Functional GI Disorders

Question 1

Describe the biopsychosocial conceptual model of functional gastrointestinal disorders.

Answer 1

Question 2

What is the definition of functional GI disorders?

Answer 2

• Functional GI disorders are disorders of the gut-brain interaction. It is a group of disorders classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered CNS processing.

Question 3

Give examples of functional GI disorders.

Answer 3

• Reflux hypersensitivity
• Functional dyspepsia
• Irritable bowel syndrome
• Functional constipation

Question 4

Describe irritable bowel syndrome?

Answer 4

• Causes symptoms such as stomach cramps, bloating, diarrhoea and constpiation. These tend to come and go over time, and can last for days, weeks or months at a time.
• Usually a lifelong problem.
• There is no cure, but diet changes and medicines can often help control the symptoms.
• The exact cause is unknown - it has been linked to things such as food passing through the gut too quickly or too slowly, oversensitive nerves in the gut, stress and a FHx of IBS.

Question 5

What are the symptoms and signs of IBS?

Answer 5

• The main symptoms of IBS are:
  
  • Stomach pain or cramps - usually worse after eating and better after bowel movements.
  • Bloating - uncomfortably full and swollen.
  • Diarrhoea
  • Constipation - incomplete evacuation.
• Can also cause:
  
  • Flatulence
  • Passing mucus
  • Tiredness / lack of energy
  • Nausea
  • Backache
  • Problems urinating - often / sudden urge / incomplete voiding
  • Faecal incontinence

Question 6

When does IBS occur?

Answer 6

• Most commonly 20-30 years
• More common in women
• Affects 11% of the population

Question 7

What are the diagnostic criteria for IBS?

Answer 7

• Rome IV criteria
  
  • That in the last 3 months, with symptom onset at least 6 months prior to diagnosis, the individual experiences recurrent abdominal pain at least 1 day / week in the last 3 months associated with 2 or more of the following:
    
    • Related to defecation
    • Associated with a change in frequency of stool
    • Associated with a change in form (appearance) of stool
• In the UK:
  
  • +2 of the following:
    
    • A change in how yo pass stools (urgency, incomplete evacuation)
    • Bloating, hardness or tension in the abdomen
    • Symptoms worse after eating
    • Passing mucus from the rectum

Question 8

Describe the diagnosis of IBS.

Answer 8

• Diagnosis is often based on symptoms alone, however:
  
  • Blood tests to rule out other conditions (coeliac).
  • Stool sample to rule out other conditions (calprotectin - IBD).
• Some patients find it difficult to cope with a diagnosis but no cure.

Question 9

What are the putative biological causes of IBS?

Answer 9

• Abnormal muscle contraction
• Serotonin receptors
• Infection
• Food intolerance

Question 10

What are the putative psychological causes of IBS?

Answer 10

• Psychological disorders e.g. depression and anxiety (precede).
• Psychiatric disorders (40-60% of patients attending FGID clinic).
• Hyperreactivity in the brain-gut interface.

Question 11

What are the putative social causes of IBS?

Answer 11

• Adverse childhood experiences
• Social learning

Question 12

What are the possible management strategies for IBS?

Answer 12

• Diet / lifestyle (physical activity) changes approach
  
  • Food diary
    
    • Food intolerances
    • Healthy diet
  • Assess activity levels
• Drug treatments approach
• Psychological approaches
• Complementary therapies approach

Question 13

Describe the drug treatment of IBS.

Answer 13

• ​Treat the symptoms
• First-line:
  
  • Anti-diarrhoeal (loperamide)
  • Laxatives (not lactulose)
  • Antispasmodics
• Second-line:
  
  • Antidepressants
    
    • TCA (if first-line ineffective)
    • SSRIs (if TCAs ineffective)
  • Laxatives (Linaclotide only if previous laxatives have not worked)

Question 14

Which complementary therapies can be used to help IBS?

Answer 14

• Neutraceuticals
• Chinese herbal medicine
• Probiotics
• NOT Recommended:
  
  • ​Acupuncture
  • Reflexology

Question 15

What are the psychological approaches to treatment for IBS?

Answer 15

• After 12 months:
  
  • Cognitive behavioural therapy
  • Hypnotherapy
  • Psychological therapy

Question 16

What is involved in the communication with a patient who suffers from a functional GI disorder?

Answer 16

• Be optomistic but realistic
• Targets can be:
  
  • Reducing disability
  • Improving coping strategies
  • Reducing dependence on the health care system
• Listen to your patient