When patients arrive at the Johns Hopkins Gastrointestinal Functional Treatment (GIFT) Center, many of them have undergone a gamut of tests without receiving a diagnosis and are seeking a second or third opinion for their gastrointestinal distress.

At the GIFT Center, opened in the spring of 2022, patients see a multidisciplinary team that specializes in disorders of the gut-brain interaction, conditions in which communication between the gastrointestinal tract and the brain becomes disrupted or overly sensitive. This can lead to chronic abdominal pain and symptoms such as nausea, constipation or diarrhea.

“They are missing school, they are missing all of their activities,” says center director and pediatric gastroenterologist Shaija Kutty. “We teach them how to cope with this pain and how to be functional, so that they can get back to their regular activity, their normal life. That is the purpose of this clinic.”

The disorders the clinic treats include chronic nausea, irritable bowel syndrome and functional dyspepsia — a condition that mimics acid reflux and can include heartburn and bloating or pain after eating. In addition to gastrointestinal disorders, patients often have comorbidities including postural orthostatic tachycardia syndrome (POTS), cyclic vomiting syndrome, anxiety, depression, fatigue and migraines.

“One of the analogies that we’ll often use is that of a computer,” says pediatric psychologist Erika Chiappini. “These kids, their hardware — their GI system — is working well, but the software is not. So, the pain pathways have become overly sensitized both to detecting and receiving pain signals. Our clinic is geared toward helping kids learn to support their software to be less glitchy.”

The clinic treats patients as young as 9 and 10, but the majority of patients who come to the clinic experiencing daily pain range in age from 14–17. Some patients’ symptoms have a precipitating factor such as a recent illness or stress in their personal lives; others don’t have a clear trigger.

Patients and their families meet with a team of four: Kutty; Chiappini; integrative medicine physician Melanie Brown, medical director of pediatric palliative care; and dietician Reanne Barbato. These clinicians take a comprehensive medical history and evaluate all symptoms and issues a patient is having. While similar multidisciplinary clinics exist at other institutions, the GIFT Center stands out for bringing multiple specialists together in a single, extended visit.

A patient’s initial appointment lasts around two hours, allowing the team to build a rapport with the patient and their family, and to ensure that the clinicians are able to educate them about the disorders and treatment. The team, which sees about 50 patients annually, also includes a nurse and medical assistant.

“We gather the story to understand what brought them to us, and more than just focusing on past test results, we’re focusing a lot on how we can improve their functioning so they can thrive,” Brown says.

The clinicians offer a variety of treatment options, including nutritional advice, cognitive behavioral therapy and psychological support, as well as medications to disrupt pain signaling pathways. Brown teaches integrative medicine strategies related to the mind-body connection, including diaphragmatic breathing and other ways to calm the nervous system, biofeedback, acupressure and aromatherapies that can help with nausea, abdominal pain and relaxation.

Kutty can administer percutaneous electrical nerve field stimulation through a device that attaches behind the ear like a hearing aid. The device sends gentle electrical pulses through nerves around the ear to help modulate pain signaling and reduce abdominal pain.

After clinic, patients have a follow-up appointment with Kutty to report on their progress.

“Patients do well,” Kutty says. “They get back to school, and they get back to their normal activities.”

Medically reviewed by Shaija Kutty, M.B.B.S., Erika Chiappini, Ph.D., and Melanie Brown, M.D.