Methods to build and maintain effective clinician-patient relationships for adults with disorders of gut-brain interaction (DGBI): a systematic review.

BACKGROUND

The clinician-patient relationship is a vital component of therapeutic success in disorders of gut-brain interaction (DGBI), recently codified as the foundational "Level 1" psychosocial care within the Rome V biopsychosocial framework. This systematic review aimed to identify evidence-based methods for building and maintaining effective clinician-patient relationships in adult DGBI care.

METHODS

Following the PRISMA 2020 and Synthesis Without Meta-analysis (SWiM) guidelines, we searched PubMed, Cochrane CENTRAL, and Ichushi Web for studies published through January 2026. Quality assessment was performed using AMSTAR 2 and RoB 2/ROBINS-I tools, facilitated by a human-AI collaborative verification process.

RESULTS

Twelve studies (four systematic reviews and eight primary studies) were identified. Narrative synthesis revealed that "augmented encounters," characterized by empathy, warmth, and active listening improved clinical outcomes, including symptom severity and quality of life, particularly in irritable bowel syndrome. Strategic communication providing a confident positive diagnosis and psychoeducation regarding the gut-brain axis (rather than a diagnosis of exclusion) was found to be superior for enhancing treatment adherence in functional dyspepsia. Furthermore, multidisciplinary care models (spanning from provider-delivered self-management education to fully integrated Level 3 gastropsychology) and the use of non-deceptive placebos optimized the therapeutic context. The review also identified potential cultural moderators, hypothesizing that disease-centered reassurance might play a distinct role in certain East Asian clinical settings compared to Western contexts, though this warrants further investigation.

CONCLUSION

This review structurally organized multiple relational tools, highlighting their fundamental role in DGBI management. Although current evidence is heterogeneous and partly relies on indirect findings, these promising supportive strategies conceptually align with Rome V psychosocial care. Further high-quality, direct clinical studies are needed to clarify which relational strategies are most effective for specific DGBI populations and clinical contexts.

PROSPERO REGISTRATION: CRD420251126617.