The Curbsiders Internal Medicine Podcast

#334 IBS, Functional Dyspepsia, and Cyclic Vomiting: Disorders of Gut Brain Interaction (DGBI)

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May 9, 2022
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INSIGHT

Gut–Brain Disorders Are Functional And Biological

  • Disorders of the gut–brain axis cause symptom clusters despite limited structural findings on tests.
  • Pathophysiology includes altered motility, visceral hypersensitivity, barrier changes, immune/microbiome and CNS processing.
ADVICE

Test H. pylori Then Trial Acid Suppression

  • For young patients without alarm features, do noninvasive H. pylori testing first and avoid routine endoscopy.
  • If H. pylori is negative, start a 4-week PPI trial or H2 blocker based on symptoms.
ADVICE

Match Treatment To Predominant Dyspepsia Symptom

  • Target therapy to the predominant symptom: use buspirone for postprandial distress and TCAs for epigastric pain from visceral hypersensitivity.
  • Offer peppermint/caraway formulations and dietary changes (smaller meals, avoid high fat/fiber) as first-line nonpharmacologic measures.
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