Functional Brain-Gut 2007 Research Group Spring 38, The mission of the Functional Brain-Gut Research Group is to support, promote and advance multidisciplinary research and education in the basic science, clinical and behavioral aspects of brain-gut interactions. Issue Table of Contents Message from the President Message from the President 1 Greetings! I have just returned from the Fifth Annual Young Editor’s Column 3 Investigators conference held March 23 to 25, 2007 near San Diego, California. This FBG event was initiated by Kevin Olden Member Spotlight 7 and has grown every year. Thanks to our chairs, Bill Chey and Rona L. Levy, MSW, PhD, MPH Carlo DiLorenzo, to our faculty, Lin Chang, Ray Clouse, Eamonn Cross-Cultural Column 8 Quigley, and Henry Parkman and to our organizer, Joyce Fried, Guest Column 10 for all of their effort in making this year’s event such a success. Book Review 12 Richard Locke, MD We had 20 enthusiastic young investigators from around the Rome III: The functional President globe. The presentations reflected the breadth of research cur- gastrointestinal disorders, Third rently underway in functional GI disorders. Congratulations to Edition Niels Eijkelkamp from Utrecht, the Netherlands, who was awarded top prize for this presentation “G protein-coupled receptor kinase IFFGD Spring 2007 Update 14 6 controls post-inflammatory visceral hyperalgesia in mice” and DDW Meeting Schedule 15 to Birgit Adam from Adelaide, Australia, who won a prize for Special Reports 19 “Gut homing properties of circulating T cells in patients with ir- Announcements 26 ritable bowel syndrome”. All 20 attendees were winners. They represent our future and we hope they continue to be interested FBG News 29 in our field. By the time you receive this newsletter, the IFFGD will have hosted its 7th International Symposium in Milwaukee, Wisconsin, on April FBG Annual Meeting 12-15 2007. The FBG has benefitted greatly from our interaction May 22 with the IFFGD. We are pleased to be involved. The FBG annual meeting and reception will Please mark your calendars for the second joint international be held at DDW in Washington DC, May neurogastroenterology and motility meeting to be held November 22, at the Grand Hyatt Hotel, Independence 6-9, 2008, in Lucerne, Switzerland. The European Society for B-C-D Ballroom. Neurogastroenterology and Motility will be the host organization. This is a joint effort of the American Motility Society (AMS), the Reception: 5:30-6:30pm Annual meeting: 6:30- 7:30pm. President Council Past-Presidents Office G. Richard Locke, MD Carlo DiLorenzo, MD 1989 - 1994 — Douglas A. Drossman, MD Rochester, MN Columbus, OH 1994 - 1996 — William E. Whitehead, PhD 1820 Spruce Meadows Drive Rochester, MN 55904 Vice President Ronnie Fass, MD 1996 - 1998 — Kenneth L. Koch, MD USA Tucson, AZ 1998 - 2000 — Nicholas J. Talley, MD, PhD Emeran Mayer, MD 2000 - 2002 — W. Grant Thompson, MD Phone: 507-538-0367 Los Angeles, CA Lesley Houghton, PhD Manchester, UK 2002 - 2004 — Kevin Olden, MD Fax: 507-266-9081 Secretary/Treasurer 2004 - 2006 — George F. Longstreth, MD E mail: [email protected] Tony Lembo, MD Lin Chang, MD Boston, MA www.fbgweb.org Los Angeles, CA Newsletter Editor Douglas A. Drossman, MD Founded 1989 Executive Director Nancy Norton (ad-hoc member) Newsletter Managing Editor Deb Geno Milwaukee,WI Kirsten Nyrop Newsletter Design John Herr 2 Message from the President European Society for Neurogastroenterology and Motility (ESNM), Of course, the person most involved with the FBG is our executive the International Group for the Study of Neurogastroenterology director Deb Geno. One special initiative she has underway is our and Motility, and the FBG. Doug Drossman and Carlo DiLorenzo web site, www.fbgweb.org. We hope to have a new version ready attended the program planning meeting on behalf of the FBG and for display at our annual meeting. we are excited about the results. This meeting should be of great interest to all of our members. The FBG annual meeting will be at DDW in Washington DC, Tuesday May 22, in the Grand Hyatt Hotel, Independence B-C-D Due to the success of the inaugural meeting in Boston, the deci- Ballroom. The reception is 5:30-6:30pm and the annual meeting is sion has been made to have this joint meeting annually, beginning 6:30- 7:30pm.. I hope to see you all there. Thanks. in 2008. I am pleased to announce that the FBG will be the host of the 2009 meeting. We now have a lot of work to do! We are pleased that the IFFGD has joined us in planning this meeting. We will have details to discuss at our annual membership meeting at DDW. We will need help! I am hoping that we will have several FBG members involved. Speaking of involvement, I am pleased to announce our new coun- cilors, Ronnie Fass and Tony Lembo. I want to thank our “retiring” councilors, Brian Lacy, Fermin Mearin, and Max Schmulson for their energy and effort. Of note, Max was elected president of the newly formed, Latin-American Society for Neurogastroenterology. I also want to thank all the candidates for council who were brave enough to have their names on the ballot, and I am hoping you all will be willing to run again. Dear FBG member, Mark your calendar’s for the Functional Brain-Gut Research Group’s Annual Meeting And Reception! The Independence, B-C-D ballrooms The Grand Hyatt Washington, DC Tuesday, May 22, 2007 Reception 5:30-6:30 pm Annual Meeting 6:30-7:30 pm Hope to see you there! Deb Geno Executive Director Functional Brain Gut Functional Brain Gut Research Group Research Group Editor’s Column 3 Gastroenterology for These historical data then need to be refined with a physical examination and diagnostic studies: when to do the blood tests Functional GI Disorders or an endoscopy, whether to order the CT scan or MRI, or even in the 21st Century do any testing at all. Once all this information is obtained, the gastroenterologist must put it all together and determine a reasonable diagnostic approach and plan of care. Thus, the science involves integrating the evident data on gastrointestinal pathology and physiology within the context of the person. The art of gastroenterology is the interaction with the patient; it is not what you do but how you do it. It involves understanding Douglas A. Drossman, MD and participating in the patient’s inner world as related to his or Editor her illness: to use good interview skills to validate the previous medical information and obtain new meaningful data directly from the patient, and to put the more personal psychosocial influences The field of gastroenterology is changing. In this article, I reflect on into proper context. It also involves understanding the patient’s the practice of gastroenterology as well as the changing pattern “illness schema” or perception of what is wrong, and what his or of care being provided particularly for patients with functional GI her concerns or expectations are from the doctor. This information disorders. It has been abstracted and modified from a chapter is integrated into an effective diagnostic and treatment plan. in an upcoming book “Inside the Minds: Gastroenterology Best Finally, the physician must convey this information in a manner Practices” by Aspatore Press, 2007. that is acceptable to the patient, and work toward reaching mutual agreement as to how to move forward. In effect, all of this involves The Science and Art of Gastroenterology establishing a trusting relationship with good communication and shared decision making between the clinician and the patient. Gastroenterology is, I believe, unique among the medical subspecialties: a blend of science and art. For example, with These skills are not learned through technology or textbooks. cardiology, pulmonary disease and nephrology, clinicians can rely Instead, it requires that gastroenterologists be mentored from on cardiac catheterization, lung physiology, or kidney function knowledgeable teachers. In fact, the AGA has recommended that tests to understand how well a specific organ is functioning and for training in functional GI and motility, the fellow must receive this closely relates to how ill the patient is. But, understanding supervised clinic time with a senior physician skilled in this gastroenterological illnesses is more complex because there are particular area(1). In addition, clinicians must learn from their own no numbers or calculations of organ function to explain why the experience with patients and possess a genuine desire to help patient has abdominal pain or nausea. We need to look at the the patient. Typically, doctors prefer patients who get better and person and his or her symptoms (e.g., pain, nausea, or diarrhea) thank them for their effort. But, with the most prevalent chronic GI within the context of daily functioning, life stress, quality of life, disorders (e.g., chronic liver disease, inflammatory bowel disease, and coping style. It is all of these in combination that determines functional GI and motility disorders, chronic pancreatitis, intestinal the challenge and excitement of working with gastrointestinal malabsorption), this is not always the case. So, physicians need to disorders. value the process of their care with patients. This means building the relationship to help patients help themselves, expecting only The science of gastroenterology starts at the sub-microscopic level, occasionally to make a rare diagnosis or to cure. What patients understanding how neurotransmitters and hormones in the bowel, with chronic illness truly want is a sense of hope, and to have a such as serotonin or cholecystokinin (CCK), affect gastrointestinal doctor who cares and won’t abandon them. Studies show that an function. Stress can produce these and other neurotransmitters effective physician-patient relationship not only improves patient in the brain and they can then work “downstream” to affect satisfaction, adherence to treatment and avoids litigation, but it intestinal motility, inflammation of the bowel, or the secretion of also leads to better clinical results (2).