Recently Dr. DiLorenzo gave our group a brilliant lecture. I have taken some notes and shared some slides. There may be inadvertent omissions and mistakes in my notes. Dr. DiLorenzo gave our group a lecture in 2021 as part of the William Meyers Lectureship. This talk extended those observations he conveyed at that visit (Carlo DiLorenzo: Lessons Learnt Over 30 Years).  I highly recommend his upcoming NED talk at NASPGHAN.

Key points (intermixed with slides):

• Diagnostic testing in the setting of DGBIs is mainly for confirmation that an adequate workup has been completed
• Schedule enough time for each patient. In evaluations of visits, one of the most negative feelings for patients is when they feel rushed

• Make sure the patient is allowed to speak. Parents may embellish (or underreport) symptoms
• Families feel that when clinicians are sitting down that they spend more time with them
• This extends into the hospital. A recent controlled study showed that having a chair within 3 ft of the bed increased the likelihood that physicians would sit when rounding and increased patient satisfaction (Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial. Iyer R, et al.BMJ. 2023 Dec 15;383:e076309). Study conclusion: “Chair placement is a simple, no cost, low tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication.”
• Dr. DiLorenzo rarely uses computers when he is in the room with families

• Don’t belittle or get upset over an “easy” or “stupid” consult. All of us need help and hardly anyone wants to manage only highly-complex patients
• Don’t speak poorly of other physicians in front of the patient

• The problem with too much testing –>it can result in ‘Munchausen by Doctor’ and the discovery of incidental problems (that may not necessitate treatment). Further testing has been associated with intensification of symptoms
• Identification of eosinophilic esophagitis is not helpful in resolving stomach pain

• Newest “epidemics” associated with stomach pains include alpha gal and multiple vascular compression syndrome
• While unusual disorders can occur, Dr. DiLorenzo mainly looks for unusual diagnoses when patients have unusual symptoms (like weight loss​, pain with exercise)

• While guidelines often emphasize the use of treatments based on double-blind, placebo-controlled (DBPC) studies, “there has never been a DBPC for the effectiveness of a parachute.” Some treatments are worthwhile even in the absence of DBPC studies
• Many of the medicines used for DGBIs and related symptoms have approval for other uses

• Fundoplication which was commonplace is used rarely these days. Yet, it is still a good treatment for reflux

• Antegrade enemas can be very effective for constipation

• “All patients with chronic pseudo-obstruction necessitating parenteral nutrition should have a G-tube and an ileostomy.” It may help them come off parenteral nutrition
• Don’t order AXR to diagnose constipation. AXRs ordered in ER to diagnose constipation are associated with a slightly higher likelihood of a missed diagnosis.
• Though, “no need to be holier than the pope.” Using AXR in specific circumstances can be helpful with treatment (like determining success of a cleanout)

• Treating the Brain is important in patients with DGBIs
• Anxiety, which is increased in patients with DGBIs, has reached epidemic levels

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