Managing Disorders of Gut-Brain Interaction, with Nicole Martinez de Andino, NP

Disorders of gut-brain interaction (DGBI), formerly known as functional gastrointestinal (GI) disorders, affect more than 40% of the global population, one of the most common being irritable bowel syndrome (IBS). Despite their prevalence, the management of DGBI in clinical practice is often suboptimal.

The Rome Foundation defines DGBI as a group of disorders classified by GI symptoms related to any combination of motility disturbance; visceral hypersensitivity; altered mucosal and immune function; altered gut microbiota; and/or altered central nervous system processing.

DGBIs lack abnormal endoscopic or radiologic findings or objective biomarkers that can be identified during routine clinical evaluation. Instead, they are diagnosed based on patient-reported symptom patterns and severity.

“For a lot of these disorders of gut-brain interaction, the diagnosis is going to be based on the Rome criteria. It's a positive diagnosis that you can make based on symptoms, which is different from what we used to think,” Nicole Martinez de Andino, NP, a nurse practitioner at Augusta University Medical Center, explained to HCPLive. “We used to think it was more of a diagnosis of exclusion where we would order all sorts of different tests for these patients, and then if everything came back normal, we would say ‘Oh, well, I guess you probably have irritable bowel syndrome.’”

At the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) conference in National Harbor, Maryland, Martinez de Andino gave a presentation on commonalities in the management of different DGBI.

Citing bidirectional interconnections between the brain and the gut, Martinez de Andino explained the use of brain-gut behavioral therapy and neuromodulators in the treatment of patients with DGBI, describing their impact on GI symptoms and psychological comorbidities frequently seen with these conditions.

“What you really need to look at when you're treating any patient with a disorder of gut-brain interaction is what is bothering them most,” Martinez de Andino said, noting different potential treatment approaches based on the symptoms patients find most burdensome. Above all else, she described the importance of explaining the pathophysiology of DGBI to patients so they understand it is a real disorder and know the cause of their symptoms.

“Once you let them know that you know they have a real disorder, that you don't think it's all in their head, or that they're crazy, then you can talk to them about some of the different treatment options,” she said.

References

1. ^{The Rome Foundation. What is a Disorder of Gut-Brain Interaction (DGBI). Accessed September 11, 2024. https://theromefoundation.org/what-is-a-disorder-of-gut-brain-interaction-dgbi/}
2. ^{Sayuk GS. Insights on Disorders of Gut-Brain Interaction. Gastroenterol Hepatol. 2021;17(12):606-608.}