In the Office with
Dr. Kyle Staller

1. Patients often fear that IBS is a misdiagnosis for more serious conditions like cancer; however, research indicates that individuals with IBS do not have an increased risk of overall mortality (death) or mortality from cancer.
2. There is a high overlap between IBS and endometriosis, both are chronic pain disorders with abnormal motility that primarily affect women. Clinicians should evaluate for cyclical symptoms or pain during intercourse to determine if an endometriosis assessment is necessary.
3. Pelvic floor dysfunction can be seen in patients with constipation who have trouble evacuating and can overlap with other symptoms such as painful sexual intercourse. A pelvic floor evaluation with formal testing and treatment with pelvic floor physical therapy and biofeedback can be helpful.
4. While SIBO can occur, particularly in patients who have undergone surgery, it is often viewed with nuance. The focus is shifting toward the specific composition and behavior of the microbiome rather than just the quantity of bacteria.
5. Understanding that IBS is a disorder of brain-gut communication can be therapeutic, helping patients move away from the idea that IBS is merely a "diagnosis of exclusion" without treatment options.
6. Shared decision making between patient and provider is key to developing an effective treatment plan for IBS. There are many evidence-based treatments for IBS that can fit with an individual patient's ideals and preferences.
7. Unpredictability is a known feature of IBS symptoms. Sometimes it can be hard to predict or identify what triggers IBS symptoms. Treatment may not completely eliminate symptoms or unpredictability but can reduce the severity of symptoms on "bad days."
8. Neuromodulators are an often overlooked but effective treatment that act as "training wheels" for malfunctioning nerves, helping to turn down the volume on abnormal nerve signals and potentially improving gut-brain communication over time. Compared to symptomatic gut-directed treatments, neuromodulators may be able to be tapered off as communication improves between the brain and the gut.

Kyle Staller, MD, MPH is a gastroenterologist, director of the Gastrointestinal Motility Laboratory at Massachusetts General Hospital, and associate professor of medicine at Harvard Medical School. Dr. Staller specializes in disorders of gastrointestinal motility and neurogastroenterology and his clinical practice is devoted to treating patients with GI motility disorders and disorders of brain-gut interaction.

Dr. Staller's research interests include clinical and epidemiologic research in neurogastroenterology and motility with particular interest in chronic constipation, irritable bowel syndrome (IBS), fecal incontinence, eating disorders, and women's health in functional GI diseases. His research has been published in medical journals across the spectrum of GI, and he also serves as a medical liaison to the media with appearances in national news outlets as well as health and wellness magazines.

Dr. Staller received his medical degree from Harvard Medical School and trained at Massachusetts General Hospital (MGH) for residency and gastroenterology (GI) fellowship. He also completed formal training in epidemiology culminating in a Masters of Public Health from the Harvard School of Public Health and subspecialty training in neurogastroenterology and motility at MGH before joining the faculty.