"My toughest patients" Dr. Prince Shah

Fellow, American College of Gastroenterology     
Fellow, American College of Physicians                
Board Certified in Gastroenterology & Hepatology

9460 No Name Uno, Suite 130
Gilroy, CA 95020

IBS is the commonest and most frustrating diagnosing for my patients and me. Young women, and they are mostly young women develop these complaints as teenagers and young adults. I follow the Rome algorithms to arrive at the diagnosis of IBS. I will have a detailed discussion with the patients explaining what is known about the pathophysiology of the disease, the concept of the second brain and the brain-gut axis, the role of the gut flora (microbiota) and the perturbations to digestive functions of secretion, absorption and motility.

Unfortunately the absence of objective data leaves the patient unable to express the severity and frequency of her symptoms to me. Its impact on her life, family and career are left unmeasured. This sets the stage for her to insist that something must be wrong and that we have just not tried or tested enough. Or she may hear my explanations as telling her, "it’s all in the head " or she feels accused of being a hypochondriac. Most gastroenterologists will confirm that this is what they face on a daily basis. They view IBS patients as reminders of their failure. These are the patients they could not heal. There was nothing for them to elegantly demonstrate on a photograph or CT what ailed them. Compassion fatigue is a common result. So the patient then seeks a second, third or fourth opinion as her symptoms recur. Often they result in repeat colonoscopy, CT scans, etc. with naught to show for it. 

What is needed is a prolonged recording of the patient's motility and to correlate that with symptoms, and physiologic events like meals, bowel movements, passage of flatus, etc. Ideally this should be portable, wireless and easy to use. The Holter monitoring of the heart is a reasonable comparison. Of course the electrical activities of the gastrointestinal system is far more complex and will need advanced algorithmic data crunching and analysis to yield actionable findings.

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