Disorders of Gut-Brain Interaction

Disorders of gut-brain interaction are characterized by gastrointestinal symptoms of visceral hypersensitivity factors, such as motility disturbance, altered microbiota, mucosal and immune function, and disordered central nervous system processing. Diagnosis is clinical. Treatment is behavior modification for mild symptoms and pharmacologic therapy for more pronounced symptoms.

Disorders of gut-brain interaction (DGBI) (formerly known as functional gastrointestinal illness) are common. DGBI may manifest with upper and/or lower gastrointestinal (GI) symptoms.

Irritable bowel syndrome (IBS) is the most common DGBI.

Patients with IBS may have visceral hypersensitivity, a disturbance of nociception in which they experience discomfort caused by sensations (eg, luminal distention, peristalsis) that other people do not find distressing. Patients with DGBI have symptoms related to a combination of not only visceral hypersensitivity but also motility disturbance, altered microbiota, mucosal and immune function, and central nervous system processing (1).

Many referring physicians and gastrointestinal specialists find DGBI difficult to diagnose and treat. A detailed history and physical examination (as described in Evaluation of the Gastrointestinal Patient) help guide testing to exclude organic etiologies of the symptoms. The Rome IV criteria should be used to make a diagnosis of DGBI (1).

An effective physician–patient interaction reduces health care–seeking behavior by the patient. Physicians should acknowledge the patient's symptoms and provide empathy. Patient education given in patient-friendly language about the cause of the pain is essential (2). Education may include reviewing prior normal results, explaining how patients may have different thresholds for pain, and addressing behavioral factors that may exacerbate symptoms. Setting expectations is an important component of the patient–physician relationship and helps manage symptoms.

Treatment commonly starts with behavior modification for mild symptoms and pharmacologic therapy for more severe symptoms. Opioids should be avoided in patients with DGBI.