Lecture 27 Functional Bowel Disorders Investigation and Management

Question 1

What are the 2 broad categories of GI disease

Answer 1

Structural and Functional

Question 2

Define structural GI disorders

Answer 2

Detectable pathology
Cancer-macroscopic
Colitis- microscopic

Question 3

Define functional GI disorders

Answer 3

• No detectable pathology
• Related to gut function
• “Software faults”
• Long-term prognosis good

Question 4

Examples of functional GI disorders

Answer 4

• Oesophageal spasm
• Non-Ulcer Dyspepsia (NUD)
• Biliary Dyskinesia
• Irritable Bowel syndrome
• Slow Transit Constipation
• Drug Related Effects

Question 5

Names causes of Non-Ulcer Dyspepsia

Answer 5

 Reflux
 Low grade duodenal ulceration
 Delayed Gastric emptying
 Irritable bowel syndrome

Question 6

How to diagnose cause of Non-Ulcer Dyspepsia

Answer 6

History
H.pylori status- eradication
ALARM
Endoscopy if in doubt

Question 7

Functional causes of vomiting

Answer 7

•	Drugs
•	Pregnancy
•	Migraine
•	Cyclical Vomiting Syndrome
o	Onset often in childhood
o	Recurrent episodes 2-3 x year – 2-3 x month
•	Alcohol
Psychogenic vomiting

Question 8

Physical examination

Answer 8

o Look for systemic disease
o Careful abdominal examination
o Rectal examination
o (FOB)-faecal occult blood test

Question 9

Alarm symptoms

Answer 9

o	Age >50
o	Short symptom history
o	Unintentional weight loss
o	Nocturnal symptoms
o	Male 
o	Family history of bowel/ovarian cancer
o	Anaemia
o	Rectal bleeding
o	Recent antibiotic use
o	Abdominal mass

Question 10

Investigations

Answer 10

o	FBC
o	Blood glucose
o	U + E, etc.
o	Thyroid status
o	Coeliac serology
o	FIT testing
o	Sigmoidoscopy
o	Colonoscopy

Question 11

Systemic cause of constipation

Answer 11

o Diabetes mellitus
o Hypothyroidism
o Hypercalcaemia

Question 12

Neurogenic cause of constipation

Answer 12

o	Autonomic neuropathies
o	Parkinson's disease
o	Strokes
o	Multiple sclerosis
o	Spina bifida

Question 13

Organic causes of constipation

Answer 13

o	Strictures
o	Tumours
o	Diverticular disease
o	Proctitis
o	Anal fissure

Question 14

Functional causes of constipation

Answer 14

o	Megacolon
o	Idiopathic constipation
o	Depression
o	Psychosis
o	Institutionalised patients

Question 15

Clinical features of IBS

Answer 15

• Abdominal pain
• Altered bowel habit
• Abdominal bloating
• Belching wind and flatus
• Mucus

Question 16

ROME III IBS diagnostic criteria

Answer 16

Recurrent abdominal pain/discomfort for more than 3 days associated with defaecation
Onset associated change in stool frequency
Onsent change in stool form

Question 17

NICE IBS Diagnostic Criteria

Answer 17

Abdominal pain/discomfort relived by defection or associated stool frequency/form plus 2 or more:
Altered stool passage
Abdominal bloating/distension
Symptoms made worse by eating
Passage of mucus

Question 18

What is Calprotectin

Answer 18

• Released by inflamed gut mucosa

* Used for differentiating IBS from IBD and monitoring IBD