Neuro Gastroenterology

The gut-brain connection refers to the complex communication network between your digestive system and brain. This connection involves the nervous system, hormones, and immune system. Stress, anxiety, and other emotional factors can directly impact digestive function, leading to symptoms like IBS, functional dyspepsia, or altered gut motility. Understanding this connection helps us provide comprehensive treatment that addresses both physical and psychological aspects of digestive disorders.

Neuro-gastroenterology focuses on disorders of gastrointestinal motility and function, including gastroparesis, irritable bowel syndrome (IBS), chronic constipation, functional dyspepsia, achalasia, and other conditions where the nervous system's control of the digestive tract is impaired. We use specialized tests like manometry and electrogastrography to diagnose these conditions and offer treatments including medications, dietary modifications, and biofeedback therapy.

Stress significantly impacts digestion through the gut-brain axis. It can slow or speed up gut motility, increase acid production, alter gut bacteria, and increase intestinal permeability ('leaky gut'). Chronic stress can trigger IBS symptoms, worsen inflammatory conditions, and affect nutrient absorption. The vagus nerve, which connects the brain to the gut, plays a key role in this communication. Managing stress through relaxation techniques, exercise, and therapy can significantly improve digestive symptoms.

Gastroparesis is a condition where the stomach muscles don't work properly, causing delayed stomach emptying. Common causes include diabetes, certain medications, and neurological conditions. Symptoms include nausea, vomiting, feeling full quickly, and abdominal pain. Treatment involves dietary modifications (small, frequent meals, low-fat, low-fiber foods), medications to stimulate stomach motility, and in severe cases, procedures like gastric electrical stimulation or surgery. Blood sugar control is crucial for diabetic gastroparesis.

Functional dyspepsia causes upper abdominal pain, bloating, early satiety, and nausea without identifiable structural abnormalities. Unlike GERD, which involves acid reflux, functional dyspepsia is related to altered stomach motility and sensitivity. Diagnosis requires ruling out other conditions through endoscopy and testing. Treatment includes dietary changes, stress management, medications that improve gastric motility or reduce stomach sensitivity, and sometimes psychological interventions. The condition is chronic but manageable with proper treatment.

IBS is diagnosed using Rome IV criteria, which include recurrent abdominal pain associated with changes in bowel habits for at least 6 months. There's no specific test for IBS; diagnosis involves ruling out other conditions. Latest treatments include the low-FODMAP diet, specific probiotics, medications like rifaximin and eluxadoline, psychological therapies (cognitive behavioral therapy, gut-directed hypnotherapy), and stress management techniques. Treatment is personalized based on predominant symptoms (diarrhea, constipation, or mixed).

SIBO occurs when bacteria from the large intestine migrate to the small intestine, causing bloating, gas, diarrhea, and abdominal pain. Many patients diagnosed with IBS may actually have SIBO. Diagnosis involves breath testing with lactulose or glucose. Risk factors include certain medications, structural abnormalities, and conditions affecting gut motility. Treatment typically involves antibiotics (rifaximin), dietary changes, and addressing underlying causes. SIBO can recur, so identifying and treating predisposing factors is important.

Motility disorders affect the movement of food through the digestive tract due to problems with muscles or nerves controlling gut function. Examples include achalasia, gastroparesis, chronic intestinal pseudo-obstruction, and hirschsprung disease. Diagnosis involves specialized tests like esophageal manometry, gastric emptying studies, small bowel manometry, and defecography. Symptoms vary by location but include difficulty swallowing, nausea, vomiting, constipation, and abdominal pain. Treatment depends on the specific disorder and may include medications, dietary changes, or procedures.

Yes, anxiety and depression can significantly affect digestive function through the gut-brain axis. These conditions can alter gut motility, increase visceral sensitivity, change gut bacteria composition, and affect immune function. Many patients with functional GI disorders also have anxiety or depression. Treatment often requires addressing both psychological and physical aspects. This may include antidepressants that also benefit gut function, cognitive behavioral therapy, stress reduction techniques, and sometimes referral to mental health professionals.

The gut microbiome consists of trillions of bacteria that help digest food, produce vitamins, regulate immunity, and communicate with the brain. Imbalances (dysbiosis) can contribute to IBS, IBD, and other digestive disorders. Factors affecting microbiome health include diet, antibiotics, stress, and illness. Maintaining microbiome health involves eating diverse, fiber-rich foods, limiting processed foods, managing stress, and judicious antibiotic use. Probiotics and prebiotics may help restore balance, though specific strains and doses vary by condition.