (0.3 - 0.8). Although the decrease in crying time was also significant in the control group (from 3.5 (3.2-4.5) to 2.0 (2.2-3.0), the difference in decreased crying time between the intervention and control group was statistically significant (2.7 versus 1.2 hours, or 1.5 hours/day less crying in the intervention group). Stool composition became looser only in the intervention group. Defecation frequency showed no statistically significant change in either group. Median scores of the QoL questionnaire obtained at inclusion, decreased after one month in both the intervention and the control group for the majority of the variables indicating improvement. More specifically, in the intervention group median scores improved significantly for all parameters. In the control group, all parameters improved as well except for the parent-child interaction and QoL related social interaction with friends and relatives. The median score changes for all the 7 QoL questionnaire variables between inclusion and after the intervention was significantly greater in the treatment group compared to the control group. The median score regarding the benefit of intervention versus no intervention was also statistically significant lower, i.e. better, in the intervention group. Conclusion: The test-formula significantly reduced the duration of crying episodes as well as the burden of the overall QoL.
Figure: Samsung Gear Virtual Reality Headset.
512 THE PREVALENCE AND IMPACT OF OVERLAPPING ROME IV FUNCTIONAL GASTROINTESTINAL DISORDERS ON SOMATISATION, QUALITY OF LIFE, AND HEALTHCARE UTILISATION: RESULTS FROM A THREE-COUNTRY GENERAL POPULATION STUDY Imran Aziz, Olafur S. Palsson, Hans Törnblom, Ami D. Sperber, William E. Whitehead, Magnus Simren Background: The population prevalence of Rome IV functional gastrointestinal disorders (FGIDs) and their cumulative effect on health impairment is unknown. We used data from a large cross-sectional study of the general population to address this, and compared somatisation, quality of life, and healthcare utilisation in those fulfilling Rome IV FGID criteria with non-GI and organic GI-disease controls. Methods: An internet-based healthcare survey was completed by 6300 general population adults from three English-speaking countries (2100 each from United States, Canada, and United Kingdom). Quota based sampling was used to ensure equal proportion of sex (50%/50%) and age groups (40% aged 18-39, 40% aged 40-64, 20% aged 65+) across countries, and to control education distributions (30% maximum with college degree or equivalent). The survey included questions on demographics, doctor-diagnosed organic GI-disease, criteria for the Rome IV FGIDs, the patient health questionnaire (PHQ)-12 somatisation measure, the Short Form-8 (SF-8) quality of life questionnaire, and questions on GI-related medication and surgical history. Results: Data was available for analysis from 5931 subjects (49.2% female; mean age 47.4 years, range 18-92) after having eliminated 369 (5.9%) inconsistent responders. The number of subjects having symptoms compatible with a FGID was 2060 (34.7%) compared to 3444 (58.1%) healthy and 427 (7.2%) organic GI-disease controls. Per organ region, the bowel disorders were the most predominant FGIDs (n=1651, 27.8%), followed by gastroduodenal (n=627, 10.7%), anorectal (n=440, 7.4%), esophageal (n=383, 6.5%), and gallbladder disorders (n=10, 0.2%). On average, the 2060 individuals who met FGID criteria qualified for 1.5 FGID diagnoses, and 728 of them (35.3%) qualified for FGID diagnoses in more than one organ region. The presence of FGIDs in multiple organ regions correlated with increasing somatic symptom (PHQ-12) scores, worse mental and physical quality of life, greater consumption of GI-related medical therapies and a higher prevalence of abdominal surgeries (all p<0.001; table 1). Of note, the overlap of FGIDs was associated with worse somatisation and quality of life scores than organic GI-disease controls. Conclusion: Roughly a third of the general adult population have GI symptoms that fulfil diagnostic criteria for a Rome IV FGID. In a third of this subset multiple organ regions are involved and this overlap is associated with increased somatisation, poorer quality of life, and greater healthcare utilisation. Study support: The Rome Foundation
511 VIRTUAL REALITY REDUCES ABDOMINAL PAIN IN HOSPITALIZED PATIENTS: RESULTS OF A CONTROLLED TRIAL Vartan C. Tashjian, Sasan Mosadeghi, Mark W. Reid, Amber Howard, Mayra Lopez, Brennan Spiegel Background: Improvements in software, design, and cost reduction have made virtual reality (VR) a practical tool for immersive, 3-dimensional (3D), multi-sensory experiences that distract patients from painful stimuli. Although VR is known to reduce somatic pain and is increasingly used as a drug-free alternative to analgesics, less is known about the effect of VR for visceral pain. As part of a larger, controlled trial of VR in hospitalized patients with diverse types of acute pain, we analyzed the impact of a one-time 3D VR intervention on abdominal pain vs. a 2D distraction video. Methods: We performed a comparative cohort study in a large, urban teaching hospital, to test VR for acute pain in inpatients with an average pain score of ≥3/10 from any cause including, but not limited to, abdominal pain. Patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, epilepsy, and in isolation were excluded. Patients in the intervention group viewed a 3D VR experience designed to reduce pain using the Samsung Gear Oculus VR headset (Figure); control patients viewed a high-definition 2D nature video on a 14" bedside screen. Pre- and postintervention pain scores were recorded. Difference-in-difference (DID) scores were compared between groups. We performed bivariate and multivariable regression analyses to evaluate whether the effect of VR varied for patients with abdominal pain vs. somatic pain. Results: There were N=100 subjects in the overall study (50 per study group), of which 33 had abdominal pain (11 in VR group; 22 controls) from an acute GI diagnosis (including IBD, IBS, functional abdominal pain, pancreatitis, post-surgical GI pain, bowel obstruction, perforation, diverticulitis, GI malignancy, other). Across all patients in the study, the mean pain reduction in the VR cohort was greater than in controls (-1.3 vs. -0.6 points, respectively; p=0.008). In the sub-group of GI patients, the mean pain reduction in the VR cohort dropped significantly (pre=5.72, post=4.18; p=0.016) with a similar effect size as observed in the overall population. In multivariable regression analysis adjusting for age, race, ethnicity, and gender, VR remained a significant predictor of pain reduction independent of whether the pain was abdominal or somatic in origin (β coefficient=-0.65 points; 95% confidence intervals=1.3 to 0; P=0.05). There were no adverse events reported from VR. Conclusion: Use of VR in hospitalized patients significantly reduces pain vs. a control distraction condition - this effect is similar for pain of both abdominal and somatic origin. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting for diverse patients with abdominal pain; future randomized trials should confirm benefit with different visualizations and exposure periods in larger GI populations.
AGA Abstracts
S-116