Report from the 10th International Symposium on Functional Gastrointestinal Disorders
The 10th International Symposium on Functional Gastrointestinal Disorders, jointly sponsored by the University of Wisconsin School of Medicine and Public Health, Office of Continuing Professional Development in Medicine and Public Health, and the International Foundation for Functional Gastrointestinal Disorders (IFFGD), took place in Milwaukee, WI April 12-14.
“This meeting is a demonstration of the importance and the significance that functional GI and motility disorders have in the field of medicine internationally.”
- IFFGD president and co-founder Nancy Norton.
The biennial symposium brings together professionals in multiple disciplines from around the world to communicate new knowledge in the field of functional gastrointestinal (GI) and motility disorders to those who treat the conditions.
Nearly 400 physicians, psychologists, researchers, fellows, physician assistants, nurse practitioners, nurses and other health professionals – from five of the seven continents – discussed the latest in clinical skills in diagnostics and patient care.
Over three full days, 31 medical education sessions were taught by 87 international experts on topics across the spectrum of these chronic digestive conditions. The first sessions of the symposium, presented by senior researchers in the field, laid out our most current knowledge about functional GI disorders, including:
- What is the currently known about functional GI disorders?
- How widespread are they?
- What is known about their causes and mechanisms?
These talks presented the background for the cutting-edge research that would be presented throughout the symposium.
WHAT WE KNOW: An integrated understanding of the functional GI disorders
Presented by Douglas Drossman, M.D. (Drossman Gastroenterology; Chapel Hill, NC), this session explained what is known and accepted by the medical community about functional GI disorders, and how best to treat them.
Dr. Drossman emphasized that, despite the fact that functional GI disorders are not defined by tests like x-ray or endoscopy, they are very real medical conditions. While not caused by stress alone, stress does make them worse. Current research into understanding and treating functional GI disorders uses what is known as the biopsychosocial model. Dr. Drossman demonstrated to the audience how this model encompasses all of the scientific findings into the causes, mechanisms, and triggers for functional GI disorders. He touched on a number of topics that were discussed later in the meeting, including:
- Early life factors
- Communication between nerves, hormones and cells within the body (Nerve, hormonal, and intercellular signaling)
- The role of infection or injury
- Gut flora
- The role of intestinal barrier functions (intestinal permeability)
- Dietary influences
- Neuroplasticity and neurogenesis (change in nerve patterns and connections; and nerve growth)
The current standards of diagnosis for functional GI disorders were then discussed, along with the work of the Rome Foundation, a professional organization that provides help for research into these disorders, to develop multi-component diagnostic measures. These consider factors such as severity and physiological function in addition to the currently used symptom-based diagnostic criteria.
Dr. Drossman went on to review current available treatments, as well as new options still being researched. The latest strategy suggests providing different types of treatment depending on disease severity, and focuses much more on how a good relationship between patient and physician is necessary for a good therapeutic outcome.
GLOBAL EPIDEMIOLOGY: How widespread are they?
Eamonn Quigley, M.D. (Methodist Hospital; Houston, TX) presented an overview of the global status of functional GI disorders, using IBS as an example. He reviewed a tremendous amount of data from around the world studying IBS, looking at symptoms, severity, causes, age, gender, and other factors. With much more international research contributions to these disorders, he says, we are establishing that functional GI disorders are an important global issue.
Scientists across the globe are researching similar topics. The genetics of IBS is being studied in many countries, as are the roles of diet and of infection. Access to healthcare is important for adequate treatments of these disorders and is being studied in many parts of the world.
“This perhaps is the most important advance… that irritable bowel syndrome is common worldwide, and is a healthcare burden for many. And this is because, for some individuals…IBS can be extremely disabling.”
– Eamonn Quigley, M.D.
Dr. Quigley noted that while there is some variation in what these studies have shown, overall the findings are quite similar. This may have implications for understanding the effects of important factors like diet, genetics, and the gut microbiota, which should be somewhat different in different countries and regions. Dr. Quigley suggested that, if IBS appears mostly the same across the world despite these differences, this could help us understand something about the fundamental nature of IBS and other functional GI disorders.
Dr. Quigley concluded with research priorities for global study of these disorders. Among these is making sure that there is consistency in the description of the conditions throughout the international community, and determining if the conditions are truly the same everywhere, and recognizing how local variables such as diet and microbiota are affecting this digestive disorder.
NEW CONCEPTS IN PATHOPHYSIOLOGY OF FUNCTIONAL GASTROINTESTINAL DISORDERS:
Causes and mechanisms:
Giovanni Barbara, M.D. (University of Bologna; Italy) discussed the latest research into what cause functional GI disorders and their symptoms.
It has been established that changes in the pathways between the brain and the gut involving the central nervous system (CNS) have a “top-down” role in the development and severity of functional GI disorders.
These include the nerve and cellular mechanisms that are the result of psychosocial triggers such as stress and lead to changes in gut motility and secretion; as well as the changes in pain signaling within the brain.
Additionally, Dr. Barbara indicates that research has shown there to be important “bottom-up” mechanisms involved as well. These are often referred to as peripheral mechanisms because rather than the CNS, they are within peripheral nerve pathways located outside the brain and spinal cord or even within the gut itself. An example would be alterations to the microbiota of the gut or changes in the gut’s behavior in response to foods. Sometimes these changes can activate responses in the gut which eventually leads to stimulation of brain responses such as increased pain perception.
With evidence for both top-down central mechanisms and bottom-up peripheral mechanisms, it is concluded that communication goes in both directions. Functional GI disorders therefore result from a disturbance in this communication in one or both directions between the brain and the gut. It is hypothesized that differences in which mechanisms, or how much of them, are altered may be associated with differences in how severe a person’s functional GI disorder is, or even which of these disorders a person has. Some of these alterations may affect how vulnerable an individual is to developing a functional GI disorder if they are exposed to certain environmental triggers. Others may themselves be the triggers to developing a disorder or symptom. There are also interactions between vulnerability and triggers that are not yet known.
“Functional gastrointestinal disorders are complex… likely with different underlying mechanisms.”
– Giovanni Barbara, M.D.
Dr. Barbara concluded his talk by discussing some candidates for future research, which may help find a unifying mechanism underlying both directions of brain-gut dysregulation.
These and other topics discussed at the 10th International Symposium on Functional Gastrointestinal Disorders shed new light on potential treatments and understanding of these disorders. There were many more exciting research avenues discussed at the meeting – we will feature these in future issues of this magazine.
“I’ve been coming to this meeting since its inception in 1995 and I’m very pleased to say, with the efforts of all you present in the room: our scientists, our basic scientists, our patients, and our patient advocates and advocacy groups, we’ve seen a vast improvement in the overall funding of research in the area of GI and functional disorders. We just want to thank you for all of your efforts that you’ve done behind the scenes in order to make a difference in the lives of so many of our patients.”
– Frank Hamilton, M.D.