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.
DGBIs in general include a wide range of disorders, classified as esophageal, gastroduodenal, bowel, centrally-mediated, gallbladder and sphincter of Oddi, anorectal, and childhood functional (1).
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).
Examples of other disorders classified as DGBIs include functional constipation, functional dyspepsia, cyclic vomiting syndrome, globus, rumination syndrome, centrally-mediated abdominal pain syndrome, and infant colic.
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 specific DGBIs (1) (see Rome Foundation).
An effective physician–patient interaction 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, helps manage symptoms, and may reduce unnecessary health-care utilization by the patient.
Treatment commonly starts with behavior modification for mild symptoms and pharmacologic therapy for more severe symptoms. Opioids should be avoided in patients with DGBI, both because they affect gastrointestinal motility and because of the potential for dependence.
References
1. Drossman DA. Functional gastrointestinal disorders: History, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150:1262–1279. doi: 10.1053/j.gastro.2016.02.032
2. Keefer L, Ko CW, Ford AC. AGA clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction: Expert review. Clin Gastroenterol Hepatol. 2021;19(12):2481–2488.e1. doi: 10.1016/j.cgh.2021.07.006
