Description
Functional gastrointestinal disorders (FGIDs) are a group of disorders that affect the normal functioning of the gastrointestinal tract. They are characterized by symptoms related to the motility and sensitivity of the gut. Common FGIDs include irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation. IBS is one of the most prevalent FGIDs, affecting millions of people worldwide. The exact cause of FGIDs is not fully understood, but it is believed to involve a combination of genetic, environmental, and psychosocial factors. Symptoms of FGIDs can vary widely but often include abdominal pain, bloating, altered bowel habits, and gastrointestinal discomfort. The symptoms of FGIDs can significantly impact an individual's quality of life and daily functioning. Diagnosis of FGIDs is based on clinical criteria after ruling out other organic diseases. There is no cure for FGIDs, and treatment primarily focuses on managing symptoms and improving quality of life. Lifestyle modifications such as diet and exercise can play a significant role in managing FGIDs.
Summary Listen
- Functional GI disorders are a broad topic, divided into upper GI (functional dyspepsia) and lower GI parts (functional constipation) for clinical purposes. The presentation covers diagnostic criteria, pathophysiology, challenges, the role of H. pylori, management, bloating/belching, demographics in the Indian context, and differences from Western scenarios.
- Dyspepsia includes early satiety, burning, vomiting, epigastric pain, abdominal fullness/discomfort, and nausea. 70% of cases are functional (non-ulcer dyspepsia, negative endoscopy). A minority involve reflux or ulcer disease, while very few (<5%) are early GI malignancy. Screening is crucial, considering patient characteristics.
- In functional GI disorders, the primary issue is the patient's experience of illness, without abnormal lab/radiological/endoscopic findings. Diagnosis relies on exclusion, adhering to Rome IV criteria. Epigastric pain syndrome and postprandial distress syndrome are distinct entities, often overlapping in clinical practice.
- Pathophysiology involves impaired fundal accommodation, altered motility, and activation of stretch receptors leading to early satiety. Other factors include delayed gastric emptying, hypersensitivity to gastric distention, and duodenal acid hypersensitivity. Gut microbiota plays a role through small bowel inflammation and changes in bile acid pools.
- Challenges in clinical presentation include patient hypervigilance, visceral hypersensitivity, and gastral sensory motor abnormalities. This results in varied clinical presentations, symptom overlap, and co-occurrence with gastroesophageal reflux disease (GERD). Alarm symptoms necessitate further investigation.
- Testing for H. pylori is more crucial in India due to its higher prevalence. Unlike Western guidelines favoring empirical PPI therapy, Indian practice often involves testing for H. pylori from the outset. Management of dyspepsia includes PPIs, anxiolytics, prokinetics (for postprandial distress), dietary modifications, and H. pylori eradication.
- Bloating is a subjective sensation of gas or distension, treated with dietary restriction, low FODMAP diets, and probiotics. Antibiotics like rifaximin can provide symptomatic relief by addressing small intestinal bacterial overgrowth. Belching involves gas escape from the esophagus, classified as supragastric (voluntary, non-reflux) or gastric (involuntary, physiological).
- Functional constipation, different from Indian perception of constipation, should be defined using Rome IV criteria, emphasizing lumpy/hard stools, straining, incomplete evacuation, anorectal obstruction, and manual maneuvers. It is categorized into normal transit, defecation disorders, slow transit, and combined types, excluding secondary constipation causes.
- Colonic transit study, anal manometry and defecography are important diagnostic tools for refractory constipation. History of constipation and the Bristol Stool Scale are essential. For management, fibers, osmotic agents, stimulants, secretoagogues, and prokinetics are used in a step-up and step-down approach.
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About the Speakers
Dr.Siddharth Dhande
Advanced Endoscopy Fellow BIDS , Global Hospital , Mumbai
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