Disorders of gut-brain interaction are a new challenge of our increasingly complex society, with worldwide repercussions

Abstract

The term disorders of gut-brain interaction (DGBIs) encompasses gastrointestinal disorders that globally affect more than one third of all people. The Rome IV criteria replaced the former term “functional gastrointestinal disorders.“ DGBIs can seriously challenge health and quality of life (QoL). A traditional but outdated approach differentiated “organic” vs “functional“ disorders, seen by some as real vs psychiatric or undefined ones. This traditional distinction did not help patients whose health and QoL are seriously affected. DGBIs include motility disturbance; visceral hypersensitivity; altered mucosal and immune function; altered central nervous system processing, and more. Several DGBIs affect both children and adolescents. DGBIs are characterized by clusters of symptoms. Their pathophysiology relates to combinations of altered motility, visceral sensitivity, mucosal immune function, and more. Routine investigations find no structural abnormality that would easily explain the symptoms. Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials. To understand DGBIs and to find ways to treat them, these rigid mechanistic views fall short.

Keywords: Disorders of gut-brain interaction; American Psychiatric Association; Rome foundation; Rome IV; Gut-brain-axis; Functional diseases; Psychiatric diseases; Mechanistic approaches; Symptom-based criteria; Clinical trials; Drugs; Biologics

Core Tip: Disorders of gut-brain interaction can seriously challenge patients‘ health and quality of life (QoL). This new approach no longer differentiates organic from functional (or psychiatric) disorders. This former, now outdated distinction did not help patients whose QoL was and is seriously impaired. Instead, todays symptom-based criteria attempts to better understand patients. The traditional explanations did not allow satisfying clinical treatment nor inclusion into exploratory trials with new drugs or biologics. With this new approach, the hope is to overcome the shortcomings of traditional approaches.