Functional GI Disorders

Question 1

What are Functional GI Disorders?

Answer 1

• GI disorders characterised by persistent and recurrent GI symptoms
• Symptoms cannot be accounted for

Question 2

What are the contributing factors?

Answer 2

• Bowel motility
• Viceral hypersensitivity
• Psychological factors
• Neurotransmitter unbalance
• Gastro infections

Question 3

What are some functional oesophageal disorders?

Answer 3

• Globus (lump or foreign body in throat)
• Rumination disorder (regurgitation after eating so you have to re-swallow and chew)
• Non burning, midline chest pain

Question 4

What are some functional bowel disorders?

Answer 4

• IBS
• Pain/gas/bloating
• Functional diarrhoea

Question 5

When should a diagnosis of Irritable Bowel Syndrome be considered?

Answer 5

=> If patient has had following for at least 6 months:

• Abdominal pain and/or
• Bloating and/or
• Change in bowel habit

Question 6

When should a positive diagnosis of Irritable Bowel Syndrome be made?

Answer 6

=> Abdominal pain relieved by defecation and altered bowel frequency stool form AND 2 of the following:

• Altered stool passage (straining, urgency, incomplete evacuation)
• Abdominal boating, distension, tenderness or hardness
• Symptoms made worse by eating
• Passage of mucus

Question 7

What is the clinical presentation of Irritable Bowel Syndrome?

Answer 7

• Lethargy
• Nausea
• Back ache
• Bladder symptoms

Question 8

What are the investigations for suspected IBS cases?

Answer 8

=> FBC

=> ESR/CRP

=> Tissue transglutaminase antibodies (to rule of Coeliac Disease)

Question 9

What are the reg flag features associated with IBS?

Answer 9

• Onset > 60
• Family history of bowel or Ovarian Cancer
• Unexplained weight loss
• Rectal bleeding

Question 10

What is the management of Irritable Bowel Syndrome?

Answer 10

=> General diet advice

=> First line pharmacological drugs - depend on predominant symptom:

• Pain: antispasmodic agent
• Constipation: Laxatives but avoid lactulose
• Diarrhoea: Loperamide is first line

=> If laxatives taken for at least 12 months and to the maximum tolerated dose to no affect, try Linaclotide

=> Second line pharmacological agent:
- Low does tricyclic antidepressants

=> Other management:

• Psychological interventions
• CBT

Question 11

What is the general dietary advice given for those with IBS?

Answer 11

• Regular meals and take time to eat
• Avoid missing meals
• Drink at least 8 cups of water a day
• Restrict tea and coffee to 3 cups a day
• Reduce alcohol and fizzy drink intake
• Reduce intake of resistant starch
• Reduce high fibre foods
• Reduce fresh fruit to 3 portions a day
• If diarrhoea, avoid Sorbitol
• For wind and bloating, consider increasing intake of oats and linseeds