Functional Bowel Disorders

Question 1

What is the definition of a ‘Functional Bowel Disorder’?

Answer 1

No detectable pathology

Related to gut function

Question 2

What are some examples of a functional bowel disorder?

Answer 2

Oesophageal spasm
Non-ulcer dyspepsia
Biliary dyskinesia
IBS
Slow transit constipation
Drug-related effects

Question 3

What are the risk factors and different types of causes for slow transit constipation?

Answer 3

Systemic
Neurogenic
Organic
Functional

Systemic

• DM
• Hypothyroidism
• Hypercalcaemia

Neurogenic

• Autonomic neuropathies
• Parkinson’s
• Stroke/MS
• Spina Bifida

Organic

• stricture
• tumour
• diverticular disease
• proctitis
• anal fissure

Functional

• megacolon
• idiopathic constipation
• depression/psychosis

Question 4

Concerning symptoms in slow transit constipation?

Answer 4

Age >50
Short symptom history
Weight loss
Nocturnal symptoms
Male
Family history of cancer
Anaemia
Rectal bleeding
Recent Ab use
Abdominal mass

Question 5

What investigations might be done in slow transit constipation?

Answer 5

FBC
Blood glucose
U+Es
Thyroid status
Coeliac serology
Proctoscopy
Sigmoidoscopy
Colonoscopy

Question 6

Risk factors and causes for IBS?

Answer 6

Altered motility
Visceral hypersensitivity
Stress, anxiety, depression

Question 7

Clinical features of IBS?

Answer 7

Abdominal pain
Altered bowel habit
Abdominal bloating
Belching wind and flatus
Mucus

Pain - variable, vague, bloating, burning, sharp
- replicated by balloon suggests caused by distension
Bloating - often prominent, wind/flatulence, mucus in stool, upper and other GI symptoms

Question 8

Investigations in IBS?

Answer 8

FBC, U+E, LFTs, Ca, CRP, TFTs, Coeliac serology
Stool culture
Calprotectin - inflammatory marker in stool - differentiates between IBD and IBS
Rectal examinationan, FOB
Possible colonoscopy

Question 9

What are the names of the two diagnostic criteria for IBS?

Answer 9

ROME III vs NICE

Question 10

Non drug treatment for IBS

Answer 10

Dietetic review (Gluten exclusion trial, FODMAP restriction, lactose restriction)
Education/reassurance

Relaxation training
Hypnotherapy
CBT
Psychodynamic Interpersonal Therapy

Question 11

Drug treatments for IBS (D and C)

Answer 11

Pain

• antispasmodics
• linaclotide (C)
• SSRIs (C) or TCAs (D)

Bloating

• probiotics
• linaclotide (C)
• avoid bulking agents/fibre
• antiflatulents (poor evidence)

Constipation

• laxatives (bulking agents, softeners, stimulants occasional, osmotics regularly)
• linaclotide
• avoid TCAs
• 5HT4 agonists (off-label)

Diarrhoea

• antimotility agents
• avoid SSRIs
• Rifaximin (insufficient evidence)