Thinking with Our Gut: How the Management of GI Conditions is Evolving

Over the last decade, the public focus on gut health has become more prominent, uncovering new connections between the gut microbiome and overall health. This has led to major strides in advancing our understanding and management of gastrointestinal (GI) conditions. 

Where GI conditions, such as irritable bowel syndrome, were once thought to be solely psychological conditions rather than true physical concerns, today that has significantly changed following a combination of consumer-driven interest in improving gut health and new medical knowledge of the human gut microbiome thanks to new technology.

As a result, the evolution of managing GI conditions and caring for our gut microbiomes on a clinical level has come a long way, from antibiotic-focused care plans to integrated approaches and even at-home diagnostics. Here are three major ways the GI field is evolving to better care for patients today. 

Bringing nutrition on staff

Appreciation for nutrition’s role in health has gained steady momentum, leading to the growth of an integrated health approach in gastroenterology. With diets such as Low FODMAP and Low Fermentation Eating designed to sustain symptom management of IBS and small intestinal bacterial overgrowth (SIBO), there’s growing recognition that dietary approaches can support longer relief from some GI conditions. 

There has been significant interest in the food-as-medicine initiative among medical professionals and patients alike. This concept encourages the consideration of nutrition in health care delivery and promotes nutritious food itself as an integral part of care plans. While the growing specialty of therapeutic nutrition may be outside of the typical wheelhouse for most gastroenterologists, the rise of food-as-medicine and recognition of therapeutic nutrition as viable management strategies for GI disorders has welcomed more gastrointestinal registered dietitians (GRD) and similar professionals as new fixtures within GI practices. 

GRDs are specialized healthcare professionals who help patients manage their unique GI health needs through appropriate diet plans. By pairing antibiotics or pharmaceutical approaches to treat the root cause of GI disorders with GRDs offering nutrition counseling for symptom management, patients can more effectively manage their chronic conditions in the long run. Educating patients on nutrition in turn reduces the potential for condition flare-ups and future costs for medical or pharmaceutical intervention. 

The shift toward nutrition-based approaches to managing GI disorders is clearly seen in patients with SIBO. Historically, the most common first protocol for treating SIBO is antibiotics, which have about a 44% eradication rate, meaning many patients will have to do multiple rounds. A viable, more effective nutrition-based alternative has been found in a palatable elemental diet formulation, which successfully eradicates SIBO in 83% of patients. More non-pharmaceutical solutions like palatable elemental diets are what therapeutic nutrition professionals can bring to GI practices to broaden, complement and strengthen care plan options for their patients. 

Advanced technology leading to better care

Like in almost every aspect of healthcare, technology plays a critical role in enabling better care for GI patients. Over the last decade, gut diagnostic technology and non-invasive solutions have allowed patients to receive more accurate diagnoses and appropriate care in much less time and at significantly reduced costs.

In 2020, the first three-gas breath test, a non-invasive method for evaluating exhaled hydrogen, methane, and hydrogen sulfide, became available. This was a significant milestone for identifying conditions like SIBO, intestinal methanogenic overgrowth (IMO), and intestinal sulfide overproduction (ISO), which had historically been diagnosed based on symptoms of lactose intolerance or were grouped under the IBS umbrella. 

This test and similar breath test devices are currently available directly to patients for at-home identification of various conditions, enabling more people suffering from GI symptoms to access and overcome the first hurdle to appropriate care. This also helps prevent patients from having to wait several months or even years to schedule an invasive exploratory procedure with overburdened medical procedure teams that could cost several thousand dollars out of pocket, all the while experiencing debilitating and worsening symptoms. 

Additionally, mobile apps to support integrated care plans for GI patients are becoming more broadly available. Lifestyle factors can keep patients in an unpleasant cycle, with stress and anxiety worsening symptoms of IBS or other chronic conditions while persistent GI issues can lead to increased stress and anxiety. Now, the loop can be broken. Gastroenterologists can recommend these apps – with a few options authorized by the FDA – to offer patients virtual support for managing lifestyle factors and fill in any gaps that their practice may not yet offer directly, such as meal-planning or mindfulness techniques to reduce stress. 

Consumer trends and impacts on GI

Consumer trends have indicated patients are drawn to “cure-all” products that social media and wellness influencers often tout as traditional remedies or convenient health “hacks,” despite claims that may extend far past benefits documented in clinical research. Oftentimes, GIs are the ones who have to sort through the aftermath of these trends.

For example, prebiotics and probiotics have gained popularity over the last few years in the forms of supplements, smoothie shots, and now “healthy” sodas. Many patients revere them as keys to curing their guts and improving their health by increasing helpful gut bacteria. For most individuals, an occasional probiotic is fine. However, due to a lack of awareness of how their microbiomes work, many don’t know that their favorite influencer’s preferred probiotic can actually enable further harm if their gut problems stem from an overabundance of certain bacteria – even the good kind.

As time passes, new harmful and surprising trends will arise that GIs have to be familiar with in order to understand all contributing factors to a patient’s symptoms. In fact, eating dirt has trended twice in the last decade. Thankfully, more health experts and providers on social media are speaking out to help combat harmful trends and highlighting data that debunk problematic fads. GIs, PCPs, and more will need to continue re-aligning patients with medical facts and clinically-backed solutions as unchecked consumerism creeps further into the world of healthcare.

Room for growth

The significant progress in advancing the management and treatment of GI disorders is breathing new life into patients by delivering much needed relief. Through new diagnostic methods, integrated approaches and innovative management solutions, patients no longer have to live with discomfort. Instead, providers can better care for patients and improve their outcomes.

While rigorous academic research delves deeper into the foundations of the human gut microbiome, policies and payer organizations will need to catch up to the latest GI innovations and sort through how to best support nutritious lifestyles as a part of integrated, whole-person care. Meanwhile, providers are doing their part by collaborating with nutrition providers and platforms to better educate and empower their patients managing chronic conditions.

Photo: OsakaWayne Studios, via Getty Images

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