Functional GI Disorders Flashcards
What are the 2 broad categories of the GI tract?
Structural and Functional
Describe structural GI diseases
They have detectable pathology
Prognosis also depends on the pathology
Describe the functional GI diseases
No detectable pathology
Related to gut function
Long term prognosis is good
What are some functional GI disorders?
Oesophageal spasm, non-ulcer dyspepsia, biliary dyskinesia, IBS, Slow transit constipation and drug related effects
Describe Non-ulcer dyspepsia
Dyspeptic type pain
No ulcer on endoscopy
Probably not a single disease - reflux, delayed gastric emptying and IBS
How is non-ulcer dyspepsia diagnosed?
FH, H. pylori status, alarm symptoms - if negative then treat symptomatically
If H. pylori positive then eradication therapy
If doubt then endoscopy
What could immediate vomiting be caused by?
Psychogenic
What can vomiting 1 hour or more after food be caused by?
Pyloric obstruction
Motility disorders - diabetes and post gastrectomy
What are some functional causes for vomiting and nausea?
Drugs, pregnancy, migraine, cyclical vomiting syndrome, and alcohol
What can show changes in gut function?
Change from normal amount
Change in frequency or consistency
Blood
Mucus
What are the alarm symptoms?
Age over 50, weight loss, nocturnal symptoms, male sex, FH, anaemia, rectal bleeding, recent antibiotic use and abdominal mass
What investigations are used?
FBC, blood glucose, U+E, thyroid, coeliac serology, FIT testing, sigmoidoscopy and colonoscopy
What are some organic causes for constipation?
Strictures, tumours, diverticular disease, proctitis and anal fissure
What are some functional causes for constipation?
Megacolon, idiopathic, depression, psychosis, institutionalised patients
What are some systemic causes for constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are some neurogenic causes for constipation?
Autonomic, Parkinson’s disease, strokes, MS, spina bifida
What are the clinical features of IBS?
Abdominal pain, altered bowel habit, and abdominal bloating
Can get belching wind and flatus
Mucus
What is the NICE diagnostic criteria for IBS?
Abdominal pain relieved by defaecation or associated with altered stool frequency and form and also - altered passage, bloating, worse when eating, passage of mucus
Describe the abdominal pain in IBS
Very variable
Bloating, burning, sharp and occasionally radiates to back
Often altered by bowel action and rarely occurs at night
Describe the altered bowel habit in IBS
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability and urgency
What is bloating like in IBS?
Often very prominent
Wind and flatulence
Relaxation of abdominal wall muscles
Mucus in stool
What is diagnosis like for IBS?
A compatible history
Normal physical exam
What investigations are done for IBS?
FBC, U+E, LFT, CRP, TFT, Coeliac serology, stool culture, calprotectin, FIT testing, rectal exam
What is calprotectin released by?
Inflamed gut mucosa
What is calprotectin used for?
Used for differentiating between IBS and IBD
Also for monitoring IBD
What is the treatment for IBS?
Education and reassurance
Dietetic review
FODMAP
What does the FODMAP diet include?
Exclude fructose, lactose, fructans, galactans and polyols
Describe drug therapy for IBS
Targets symptoms
Pain - antispasmodics, linaclotide
Bloating - probiotics, linaclotide
Constipation - laxatives
Diarrhoea - FODMAP, antimotility agents
What are some phycological innervations for IBS
Relaxation therapy
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
What are the causes for IBS?
Altered motility
Visceral hypersensitivity
Stress, anxiety and depression
Describe IBS-D + IBS-C and intestinal motility
Muscular contractions may be stronger and more frequent than normal
In IBS-C contraction may be reduced
When can contractions of intestinal motility happen?
By waking and eating
Reduced in IBS-C
Increased and stronger in IBS-D
Describe IBS and brain hearing messages from gut
In IBS brain hears messages from gut like hunger or urge to toilet more loud
They also have excessive awareness of normal digestion process
