Working with Trauma in the Gastroenterology Setting.

Patients with gastrointestinal (GI) complaints report high rates of previous psychological trauma such as physical, emotional abuse and neglect, sexual trauma, and other traumatic experiences. History of trauma is considered a risk factor for the development of disorders of gut-brain interaction, including irritable bowel syndrome. This article discusses key points for providers in understanding how various aspects of trauma can affect patients' physical and mental health and medical interactions, as well as trauma-informed strategies providers can use to increase patient comfort, improve communication, and improve effectiveness of treatment.

Psychological Considerations in the Dietary Management of Patients With DGBI.

In this article, an expert team of 2 gastro-psychologists, a dietician, and an academic gastroenterologist provides insights into the psychological and social implications of evidence-based and "popular" dietary interventions in disorders of gut-brain interaction (DGBI). We focus on practical approaches for evaluating a patient's appropriateness for a dietary intervention, considering the nutritional, psychological, behavioral, and social context in which a patient may find themselves managing their DGBI with dietary intervention. We also discuss how to identify risk factors for and symptoms of avoidant/restrictive food intake disorder, a growing concern in the DGBI population.

Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics.

Irritable bowel syndrome affects 10% to 15% of the population, and up to 90% of patients with irritable bowel syndrome exclude certain foods to improve their gastrointestinal symptoms. Although focused dietary restrictions are a normal, adaptive response, restrictions can spiral out of control and result in maladaptive restriction. Dietary therapies are rapidly becoming first-line treatment of irritable bowel syndrome, and gastroenterologists need to be aware of red flag symptoms of maladaptive eating patterns and the negative effects of prescribing restrictive diets. There is also growing awareness of the association between eating disorders and gastrointestinal symptoms, including irritable bowel syndrome symptoms.

Irritable Bowel Syndrome: Food as a Friend or Foe?

Irritable bowel syndrome (IBS) affects 10% to 15% of the population and often is difficult to treat with available pharmacologic agents. Dietary therapies for IBS are of particular interest because up to 90% of IBS patients exclude certain foods to improve their gastrointestinal symptoms. Among the available dietary interventions for IBS, the low FODMAP diet has the greatest evidence for efficacy. Although dietary therapies rapidly are becoming first-line treatment of IBS, gastroenterologists need to be aware of the negative effects of prescribing restrictive diets and red flag symptoms of maladaptive eating patterns.

Functional Dyspepsia: A Review of the Symptoms, Evaluation, and Treatment Options.

The community prevalence of dyspepsia ranges from 20% to 40%, and dyspepsia accounts for 3% to 5% of primary care visits. Dyspepsia symptoms include epigastric pain, epigastric burning, postprandial fullness, early satiety, epigastric bloating, nausea, and belching. Functional dyspepsia is diagnosed when an organic etiology for the symptoms is not identified. Diagnostic symptom-based criteria are defined by Rome IV. Functional dyspepsia is further subclassified into postprandial distress syndrome and epigastric pain syndrome based on the predominance of post-prandial bloating and fullness vs epigastric pain. Evaluation of functional dyspepsia is driven by patient age and the presence of red-flag symptoms, such as patients over age 60 years or those with anemia undergoing evaluation with esophagogastroduodenoscopy. Helicobacter pylori infection should be excluded in all patients. Treatment options include proton pump inhibitors, neuromodulators, and prokinetics; however, the evidence supporting these therapies is weak, and the response rate is less than robust.

Chronic Unexplained Nausea and Vomiting or Gastric Neuromuscular Dysfunction (GND)? An Update on Nomenclature, Pathophysiology and Treatment, and Relationship to Gastroparesis.

OPINION STATEMENT: Chronic unexplained nausea and vomiting is a debilitating condition that dramatically decreases patient quality of life and creates diagnostic and treatment challenges for healthcare providers. Additionally, the significant overlap in symptoms between disorders such as chronic unexplained nausea and vomiting, gastroparesis, and functional dyspepsia has resulted in a blurring of diagnostic lines and added confusion to the therapeutic approach. The identified overlap in clinical symptoms also suggests a common underlying pathophysiological mechanism may drive these conditions, indicating they could possibly be part of a spectrum of gastric neuromuscular disorders instead of discrete processes. This article will discuss the classification, updates in pathophysiology and therapeutic research, and future directions of research in the treatment of chronic unexplained nausea and vomiting.