LESSON 13

In the Office with Dr. Andrea Shin

Andrea Shin, MD · Gastroenterologist · Associate Professor of Medicine · UCLA

TOPICS DISCUSSED

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About Dr. Andrea Shin

Gastroenterologist · UCLA

Dr. Shin specializes in the care of patients with disorders of gut-brain interaction (DGBI) and gastrointestinal motility disorders. She is committed to providing individualized care that emphasizes the multidimensional nature of DGBI and motility disorders.

Her research interests relate to her clinical expertise and focus on developing novel diagnostic and therapeutic approaches to treating disorders such as irritable bowel syndrome, functional diarrhea, chronic diarrhea, chronic constipation, and other DGBI.

She received a K23 career development award through the National Institutes of Health, has co-authored over 80 peer-reviewed publications, and is a member of the Rome V Bowel Disorders Committee, the AGA Research Awards Panel and Research Institute Policy Committee, and the American Neurogastroenterology and Motility Society (ANMS) Council. She serves as chair of the ANMS Research Council, associate clinical editor for Neurogastroenterology & Motility, and as an editorial board member for Alimentary Pharmacology & Therapeutics, Clinical Gastroenterology and Hepatology, and BMC Medicine.

In The Office segments are in-depth conversations with our experts on how they approach IBS with their own patients.

Key Takeaways

The gut microbiome is an integral, dynamic community that regulates physiology, sensation, motor function, and the immune system. While it is recognized as an important contributor to the development of IBS, research is still ongoing regarding the development and application of microbiome testing and treatment to everyday clinical practice.
The low-FODMAP diet is a well-studied approach for the treatment of IBS that involves eliminating fermentable carbohydrates and then reintroducing them to identify triggers. Long-term overly restrictive diets may negatively impact the microbiome, and patients are cautioned against becoming overly restrictive without medical guidance.
Bacterial overgrowth is historically associated with severe motility or anatomical issues. Diagnosing it in patients with IBS is challenging because the most commonly used diagnostic test for SIBO (breath testing) has limitations.
The "GI Map" test utilizes sequencing technology to categorize the relative abundance of bacteria in the gut. However, it is difficult to interpret the microbiome results of this panel clinically. Research regarding what constitutes "healthy" versus "unhealthy" and how this should dictate treatment plans is not well-defined.
The gastrocolic reflex is part of the colon's natural increase in activity following meals. Some patients with IBS experience a hyperactive response to this, which can be managed with anti-spasmodics or central neuromodulators.