167. Functional GI Disorders

Question 1

Define Functional GI Disorders

• prevalence

- pathogenesis

Answer 1

Disorders of brain-gut interaction
Difficult to define, for all parties involved
Prevalence: 5-10%
functional = ELIMINATED
PGen: bile acid malabsorption, post-infection, diet, dysbiosis, genetics, SIBO, visceral hypersensitivity/motility
BIOPSYCHOSOCIAL PGEN

Question 2

Dx criteria for IBS

Types of IBS

Answer 2

recurrent abd pain on avg 1day/week with 2+ of:
- pain related to defecation
- associated with change in stool form
- assoc with change in stool freq
Dx based on ruling IN clinical syndrome and ruling OUT alarm features (anemia/bleeding, famhx, weight loss, new sx after age 50)
- if no alarm sx and meets clinical dx = NO TESTING NECESSARY (may rule out IBD with inflammatory markers, Celiac with IgA transglutaminase)

IBS-C: with constipation (hard, lumpy stool)
IBS-M: mixed
IBS-D: with diarrhea (loose, watery stool)

Question 3

Tx of IBS-C

Answer 3

Secretagogues

• Lubiprostone: Cl Channel agonist: increase luminal fluid secretions = improve intestinal transit
• Linaclotide/Pleanatide: activates guanylate cyclase = more cGMP = blocks pain fibers and increases secretions = less pain, improved intestinal transit

Question 4

Tx of IBS-D

Answer 4

Rifaximin: reduce SIBO = less abd pain = less bloating

Eluxadoline: mu opioid receptor agonist = decrease pain, gastric propulsion (good if failed over the counter stuff)

Question 5

Natural/Alternative Tx of IBS

Answer 5

Small meals, avoiding fat, increasing fiber, avoiding milk (comorbid lactose intolerance)

low FODMAP diet (low intake of short-chain carbs = less bacterial activity = less GAS) - HELPS MORE than small meals/avoiding triggers by better LOWERING ABD PAIN

Peppermint Oil: anti-inflammatory, anti-5HT, anti-spasmodic, anti-bacterial - reduces global IBS sx/abd pain (some SE: heartburn, abd pain, burning)

CBT: gut-brain interaction tx - minimal contact better than standard CBT - education helps!

role of chinese herbals, capsaicin, turmeric

Fecal microbiota tx? unclear for IBS (only recurrent C Dif colitis)

BEST WAY TO IMPROVE OUTCOMES: foster good MD-pt relationship - validate sx, empathy, therapeutic relationship