14 - Functional GI disorders

Question 1

alarm features that warrant further workup when thinking about functional GI disorders

Answer 1

wt loss (>10 lbs)
iron def anemia
high volume diarrhea
age > 50
family history of IBD, CRC, celiac
rectal bleeding
nocturnal diarrhea or pain

Question 2

what is the one test worth doing on a pt w/ functional GI disorder?

Answer 2

celiac serologies - much higher prevalence of this in IBS pts than normal population

Question 3

ROME III criteria for functional dyspepsia

Answer 3

one or more: bothersome postprandial fullness, early satiety, epigastric pain, epigastric burning
AND no structural dz to explain sx

Question 4

time frame req for functional GI dx

Answer 4

present for last 3 mo and sx onset at least 6 mo ago

Question 5

ROME III criteria for IBS

Answer 5

recurrent abd pain/discomfort at least 3 d/mo

AND 2 or more of: improvement w/ defecation, change in stool freq, change in stool appearance/form

Question 6

associated sx w/ IBS

Answer 6

abnl stool freq/form
defecation straining
urgency
feeling of incomplete BM
passing mucus
bloating

Question 7

suspected cause of IBS bloating

Answer 7

bacteria play a role - small bowel overgrowth or altered colonic flora implicated

Question 8

pathophys of functional GI disorders

Answer 8

genetic/env factors that predispose > some insult like infxn, food sensitivity, emotional stress > resulting neuropathy, motor disturbance, hypersensitivity, sensory processing, psych problem > symptoms

Question 9

tx for IBS

Answer 9

treat predominant sx - constipation, diarrhea same as in a normal pt
pain predominant - antispasmodics, antidepressants