Disorders of Gut–Brain Interaction

Real symptoms. Real biology. Treatable conditions.

Digestive symptoms can be severe even when blood and stool tests, Xrays or scans, gastroscopy and colonoscopy are normal.

Disorders of gut–brain interaction, or DGBI, are conditions where the gut does not move, sense, signal or communicate normally with the nervous system and brain.

They are common. They are real. And, with the right diagnosis and treatment plan, they can often be improved.

Key points

Normal tests do not mean nothing is wrong

Many DGBI symptoms come from gut sensitivity, movement, nerve signalling or pelvic floor coordination rather than visible damage.

This is not “just stress”

Stress can worsen gut symptoms, but DGBI are biologically based conditions involving the gut, brain, nerves, immune system and microbiome.

Treatment is matched to the symptom pattern

Constipation, diarrhoea, bloating, nausea, reflux-like symptoms, abdominal pain or discomfort and pelvic floor symptoms often need different treatment plans.

What symptoms are you having?

Digestive symptoms often overlap. Many people have more than one symptom at the same time. These patterns can help guide what may be happening, what may need checking, and what sort of treatment may help.

Not sure which symptom fits? Start with the symptom that bothers you most, or the symptom that has changed most recently.

Abdominal pain or cramping

Pain, cramping, pressure or discomfort may relate to irritable bowel syndrome, constipation, gut sensitivity, functional dyspepsia or other digestive conditions.

Bloating or visible distension

Bloating, swelling or a visibly enlarged abdomen may relate to constipation, food fermentation, gut sensitivity, IBS, belching patterns or changes in how the abdominal wall responds to gas.

Constipation or difficult emptying

Constipation can mean infrequent bowel motions, hard stool, straining, incomplete emptying, a sense of blockage, or difficulty coordinating the pelvic floor.

Diarrhoea or urgency

Loose stool, urgency or unpredictable bowel habit may relate to IBS, functional diarrhoea, bile acid diarrhoea, microscopic colitis, coeliac disease, infection, medication effects or other causes.

Nausea, vomiting or fullness

Nausea, vomiting, early fullness or feeling uncomfortably full after meals may relate to functional dyspepsia, gut sensitivity, delayed stomach emptying, rumination syndrome, cyclic vomiting syndrome or other conditions.

Reflux-like or throat symptoms

Heartburn, throat lump sensation, excessive belching, regurgitation or non-cardiac chest discomfort may relate to reflux disease, reflux hypersensitivity, functional heartburn, globus, belching disorders or rumination.

Chest pain should not be assumed to be digestive until heart-related causes have been considered.

Faecal leakage or poor control

Leakage, urgency or difficulty controlling stool may relate to loose stool, rectal sensitivity, pelvic floor weakness, nerve injury, childbirth injury, previous surgery or other bowel conditions.

Rectal pain or pelvic floor symptoms

Rectal pain, pressure, spasm, straining or difficulty emptying may relate to pelvic floor dysfunction, levator ani syndrome, proctalgia fugax, dyssynergic defecation or altered rectal sensation.

When to seek medical advice

Most digestive symptoms are not dangerous, but some symptoms should be checked promptly.

Please seek medical review if you have:

  • blood in your stool or black, tarry bowel motions
  • vomiting blood or material that looks like coffee grounds
  • unexplained weight loss
  • iron deficiency or anaemia
  • persistent or repeated vomiting
  • difficulty swallowing, pain with swallowing, or food feeling stuck
  • a new lump or swelling in your abdomen
  • fever with digestive symptoms
  • diarrhoea or pain regularly waking you from sleep
  • new bowel symptoms starting after age 50
  • a strong family history of bowel cancer, inflammatory bowel disease or coeliac disease
  • a major change from your usual symptom pattern

Chest pain safety note

Chest pain or pressure can sometimes come from the heart rather than the gut. If chest discomfort is severe, new and unexplained, or occurs with breathlessness, sweating, faintness, or pain spreading to the arm, neck, jaw or back, treat it as an emergency and call 000.

Do not assume chest pain is digestive until heart-related causes have been considered.

Call 000

What does DGBI mean?

DGBI stands for disorders of gut–brain interaction.

The gut and brain constantly communicate through nerves, hormones, immune signals, the microbiome and the autonomic nervous system.

In DGBI, one or more parts of this system becomes dysregulated. This can involve:

  • increased gut sensitivity
  • altered gut movement
  • abnormal nerve signalling
  • changes in the gut lining or immune system
  • microbiome changes
  • altered brain processing of gut signals
  • pelvic floor coordination problems

The result can be pain, bloating, nausea, constipation, diarrhoea, urgency, reflux-like symptoms or difficulty emptying — even when standard tests look normal.

Symptoms often overlap. For example, pain, bloating, constipation, diarrhoea, nausea and reflux-like symptoms can occur together, so treatment often needs to address more than one pattern.

Rome V: the current framework

Rome V is the current international framework, published in 2026, used to classify disorders of gut–brain interaction.

It continues the move away from older terms such as “functional gastrointestinal disorders” and toward language that better reflects the biology of these conditions.

Rome V emphasises that DGBI are real conditions involving gut movement, gut sensitivity, immune and microbiome factors, nervous system processing and the two-way communication between the gut and brain.

It also supports a more individualised approach to care, including diet, medication, pelvic floor therapy, gut-directed psychological therapies, biofeedback and attention to the person’s broader health context.

For patients, the most important message is simple: DGBI are real, common, explainable and treatable.

How diagnosis works

A good assessment usually asks:

What is the main symptom?

Pain, bloating, constipation, diarrhoea, nausea, reflux-like symptoms and pelvic floor symptoms point to different causes.

How long has it been happening?

Pattern and duration help identify the likely DGBI diagnosis.

Are there warning features?

Some symptoms need blood tests, stool tests, imaging, endoscopy or colonoscopy.

What has already been checked?

Normal tests can be helpful, but they need to be interpreted in context.

What is driving the symptoms now?

Common drivers include constipation, diarrhoea, gut sensitivity, reflux hypersensitivity, pelvic floor dysfunction, diet triggers, medications, sleep disruption, stress physiology and previous gut infection.

Treatment options

Treatment should match the symptom pattern.

Gut pain or sensitivity

Options may include bowel habit treatment, peppermint oil in selected patients, gut-directed neuromodulator medication, gut-directed CBT, gut-directed hypnotherapy and flare planning.

Constipation

Options may include fibre adjustment, osmotic laxatives, stimulant laxatives, prescription constipation medicines, pelvic floor testing and pelvic floor physiotherapy.

Diarrhoea or urgency

Options may include soluble fibre, antidiarrhoeal medication, bile acid diarrhoea assessment, diet review, IBS-D therapies and selected microbiome-directed treatment.

Bloating

Options may include constipation treatment, dietitian-guided low FODMAP therapy as a short-term way to identify triggers before foods are reintroduced, meal pattern changes, treatment of belching patterns and breathing or abdominal wall strategies.

Nausea or fullness

Options may include smaller meals, constipation treatment, reflux assessment, anti-nausea medication, prokinetic medication in selected patients and gut–brain neuromodulator approaches.

Pelvic floor symptoms

Options may include anorectal manometry, balloon expulsion testing, pelvic floor physiotherapy and biofeedback.

Preparing for your appointment

Please bring:

  • your main symptoms
  • when they started
  • what makes them better or worse
  • your usual bowel pattern
  • current medicines and supplements
  • previous blood, stool, scan, endoscopy or colonoscopy results
  • treatments you have already tried
  • your biggest concern
  • what you most want treatment to help you get back to, such as work, travel, exercise, eating out or social activities

Our approach

We aim to give a clear explanation, avoid unnecessary repeat testing, identify when further investigation is needed, and build a practical treatment plan.

The goal is not just to name the condition.

The goal is to reduce symptoms, restore confidence and help you get back to normal life.