Functional Bowel Disorders Flashcards
What are the 2 broad categories of GI disease?
Structural
Functional
What is the difference between structural and functional GI disease?
Structural has detectable pathology whereas functional does not
What are examples of functional GI disorders?
Oesophageal spasm
Non-ulcer dyspepsia (NUD)
Biliary dyskinesia
Irritable bowel syndrome
Slow transit constipation
Drug related effects
What does NUD stand for?
Non-ulcer dyspepsia
What do functional GI disorders have a large impact on?
Quality of life
Psychological factors
What are functional GI disorders not associated with that structural disorders are?
Serious pathology
What is non-ulcer dyspepsia?
Chronic or recurrent abdominal pain or nausea, without an ulcer
What is the helicobacter pylori status of non-ulcer dyspepsia?
It varies
What diseases i non-ulcer dyspepsia probably a combination of?
Reflux
Low grade duodenal ulceration
Delayed gastric emptying
Irritable bowel syndrome
What does the diagnosis of non-ulcer dyspepsia involve?
Careful history and examination - FH is important
H Pylori status
Alarm symptoms
If in doubt, endoscopy
What therapy is required for non-ulcer dyspepsia when H Pylori is positive?
Eradication therapy
What is nausea?
The sensation of feeling sick
What is retching?
Dry heaves (antrum contracts, glottis closed)
What is vomiting?
Abdominal contents expelled
What is often found in the history of nausea and vomiting immediately, 1 hour or more, 12 hours?
Immediate cause is psychogenic
1 hour or more is due to pyloric obstruction or motility disorders (diabetes, post gastrectomy)
12 hours or more is obstruction
What are some functional causes of nausea and vomiting?
Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol
What is psychogenic vomiting?
Vomiting without any obvious organ pathology or with a psychological aetiology
Who often suffers from psychogenic vomiting?
Young woman
What often happens to psychogenic vomiting after admission?
It stops
What is irritable bowel syndrome?
Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation
What is slow transit constipation?
Reduced motility of the large intestine caused by abnormalities of the enteric nerves
How does bowel habit from person to person vary?
There is a great variation in both bowel habit and stool weight
What is the average stool weight in the UK?
100-200g/day
What should be known about the interpretation of the word constipation?
It means different things to different people, so a better approach is to ask the patient about changes in the frequency, consistency, presence of blood or mucus from there normal
What are alarm symptoms relating to constipation?
Age >50 years
Short symptoms history
Unintentional weight loss
Nocturnal symptoms
Male sex
Family history of bowel/ovarian cancer
Anaemia
Rectal bleeding
Recent antibiotic use
Abdominal mass
What investigations should be done for slow transit constipation?
Colonoscopy
FBC
Blood glucose
U + E
Thyroid status
Coeliac serology
FIT testing
Sigmoidoscopy
What are different categories of the aetiology of constipation?
Systemic
Neurogenic
Organic
Functional
What are examples of systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are examples of neurogenic causes of constipation?
Autonomic neuropathies
Parkinson disease
Strokes
Multiple sclerosis
Spina bifida
What are examples of organic causes of constipation?
Strictures
Tumours
Diverticular diseases
Proctisis
Anal fissure
What are examples of functional causes of constipation?
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
What are clinical features of irritable bowel syndrome?
Abdominal pain
Altered bowel habit
Abdominal bleeding
Belching wind and flatus
Mucus
What does IBS stand for?
Irritable bowel syndrome
What do NICE guidelines say is required to diagnose irritable bowel syndrome?
Abdominal pain/discomfort relieved by defaecation or association with altered stool frequency/form plus two or more of:
altered stool passage
abdominal bloating/distension
symptoms made worse by eating
passage of mucus
What can be said about abdominal pain for IBS?
Very variable
What are different kinds of abdominal pain that can be felt with IBS?
Vague
Bloating
Burning
Sharp
Does abdominal pain due to IBS ever radiate?
Occasionally, often to the lower back
What are some examples of altered bowel habit for IBS?
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency
What symptoms often coincide with bloating?
Wind and flatulence
Relaxation of abdominal wall muscles
Mucus in stool
What is the physical examination for IBS like?
Normal
What investigations are done for IBS?
Blood analysis
Stool culture
Calprotectin
FIT testing
What causes calprotectin to be released?
Inflamed gut
What is calprotectin used to differentiate?
IBS from IBD, and to monitor IBD
What is the treatment for IBS?
Education and reassurance
Dietetic review
What is discussed in a dietetic review for IBS?
Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP
What is the FODMAPS diet?
Excess fructose
Lactose
Fructans
Galactans
Polyols
What drug therapy is given for pain due to IBS?
Antispasmodics
Linaclotide (IBS-C)
Antidepressants
What drug therapy is given for bloating due to IBS?
Some probiotics
Linaclotide (IBS-C)
What drug therapy is given for constipaition due to IBS?
Laxatives
Linaclotide
What drug therapy is given for diarrhoea due to IBS?
Antimotility agents
FODMAP diet
What psychological interventions can be done for IBS?
Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
What patients should get relaxation training for IBS?
Patients with diarrhoea and psychological comorbidity
What is the mode of action of relaxation training?
Uses progressive muscle relaxation, biofeedback and meditation for stress relief
What is the mode of action for hypotherapy?
Hypnosis induces a state of deep relaxation
What patients with ISB should receive hypnosis?
Refractory patients with pain, constipation, flatulence or anxiety
What is flatulence?
Build up of gas in the digestive system that leads to abdominal discomfort
What is the mode of action of cognitive behavioural therapy?
Involves identifying symptom triggers and learning to respond more appropriately
What patients with IBS is cognitive behaviour therapy useful for?
Ones with abdominal pain, bloating or flatulence
What patients with IBS is cognitive behaviour therapy not effective for?
Ones with depression or when patients believe in a physical cause for their symptoms
What is the mode of action of psychodynamic interpersonal therapy?
Helps the patient to understand how emotions and bowel syndromes interrelate
What patients with IBS is psychodynamic interpersonal therapy useful for?
Patients with a history of abuse
What patients with IBS is psychodynamic interpersonal therapy not useful for?
Patients with constipation, constant pain or depression
What causes IBS?
Altered motility
Visceral hypersensitivity
Stress, anxiety, depression
In simple terms, what is the bowel?
A muscular tube that squeezes content from one end to the oyther
In what form of IBS are muscular contractions of the bowel stronger, and what form are they weaker?
In IBS-D muscular contractions may be stronger
In IBS-C contractions may be reduced
What is an example of gut response triggers being altered in IBS?
Contractions can be triggered by walking and eating
What is the awareness of someones gut who has IBS like?
Excessive awareness of normal digestive processes, which most people do not feel
How is the sensitivity of the gut due to stress in IBS different from normal?
The gut is more sensitive
What can be said about mortality and qualitiy of life of functional GI problems?
Low mortality
High impact on quality of life
