GI Motility and Functional Disorders

Question 1

Non-ulcer dyspepsia treatment

Answer 1

If H. pylori present, treat like PUD
- PPI + clarithromycin + amoxicillin 10-14 days

TCA if PPI fails

Metoclopramide if TCA fails

(try things until something works, cause unknown so no definitive tx)

Question 2

Differentiate between IBS and IBD

Answer 2

IBS
- not an autoimmune condition like
- no risk of cancer, often a self-contained disease

IBD
- autoimmune mediated
- extraintestinal manifestations
- risk of malignancy (UC)

Question 3

Gastroparesis physical exam sign

Answer 3

Succussion splash

(sloshing sound in stethoscope when patient moves)

Question 4

IBS is most common in these people

Answer 4

Young women

(rare after age 50)

Question 5

Treatment for IBS

Answer 5

Soluble fiber

(insoluble fiber may trigger symptoms by increasing water contents of stools)

Exercise

Moderate/severe:
- PEG for IBS-C
- Loperamide for IBS-D
- Consider TCAs for IBS-D

Question 6

Normal transit constipation treatment

Answer 6

• Fiber (insoluble), psyllium, prunes
• PEG, MOM, lactulose for long-term
• Bisacodyl, senna for short-term

Question 7

Symptoms of IBS

Answer 7

Abdominal pain and altered bowel movements

Cramping pain related to defecation

Exacerbated by meals/emotional stress

Question 8

Defecatory disorder/outlet transit constipation treatment

Answer 8

Biofeedback and muscle relaxation exercises

Increase dietary fiber

Increase water intake

Bulk-forming laxatives

Enemas (rescue therapy only)

Surgery

Question 9

These two anatomical abnormalities are present in >90% of patients with defecatory disorder/outlet transit constipation

Answer 9

Rectocele

Internal mucosal prolapse

Question 10

Diagnosis of non-ulcer dyspepsia

Answer 10

By exclusion (endoscopy and h.pylori etc negative)

“Waste basket diagnosis”

Question 11

Hirschprung disease treatment

Answer 11

Surgical resection of aganglionic portion of bowel

Question 12

Slow-transit constipation diagnosis

Answer 12

Delayed passage of radiopaque markers through the colon

Question 13

Most common cause of gastroparesis

Answer 13

Diabetes

(also idiopathic, postsurgical)

Question 14

Hirschprung disease is most common in these patients

Answer 14

Down syndrome

Question 15

Defecatory disorder/outlet transit constipation cause

Answer 15

Anatomical abnormality or inability to coordinate the abdominal and pelvic floor muscles to evacuate stool

Question 16

Is defecatory disorder/outlet transit constipation more common in males or females?

Answer 16

Females

Question 17

IBS diagnostics

Answer 17

No definitive test, just exclude other conditions

(stool sample for bacterial/parasitic, serologic for celiac, breath testing for lactase deficiency, endoscopy)

Question 18

Gastroparesis treatment

Answer 18

Dietary modification:
- small, frequent meals
- low fat, high insoluble (?) fiber

Metoclopramide
(Domperidone + erythromycin if metoclopramide fails)

Question 19

Normal transit constipation symptoms

Answer 19

Persistently difficult, infrequent, or seemingly incomplete defecation, without evidence of a primary anatomic or biochemical cause

(symptoms but no clear cause, like non-ulcer dyspepsia)

Question 20

Symptoms of non-ulcer dyspepsia

Answer 20

Postprandial fullness

Early satiety

Epigastric pain

(feel full early and discomfort after eating)

Question 21

Name of condition characterized by rapid gastric emptying leading to nausea, diarrhea, light-headedness

Answer 21

Dumping syndrome/accelerated gastric emptying

Question 22

Diagnostic criteria for IBS

Answer 22

Pain and change in stools at least once a week for at least 3 months

No other known cause

(Rome IV criteria)

Question 23

Defecatory disorder/outlet transit constipation symptoms

Answer 23

Fragmented stools, straining, sense of incomplete evacuation, tenesmus

Question 24

Symptoms of Hirschprung disease

Answer 24

Intestinal obstruction with bilious emesis/distension/no stool within 48 hours of birth

Question 25

Most common cause of dumping syndrome

Answer 25

Surgery of the stomach (gastric bypass)/esophagus

Question 26

Gastroparesis symptoms

Answer 26

Delayed gastric emptying in the absence of mechanical obstruction

Upper GI symptoms:
- nausea/vomiting
- early satiety
- bloating
- pain

Question 27

Hirschprung disease diagnosis

Answer 27

Rectal biopsy

Question 28

Slow-transit constipation is more common in these people

Answer 28

Young women

Question 29

Gastroparesis diagnostics

Answer 29

Delayed gastric emptying on scintigraphy is required to make diagnosis

(after excluding other causes with endoscopy, barium swallow, CT)

Question 30

Slow-transit constipation treatment

Answer 30

Behavioral training (breathing exercises, timed toilet training)

Increase dietary fiber

Osmotic laxatives (magnesium, PEG)

Stimulant laxatives (bisacodyl, senna)

Question 31

Dumping syndrome treatment

Answer 31

5-6 small meals a day

Avoid liquids (with meals?)

Go lie down for 30 minutes

(may resolve on its own in 3 months)

Question 32

This disease is also known as “congenital aganglionic megacolon”

Answer 32

Hirschprung disease

(absence of ganglion cells in distal rectum)

Question 33

Slow-transit constipation cause

Answer 33

Motility disorder of colon, caused by abnormalities of enteric nerves

Question 34

Dumping syndrome diagnosis

Answer 34

Gastric emptying scan

Question 35

True or false. IBS can have bloody or oily stools

Answer 35

False

Question 36

Three forms of primary constipation

Answer 36

Normal transit

Slow transit

Outlet transit

Question 37

Which, IBS or IBD is more likely to wake patients from sleep?

Answer 37

IBD