Functional disorders of the gut Flashcards
Characteristics of functional gut disorders
No structural or tissue abnormality
Defined by constellation of symptoms but without overt pathology
Disturbed motility
Visceral hypersensitivity
Brain gut dysfunction
Psychosocial factors (stress, anxiety worsens symptoms)
No specific diagnostic test (biochem, histological, radiological)
Rome criteria
Long criteria for diagnosis of all functional GI disorders. I.e that people suffering from a condition fit the same criteria.
Functional conditions of oesophagus
Globus- sensation of lump or something stuck in throat
Functional heartburn- reflux symptoms without evidence of GORD etc
Stomach
Functional dyspesia- epigastic discomfoft without pathology Functional vomiting (cyclic vomiting syndrome)- recurrent vomiting no diagnostic pathology.
LI
Irritable bowel syndrome:
Swinging bowel habit (from constipation to diarrhoea)
Abdo pain relieved with defection.
Associated symptoms- urgency, mucous, bloating, ++flatus.
May occur after gastroenteritis
Alarm symptoms
d
Diagnosis of a functional gut disorder is often…
‘a diagnosis of exclusion’ (of other GI disorders)
ROME 3 criteria for IBS
Chronic- 3 days per month in at least the last 3 months
Onset at least 6 months before diagnosis
associated with two or three of the following
Improves with defecation
Onset of pain coincides with changes in stool frequency
Onset of symptoms is accompanied by changes in the stool
Associated symptoms with IBS
FAtigue Functional dyspepsia Nausea, vomiting Backache Headache Urinary symptoms Dysmenorrhea, dyspareunia Palpitations Poor sleep
Alarm symptoms
Older Short Hx Nocturnal diarrhoea Rectal bleeding anaemia Weight loss Vomiting Family hx of colon cancer/ coeliac disease
How common is IBS
Up to 1:5, possibly more common 1:4
Pathophysiology: altered gut motility
Altered gut motility
Frequency and duration of contractions
Transit time
Exaggerated response to meal (need to defaecate soon after meal)
Exaggerated with diarrhoea, reduced with constipation.
Pathophysiology: visceral hypersensitivity
Balloon distention of colon causes pain in 50-60% IBS patients, compared with 10% non IBS
Peripheral sensititasation post gastroenteritis: upregulate nociception of stimuli leading to hyeraglgesia
Mechanism of visceral hypersensitivity
Brain processing of visceral sensation maybe different in IBS.
Gate control theory- pain messages from periphery encounter nerve gates. Maybe increased focused on unpleasant stimuli, hypervigilance.
Treatment
Conventional
Dietary
Natural
Lifestyle
