Current Approach Treatment for

Functional Gastrointestinal
Disorders
Introduction
• Functional gastrointestinal disorders (FGID) are a group of
disorders characterized by chronic gastrointestinal (GI) symptoms
(eg abdominal pain, dysphagia, dyspepsia, diarrhea, constipation
and bloating) in the absence of demonstrable pathology on
conventional testing.
• Historically, they were defined as conditions which had no organic
basis, but this definition has evolved with increasing
understanding of these conditions and we now know that they
arise due to alterations in brain–gut communication

Asma FikreeA and Peter ByrneB; Management of functional gastrointestinal disorders; Clinical Medicine 2021 Vol 21, No 1: 44–52
Epidemiology
• FGID are very common with a worldwide prevalence of 40%, more
common in women than men and this decreases with age. They
account for 12% of the workload in primary care and 30% of
gastroenterology outpatient consultations. More than two thirds of
patients with FGID will have seen a doctor in the last 12 months
and 40% will use regular medication.
• FGID pose a huge economic burden and treating them cost the
NHS at least £72.3million in the year 2014/2015, of which, two-
thirds was on prescriptions, community care and hospital
treatment
Asma Fikree A and Peter Byrne B; Management of functional gastrointestinal disorders; Clinical Medicine 2021 Vol 21, No 1: 44–52
Pathophysiology
• It is now clear that there is abnormal physiological functioning in
patients with FGID, thought to be due to underlying alterations in
GI motility (either too fast or too slow), visceral hypersensitivity,
altered microbiota, increased intestinal permeability, low grade
immune infiltration and altered central nervous system processing
of sensory input. However, symptoms and healthcare seeking
arise for complex reasons involving an interplay between early life
events and coping styles, learned behaviour, alterations in GI
physiology, and associated psychological morbidity as seen in the
biopsychosocial model in Fig 1.

Asma FikreeA and Peter ByrneB; Management of functional gastrointestinal disorders; Clinical Medicine 2021 Vol 21, No 1: 44–52
Pathophysiology FGID

Singh et al ; Current Treatment Options and Therapeutics Inside for FGIDs ;Frontiers in Pharmacology ; published: 25 January 2022
Biopsychosocial model of functional
gastrointestinal disorders

Asma FikreeA and Peter ByrneB; Management of functional gastrointestinal disorders; Clinical Medicine 2021 Vol 21, No 1: 44–52
Biopsychosocial model of functional
gastrointestinal disorders

Functional gastrointestinal disorders: advances in understanding and management ; www.thelancet.com Vol 396 November 21, 2020
FGID Classification ( Rome IV )

Functional gastrointestinal disorders: advances in understanding and management ; www.thelancet.com Vol 396 November 21, 2020
FGID Classification ( Rome IV )

Functional gastrointestinal disorders: advances in understanding and management ; www.thelancet.com Vol 396 November 21, 2020
Clinical Pathway for The Diagnosis and
Management of FGIDs

EC Linedale ; Issue Clinical Pathway for The Diagnosis and Management of FGIDs ; Adelaide University 2017