Building a Neurogastroenterology Unit: Why, Where, and How?

Background: Disorders of the gut-brain axis are public diseases ("Volkskrankheiten") and are among the most frequent reasons to visit a doctor. Despite their great medical and socio-economic importance, patients suffering from these disorders are often not taken seriously and, therefore, do not receive sufficient diagnostic evaluation, or a diagnosis, in conformity with the relevant guidelines. In addition, the inadequate compensation of services makes handling of neurogastroenterological disorders increasingly unattractive. As a result, neurogastroenterology is under-represented in medical curricula, with a decreasing number of scientists in academia who are familiar with this field in Germany. Summary: The prevalence of neurogastroenterological diseases, which is associated with the need for medical care, should create corresponding care as a "bottom-up" development. However, this is not possible in the German healthcare system, due to the inadequate reimbursement structures. Therefore, a "top-down" strategy must be developed through health policy directives, directing the establishment of neurogastroenterology units based on quality parameters and need. These centers must form comprehensive network structures and share essential information on neurogastroenterological diseases with general practitioners, clinicians, and patients. Appropriate apps that also focus on interdisciplinary care with the involvement of various specialist disciplines (e.g., gastroenterology, neurology, gynecology, urology, psychology, psychosomatics, nutritional medicine) would be helpful for this purpose. Key Messages: Neurogastroenterology units are important and should be interdisciplinary and located in tertiary centers. Due to the lack of incentives in the German healthcare system, they must be instituted through health policy directives from the top down.