The Curbsiders Internal Medicine Podcast

#334 IBS, Functional Dyspepsia, and Cyclic Vomiting: Disorders of Gut Brain Interaction (DGBI)

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May 9, 2022
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ADVICE

Match Treatment To Predominant Dyspepsia Symptom

  • Target therapy to the predominant symptom: use buspirone for postprandial distress and TCAs for epigastric pain from visceral hypersensitivity.
  • Offer peppermint/caraway formulations and dietary changes (smaller meals, avoid high fat/fiber) as first-line nonpharmacologic measures.
INSIGHT

Use A Positive Diagnosis To Improve Outcomes

  • Make a positive diagnosis early and explain it to patients rather than using it as an exclusion after normal tests.
  • Patient confidence in the diagnosis boosts placebo response and adherence to therapy.
ANECDOTE

Caraway Tea 'Cured' A Case

  • The hosts closed Miss Floyd's case humorously: her caraway tea 'miraculously' resolved symptoms overnight.
  • This illustrates how patients often try many remedies before presentation.
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