DGBI Study

Abdominal pain is the most common chief complaint in US EDs, representing over seven million annual visits. Yet, despite intensive Emergency Department (ED) work-ups, approximately 25% of these patients leave the ED with a diagnosis of “nonspecific abdominal pain.” While infections, inflammation, surgical processes, and cancer-related gastrointestinal (GI) conditions are often readily diagnosable through standard testing, many causes of abdominal pain cannot be clearly identified through traditional diagnostic methods. Many of these causes fall under the umbrella of Disorders of Gut-Brain Interaction (DGBI), formerly known as “functional abdominal pain.” DGBI are disorders that affect more than a third of the U.S. population. The underlying etiologies remain poorly defined but are likely due to a combination of various factors

The chronic and relapsing nature of DGBI symptoms lead to multiple ED visits, multiple negative computerized tomography (CT) scans, and contribute to a significant burden on the emergency healthcare system as well as patient dissatisfaction with treatment. The end result of these intensive diagnostic efforts for most patients with DGBIs is the absence of a clear diagnosis. Moreover, these patients are often prescribed opioid analgesics for symptom management, exposing them to a greater risk of developing an opioid use disorder.  This contributes to the perpetual cycle of failure to resolve symptoms, recurrent healthcare visits, ED overcrowding, increased ED wait times, and increased length of stay for all patients.  

To address these challenges, the first multicenter prospective observational study of ED patients with suspected DGBIs was launched at The George Washington University Hospital (DC), Duke University Hospital (NC), and Henry Ford Hospital (MI). Patients eligible for the study include those who present to the ED with undifferentiated abdominal pain with a frequency of at least one painful episode per week for at least 8 weeks, hence meeting Rome criteria for a DGBI. 

The study queries various biopsychosocial factors, including abdominal pain characteristics, sleeping habits, anxiety, depression, and social determinants of health. The overall aims of the study are to:

• Identify ED patients with undiagnosed DGBIs
• Assess the impact of undiagnosed DGBIs on ED utilization and other economic implications
• Characterize the biopsychosocial features of ED patients with suspected DGBIs to guide the development of targeted interventions
• Evaluate the role of evidence-based pain management strategies based on the biopsychosocial approach for treating ED patients with suspected DGBIs 

We hope that this study will help us understand the causes of DGBI and create new approaches to this difficult medical condition.