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Physicians Understanding Gut Health

It is well known that chronic diseases are the leading cause of illness and disability in the United States—in fact, they affect more than half the population and cause 7 out of every 10 deaths.1,2,3 People with chronic conditions are the most frequent users of health care, accounting for more than 86% of health care costs.3,4 What’s more, common patient symptoms, e.g., fatigue, aches and pains, headaches, and loss of appetite, could equally well reflect one of several chronic conditions, often making diagnosis and treatment difficult. Available therapies generally target the symptoms without getting to the root cause and truly effecting a cure.

Poor gut health is at the heart of many chronic conditions and a healthy gastrointestinal (GI) tract is vital to our overall wellbeing—indeed, our very survival. GI symptoms are among the most highly prevalent of chronic health complaints (affecting two in five Americans) but are also largely hidden and the least understood.5  Sedentary lifestyles and standard Western diets do little to support this neglected organ system. Studies suggest that irritable bowel syndrome (IBS) or related symptoms account for 10–20% of primary care physician visits and up to 20% of GI outpatient clinic time.5,6 In fact, spending on GI diseases in the US has been estimated at $142 billion per year, with an annual cost for outpatient GI endoscopy of $32.4 billion.7

Symptoms of Irritable Bowel Syndrome

  • Abdominal pain/cramping
  • Diarrhea
  • Constipation
  • Bloated feeling
  • Gas
  • Indigestion
  • Burping
  • Loss of appetite
  • Mucus in the stool
  • Nausea
  • Anxiety

The family physician plays an increasingly important role in the diagnosis and management of GI disorders. Interestingly, however, only 30% of individuals with IBS consult a physician about their symptoms.6 This may reflect patients’ tendency to tolerate symptoms that are episodic and variable, to be reluctant to discuss IBS symptoms with their doctor, or to self-medicate, given the large amount of over-the-counter drugs that claim to offer symptom relief. Unfortunately, unguided use of such medications can compound the problem while temporarily masking a symptom of something more serious.

Many sufferers simply adjust to their “new normal.” But chronic abdominal pain/discomfort, acid reflux, diarrhea, constipation, gas, and bloating are never normal!

Irritable bowel syndrome, like so many chronic conditions, is actually a symptom of an underlying issue, not a disease in and of itself. Although it affects up to 20% of the general adult US population, properly diagnosing IBS can be challenging.6 It is often considered to be a functional bowel disorder caused by stress, with no clear etiology. Physicians can be frustrated by the lack of specific biomarkers, reliance on clinical symptoms for diagnosis, and overlap of symptoms with those of organic conditions.8,9,10 Patients with this disorder greatly desire effective therapies and would take considerable risk to obtain symptom benefit.11 But without the necessary tools to personalize diagnosis, treatment is often trial and error—at best a temporary “band-aid”—with patients typically returning once symptoms recur. Salveo Diagnostics offers a solution that will help get to the root of the matter, transforming the physician-patient relationship in the process, for dramatically improved health outcomes.

Schematic showing a section through the gut lining and damage caused by intestinal permeability.

In the healthy state, the single-cell-thick intestinal mucosa forms a barrier which allows properly digested nutrients to enter the bloodstream but not pathogens, toxins, or undigested food. IBS is often linked to increased permeability of the intestinal mucosa. Here, the epithelial cells become inflamed and release the tight-junction regulator protein zonulin, triggering the disassembly of the tight junctions and allowing pathogens, toxins, and undigested food to enter the bloodstream.12 This can lead to an improperly controlled immune response and chronic inflammation, negatively affecting metabolism and multiple organ systems.



  1. Ward BW, et al. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis 2014;11:130389.
  2. Centers for Disease Control and Prevention. Death and mortality. NCHS FastStats Web site. Accessed Mar 6, 2016.
  3. Gerteis J, et al. Multiple Chronic Conditions Chartbook. [PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed Mar 9, 2016.
  4. Anderson J. Chronic care: Making the case for ongoing care. 2010 Chartbook. Robert Wood Johnson Foundation. Accessed Mar 6, 2016.
  5. Tally NJ. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil 2008;20 Suppl 1:121–129.
  6. Canavan C, et al. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014;6:71–80.
  7. Peery AF, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179–1187.
  8. Levy S, et al. Perceptions of gastroenterologists and patients regarding irritable bowel syndrome and inflammatory bowel disease. Eur J Gastroenterol Hepatol 2014;26:40–46.
  9. Gikas A, Triantafillidis JK. The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases. Intern J Gen Med 2014;7:159–173.
  10. Spiegel BMR. Do physicians follow evidence-based guidelines in the diagnostic work-up of IBS? Nat Clin Prac 2007;4(6):296–297.
  11. Drossman DA, et al. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol 2009;43(6):541–550.
  12. Camilleri M, et al. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2012;303:G775-G785.