Lecture 31

Question 1

Functional conditions of the gut

Answer 1

Do not appear to have an obvious pathological cause - no abnormality histologically, macroscoprically or anatomically
-more related to disturbance to gut function
many of the mechanism relate to many other functional gut disorders

Question 2

Function gut disorders

Answer 2

No structural or tissue abnormality (dont detect anything in biopsy)
Defined by a constellation of symptoms but without overt pathology
-group of symptoms characterising a particular condition= syndrome
Thought to be due to disturb function, multiple factors (complex underlying mechanisms)
-disturbed motility (not co-ordinated, enhanced or decreased)
-visceral hypersensitivity (increased pain or stimulous beyond what is normaly percieved by average person)
-brain gut dysfunction (miscommunication, gut effected by brain-anxious or nervous. brain effected by gut-IBS develop problems with mood in response to gut symptoms)
-psychosocial factors (IBS and Stress worsening of symptoms)

Question 3

No overt pathology means no diagnostic test

Answer 3

No biochemical abnormality with conventional testing

No histological or radiological features (biopsy or radiology)

Question 4

Rome critera

Answer 4

Developed by experts of the Rome foundation
Criteria for diagnosis of all functional GI disorders
Mostly used in research and study design
-to ensure people who are entered into research for functional disorders fulfil the same criteria
-not rigidly adhered to in clinical context (need to be aware of what is in criteria but dont need to nescesarily fulfil the criteria for clinical diagnosis of IBS)

Question 5

Occurrence of functional gut disorders

Answer 5

Functional gut disorders make up the most common presentation of people with GI disorders

• not much to learn re limited anatomical/histological
• will be most common thing to see re people presenting with GI symptoms

Question 6

Areas affected by functional gut disroders

Answer 6

Oesophagus (hypersensitive oesophagus, symtpoms like reflux but no pathological amount of reflux occuring)
Stomach (most common functional condition is dyspepsia- epigastric discomfort, similar to indigestion, w/o any obvious pathology (ulceration or inflammation))
Small Intestine (not common)
Large intestine (IBS, abdominal pain)

Question 7

Functional gut disorders in the Oesophagus

Answer 7

1. Globus
   - sensation of lump or something stuck in throat (but without any actual structural problems)
2. Functional heartburn
   - symptoms of reflux without evidence of GORD (both in endoscopy and pH study) or a motility disorder

Question 8

Functional gut disorders in the Stomach

Answer 8

1. Functional dyspepsia
   - upper abdomen pain or discomfort (like indigestion) without structural abnormality e.g. no ulcer, pancreas or gallbladder pathology
2. Functional vomiting/cyclical vomiting syndrome
   - recurrent vomiting; no diagnostic abnormalities and no psychiatric cause (periods of being really well and then periods of recurrent vomiting. sometimes assoc. abdominal pain and headaches) - no obvious structural abnormalities

Question 9

Functional gut disorders in the Small/Large Intestine

Answer 9

1. Irritable bowel syndrome
   - most common cuase of functional gut disorder
   - abdominal discomfort/bloating associated with defaecation and altered swinging bowel habit (i.e. constipation/diarrhoea or both)(one may predominate)
2. Functional abdominal pain
   - recurrent or continuous abdominal pain unrelated to defaecation and without disturbed bowel habit - no diagnostic abnormalities

Question 10

How can a functional gut problem be diagnosed

Answer 10

1. Symptom complex
   - analogous to diagnosis or migraine (consistent symptoms with syndrome)
   - be aware of red flags which make functional gut conditions unlikely (iron deficiency, bleeding, anaemia, weight loss, dysphagia)- warnign to investigate for other pathologies
   - typically presented in young people
2. Important not to miss other GI diseases
   - symptoms of functional gut disorders can be similar to those with serious pathology
   - diagnosis of functional gut disorders is a “diagnosis of exclusion” (can mimic other functional disorders. need to consider other things to be excluded, and need to do a basic workup atleast)
3. Always consider other GI diagnoses first before making a diagnosis of functional gut disorder