A Personalized Approach to the Patient Requiring Central Therapies

Abstract

The consultant dealing with patients with disorders of gut-brain interactions (DGBI previously known as FGIDs) who do not respond to gut-directed medications or dietary change faces a challenge. Central therapies, including the use of central neuromodulators and psychological therapies, may be essential. This chapter shares the approach of the author on the initial evaluation of patients and on dealing with patient’s defense mechanisms. How to discuss the use of central neuromodulators with patients is addressed. The notion of setting realistic expectations, how to evaluate the response to central neuromodulators, and how to encourage patients to remain on these drugs is reviewed. Personal preferences for central neuromodulators to treat pain, nausea, and dyspepsia are discussed along with preferred SSRI, SNRI, and second-generation antipsychotic choices.