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Diagnosis and Treatment |

Diagnosing and Treating Patients with Refractory Functional Gastrointestinal Disorders

Douglas A. Drossman, MD
[+] Article and Author Information

From the University of North Carolina, Chapel Hill, North Carolina. For the current author address, see end of text. Requests for Reprints: Douglas A. Drossman, MD, Division of Digestive Diseases, CB #7080, 420 Burnett-Womack Building, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(9):688-697. doi:10.7326/0003-4819-123-9-199511010-00008
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One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient–physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms. This approach is likely to improve patient and physician satisfaction, adherence to treatment, and clinical outcome.

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Grahic Jump Location
Figure 1.
A diagnostic strategy for evaluation of patients with functional gastrointestinal disorders.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Descending inhibitory pathway for pain control.

Diagram shows the inhibitory effect of the descending corticofugal pathway on pain control.

Grahic Jump Location

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