Functional Gastrointestinal Disorders

Question 1

FUNCTIONAL GASTROINTESTINAL DISORDERS (FGID)

Answer 1

• Large group of disorders; Symptoms occurring in absence of demonstrable abnormalities of
Digestion and Absorption without Structural Abnormalities
o May have Abnormalities in Neuromuscular Function (E.g. Dysmotility, Visceral
Hypersensitivity), but not routinely investigated

• Extremely common; Large majority of patients who attend Gastroenterology clinic
• Classified by Rome III Criteria (Oesophageal, Gastroduodenal, Bowel, Abdominal Pain and
Gallbladder/Sphincter of Oddi Disorders)
• Disturbed motility leading to distention, with visceral hyperalgesia; Extrinsic and Intrinsic
information affects GI sensation due to neural connections with higher centres (Brain-Gut
Axis); Psychological stress can exacerbate, and Psychological disorders more common in FGID

Question 2

Functional Dyspepsia

Answer 2

• Spectrum of illness, from Upper Abdo Pain/Discomfort, Fullness, Early Satiety, Bloating and
Nausea; No structural abnormalities
• Suggested classification – Epigastric Pain Syndrome and Postprandial Distress Syndrome
• Reassurance, Explanation and Lifestyle changes; PPI and Prokinetic Agents respectively; SSRI
for refractory cases; H pylori eradication therapy might be effective
• Gastroparesis – Differential includes Diabetes Mellitus (Most common; due to Autonomic
Dysfunction), Vagal Nerve Damage, Systemic Sclerosis, Acute Abdomen, Electrolyte
Imbalances, Drugs, Thyroid Disease; Idiopathic is second more common cause)

Question 3

Irritable Bowel Syndrome

Answer 3

• Most common FGID; 1/5 of people in West; 50% will
consult GP, up to 30% referred to specialist; Financial
burden not only in healthcare services but also time
off-work
o Medical care seekers tend to have higher
illness attitude scores, Anxiety and Depression
scores; 2-3F:M

• Extraintestinal – Gynaecological (Dysmenorrhoea,
Dyspareunia), Urinary Symptoms, Joint Hypermobility,
Back Pain, Headaches, Poor sleep, Fatigue
• Might co-exist with Chronic Fatigue Syndrome,
Fibromyalgia and TMJ Dysfunction
• Infectious Diarrhoea precedes 7 – 30%; Risk Factors
– Female, Severe/Chronic Diarrhoea, Pre-existing
Life Events, High Hypochondrial Anxiety and
Neurotic Scores

Question 4

Management of IBS

Answer 4

• Consider Assessment if – Abdominal
Pain/Discomfort, Bloating, Change in Bowel Habit
for at least 6/12; Assessment for IBD and Cancer if
Red Flag symptoms present
• Rome III 2006 Criteria – 3/12 of at least 3/7 per
month of Recurrent Abdominal Pain or Discomfort,
associated with ≥2 of: Improvement with
Defecation, Onset associated with Change in
Frequency, Onset associated with change in
Appearance of Stool
o Classified as IBS with Constipation (Hard
lumpy >25%, Loose <25%), IBS with
Diarrhoea (Loose >25%, Hard Lumpy <25%),
Mixed IBS (>25% of either), Unsubtyped IBS
(<25% of either)

• Exclude other causes – FBC, ESR, CRP, Antibodies
for Coeliac (EMA, TTG)
• Patient Education, Relaxation, Diet and Nutrition
Advice (Regular Meals, Avoid Missing, Fluid Intake,
Restrict Caffeine, ETOH, Fizzy Drinks; Avoid
‘Resistant Starch’, Limit Fresh Fruit and Fibre; Avoid
Sorbitol if Diarrhoea)
• Probiotics – Advised to take for at least 4/52 while monitoring
• Pharmacotherapy – Antispasmodics, Laxatives (Avoid Lactulose), Loperamide
o Consider TCAs if conventional therapy not useful; Consider SSRIs if TCA ineffective
• Psychological Therapies (CBT, Hypnotherapy, etc) if no response to Pharmacotherapy 12/12,
and develop continuing symptoms profile (=Refractory IBS)