Where the brain goes, the gut follows

There has been a growing understanding of the powerful two-way connection between our stomach and brain in recent years, suitably named the gut-brain connection.

This link is so strong that the gut is sometimes nicknamed our “second brain”, highlighting how real your “gut feelings” can be. If you’ve ever felt nauseous before a big presentation or butterflies in your stomach during a first date, you’ve experienced the gut-brain connection (GBC) in action.

The stomach and the brain communicate constantly through the vagus nerve, a direct pathway between the two, meaning what happens in your brain can affect your stomach and vice versa. As a result, the emerging field of psychogastroenterology, which focuses on the GBC, is gaining traction, a recognition of the importance of understanding this intricate relationship.

But what happens when this connection malfunctions? For many, it leads to severe and long-lasting symptoms such as pain, nausea, and even bouts of vomiting. Digestive problems affect at least 40 percent of people worldwide, but for many, standard medical tests reveal no obvious physical causes, such as infections or cancer. Such patients fall under the umbrella term of Disorders of Gut-Brain Interaction (DGBI), which are characterised by a disrupted GBC.

The impact of these disorders extends beyond physical discomfort. Patients often endure years of invasive tests and trial various treatments, often without finding relief. Their work, relationships, finances, and mental health can suffer as a result. Clinical anxiety and depression often accompany DGBIs, more evidence of the intricate relationship between our gut and our brain.

The good news is that emerging research shows that treating both the mind and the body can improve outcomes for those with gut issues. Psychological therapies – like stress management, relaxation training, cognitive behavioural therapy, and even hypnosis – have been shown to improve both mental and digestive health. Yet mental health assessments and treatments are rarely used in clinical practice.

While society’s view of mental illness has evolved over recent years, stigma around mental health remains particularly strong in fields like gastroenterology. Many fear that if their mental health is raised in discussion, their stomach symptoms may be dismissed as “all in their head” and their condition will be taken less seriously. Doctors, too, may hesitate to bring up mental health, fearing it could harm their relationship with patients.

These gastrointestinal symptoms are very real, but they can be intensified by miscommunication between the gut and brain – an issue that both patients and doctors might not fully understand. The stigma surrounding mental health can make it difficult for patients to seek and receive treatment, which can have negative impacts on their mental wellbeing, quality of life, and stomach symptoms.

How do we ensure patients with DGBIs get the mental health support they need while avoiding the negative impacts of stigma? My team has been exploring this question through in-depth conversations with both patients and doctors to develop new strategies that can be implemented within clinical care.

Our conversations have indicated that mental health assessments should be part of standard care for patients with DGBIs and included alongside routine physical testing. By doing so, we can normalise mental health assessments and reduce the stigma associated with them. Both patients and doctors are open to this approach, recognising it could improve understanding of the patient’s condition and lead to more personalised treatment.

We’ve already implemented this approach at Alimetry, a company spun out of the University of Auckland, which has developed a Gastric Alimetry Test, a wearable, non-invasive tool designed to help diagnose stomach disorders; a flexible patch of sensors are placed on the abdomen to detect gastric electrophysiology (stomach activity) combined with real-time symptom tracking. This provides doctors with insights into how the stomach is working in relation to what the patient is experiencing.

Earlier this year, we added a new mental health assessment to the test, offering doctors a more comprehensive view of their patient’s health. This holistic approach allows for more personalised diagnoses and treatments that address both the mental and physical aspects of DGBIs, helping to restore the GBC and reduce symptoms.

To effectively manage DGBIs, we need to treat both the gut and the mind, making this multidisciplinary approach – combining physical and mental health assessments – fundamental for long-term symptom management.