J Gastrointestin Liver Dis, March 2024 Vol. 33 No 1: 107-114 Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania Address for correspondence: Kuliaviene Irma Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania irma.kuliaviene@gmail.com Received: 12.05.2023 Accepted: 02.08.2023 Patient-Physician Relationship in Irritable Bowel Syndrome: Review on Empathy and Stigma Irma Kuliaviene, Sigita Gelman, Juozas Kupcinskas INTRODUCTION Irritable bowel syndrome (IBS) has a heterogenic and multifactorial pathogenesis involving complex interactions between genetic, neuroendocrine, immunological, psychological, dietary, and environmental factors [1-3]. It is highly prevalent, as more than 40% of persons worldwide have functional gastrointestinal disorders affecting the quality of life and health care use [4- 6]. It is associated with chronic abdominal pain, altered bowel habits, psychiatric comorbidities, such as anxiety and depression, and no “structural findings” REVIEW DOI: http://dx.doi.org/10.15403/jgld-5018 ABSTRACT Irritable bowel syndrome (IBS) lacks a clear understanding of the disease‘s pathogenesis and effective treatments thus producing frustration among providers and patients, leading to the stigmatization of the disease and the patients with the syndrome. A literature search was performed to make a hermeneutical review on empathic patient-provider communication and IBS. e relationship is defined by partners being dependent on one another in the pursuit of obtaining good outcomes. It is a unique interaction depending not only on the individual qualities of each partner but also on the specific patterns of the patient-physician synergy. Empathy is crucial for any relationship. It helps to recognize the other as the other of myself, a person like me. Meanwhile, stigmatization results from identifying and labelling human differences and stereotyping persons who are linked to undesirable characteristics. IBS is at high risk of stigmatization in various contexts and settings including health care, causing patients and physicians misconceptions and distress, which in turn leads to the worsening of the disease in patients and burnout in physicians. Narrative-based medicine helps create a holistic perspective of a patient’s problems and health, thus providing a tool for an empathic doctor- patient relationship that fosters mutual understanding and helps patients with IBS make sense of symptoms, increases their ability to manage their IBS in a psychologically flexible manner, subsequently helping them maintain their quality of life. Key words: patient-physician relationship − empathy − stigma − irritable bowel syndrome. Abbreviations: IBS: irritable bowel syndrome. suggesting the functional origin of the disease [7-9]. At this point IBS is prone to be considered a less legitimate unexplained psychiatric disorder [1]. This common misunderstanding produces frustration among providers, leading to the stigmatization of the disease and the patients with the syndrome. A comprehensive model of brain-gut-microbiome interactions has emerged in the past decade aiming to explain the nature of IBS as well as offer a basis for novel treatment options targeting microbiota, brain function, and other possible pathogenetic mechanisms [10-12]. Still there is not yet a breakthrough in this process, and gastroenterologists still encounter a large workload of gut-brain axis diseases. Functional gastrointestinal diseases account for about 30% of ambulatory care gastrointestinal consultations, especially because many consult repeatedly [13]. e relationship between patient and physician is thought to have a relevant role in treating IBS patients. Interventions targeting patient–provider interactions improve population health, patient experience, physician experience, and costs