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In gastroenterology, office visits, led by the provider, frequently emphasize physical symptoms in a focused interview process that ends with diagnostic procedures, order slips, and medication prescriptions. But I would argue that the patient’s story is the most important piece of the diagnostic process. If you’re missing the story, you’re missing the point. GI conditions don’t occur in a vacuum—they’re usually multifactorial and heavily influenced by emotional, relational, and environmental considerations. As life becomes increasingly stressful for patients, the call for patient-centered, holistic care grows louder.

Strengthening the patient-provider relationship

One of the most important things providers can do is respect our relationship with patients. They trust us with personal information about their health and their lives. We must honor this trust by speaking clearly and directly about their conditions, respecting their time, remaining fully present during appointments, empowering them to make their own decisions, respecting their input, setting realistic expectations, and providing appropriate education.

If we want the patient to share their story, we must create a sense of safety. A study by Drossman and colleagues found that a strong patient-provider relationship encourages patients to provide more meaningful, clinically relevant information. This improves appointment efficiency, increases patient trust and engagement, leads to better clinical outcomes, and enhances provider fulfillment.

Understanding the gut-brain axis

The brain and gut are in constant communication via the vagus nerve. Factors like past and present trauma, stress, relational complexities, resilience, sleep, mood, nervous system regulation, breathing patterns, and adaptive survival techniques (such as hypervigilance and emotional detachment) affect how the GI tract functions—or doesn’t.

Gut-brain interaction is more complex than a single article can cover, but one key aspect is nervous system regulation. When the sympathetic nervous system is engaged, all available energy is diverted to life-saving measures, such as muscle tension and elevated heart rate.

Some of our patients live in a constant state of red alert because their life experiences keep them in fight-or-flight mode. Usual operations of digestion, such as peristalsis and nutritional absorption, stop. When an unregulated nervous system disrupts digestion, patients may experience chronic abdominal symptoms, such as diarrhea, constipation, bloating, or nausea.

Call to action

The time has come for gastroenterology to assess and treat the gut and brain as interdependent.
A study by Salwen-Deremer and colleagues supports the integration of psychiatric treatment modalities into GI care. Techniques like cognitive behavioral therapy, gut-directed hypnotherapy, polyvagal theory, trauma-informed care, and mindfulness-based interventions can improve
patients’ GI outcomes.

To make GI care more holistic and effective, providers can begin simply—listen to patients and their stories. Ask patients how they’re sleeping, build rapport by looking up from the computer and making eye contact, normalize symptoms and patient experiences, and encourage questions. Providers also can establish a trusted referral list and collaborate with psychiatric health specialists to help patients access more comprehensive care. Let’s do better for our patients.

Lindsay Bitto owns and operates Evergreen Health and Life, a virtual private practice focused on treating integrative psychiatry and gastropsychiatry patients.

References

Drossman DA, Ruddy J. Improving patient-provider relationships to improve health care. Clin Gastroenterol Hepatol. 2020;18(7):1417-26. doi:10.1016/j.cgh.2019.12.007

Salwen-Deremer JK, Bardach SH, Tormey LK, Szkodny LE, Gohres K, Siegel CA. Redesigning a gastroenterology behavioral health program to improve patient access. Clin Gastroenterol Hepatol. 2024;22(1):12-5.e1. doi:10.1016/j.cgh.2023.09.032

Disclaimer: This content is sponsored and supplied to American Nurse Journal by Walgreens. Content has been reviewed by ANJ editorial staff but is not peer-reviewed.