Disorders of Gut-Brain Interaction (DGBI)

Disorders of gut-brain interaction (DGBI), formerly called functional gastrointestinal disorders, are a group of conditions that affect your digestive system. The word “functional” means there’s a problem with how your gut works. These conditions cause ongoing symptoms, like belly pain, bloating, constipation and diarrhea. But they don’t show signs of any structural issues during routine testing, like a blockage or an ulcer.

These disorders occur because of changes in the way your gut and brain communicate. Your gut and brain are closely connected through nerves and chemical signals. When this communication changes, your gut may:

• Become more sensitive
• Move food too quickly or too slowly
• Send stronger pain signals to your brain

DGBI are common. More than 1 in 4 adults have symptoms of at least one of these disorders.

DGBI examples

There are more than 50 disorders of gut-brain interaction. The most common include:

• Irritable bowel syndrome (IBS)
• Functional dyspepsia (upper belly discomfort)
• Functional constipation
• Functional diarrhea
• Functional bloating
• Functional belly pain

IBS and functional dyspepsia are the two most common types.

DGBI symptoms

Symptoms depend on which part of your digestive system the condition affects. They can range from mild to severe, and they often come and go.

Common symptoms include:

• Belly pain or discomfort
• Bloating or visible swelling of your belly
• Changes in bowel habits, like constipation or diarrhea
• Nausea and vomiting
• Feeling full quickly when eating
• Excess gas or burping

DGBI causes

Researchers don’t fully understand the causes. But there are several factors that may play a role. These include:

• Changes in gut-brain communication: Your gut and brain constantly send signals back and forth. In DGBI, those signals may become damaged or overly sensitive.
• Altered gut movement: Food may move too quickly or too slowly through your digestive system.
• Increased gut sensitivity: Your nerves may react more strongly to normal stretching or movement in your intestines. This can make normal digestion feel painful.
• Changes in your gut lining: Some people, especially after an infection, may develop changes in their gut barrier. This can make your digestive system more sensitive.
• Microbiome changes: Your gut bacteria are different from those of someone without symptoms. These changes can affect how much gas you produce and your bowel habits.
• Bile acid changes: In some people with IBS with diarrhea (IBS-D), higher bile acids may speed up movement in their large intestine.
• Stress and central nervous system involvement: Stress can affect how your brain and gut interact. Anxiety and depression are common in people with these disorders, and the relationship works both ways. Gut symptoms can affect your mood, and mood can affect your gut.

Risk factors

You may be more likely to develop a DGBI if you:

• Are under 50
• Are female
• Have anxiety or depression
• Had a recent gastrointestinal infection
• Took certain medications, like antibiotics or opioids

Complications of this condition

These disorders don’t cause structural damage to your digestive system. But they can:

• Lower your quality of life
• Affect your work and social activities
• Increase visits to your healthcare provider
• Lead to anxiety or depression

How doctors diagnose this condition

Healthcare providers diagnose DGBI by asking about your medical history and performing a physical exam. They’ll ask about your symptoms to try to figure out which type of DGBI you have.

There isn’t one single test that confirms the disorder. But your provider may order tests to rule out other conditions. These tests include:

• Blood tests
• Thyroid testing
• Celiac disease testing
• Stool (poop) test
• Colonoscopy

How is it treated?

DGBI treatment focuses on managing your symptoms. You may have to make changes to what you eat. Your provider may also recommend specific treatments based on your main symptoms. These may include:

• For constipation: Laxatives, soluble fiber like psyllium or prescription medicines that increase fluid in your intestines.
• For diarrhea: Anti-diarrheal medicines, targeted prescription medications and short courses of certain antibiotics to control bowel movements.
• For upper belly discomfort: Short-term prokinetic medicines to help move food along or proton pump inhibitors to reduce acid.
• For abdominal pain: Low-dose tricyclic antidepressants to calm nerve signals or antispasmodic medications to relax your muscles.

In addition, certain therapies can help control the signals between your gut and brain, including:

• Cognitive behavioral therapy (CBT)
• Gut-directed hypnosis
• Stress management

Because these conditions are long-lasting (chronic), you may need to change treatment over time.

When should I see my healthcare provider?

See your provider if:

• Your symptoms are new or worsening.
• You notice blood in your poop.
• You lose weight without trying.
• You feel very tired or weak.
• Symptoms begin after age 50.
• You have a biological family history of colon cancer.

Seek urgent care if you have severe pain, black poop or signs of dehydration, like dry mouth.

What can I expect if I have this condition?

DGBI are chronic but manageable. They don’t damage your digestive system or increase your risk of cancer.

With the right treatment plan, many people see great improvement. But symptoms may still come and go throughout your life.

Is there anything I can do to feel better?

Yes. You can:

• Keep a food diary.
• Try a low FODMAP diet under guidance.
• Increase soluble fiber if you have constipation.
• Get regular physical activity.

Building a strong relationship with your provider can improve your outcome.

Can this be prevented?

You can’t prevent all of these disorders. But you may be able to reduce flare-ups by:

• Staying active
• Managing stress
• Eating healthy, balanced meals that avoid ultra-processed foods
• Avoiding known food triggers
• Using medications carefully