Creating a multidisciplinary team to manage the refractory disorder of gut–brain interaction: practical experience from a neurogastroenterology centre

Disorders of gut–brain interaction (DGBI) are common gastrointestinal conditions, affecting over one-third of the UK population and are characterised by symptoms in the absence of structural abnormalities. Refractory DGBI cases that fail to respond to first-line and second-line therapies require a more comprehensive approach than traditional gastroenterologist-only care. In this article, we outline the roles of gastroenterologists, clinical nurse specialists, dietitians, psychologists and psychiatrists in delivering an integrated multidisciplinary team (MDT) model for managing patients with refractory DGBI and describe how each discipline contributes to assessment, formulation and treatment within a biopsychosocial framework. Gastroenterologists provide positive diagnoses and personalised formulations, establishing trust and setting the foundation for multidisciplinary input. Clinical nurse specialists offer education, bowel retraining and behavioural interventions. Dietitians address maladaptive food behaviours through psychoeducation and graded food exposure, reinforcing the biopsychosocial model. Psychologists deliver evidence-based psychological therapies, trauma-informed care and team support and supervision. Psychiatrists diagnose and manage psychiatric comorbidities and advise on neuromodulator use. Wider adoption of MDT models, supported by appropriate resource allocation and training, is crucial to improve outcomes and reduce the burden of DGBI on patients and healthcare systems.