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BellyMD
The Gut-Brain Consultation
A private educational session with Rick Pescatore, DO
From the desk of Rick Pescatore, DO
I am an emergency physician. For years, strangers have written to me with the same story: a decade of gut-brain symptoms, a folder of normal labs, and a string of seven-minute appointments that ended before the story did.
Let me be straight about what this is not. It is not a medical visit. I will not diagnose you, prescribe to you, or replace the clinicians who examine you. That is the law, and it is also the design.
What I will do is read your story before we ever speak, sit with you for thirty minutes, and explain the pattern in plain language: what is known, which tests exist, and exactly what to ask your own doctors. Then I put it in writing, so you walk into your next appointment armed.
If that is what you have been missing, I will see you.
Rick Pescatore, DO
Emergency physician · Founder, BellyMD
Reserve your session
Full refund any time before your session.
Emergency physician
Editor-in-Chief, Emergency Medicine News
Author, The Merck Manuals
Former Chief Physician, Delaware Division of Public Health
Why thirty minutes matters
11 seconds
The median time a patient speaks before the doctor interrupts.
J Gen Intern Med, 2019
Here, you get a physician who has read your story before you say a word and listens all the way through.
Share your story
A short intake, answered once. Rick reads everything before the call.
The session
Fifteen or thirty minutes, one on one, video, in your time zone. The full consultation ends in writing: recap and question list within two business days.
What you get
More than the call.
- Pre-read. Rick studies your intake first. No time wasted retelling.
- The session. Your pattern, explained in plain language.
- Doctor questions. Exactly what to ask, and which tests to ask about.
- Written recap. Yours within two business days.
Everything above is the full consultation. The focused session is fifteen minutes and one question, live only, with nothing written up afterward. That is what keeps it $275.
Sample recap · fictional patient, for illustration
Gut-Brain Consultation
Written recap
Prepared for L.M. · Thirty-minute session · Prepared by Rick Pescatore, DO
Educational summary. Not a medical record, and not a diagnosis.
What you told me
Four years of upper-abdominal pressure that begins within about twenty minutes of eating and lasts roughly two hours. Early fullness: you stop a third of the way through a plate you used to finish. Worse through the stretch after your father was ill, better on vacation, unchanged by the six weeks you spent on a low-FODMAP trial. Nausea most mornings, no vomiting. Sleep intact. Weight steady within four pounds for two years.
Read the full recap
What has already been ruled out
Upper endoscopy in 2024 with normal mucosa and no biopsy evidence of celiac disease. CBC, metabolic panel, thyroid studies and CRP all in range this spring. H. pylori stool antigen negative in 2023. Abdominal ultrasound with a normal gallbladder. That is a substantial negative workup, and it is worth saying plainly: none of it suggests you are imagining this. It suggests the problem is not structural damage.
How I would frame the pattern
What you describe fits the shape of a disorder of gut-brain interaction, the current term for symptom patterns generated by signaling between the gut and the brain rather than by visible tissue injury. The specific shape here, pressure and early fullness after meals with a normal endoscopy, is what the Rome criteria call postprandial distress syndrome.
Three things drive that pattern in most people, in some combination: how quickly the stomach empties, how well the upper stomach relaxes to accommodate a meal, and how loudly the nerves in the gut wall report ordinary sensation. The third is the one most often skipped. Nerves that have become hypersensitive report normal stretch as pain. That is a measurable phenomenon, not a description of your character.
What does not fit
The morning nausea, before you have eaten anything, is not classic for this pattern. I would rather name that than file it away. If it becomes the dominant symptom, or if vomiting starts, the differential widens and the workup should widen with it.
Worth raising with your gastroenterologist
- Whether a gastric emptying study adds information here. Given the early fullness, the result reframes the conversation whether it comes back delayed, normal, or rapid. Ask what each of those three results would change.
- Confirmation of H. pylori status. The 2023 test was negative, but acid-suppressing medication taken near the time of testing makes false negatives common. Ask whether the test conditions were right.
- Whether a gut-brain neuromodulator has a role. These are long-established medications used at doses well below their original psychiatric dosing, chosen for their effect on gut nerve signaling. Ask which class they would choose, why that one, and what the plan is if the first does not help.
- Whether four years of acid suppression is still earning its place. That is a long time on a medication started for a symptom it has not resolved.
Questions to bring, in these words
- “If the emptying study is normal, what is your next step?”
- “What would have to change for you to revisit the diagnosis?”
- “Is there a role for a gut-brain neuromodulator here, and what would you start with?”
- “What might I be doing that makes this worse without realizing it?”
What you can work on regardless
Meal size is the most controllable variable in this pattern: smaller, more frequent meals reduce the stretch that sets it off. Fat slows gastric emptying, so heavier meals tend to land harder. Neither of these is a fix, and neither replaces the conversation above. They are simply the levers you hold while you wait for the appointment.
What would make me want you seen promptly
Unintended weight loss, black or bloody stool, vomiting that will not stop, difficulty swallowing, or pain that wakes you from sleep. Any of those changes the picture and deserves in-person evaluation rather than a video call.
Closing
You have carried this for four years and been told repeatedly that everything looks fine. Both of those are true at the same time. The work now is asking a narrower set of questions, and you have them.
Rick Pescatore, DO
This recap is educational. It is not a diagnosis, a treatment plan, or a substitute for care from the clinicians who can examine you, and it does not create a doctor-patient relationship.
From the comments
Reserve your session
Gut-Brain Consultation
How long have you been chasing an answer?
Your answer reaches Rick with your booking.
Education, not a medical visit. No diagnosis, no prescriptions, no doctor-patient relationship. Your own clinicians stay in charge. That is the design, and it is why anyone, anywhere can book.
Questions
Is this a medical visit?
No. It is an educational session. Rick will not diagnose, treat, or prescribe, and he does not become your physician. Medical licensure is bound to states and countries; education is not, which is why this session can exist for anyone, anywhere.
The full consultation or the focused session?
Length, and what you leave with. The full consultation is thirty minutes for the whole story, and it ends in writing: a recap and a question list for your own clinicians within two business days. The focused session is fifteen minutes built around one question you name when you book. Your intake is still read in advance, but nothing is written up afterward. If you are unsure, take the full consultation.
I live outside the US. Can I book?
Yes. Video, scheduled in your time zone.
Will Rick tell me which tests to get or what to take?
He will explain which tests exist for patterns like yours and what they measure, then help you build the question list for your own clinician. The ordering and prescribing stay with the physician who examines you.
Do I have to buy BellyMD products?
No. If a formula honestly fits your pattern, he will say so and explain why. If not, he will say that too.
Reschedules and refunds?
Reschedule free with 24 hours notice. Full refund any time before your session; completed sessions are not refundable. The 12-week supplement guarantee covers formulas, not consultations.
Consultation Terms, in plain English
- Educational service. The Gut-Brain Consultation is an educational session. It is not medical care, diagnosis, treatment, or a medical opinion on your case. No prescriptions are written, no tests are ordered, and no medication changes are directed.
- No doctor-patient relationship. Purchasing or attending a session does not make Dr. Pescatore your physician and does not create a doctor-patient or other clinical relationship.
- Your own clinicians stay in charge. Nothing discussed replaces the advice of the physicians who examine you. Make medical decisions with them.
- Not for emergencies. If you have severe, sudden, or worsening symptoms, contact your local emergency services immediately. Do not wait for a scheduled session.
- Adults only. Sessions are for people 18 and older, discussing their own health.
- Scheduling. You will receive an intake and scheduling email within one business day of purchase. Sessions are typically held within two weeks, video, in your time zone.
- Rescheduling and refunds. Reschedule free with at least 24 hours notice. If you miss a session without notice, one courtesy rebooking is included. Full refund any time before your session takes place. Completed sessions are not refundable. Consultations are not covered by the BellyMD 12-week supplement guarantee.
- Privacy. Sessions are not recorded. Your intake and recap are kept confidential and used only to prepare and summarize your session. This is an educational service, so it does not create a medical record.
- Acceptance. Purchasing a Gut-Brain Consultation constitutes acceptance of these terms.