The Visiting Scholar Program is a great opportunity for clinicians and researchers to engage with key leaders, including Rome Foundation Board members and other international experts, to learn not only about DGBI diagnosis and treatment but also about advanced communication skills and targeted research methods.

This program is open to clinicians and scientists in gastroenterology, primary care, psychologists, advanced practice providers (NP/PA), and dietitians. The attendees usually spend two to three days on-site or longer by arrangement. This program is critical to help develop and inspire the next generation of providers to become skilled communicators and exceptional clinicians treating patients with DGBI.

When asked about her experience, Dr. Sarnoff gave this summary:

I chose to apply for the Visiting Scholar Program with the Rome Foundation/DrossmanCare towards the tail end of clinical training in my Disorders of Gut-Brain Interaction-Internal Medicine Physician Scientist Training Program (which my mentor and DGBI Specialist Dr. Lin Chang and I designed together). The rotation was one of the most meaningful learning experiences I have ever had.

The patient visits in which I participated were unlike any I had experienced prior. We performed a full intake of the patient’s symptoms, but also their backgrounds and life contexts, psychological histories, and home environments, all of which can influence how our central and peripheral nervous systems can get dysregulated.  We then performed comprehensive physical exams (including rectal exam, rectal hypersensitivity testing, and balloon expulsion test), and formulated a patient-centered assessment and therapeutic plan. The visits were not rushed: we took the time that the patient needed and deserved, and the patients clearly felt seen and heard like they never had been before. Dr. Drossman’s use of helpful, easy-to-understand visual aids and reading materials with the patients empowered them to step into a place of knowledge and clarity about what was happening in their body; this itself, I could see, was incredibly healing for them. Seeing both new and return visits together, I also had the opportunity to observe how patients’ symptom courses evolved over time, and how the relationship with Dr. Drossman and the therapeutic interventions could so meaningfully change their lives. It was amazingly gratifying to see patients who at one point were essentially home-ridden, on disability, now be more integrated into society, able to work and take vacations and participate in other activities that felt impossible prior. During the visits, I noticed that emotions were expressed freely and frequently, as the patients could clearly feel how safe and honest of a space Dr. Drossman and his PA Elizabeth Smith held for them.

I learned a great deal from the way Dr. Drossman engaged in sharing our assessment and plan with the patient. Instead of a one-way communication of our thoughts, he instead involved the patient in this assessment and plan. He asked what the patient thought was going on, and what they were most open to in terms of therapeutics. For return patients, he would ask, “is there anything you think we should be doing differently?” rather than unilaterally suggesting changes where there might not be a patient-centered need or want. The patients clearly responded positively to their involvement in the plan, and they seemed more motivated to execute the plan given this involvement. I also appreciated his advanced and nuanced approach to neuromodulator therapies and my comfort with utilizing them – as well as using multiple at once – significantly increased after the rotation. Finally, I had the opportunity to participate in a Biofeedback/Pelvic Floor Physical Therapy Teaching Session with his colleague and pelvic floor physical therapist, Jennifer Harrington. I had never had the opportunity to participate in such a session prior and learned a great deal from Jennifer and her unique, dual expertise in Pelvic Floor Physical Therapy and Biofeedback. I learned about how to cue patients and interpret the Biofeedback digital readouts as well as appropriate indications for Biofeedback vs. Pelvic Floor PT.

Overall, I was incredibly moved and inspired by the experience of the Visiting Scholars Program. I will bring into my practice newfound learnings, perspective, and expertise that I believe no other program could have given me.

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Rome Foundation Board members were delighted to announce two new Board Members at DDW: Madhusudan Grover, MBBS, AGAF, and Maura Corsetti, MD, PhD.

Rome Foundation staff members worked hard and enjoyed being all together at DDW!

The Rome V pediatric group met at DDW to revitalize their diagnostic criteria to meet current healthcare needs. Stay tuned for more updates!

Updating scientific evidence and revising medical information on the DGBI and the Rome Criteria is one of the major functions of the Rome Foundation. These updates evolve over a 5-yr. period, are peer-reviewed, and rely on obtaining recent scientific evidence and using consensus (Delphi approach) to create a variety of educational documents. Learn more about the upcoming Rome V  here: https://theromefoundation.org/rome-iv/rome-v/

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Kalin is a psychologist with 8 years of psychology experience and 1.5 years working with DGBI patients. She is an Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at Oregon Health and Science University, Portland, OR.Her visit with Dr. Douglas Drossman, President Emeritus and CEO of the Rome Foundation, included advanced training in communication skills, observation of patients seen in clinic with DGBI, and neuromodulator treatment methods for patients with DGBI.

The Visiting Scholar Program is a great opportunity for clinicians and researchers to engage with key leaders, including Rome Foundation Board members and other international experts, to learn not only about DGBI diagnosis and treatment but also about advanced communication skills and targeted research methods.

This program is open to clinicians and scientists in gastroenterology, primary care, psychologists, advanced practice providers (NP/PA), and dietitians. The attendees usually spend two to three days on-site or longer by arrangement. This program is critical to help develop and inspire the next generation of providers to become skilled communicators and exceptional clinicians treating patients with DGBI.

When asked about her experience, Katlin answered these program evaluation questions:

Please describe in a few sentences what was most meaningful to you and why.

It was meaningful to get to see Dr. Drossman in action and to see the skills he describes in his publications (books and peer-reviewed articles) applied to patient care in real time. It was also very helpful to hear him discuss case conceptualizations.

I think this is a great opportunity not only for psychologists but also for all medical learners. I think so many of the providers I work with could benefit from this [training].

Please describe the areas you found most helpful.

It was very helpful to observe Dr. Drossman’s final portion of the initial evaluation, during which he explained the treatment plan, brain-gut connection, and how neuromodulators could be helpful to the patient.

I also learned a lot more about bloating/distention, for which I’m starting to get more referrals.

Please describe what else you would have liked to have seen.

Time permitting, I would have enjoyed the opportunity to hear about even more types of cases.

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For further information on the Drossmancare-Rome Foundation Communication Skills programs, click here.

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Close to 200 academic and clinical professionals in basic and clinical research and patient care working in DGBI convened in Rome, Italy, to work on the Rome V consensus. The work from 25 chapters and support committees representing 27 countries spent at least two days finalizing their manuscripts with the intent to publish six books and a supplement in Gastroenterology in May 2026, 10 years after the publication of Rome IV.

At the evening reception in the Westin, Douglas Drossman, MD, presented the history and growth of the Rome Foundation, detailing its evolution, notable breakthroughs, and achievements and recognizing the unique contributions and accomplishments of many of the Rome Foundation founders, researchers, and supporters.

Click on this video to hear the presentation:

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In August 2023, Dr. Justin Brandler completed the Rome Foundation-DrossmanCare Visiting Scholar Program.

Dr. Brandler is a neurogastroenterologist at Virginia Mason Medical Center in Seattle, WA, and he specializes in Disorders of Gut-Brain Interaction (DGBI). His visit with Dr. Douglas Drossman President Emeritus and CEO of the Rome Foundation included advanced training in communication skills and neuromodulator treatment methods for patients with DGBI.

The Visiting Scholar Program is a great opportunity for researchers and clinicians to engage with key leaders, including Rome Foundation Board members and other international experts to learn not only about DGBI diagnosis and treatment, but also about advanced communication skills and targeted research methods.

This program is open to clinicians and scientists in gastroenterology, primary care, and selected subspecialties, as well as to mental health providers, advanced practice providers (NP/PA), and dietitians.  The attendees usually spend two to three days on-site or longer by arrangement. This program is critical to help develop and inspire the next generation of providers to become skilled communicators and exceptional clinicians treating patients with DGBI.

When asked about his experience, Dr. Brandler said:

What were your goals and objectives in attending the program?

My main goal in flying across the country from Seattle to North Carolina was to enter this space with openhanded curiosity. How did one gastroenterologist in one career transform the culture for some of the most challenging patients in medicine into the powerhouse we know today as the Rome Foundation? The other global objective was to enter the sacred space of some of the most stigmatized and villainized patients in the healthcare system. Despite this challenge, I desired to learn how to validate their experience, educate, and empower them. It was inspiring to see how a team of just one physician, one stellar physician assistant, and one compassionate secretary could provide a sanctuary for these patients and quite literally change the world from a single exam room. As soon as I arrived, I became like a kid at the Disneyland of Functional GI, taking pictures of everything in the room, essentially becoming the “Drossman Care Groupie.”

To what degree were these goals/objective met? Please describe.

These goals and objectives were met in ways I didn’t even see coming. From this experience, Dr. Drossman has graciously agreed to provide me with direct mentorship as I seek to grow in my ability to care for these patients at the end of the line of Neurogastroenterology. I know I will never be Doug Drossman and will never try to. No one ever will be. But I do believe that he has sparked a brain-gut renaissance that is inspiring younger neurogastroenterologists like myself to pick up the mantle from him and so many other giants in the field.

What were the most meaningful aspects of your experience?

The most meaningful aspect of the experience that his patients echoed was what I have experienced just in my first year of practice. The simple truth is that when provided the safe space to truly be heard, they can truly be their own healers. We as providers are simply guides by the side to help facilitate their healing.

For more information regarding the Rome Foundation Visiting Scholar Program, contact Michelle Berry at mberry@theromefoundation.org.

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Rome Foundation President Dr. Jan Tack has been awarded the 2023 Lifetime Achievement Award From United European Gastroenterology. The award recognizes European clinicians or researchers who have made significant lifelong contributions to gastroenterology.

In addition to his role as President of the Rome Foundation, Professor Jan Tack is also Chief of the Gastroenterology and Hepatology Division at Leuven University Hospitals (Belgium) and a Professor in Internal Medicine at Leuven University.

In 2009, he was the driving force behind the creation of TARGID, the Translational Research Center for Gastrointestinal Disorders at Leuven University, which evolved into one of the leading gastroenterology research centers in the world.​

Jan Tack has also contributed to United European Gastroenterology. He became a member of the UEG Scientific Committee in 2009. In 2012, he became the founding Editor-in-Chief of the United European Gastroenterology Journal which he handed over in 2018 after reaching an impact factor of over 3.5 after the first 5 years.

In 2015, he received the UEG Research Prize. In 2018, the Leuven team of Jan Tack organized the UEG Basic Translational Course on Neurogastroenterology and Motility.

The UEG Lifetime Achievement Award to Jan Tack also recognizes the importance of the Disorders of Gut-Brain Interaction field, and his role as a clinician-researcher dedicated to this patient group. With an H-index of 103, Jan Tack has published more than 900 peer-reviewed articles in the international literature, with over 46000 citations, and he contributed to more than 45 book chapters on various aspects of scientific and clinical gastroenterology.

Learn more about this prestigious award and previous award winner here: https://ueg.eu/…/recognition…/lifetime-achievement-award

A big congratulations to Dr. Tack from all of us here at the Rome Foundation and everyone in the Disorders of Gut-Brain Interaction field.

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Am J Gastroenterol 2022;00:1–3. https://doi.org/10.14309/ajg.0000000000002090; published online December 7, 2022

CASE STUDY

A.G. was a 42-year-old man referred for chronic abdominal pain. His pain had been treated with opioids by multiple emergency department (ED) providers over the past 3 years. Extensive testing had not identified a specific cause for his symptoms. He could not work because of his pain and coexisting anxiety and depression. He was correctly diagnosed with centrally mediated abdominal pain syndrome; the treating physician suggested a trial of a neuromodulator. The patient requested a fentanyl patch—“just to tide me over”—but was told that opioids are inappropriate for his condition. The office visit seemed to end cordially; however, at the checkout desk, he screamed at the nurse, threw his paperwork, and told her that he will “find her” if he does not get Percocet immediately.

WHY IS THIS AN IMPORTANT TOPIC?

Anger is a negative emotional state accompanied by physiologic arousal and antagonistic thoughts. Manifestations of anger range from mild irritation to out-of-control rage and highly disruptive behavior, potentially leading to danger to others. In the acute care setting, angry episodes may disrupt patient flow, delay or prevent healthcare for other patients, and consume valuable resources and time. Such episodes generate significant stress to the staff and may escalate into a dangerous situation resulting in physical harm or even death. Staff may experience these episodes as threatening, leading to emotional distress, disrupted sleep, and job burnout. These episodes negatively affect the patient and, without proper intervention, will reinforce the patient’s behavior and prevent optimal care. Understanding the basis for the anger is essential to implement appropriate care and avoid disruptive behavior.

HOW COMMON?

Angry patient interactions are, unfortunately, quite common. One national survey found that 100% of ED nurses reported verbal assaults while 83% had \ experienced physical assaults (1). A survey of intensive care unit/medical surgical/ED nurses in an acute medical center found that 88% had been verbally assaulted during a 1-year period and 74% had been physically assaulted (2). Workplace violence seems to be increasing during the ongoing COVID-19 pandemic. Asystematic review of 17 studies involving 17,207 medical staff in a variety of clinical situations identified a workplace violence prevalence of 47% (3). Data specific to the gastrointestinal setting are not available but are thought to mirror national reporting.

WHAT ARE THE INCITING EVENTS?

There are multiple reasons why patients suddenly erupt angrily (Table 1). Often it is a combination of events, rather than a single issue, which triggers an angry outburst (4). In this patient’s case, financial stress due to his inability to work, ongoing anxiety and depression, and abrupt withdrawal from opioids played a role. A key inciting factor is his providers not communicating and educating the patient on the diagnosis and proper treatment strategies for pain management. The patient felt deprived of opioids by the healthcare providers, which he believed to be his only treatment. He had not learned that there are better options such as neuromodulators and brain-gut therapies (5–8).

SET UP A GAME PLAN IN ADVANCE

Successfully managing an angry patient requires mapping out scenarios in advance (9) (Figure 1 and Box 1). The approach to a disgruntled patient who communicates well differs from the highly agitated patient who is spiraling out of control. Help colleagues and staff understand the critical signs for the latter. Ensure a plan is ready for the patient who becomes out of control, and consider using a keyphrase or buzzword to alert colleagues to call security.

LEARN TO IDENTIFY POTENTIAL DISRUPTIVE SITUATIONS EARLY TO PREVENT ESCALATION TO THE NEXT LEVEL

Early identification of the angry patient is essential to defuse an emotional outburst successfully. Clenched fists and a tightly closed mouth are early nonverbal signs of anger. Some may adopt a stiff posture, lean forward threateningly, or abruptly look down. Before losing control, patients may seem agitated, restless, or unable to sit still. Some patients talk rapidly, switch from topic to topic, and swear or use threatening gestures. Aggressive behavior typically escalates in 3 stages: severe anxiety, verbal aggression, and physical aggression. If either of the first 2 signs is present when the patient is in the examination room, keep the door open; ensure no provider is left alone; and let the staff know that security may need to intervene.

MANAGEMENT

De-escalating a potentially dangerous situation early takes advanced planning. Rehearsing a scenario with a colleague in advance is vital. Knowing what not to do is as important as knowing what to do. Key elements include recognizing severe anxiety, which is usually the first stage before the behavior becomes disruptive (Figure 1 and Box 1). A severely anxious patient who has not progressed to the second phase, verbal aggression, can often be calmed down by sending a positive nonverbal signal by sitting nearby (but out of reach) while maintaining a relaxed, open position. Standing above the patient and looking down can be construed negatively. If the patient is speaking, do not interrupt. At the appropriate time, speak calmly, slowly, and clearly. Let the patient know, “You seem tense, frustrated, or anxious today.” If they acknowledge this, ask “why are you feeling that way?” or “can you tell me more about that?” The next few minutes spent listening may prevent progression to the next level. If the patient is talking loudly or yelling, calmly state, “I’d like to understand you better. May I ask if you could lower your voice?” If there is a verbal or physical signal that violence may ensue, then coolly state, “I need to be excused for a minute, and I will return later.” At this point, alert colleagues and staff that you may need assistance, and if appropriate, notify security. However, if the patient can maintain a controlled dialog, then acknowledge and validate the patient’s feelings in an empathic manner. For example, “I can understand why all of these things would make you angry.” Or “I can understand why you would be so upset given everything you have gone through.” Again, listen carefully without interrupting; this can be immensely therapeutic. At an appropriate time, set up an arrangement to resolve the problem. Do not suggest a quick fix; angry situations are complex and are not solved with a single intervention, “Let’s take some time and see how we might be able to work together on this.” RESOLUTION After an episode, it is important to debrief the staff. Determine whether the approach used worked. Ask whether a new approach is required, and revise accordingly (9–11). Importantly, assess whether the incident has caused psychological distress to the staff and then treat appropriately (e.g., refer to human resources and counseling). Whether to discharge an angry patient from the provider’s practice is complicated because multiple medical and legal issues are involved. If the episode was mild, quickly defused, and did not involve physical threats or violence and if the provider believes that a therapeutic relationship can continue, there is no need to discharge the patient. However, suppose the episode escalated to threats or violence. In that case, the patient should be released from the practice with the institution’s legal staff assistance.

CASE CONCLUSION

Dr. T was called and calmly asked whether they can return to the office to address A.G.’s concerns privately (with the door left open). He actively listened to A.G.’s concerns without interrupting. He acknowledged that the pain is real and empathized with his symptoms and his long healthcare journey. After the patient calmed down, Dr. T asked about the patient’s concerns and goals. Next, he discussed the diagnosis of centrally mediated abdominal pain syndrome and explained the basis for his pain through disrupted gut-brain neural control (12). Dr. T. acknowledged that A.G. felt the need to be on opioids for pain relief, noting that he believed he has no other options; however, there are better treatment strategies. Dr. T. then reviewed better long-term pain relief solutions and reassured the patient that he will be available to work with him on his care. He proposed an integrated care plan involving a psychologist (to focus on brain-gut behavioral therapy) and the use of a neuromodulator (4–8). He reassured the patient that he has successfully treated many similar patients with this approach and that he will see him again in follow-up. He asked the patient whether he has any questions and again reviewed the plan. His encounter at the checkout desk is uneventful.

CONFLICTS OF INTEREST

Guarantor of the article: Brian Lacy, MD, PhD, FACG.

Specific author contributions: All authors contributed equally to the development, research, and writing and editing of the manuscript.

Financial support: No financial support of any kind was provided for the development and writing or editing of this manuscript.

Potential competing interests: None to report.

Read the full publication with supporting tables and figures

Authors & Rome Foundation Board Members

The post <strong>De-escalate Don’t Escalate: Essential Steps to Effectively Recognize and Manage the Patient Who Is Angry and Disruptive</strong> appeared first on Rome Foundation.

Objectives:

The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut–brain interaction after hospitalisation for SARS-CoV-2 infection.

Design:

GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires.

Results:

The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrollment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls.

Conclusion:

Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls.

Trial registration number NCT04691895.

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Correspondence to Dr Giovanni Barbara, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Emilia-Romagna, Italy; giovanni.barbara@unibo.it

Received 15 August 2022 Accepted 23 November 2022 Published Online First 9 December 2022

Marasco G, et al. Gut 2023;72:484–492. doi:10.1136/gutjnl-2022-328483

Gut: first published as 10.1136/gutjnl-2022-328483 on 9 December 2022.

Downloaded from http://gut.bmj.com/ on February 7, 2023 at Azienda Ospedaliero-Universitariapoliclinicos. Orsola Malpighi.

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As the Rome Foundation grows in the degree and scope of its educational and research activities in Disorders of Gut-Brain Interactions (DGBI), we have found the need to broaden the leadership. Since its inception more than 30 years ago, the Rome Foundation has been led by Dr. Douglas Drossman as President and governed by a Board of Directors comprised of key international leaders. This organizational structure served well and allowed for the creation of Rome I-IV and countless other contributions to the field.

Over the past five years, the expansion of clinical education and programming, as well as the growth of the Rome Foundation Research Institute, the Rome Foundation/Drossman Center Communication Skills Program, the Rome GI Psych and Rome Pediatric Sections, and other initiatives have driven the need to expand our leadership model beyond Dr. Drossman and the Board. As we look at these and other programs and the Foundation’s future beyond the immediacy, we have expanded our leadership structure to allow for continuity and sustained growth.

This change brings Douglas Drossman, MD, to the role of Chief Executive Officer and President Emeritus, Johannah Ruddy M.Ed. as Chief Operating Officer and Executive Director, and Jan Tack MD, Ph.D. as President and Chairman of the Board. These three leaders will continue to work together, along with the Board of Directors, to create a diverse portfolio of activities and operationalize them into meaningful outcomes to advance the field.

We are excited about the growth and breadth of our programming and for what’s to come with Rome V in 2026, new and innovative clinical initiatives, and expansion into more research activities that will continue to drive the science of DGBI and improve the care of patients living with these conditions.

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