LESSON 12

In the Office with Dr. Gregory Sayuk

Gregory Sayuk, MD · Gastroenterologist · Professor of Medicine & Psychiatry · Washington University in St. Louis

TOPICS DISCUSSED

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About Dr. Gregory Sayuk

Gastroenterologist · Washington University in St. Louis

Dr. Gregory Sayuk joined the Washington University School of Medicine Division of Gastroenterology in 2006. He completed his medical school training at the University of Texas in Houston (1996-2000) and then came to Washington University in St. Louis for his Internal Medicine Residency training (2000-2003) and Gastroenterology fellowship (2003-2006).

Dr. Sayuk trained under the mentorship of Dr. Ray Clouse, and has a clinical interest in irritable bowel syndrome (IBS) and related functional GI disorders. Dr. Sayuk collaborates with colleagues in Neuroradiology and Psychiatry at Washington University in St. Louis to perform neuroimaging research using functional magnetic resonance imaging (fMRI) technology to identify central symptom amplification mechanisms and defective pain inhibitory pathways that may be relevant to IBS pathophysiology.

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

Key Takeaways

IBS often co-occurs with other non-GI chronic issues such as fibromyalgia, headaches, anxiety, and depression. Effective treatment requires looking beyond the gut symptoms and treating the whole person, as patients with overlapping conditions may be more refractory to treatment.
SIBO can present similarly to IBS with common symptoms like gas, bloating, and diarrhea. Diagnosing SIBO via breath testing is challenging due to issues with both false positives and false negatives; therefore, physicians may opt for an empiric trial of antibiotics to see if symptoms improve.
Laxatives and anti-diarrheal medications are useful for managing specific bowel symptoms of IBS but often fail to address the global symptoms of IBS, such as abdominal pain and bloating. Treatment plans should be tailored based on the most bothersome symptoms, the impact on quality of life, identifiable triggers (like food or stress), and patient preferences.
Endoscopy or colonoscopy is generally not required for IBS diagnosis unless the patient meets age-based screening guidelines, presents with alarm features (e.g., blood in stool, anemia), or is not responding to treatment as expected.