Improving Care for Patients with Disorders of Gut Brain Interactions - Presented by Dr. David Rodrigues
By Hailey Schincariol, MSc Candidate, TMED801 Student
On October 6, the Department of Medicine had the pleasure of hosting Dr. David Rodrigues, a
Gastroenterologist and Assistant professor in the Division of Gastroenterology at Queen’s
University. Dr. Rodrigues introduced the topic of Disorders of Gut Brain Interaction (DGBI), with
an emphasis on improving patient care through medical education.
DGBI, previously known as functional gastrointestinal disorders, are a group of illnesses
characterised by chronic gastrointestinal symptoms (e.g., abdominal pain, dyspepsia, diarrhoea,
constipation, and bloating) in the absence of pathological evidence(3). Symptom presentation is
generally used to diagnose these disorders as lab results, endoscopic findings, and imaging
show no structural changes(2). The global prevalence of DGBI is more than 40% with irritable
bowel syndrome (IBS) and functional dyspepsia (FD) representing 10% of the total cases(1).
Dr. Rodrigues emphasized how DGBI are challenging to treat due to perceptions of stigma
associated with the disorder. Stigma is a common phenomenon in healthcare that undermines
the quality of care for patients such as those with DGBI(3). In the clinical setting, stigma is
associated with lower quality of life due to increased depression or anxiety and treatment non-adherence(3).
Without physical findings, patients with DGBI do not fit into the biomedical model,
making the disorder difficult to diagnose and understand for many physicians(3).
The societal stigma stemming both from the patients and physicians creates what Dr. Rodrigues
describes as a “vicious cycle” of healthcare seeking behaviours. He went on to explain how
deficiencies in the training of gastroenterologist residents prevents them to accept the
diagnosis of a DGBI. In the process, there may be a lack of communication between the
physician and patient, resulting in an exacerbation of patient distress, restriction in physician
satisfaction and inevitably clinical burnout.
It is evident many residents are underprepared to deal with patients of DGBI(4). Therefore, Dr.
Rodrigues promotes the idea of continued medical education throughout a physician’s career
to continually be knowledgeable in treating these disorders. He believes “increasing the
frequency of cases and increasing instruction of care is one of many steps that can help address
potential deficiencies in gastroenterologist training”. Likewise, Dr. Rodrigues mentions
“identifying when and where perceptions of stigma occur could help design interventions to
prevent against them”.
Following the excellent presentation, Dr. Rodrigues was gracious to lend his time to the
Translational Medicine Graduate Students for an interactive discussion on DGBI. One point of
interest was the role of the gut microbiome and patients with DGBI. Gut dysbiosis, or the
disruption of the homeostasis of the gut microbiome, has a significant impact on the gut-brain
axis and may manifest physiologically, in the form of IBS or mental illness, such as depression.
We spoke about Equity, Diversity, Inclusion, and Indigeneity (EDII) initiatives that Dr. Rodrigues
practices in his research and clinic. Stigma associated with DGBI disproportionately impacts
those with lower socioeconomic status and Dr. Rodrigues highlighted the importance of
listening to each patient’s story individually to learn more about how DGBI impacts their daily
life. In doing so, Dr. Rodrigues provides treatment plans that are tailored to his patients’ needs.
Speaking on the impact of his education, Dr. Rodrigues is an alumnus of Queen’s University,
undertaking his graduate and gastroenterology residency here, and mentioned of his valuable
time in the Queen’s Motility Clinic with his mentors that provided him with a strong
foundational understanding of DGBI. Notably, he mentioned that not all medical learners may
be privy to such experiences; learners at more remote institutions may not have the
opportunities that he was fortunate to have, and that continuing education for medical learners
should be accessible for all, regardless of location, socioeconomic status, etc. Speaking about
his career at present day, he emphasized the importance of work-life balance. Despite working
in a demanding profession, Dr. Rodrigues makes an emphasis to spend time with his family, as
well as continuing his passion for music. He believes that maintaining this work-life balance
allows him to refresh after a long day’s work and prevent burnout, something that is becoming
more prevalent in the healthcare field.
On behalf of the Translational Medicine Graduate Program and its students, I would like to
thank Dr. Rodrigues for his captivating presentation at Grand Rounds and taking the time to sit
down with us for an impactful conversation. His work continues to make a great impact in our
community, and we look forward to seeing him continuing the be a patient advocate and
champion.
References
1. Colomier, E., Melchior, C., Algera, J. P., Hreinsson, J. P., Störsrud, S., Törnblom, H., Van
Oudenhove, L., Palsson, O. S., Bangdiwala, S. I., Sperber, A. D., Tack, J., & Simrén, M.
(2022). Global prevalence and burden of meal-related abdominal pain. BMC medicine,
20(1), 71. https://doi.org/10.1186/s12916-022-02259-7
2. Feingold, J. H., & Drossman, D. A. (2021). Deconstructing stigma as a barrier to treating
DGBI: lessons for clinicians. Neurogastroenterology & Motility, 33(2), e14080.
3. Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders.
Clinical Medicine, 21(1), 44.
4. Simons, J., Shajee, U., Palsson, O., Simren, M., Sperber, A. D., Törnblom, H., Whitehead,
W., & Aziz, I. (2022). Disorders of gut-brain interaction: Highly prevalent and
burdensome yet under-taught within medical education. United European
gastroenterology journal, 10(7), 736–744. https://doi.org/10.1002/ueg2.12271
