Improving Care for Patients with Disorders of Gut Brain Interactions - Presented by Dr. David Rodrigues

TMED Blog

| 14 October 2022

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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

Improving Care for Patients with Disorders of Gut Brain Interactions - Presented by Dr. David Rodrigues

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Improving Care for Patients with Disorders of Gut Brain Interactions - Presented by Dr. David Rodrigues