Every gastroenterologist deals with difficult GI consultations. Often these are patients who have functional abdominal pain or functional bowel disorders.

“What becomes so frustrating is these are symptoms for which we can’t run a test, can’t take a picture of it, can’t get an X-ray for it,” said Brennan Spiegel, MD, MSHS, AGAF, professor of medicine and public health at the University of California, Los Angeles, and director of health services research at Cedars-Sinai Hospital. “When you are left with no objective data, working with patients to improve their well-being while retaining the authority that we know what we are talking about can be a challenge.”

Dr. Spiegel and Douglas A. Drossman, MD, AGAF, co-director emeritus of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill, and president of the Rome Foundation, will moderate Sunday afternoon’s AGA Clinical Symposium How to Manage Difficult Gastroenterology Consultations.

The symposium’s presenters will examine techniques to control pain in patients with functional GI disorders, manage patients with complex inflammatory bowel disease and incorporate psychological care in the clinic to manage the brain-gut axis.

“When you look at functional GI patients, there’s always the temptation and the risk of doing more tests to find a more specific disease,” Dr. Drossman said. “Not every GI is skilled in more appropriate techniques, such as using central neuromodulators or referring for behavioral treatment, or even personally building an effective provider-patient relationship. A good relationship is a very low-cost and highly efficient way to help patients with conditions like chronic pain.”

Indeed, psychological care is a new frontier for many GIs, Dr. Drossman said. The Rome Foundation has created a psycho-gastroenterology group of psychologists who work specifically with GI patients.

Building a useful provider-patient relationship can also be a new frontier.

“Patients with chronic pain are often looking for a quick fix or a new diagnosis or a different workup,” Dr. Spiegel said. “The reality is that you have to set realistic expectations and explain the pathophysiology of pain. And you have to look at treatments that could include pharmacotherapy and psychological treatment.”

One element in building a good relationship is simply listening to the patient, Dr. Spiegel said. Studies have found that when patients try to explain their condition, the typical clinician interrupts within 10 to 20 seconds.

“There’s a real therapeutic benefit from listening,” Dr. Spiegel said. “Doctors don’t always appreciate how powerful it can be to allow someone the opportunity to describe their illness experience in their own words while being empathetic. It may not lead to a diagnosis but it can make people feel better just to know that somebody is listening to them.”

Please refer to the DDW Mobile App or the Program section in Sunday’s issue for the time and location of this and other DDW^® events.