The full content of Annals is available to subscribers

Subscribe/Learn More  >
Diagnosis and Treatment |

Diagnosing and Treating Patients with Refractory Functional Gastrointestinal Disorders

Douglas A. Drossman, MD
[+] Article, Author, and Disclosure 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
Text Size: A A A

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.


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




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.