DGBI RESEARCH AND CARE
The changing terminology for these disorders — which include irritable bowel syndrome (IBS), chronic constipation, chronic abdominal pain, functional diarrhea, functional dyspepsia, and cyclic vomiting syndrome — reflects a greater understanding of their underlying causes. But, although a substantial body of evidence now supports the pathophysiology that the conditions involve alterations in brain-gut interactions, that pathophysiology is multifactorial, and not well understood. As a result, DGBI is challenging to diagnose and treat, notes Andrea S. Shin, MD, MSCR, who recently joined the Vatche and Tamar Manoukian Division of Digestive Diseases faculty as a health sciences associate clinical professor of medicine. These conditions can be highly debilitating and are extremely prevalent: Collectively, according to epidemiological research, DGBI affects as much as 40% of the world’s population and nearly half of all women. Dr. Shin explains that DGBI are symptom-based disorders, and reliable diagnostic tests are largely lacking. “The decision-making on treatment is Disorders of gut-brain interaction (DGBI), previously known as functional gastrointestinal disorders, encompass a wide range of conditions characterized by increased visceral sensitivity and alterations in gut motility, immune and mucosal function, and central nervous system processing of visceral information.
Andrea S. Shin, MD, MSCR
not always straightforward,” she says. “What’s most important is to both educate and listen to patients in order to clearly understand their symptoms, how their lives are affected, and the treatment approaches that most interest them.” For decades, UCLA’s Vatche and Tamar Manoukian Division of Digestive Diseases has been a national leader in treating DGBI. Now part of the new Goodman-Luskin Microbiome Center, the program is a designated Center of Excellence — one of the few in the nation. Most recently, that tradition has been bolstered by the recruitment of Dr. Shin, who focuses on treating patients who suffer from DGBI, as well as running an active clinical research program. “Because these disorders aren’t fully understood, there is a lot of opportunity to investigate everything from pathophysiology and patients’ experiences to new tools and therapies aimed at improving diagnosis and treatment,” Dr. Shin says. Dr. Shin’s clinical research homes in on the pathophysiology of IBS to provide a foundation for understanding of which treatments are likely to benefit which patients. She has a particular
interest in examining the interaction of diet and the microbiome, and how that relates to IBS symptoms. Her group is investigating how the human microbiome may reveal mechanistic information about individuals with IBS that could be used as a treatment target. Dr. Shin also studies what drives IBS symptoms, as well as patient- reported outcomes and experiences with the health care system. After spending nearly a decade on the faculty at the Indiana University School of Medicine, Dr. Shin was drawn to UCLA by the opportunity to work with a wide-ranging group of DGBI experts. UCLA’s DGBI program has increasingly emphasized integrative care — an interdisciplinary approach in which the gastroenterologist works closely with GI dietitians, GI psychologists, and an integrative health nurse practitioner, all of whom collaborate closely while offering the full spectrum of care approaches. “There aren’t many institutions that build an infrastructure specifically focused on treating these disorders,” Dr. Shin says. “If you want to go ‘all in’ on improving the lives of DGBI patients, this is the place to be.”
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Beyond the Scope
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