How culture, stress, and social life may shape gut health

by Wroclaw Medical University

edited by Stephanie Baum, reviewed by Robert Egan

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Abdominal pain before an important exam, nausea during intense stress, or sudden intestinal problems following difficult life experiences—many people regard such symptoms as a temporary bodily reaction. However, a growing body of evidence confirms that the relationship between the brain and the gut is far deeper. A publication co-authored by Professor Agata Mulak of Wroclaw Medical University indicates that gastrointestinal health is influenced not only by genes, diet and gut bacteria, but also by culture, social relationships, economic status and the way individuals function within society.

The article, published in the journal Gastroenterology, forms part of the update of the Rome V Criteria, the most important international system for the classification and diagnosis of disorders of gut–brain interaction (DGBI). These conditions, until recently referred to as functional gastrointestinal disorders, include—among others—irritable bowel syndrome.

Disorders of gut–brain interaction

Disorders of gut–brain interaction are currently among the most common gastroenterological conditions. It is estimated that they may affect up to approximately 42% of the general population. At the same time, they remain a major diagnostic and therapeutic challenge.

Patients often spend years being told that their test results are normal, even though symptoms such as abdominal pain, bloating, diarrhea, constipation or nausea significantly impair daily functioning.

"The shift in our understanding of the pathogenesis and course of disorders of gut–brain interaction is the result of a holistic approach to health and disease, consistent with the biopsychosocial model, which takes into account the interactions of biological, psychological and sociocultural factors," explains Professor Mulak, from the Department and Clinic of Gastroenterology, Hepatology and Internal Diseases, Wroclaw Medical University.

The new Rome Criteria emphasize that symptoms are neither "purely psychological" nor "solely intestinal." Rather, they result from complex interactions among the nervous, immune and endocrine systems, as well as the gut microbiota.

The gut–brain axis

In recent years, scientists have increasingly focused on the gut–brain axis, a system of bidirectional communication between the gastrointestinal tract and the brain. The gut is no longer viewed solely as an organ of digestion, but as an active component regulating the functioning of the entire body.

This communication involves nerves, hormones, immune cells and the gut microbiota—the billions of microorganisms inhabiting the gastrointestinal tract. This is why chronic stress can affect not only mental well-being but also intestinal function.

"Chronic stress disrupts communication between the brain and the gastrointestinal tract, affecting intestinal motility, visceral hypersensitivity, intestinal barrier permeability and the composition of the microbiota," explains Professor Mulak.

Research shows that prolonged psychological stress may increase intestinal hypersensitivity, alter the composition of gut bacteria and intensify inflammatory processes. This, in turn, leads to greater symptom severity and a reduced quality of life for patients.

Loneliness, pressure and sociocultural factors also affect the gut

One of the most important aspects of the new publication is its emphasis on sociocultural factors. This is an area that had received little attention in gastroenterology until only a few years ago.

Scientists now have a much better understanding that gut health may also depend on living conditions, economic security, the quality of social relationships and cultural norms concerning the expression of emotions and illness.

"Sociocultural factors exert a significant influence on stress levels, lifestyle and the way we perceive and respond to symptoms," emphasizes the researcher.

Factors such as excessive workload, chronic financial insecurity, lack of social support or experiences of exclusion may all play a role. In some cultures, openly discussing gastrointestinal problems remains socially taboo, which may delay seeking medical help.

"Cultural norms shape the interpretation and expression of symptoms, as well as health care-seeking behavior, directly influencing the course of these disorders and the effectiveness of treatment," adds Professor Mulak.

An increasing body of evidence suggests that disturbances of the gut–brain axis may have implications beyond gastroenterology. Researchers are investigating their associations with metabolic, autoimmune, neurological and psychiatric disorders.

The gut microbiota may influence immune system function, metabolism and brain activity. Consequently, imbalances in the microbiota are now being studied in the context of depression, neurodegenerative diseases and obesity, among other conditions.

The medicine of the future will be more holistic

The new approach is also changing the way patients are treated. Increasing importance is being placed on building strong physician–patient relationships and tailoring therapy to each patient's individual needs.

"Effective physician–patient communication, based on active listening, empathy and trust, forms the foundation of successful treatment," notes Professor Mulak.

Experts emphasize that effective therapy should not rely solely on medication. It increasingly includes dietary modifications, improved sleep quality, physical activity, stress-reduction techniques and psychological support.

"A holistic approach not only reduces symptom severity but also improves patients' quality of life. In the future, we can expect increasingly personalized therapies that take into account both the biological and psychosocial dimensions of health," concludes the researcher.

Publication details

Reuben K. Wong et al, Sociocultural Aspects of the Pathophysiology, Clinical Presentation, and Management of Disorders of Gut–Brain Interaction, Gastroenterology (2026). DOI: 10.1053/j.gastro.2026.02.006

Journal information: Gastroenterology

Key medical concepts

Brain-Gut AxisFlora, IntestinalIrritable Bowel SyndromeModels, Biopsychosocial

Clinical categories

GastroenterologyDigestive healthPsychology & Mental healthCommon illnesses & Prevention Provided by Wroclaw Medical University Who's behind this story?

Stephanie Baum

Master's in TESOL from The New School. Passionate about language learning and editing science news on biology and space exploration. Full profile →

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