Diagnosing and treating patients with refractory functional gastrointestinal disorders.

One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient-physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms. This approach is likely to improve patient and physician satisfaction, adherence to treatment, and clinical outcome.