Integrative Gastroenterology PDF
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A few years ago, a leading gastroenterologist in Tucson asked me to meet with him. Over dinner, he expressed the hope that integrative medicine (IM) might have something to off er him. He was frustrated, he said, because, “ninety percent of the patients I see have problems that my training does not enable me to solve.”
At that time, the Arizona Center for Integrative Medicine was offering a comprehensive IM fellowship in distributed learning format to physicians and nurse practitioners. We were training family medicine doctors, internists, and surgeons, but had not yet had a GI specialist apply. Th at disappointed me, because I knew that integrative medicine could greatly enrich the field of gastroenterology, increasing its efficacy and reducing the frustration expressed by my colleague in Tucson and shared by many others.
One of the core curricular areas of IM is mind/body medicine. It covers the theory and evidence base for interactions between mental/emotional states and physiology, as well as therapies that take advantage of those interactions. Steven Gurgevich, PhD, a clinical psychologist on the faculty of the American Society of Clinical Hypnosis, helped design the mind/body medicine module. He has said, “Patients with gastrointestinal problems should be seen by hypnotherapists before they go to gastroenterologists,” and over the years, I have referred many patients with GI complaints to him and other mind/body practitioners, with good outcomes. His reasoning is that the organs of the GI system, along with the skin, have the greatest amount of innervation of any organs and, as a result, are the most frequent sites of expression of stressrelated disorders. Michael Gershon, MD, chairman of the Department of Anatomy and Cell Biology at Columbia University Medical Center, in an excellent book on enteric neurology, refers to the gut as the “second brain.”
Many common GI disorders arise from disturbed function of the gut—in particular, an imbalance between its intrinsic motility and extrinsic control by the autonomic nervous system (oft en caused by stress-related overactivity of the sympathetic nerves). Without harmonious coordination, gut motility is abnormal and digestion impaired. In late stages of these disorders, we can visualize or otherwise detect pathological changes, but early on they present as functional complaints. Patients seek relief of GI symptoms; there are few or no measurable correlates of the symptoms.
“Functional disorder” is a loaded term in conventional medicine. Oft en it is used to dismiss complaints of patients without visible pathology; at worst, it is used as a synonym for “imagined disease.” Patients are easily angered by suggestions that their GI problems are all in the mind. Practitioners must be able to help them understand the underlying somatopsychic mechanism that accounts for their very real symptoms.
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