Disorders of the Gut-Brain Interaction: You Don't Have to Suffer Alone
Ellen Joseph, PhD, GI Psychology
Have you ever gotten that nervous feeling in your stomach right before giving an important presentation? When you travel do you get more constipated? Before playing in a big game, do you find that you need to have a bowel movement ASAP?
If so, you’re not alone. Our brain and gut are so closely connected that during periods of increased pressure, stress, or change, many people notice short-term, mild changes in the gut. However, for some, these gut-related changes last longer, are more severe, and interfere with their daily lives.
These gut issues can include diarrhea, constipation, bloating, abdominal pain, gas, discomfort, and nausea, just to name a few. In some cases, after extensive testing, lab work, and procedures through a gastroenterologist, patients are told that everything “looks normal” even though they feel worse than ever before. So what is happening in the gut?
Gastrointestinal (GI) conditions that do not have an identifiable structural cause previously fell under the category of “functional GI disorders”. The label has since changed to “disorders of the gut-brain interaction” (DGBI) to better illustrate what is really happening in our bodies and how we can correct this issue (i.e., the brain plays a role in these disorders and the problem exists in how the brain and gut are communicating).
What is the gut-brain interaction?
Our brain and gut communicate through our central nervous system (i.e., brain and spinal cord) and enteric nervous system (i.e., gut), which cannot be “seen” in lab work or through scopes. These parts of our body are constantly in communication, letting us know when it is time to eat, when we feel full, and when something problematic is in our stomach (like a virus).
This communication system can become faulty for many reasons, like genetics, an infection, chronic stressful life events, or constipation/diarrhea. As a result, our brain is more reactive to normal signals in the gut/GI system, resulting in the experience of increased pain and discomfort. This is called visceral hypersensitivity, which together with our brain constantly scanning for gut-related issues (i.e., hypervigilance) results in a vicious cycle of pain and worry, potentially causing a disorder of the gut-brain interaction, or DGBI.
What is defined as disorders of the gut-brain interaction?
The Rome Foundation defines and outlines the diagnostic criteria for disorders of the gut-brain interaction (DGBIs), all of which have some combination of motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, or altered central nervous system (CNS) processing.
There are currently 33 diagnoses for adults and 17 diagnoses for children, including but not limited to, Irritable Bowel Syndrome, Functional Dyspepsia, Functional Abdominal Pain, Functional Nausea, and Functional Vomiting. Approximately 40% of adults and 24% of children suffer from a DGBI at some point in their lives.
What are some DGBI treatment methods?
The not-so-great news: many people suffer in silence for years or decades with these conditions. The various reasons include feeling uncomfortable talking about poop, feeling as if they “just have to live with it”, minimizing their symptoms, or experiencing stigma when seeking out care. Here’s the good news: DGBIs are treatable and you do not have to suffer alone!
Gut-Directed Therapy
Did you know that there are behavioral health specialists trained specifically in gut-brain therapies? These treatments include gut-directed Cognitive Behavioral Therapy (CBT) and gut-directed clinical hypnosis. In fact, the American College of Gastroenterology (ACG) has published new guidelines recommending the use of these therapies as a first-line treatment for IBS. And even better, these treatments are highly effective!
Medications
Gastroenterologists may prescribe neuromodulators to treat DGBI-related symptoms, including medications that target visceral hypersensitivity, anxiety, and/or depression associated with the condition. It is always best to talk with your gastroenterologist to determine which medications might be the right fit for you and your health history.
Dietitians/Nutritionists
In addition to gut-brain therapists, there are also dieticians who specialize in treating gut-brain disorders. They can provide additional screening and testing to determine ways to best intervene using dietary and lifestyle changes. Depending on their approach, they may also be able to support certain elimination diets that are recommended by gastroenterologists. They can be a critical member of your treatment team, too.
DGBI Resources
Interested in learning more? Here are some great resources to check out!
Information about DGBIs
Rome Foundation - https://theromefoundation.org/
GastroGirlTM - https://gastrogirl.com/
GI On Demand - https://giondemand.com/
Mind Your Gut: The Science-Based, Whole-Body Guide to Living Well with IBS - https://www.drriehl.com/general-8
Finding a gut-brain therapist
GI Psychology - https://www.gipsychology.com/
Rome Foundation Searchable Directory - https://romegipsych.org/
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