Functional Bowel Disorders

Question 1

What is the definition of functional bowel disorders?

Answer 1

1) Structural

• Detectable pathology e.g. macroscopic cancer, microscopic colitis.
• Prognosis depends on pathology

2) Functional

• No detectable pathology
• Related to gut function
• ‘Software faults’
• Long term prognosis good

Question 2

How is a patient with a functional bowel disorder investigated?

Answer 2

• Thorough history & examination can diagnose most funtional GI disorders

Investigations:

• Take a careful history (what does the patient mean? how long have you had it? Have you soiled yourself? Taking any drugs?)
• Physical examination (systemic disease, careful abdominal examination, PRE)
• Check ALARM symptoms (>50 y.o., short symptom history, unexplained weight loss, night time symptoms, male, family history of bowel cancer, anaemia, rectal bleeding)
• FBC
• Blood glucose & calprotectin
• Thyroid status
• Coeliac serology
• Sigmoidoscopy
• Colonoscopy

Question 3

How is a patient with a functional bowel disorder managed? E.g. IBS

Answer 3

Diet - Limit tea & coffee but drink plenty of water, limit fibre, probiotics

Constipation - Increase fibre gradually

Colic/bloating - Antispasmodics

Psychological therapy

Question 4

What is the impact of functional bowel disorders and what role do psychological factors play?

Answer 4

Stress, anxiety and depression can all play an important role in IBS

It is thought that the Brain-Gut axis is much stronger in IBS patients

As a result, any psychological influences can have a big impact on the physiology of the gut

Other impacts:

• Absenteeism from work
• Impact on quality of life
• Lots of medical consulations

Question 5

What are the ALARM symptoms for investigation of functional bowel disorders?

Answer 5

Age - >50

Male

Strong family history of CRC

Unexplained weight loss

Nocturnal pain/symptoms

Anaemia

Rectal bleeding

Abdominal mass

Question 6

What are the drug, dietary and other management techniques for functional bowel disorders?

Answer 6

Dietary:

• Reduce caffeine intake
• Drink plenty of fluids
• Low FODMAP diet (Fermentable, Oligo, Di & Mono saccharides and Polyols)

Drug:

Pain - antispasmodics

Bloating - Probiotics

Constipation - Laxatives

Diarrhoea - Antimotility agents

Psychological Interventions:

Relaxation training

Hypnotherapy

CBT

Psychodynamic interpersonal therapy