Douglas A. Drossman, MD: Addressing the Future of Gastroenterological Issues

Is fecal microbiota transplant the future of Clostridium difficile therapy?

Douglas A. Drossman, Professor Emeritus, Medicine and Psychiatry, University of North Carolina School of Medicine: I think it's going to make the difference in the resistant strains, but I don't think it's cost-effective or even medically reasonable to do that for everybody where most patients — about 80% — will respond, and that's it. But for those who recur, there are protocols that allow you to alternate the drugs or taper them down. But in the 5 or 10% where it doesn't happen, that's where you have a good treatment now.

What are your thoughts on treating gastroenterological conditions in an aging population?

I think one way to look at this is, because modern medicine has allowed people to live longer, you're going to be more vulnerable to things that would occur in aging. And C. difficile is a result of hospitalizations, and aging is going to increase your vulnerability to it.

On efforts to better the treatment and diagnosis of irritable bowel syndrome:

We're really changing the paradigm. I'm president of the Rome Foundation, which is an organization that provides guidelines for diagnosis and treatment. And we are looking to increase awareness and legitimization, because this disorder is one of those disorders where you don't see anything on an x-ray or endoscopy. There's always that risk that it becomes trivialized or considered psychiatric, and it's not. It's not a psychiatric disorder. So we're trying to increase the education and understand how the microbiome plays a role, how we can use what has been called neuromodulators to treat this disregulation. I think this field is wide open for new learning in this area.