functional disorders of the gi tract

7/28/2019 Functional Disorders of the GI Tract

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IBS

Summary

IBS denotes a mixed group of abdominal disorders for which no organic cause can be found.

Aetiology and Epidemiology

- Prevalence: 10-20 %; age at onset 40 y; :2:1

Pathogenesis

- Most IBS probably arises from disorders of intestinal motility or enhanced visceral perception;

research is underway into possible modulation of the brain-gut axis by neurotransmitter

manipulation (see Rx)

- Several diagnostic criteria exist to evaluate Sx and their duration (Manning, Rome I/II/III), but

complex interactions between IBS and chronic pain syndromes may complicate their use

Clinical Presentation

- Diagnosis: only x IBS ifabdominal pain (or discomfort) is eitherrelieved by defaecationorassociated with altered stool form or bowel frequency and 2 of urgency; incompleteevacuation; abdominal bloating/distention; mucous PR; worsening of Sx after food

- Other Sx: nausea, urinary Sx, backache; Sx are chronic (>6/12), exacerbated by stress,

menstruation or gastroenteritis

- Signs: examination often normal, but general abdominal tenderness common; insufflation of air

on sigmoidoscopy (not usually indicated) may reproduce pain

- Reconsider IBS x if >40 y (esp. ), Hx lactulose

1 If diarrhoea prominent, add on B12/folate, TFTs


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- Diarrhoea: avoid sorbitol; try a bulking agent loperamide 2 mg after each loose stool (max 16

mg.d1); bismuth 120 mg/8 h has been tried (S/E: dark stools)

- Colic/bloating: antispasmodics (e.g. mebeverine 135 mg/8 h PO, available OTC; alverine citrate

60-120 mg/8 h PO; dicycloverine 10-20 mg/8 h PO)

- therapy: emphasise positive aspects and prognosis (in 50 % some Sx improve or resolve after 1

y,


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Other functional disorders of the GI tract

seeRome III Diagnostic Criteria for FGIDs

Functional/non-ulcer dyspepsia

- Present similarly to DUs/GUs

- Rx: difficult and often unsatisfactory; eradication ofH. pylori, if present, may be helpful; some

evidence for Rx with PPIs or psychotherapy; evidence for metoclopramide (sometimes used)

uncertain

functional disorders of the gi tract

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