functional gut disorders

Question 1

Definition of FGIDs

Answer 1

Chronic GI symptoms in the absence of organic disease to explain the symptoms

Also termed “disorders of gut-brain interaction”

Question 2

Most commonly recognised

Answer 2

• IBS (bowel)
• Functional dyspepsia (stomach)

Question 3

diagnosis algorithm

Answer 3

• chronic GI symtpoms
• no alarm features
• diagnose FGID

Question 4

name some of these alarm features

Answer 4

• Age >45 years
• Short history of symptoms
• Documented unintentional weight loss
• Nocturnal symptoms
• Family history of GI cancer/IBD
• GI Bleeding
• Palpable abdominal mass or lymphadenopathy
• Evidence of iron deficiency anaemia on blood testing
• Evidence of inflammation on blood/stool testing

Question 5

Making a diagnosis of functional dyspepsia

Answer 5

Characteristics symptoms – chronic upper GI symptoms

Exclusion of organic pathology
- History

Examination

1st line investigations
- FBC,CRP, LFT, coeliac serology
- Stool Helicobacter pylori

2nd line investigations in a subset with alarm features
- e.g.Upper GI endoscopy (OGD), Ultrasound abdomen
- CT scan (if suspect cancer)

Question 6

Making a diagnosis of IBS

Answer 6

Characteristics symptoms – chronic lower GI symptoms

Exclusion of organic pathology
- History

Examination

1st line investigations
- FBC,CRP, coeliac serology
- Stool faecal calprotectin
- Stool M,C & S
- Ca-125 in women (if appropriate)

2nd line investigations in those with alarm features
- e.g. Lower GI endoscopy (Colonoscopy), CT scan (if suspect cancer

Question 7

IBS symptoms with normal examination and results

Answer 7

post infectious IBS
- after salmonella, shigella, campylobacter

Question 8

function dyspepsia definition

Answer 8

Chronic upper GI symptoms without structural cause (Rome IV criteria).

Symptoms ≥3 months, onset ≥6 months prior.

Question 9

functional dyspepsia Aetiology

Answer 9

• Delayed gastric emptying (gastroparesis).
• Visceral hypersensitivity (increased pain perception).
• Gut-brain axis dysfunction (stress, anxiety).
• H. pylori infection (possible contributor).
• Dietary triggers (spicy foods, alcohol, caffeine).

Question 10

functional dyspepsia presentation

Answer 10

Two subtypes:

1️⃣ Postprandial Distress Syndrome (PDS) → Early satiety, post-meal bloating/fullness.
2️⃣ Epigastric Pain Syndrome (EPS) → Epigastric pain/burning, unrelated to meals.

🚩 Red flags (require urgent investigation): Weight loss, vomiting, GI bleeding, dysphagia, new-onset in >55 years.

Question 11

dysfunctional dyspepsia diagnosis

Answer 11

Clinical diagnosis (Rome IV criteria).

H. pylori testing (urea breath test, stool antigen).

Endoscopy if red flags or non-responsive to treatment.

Question 12

functional dyspepsia treatment

Answer 12

• Lifestyle & Diet: Small frequent meals, avoid triggers, stress management.
• H. pylori eradication (if positive).

Medications:
- PPIs (omeprazole) → First-line for EPS.
- Prokinetics (domperidone, metoclopramide) → If gastroparesis suspected.
- TCAs (e.g., amitriptyline) → If refractory symptoms.

Psychological therapy (CBT, gut-directed hypnotherapy) if stress-related.