There is increasing evidence that the investigators need to expand this paradigm to include interaction of the biopsychosocial model with the intestinal flora, i.e. a brain-gut-microbiota axis (B-G-M axis). It is becoming increasingly clear that host anxiety and stress can effect the composition of the microbiome. (8) Likewise, the microbiome can influence neural development, brain chemistry, and a wide range of behavioral phenomena including emotional behavior, pain perception, and how the stress system responds. (9) Both immune and neural pathways are involved intimately in visceral pain perception and intestinal microbiota can modulate this communication. (8) The general scaffolding of the brain-gut-microbiota axis includes the CNS, neuroendocrine and neuroimmune systems, autonomic nervous system, and the enteric nervous system. (10) Microbiota communicate with the brain-gut axis through different mechanisms including direct interaction with mucosal cells, via immune cells, and via contact with neural endings. (11)