Conventional Assessment of Gastrointestinal Disorders

The gastrointestinal tract is a highly complex and dynamic organ system having a multitude of physiological functions. The choice of laboratory tests should be personalized and not performed in a shotgun manner, which can lead to false positive results and imparts financial stress to patients. The assessment of digestive health conditions requires giving astute attention to the patient’s history and a methodical utilization of laboratory tests to define root causation of illness and opportunities for intervention. This chapter segregates the most common tests and procedures to evaluating gastrointestinal condition into conventional tests that are usually covered by medical insurance and functional medicine and genomic testing that by-in-large have larger out-of-pocket expenses. Strategic utilization of these tests are essential to the proper evaluation of gastrointestinal illness.

Weight Disorders

Obesity and its associated comorbidities remain a significant global health issue. Despite the well-known consequences and related comorbidities associated with being overweight and obese, the prevalence remains alarmingly high and is increasing. In 2011–2014, the prevalence of obesity was 36.5% in adults and 17% in youth. The exact reasons for the prevalence and increase are multifactorial but reflect the overall lack of success of standard treatments. It is therefore not surprising that individuals often seek alternative therapies, including a variety of fibers, minerals, teas, and herbal supplements. Aside from the financial implications, many of these products have very little supporting evidence; some are unsafe. This chapter will review some of these alternative therapies with emphasis on the scientific evidence that supports or refutes their use.

Upper Gastrointestinal Disorders

Upper gastrointestinal disorders are common conditions that have afflicted humans since antiquity. They can be categorized by primary location (esophagus or stomach) and by the presence of identifiable pathological changes. Symptoms range in severity and may not correlate with severity of underlying disease. This chapter explores the pathophysiology, symptoms, and diagnoses of gastroesophageal reflux disease, gastritis, peptic ulcer disease, and functional dyspepsia. Modifiable risk factors and potential benefits and harms of conventional treatments are examined. Specific recommendations for comprehensive lifestyle modifications for these conditions are described, including proper nutrition, physical activity, stress management, sleep, toxin reduction, and other external factors. Integrative approaches are then explained, with a focus on botanicals and supplements, followed by a review of homeopathy, psychological therapy, and acupuncture. Finally, lifestyle changes and integrative treatments are summarized.

An Integrative Approach to Abdominal Pain

This chapter discusses abdominal pain in the context of functional gastrointestinal disease (FGID) and some chronic inflammatory bowel diseases, recognizing the huge burden it places on the health care system and emotional costs to patients and health care professionals. It presents a review of several modalities that include mind–body medicine practices, natural products, botanicals, manual and movement-based therapies, and pharmaceuticals that can be used as part of an integrative health plan for patients presenting with FGID and abdominal pain. It describes an integrative approach that weaves in concepts of patient-centered care, effective communication, empathic listening, mindfulness, and evidence-informed practice.

Mind–Body Interventions in the Care of Functional Gastrointestinal Disorders

This chapter reviews the clinical utility of various mind–body interventions (MBIs) in the treatment of functional gastrointestinal disorders (FGID), including cognitive behavioral therapy, mindfulness, yoga, hypnosis, and biofeedback. Chronic or traumatic stress may dysregulate functions of the autonomic nervous system and lead to maladaptive changes in the brain–gut axis. Optimized regulation of the autonomic nervous system improves gastrointestinal function and may be a common factor in various MBIs used to treat stress-related FGID. In recent years, an expansion of randomized controlled trials and meta-analyses has provided additional evidence supporting the use of MBIs in treatment of FGID symptoms and related quality of life. This chapter includes a theoretical discussion of the stress response, the relaxation response, and the role of the mind as a regulatory process. The chapter also addresses practical issues relevant to incorporating MBIs into the treatment of FGID, including the doctor–patient relationship and successful referral to an MBI practice or provider.

Energy Medicine and Gastrointestinal Disorders

Energy medicine (EM) consists of a range of modalities and techniques that work with the underlying energy field of the body. Techniques range from hands-on healing to using vibration, movement or sound. There is moderate evidence that energy medicine significantly decreases many types of chronic pain and is most utilized in patients with chronic pain syndromes. Energy medicine prevalence of use and evidence, specifically in GI disorders, has been less investigated. There are a few small studies demonstrating evidence for decreasing symptoms in inflammatory bowel disease and colorectal cancer. Despite the lack of specific data for GI disorders, due to its role in increasing relaxation and decreasing pain, it can be a useful adjunct therapy. Most energy medicine modalities have specific techniques for GI disorders. Finding a skilled practitioner, as well as learning how to use self-healing techniques, can be valuable additions to a patient’s plan of care.

Acupuncture for Gastrointestinal Disorders

This chapter provides an introduction to acupuncture, elucidates known neurobiological mechanisms of action, and summarizes the current evidence base for the use of acupuncture in the treatment of various gastrointestinal (GI) disorders. It reviews how acupuncture can increase esophageal and GI motility, reduce transient lower esophageal sphincter relaxations, stimulate gastric emptying, accelerate antral contractions, regulate neurohormonal mediators, promote autonomic and vagal tone, and modulate different regions of the brain-gut-microbiota axis. The therapeutic rationale for acupuncture as well as basic theories and concepts from a traditional Chinese medicine (TCM) perspective are also described. This chapter concludes with a discussion about the potential therapeutic combination of integrative East-West medicine to treat GI disorders.

Chiropractic

From its inception in 1895, chiropractic has overwhelmingly been a spine-focused discipline. The central connection between chiropractic and gastroenterology is the anatomy and physiology of viscerosomatic and somatovisceral reflexes. The profound anatomical and physiological interconnection of the gastrointestinal and musculoskeletal systems calls doctors of gastroenterology and chiropractic to understand this potent interface. Gut issues often cause back problems, and vice versa, through viscerosomatic and somatovisceral reflexes. Chiropractors, through spinal manipulation and other modalities, influence both systems. Root-cause gastrointestinal treatments also influence both systems. Recognizing these relationships better positions any health care practitioner to discern causative elements of presenting cases. This chapter explores the intersections between these two systems and two medical disciplines.

Herbal Medicine and Nutritional Supplements for Gut Health

Gastrointestinal complaints are among the most common health considerations. Current therapies such as acid blockers, non-steroidal anti-inflammatory drugs (NSAIDS) and antibiotics are not without their challenges and adverse effects. Herbal medicine provides an array of anti-inflammatory, antimicrobial, antiemetic, and carminative plants that provide additional tools to the health care professional. Quality dietary and nutritional supplements containing extracts of herbs, prebiotics, or probiotics offer a standardized delivery system for these ingredients. Herbal medicine and dietary supplements have been demonstrated to be effective in various gastrointestinal conditions. This chapter will highlight the nutraceutical products that have been proven in clinical trials to treat and mitigate digestive health ailments.

Conclusions

Integrative gastroenterology is an important field of medicine whereby the practitioner has the opportunity to not only improve troubling gastrointestinal symptoms but also to attain this goal from a multifaceted approach, using principles and modalities that involve the mind, body, gut microbiome, nutrition, stress management, and lifestyle modifications in order to address the entire patient while modulating gene expression, epigenetics, and the gut microbiome. This chapter presents conclusions regarding the future of integrative gastroenterology and its implementation.