Functional GI disorders (paeds)

Question 1

What are functional GI disorders?

Answer 1

A number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances

Question 2

How are they classified?

Answer 2

The Rome criteria IV contain lots of different criteria for different functional GI disorders

https://en.wikipedia.org/wiki/Functional_gastrointestinal_disorder

Question 3

What are some examples of functional GI problems?

Answer 3

Globus pharyngis - feeling of a lump in the throat; swallow is normal

Aerophagia - swallowing air

Functional chest pain and heart burn

Cyclical vomiting syndrome

IBS

Functional diarrhoea or constipation

Rumination syndrome - bringing food up

Abdominal migraines

Question 4

What are the suspected causes of functional GI problems?

Answer 4

Abnormal bowel activity in response to:

• physiologic stimuli (meal, gut distention, hormonal),
• noxious stressful stimuli (inflammatory process),
• psychological stressful stimuli (parental separation, anxiety)

Question 5

What are some key pointers in a history that a GI presentation might be functional?

Answer 5

Onset = concurrent with stressful life events

Duration = prolonged with no clear signs

Pain character = vague, slow onset w/variable severity; made worse by reinforcement from parents and poss little improvement with interventions

Other signs/symptoms = signs of anxiety (mottled skin, nail biting); FHx IBS, migraines

Question 6

What is the goal of treating functional GI disorders?

Answer 6

Maximising functioning

Avoid pain reinforcement behaviours - distraction/diversion of attention away from triggers and the pain itself

Reassurance and education of family and patient - no serious life threatening process

Also managed with: relevant pharmacology if debilitating (e.g. laxatives), CBT, relaxation, massage/PT/OT/exercise