GIT-MED-8-functional Bowel Disorders

Functional Bowel
Disorders
Functional dyspepsia
Irritable bowel syndrome
Functional Bowel
Disorders
• Functional bowel disorders are
disease causing GIT symptoms in
the absence of pathological findings
that would adequately explain them
and the diagnose usually depend on
the symptoms and some time need
to exclude organic causes.
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Functional Dyspepsia
• Dyspepsia is the term used to describe
epigastric pain or discomfort associated
with other symptoms like bloating,
hiccough and nausea
• Functional dyspepsia accounts for
60% of cases of dyspepsia.
• Functional dyspepsia, defined as 3 months
of dyspepsia without an organic cause
• Chronic Dyspepsia affects up to 20% of
the population at some time in life and
many patients have no serious underlying
disease
functional Dyspepsia
Pathophysiology
Gastric Motor Dysfunction
also is found in 25 to 50% of functional dyspeptics.
The relation of these defects to symptom induction is
uncertain;
many studies show poor correlation between symptom
severity and the degree of motor dysfunction.
Visceral Afferent Hypersensitivity
was first demonstrated in patients with irritable bowel
syndrome Patients with dyspepsia may experience
discomfort with fundic distention to lower pressures than
healthy control
.Psychological factors
functional dyspepsia is associated with a reduced sense of
physical and mental well-being and is exacerbated by stress
functional Dyspepsia
Helicobacter pylori
The importance of H. pylori in the genesis of
functional dyspepsia is controversial
but most investigators believe it is of minor
importance because minority have symptoms
Improvement of dyspepsia after eradication of H.
pylori seen in minority of the patients (35%) which not
clear why this no all patient.
They recommend to test and treat patient with FD for

H.pylori Rx before doing endoscopy .
Causes of secondary dyspepsia
Upper gastrointestinal disorders

• Peptic ulcer disease
• H.pylori gastritis( minority)
• Gastric malignancy
• Gallstones
Other gastrointestinal disorders
• Pancreatic disease (cancer, chronic
pancreatitis)
• Hepatic disease (hepatitis, metastases)
Causes of secondary dyspepsia
Drugs
• Non-steroidal anti-inflammatory drugs
(NSAIDs)
• Iron and potassium supplements
• Corticosteroids
• Digoxin
Others
• Alcohol
• Psychological, e.g. anxiety, depression
•
Dyspepsia
'Alarm' features in dyspepsia
• Weight loss
• Anaemia
• Vomiting
• Haematemesis and/or melaena
• Dysphagia
• Palpable abdominal mass
An algorithm for the
investigation of dyspepsia .
IRRITABLE BOWEL
SYNDROME
IRRITABLE BOWEL
SYNDROME
• Irritable bowel syndrome (IBS) is a

functional bowel disorder
characterized by abdominal pain or
discomfort and altered bowel habits
in the absence of detectable
structural abnormalities
IRRITABLE BOWEL
SYNDROME
• Approximately 20% of the general

population fulfill diagnostic criteria
for IBS but only 10% of these
consult their doctors because of
gastrointestinal symptoms.
• Female predominant
IRRITABLE BOWEL
SYNDROME
Etiology
The pathogenesis of IBS is poorly
understood
• psychosocial factors
anxiety
depression
somatisation and neurosis
• altered gastrointestinal motility
no consistent evidence of
abnormal motility
IRRITABLE BOWEL
SYNDROME
• altered visceral sensation
a consequence of altered central
nervous system processing of
visceral sensation.
• luminal factors
 following an episode of
gastroenteritis
 intolerant of specific dietary
components, particularly lactose and
wheat
 gut microflora change
IRRITABLE BOWEL
SYNDROME
Clinical features
• Colicky abdominal pain
• Altered bowel habit
• Abdominal distension and bloating
• Rectal mucus
• Feeling of incomplete defecation
IRRITABLE BOWEL
SYNDROME
Abdominal Pain
• Abdominal pain episodic and crampy
• Mostly lower /st left upper
• The pian is mild it may interfere with
daily activities.
• Pain is often exacerbated by eating or
emotional stress and improved by passage
of flatus or stools
• Night pain is also unusual
IRRITABLE BOWEL
SYNDROME
• Altered Bowel Habits
• The most common pattern is constipation
alternating with diarrhea, usually with one
of these symptoms predominating.
• Stools are usually hard with narrowed
caliber
• Diarrhea resulting from IBS usually
consists of frequent small volumes of
loose stools
• Nocturnal diarrhea does not occur
• Diarrhea may be aggravated by emotional
stress or eating.
• Stool may be accompanied by passage of
large amounts of mucus
IRRITABLE BOWEL
SYNDROME
• Gas and Flatulence
abdominal distention
increased belching
flatulence,
IRRITABLE BOWEL
SYNDROME
The diagnosis
is clinical no need for investigations unless
secondary disease suspected (IBS with
alarm features)
Features supporting a diagnosis of IBS
• Symptoms > 6 months without progressive
deterioration,
• absence of other systemic symptoms such
as anemia and weight loss
• without any evidence of blood.
• Frequent consultations for non-GI
problems
• Previous medically unexplained symptoms
• Stress worsens symptoms
•
IRRITABLE BOWEL
SYNDROME
Diagnostic Criteria (Rome)
Recurrent abdominal pain or discomfort at

least 3 days per month in the last 3 months
associated with two or more of the
following:
1. Improvement with defecation

2. Onset associated with a change in
frequency of stool
3. Onset associated with a change in form
(appearance) of stool
IRRITABLE BOWEL
SYNDROME
Investigation
for typical symptoms no need
With alarm features
 Full blood count
 GSE
 lower GI endoscopy
(sigmoidoscopy, Colonoscopy)
alarm features.
Diarrhoea-predominant
IRRITABLE BOWEL
SYNDROME
Alarm features
• Age > 50 years; male gender
• Weight loss
• Nocturnal symptoms
• Family history of colon cancer
• Anaemia
• Rectal bleeding
IRRITABLE BOWEL SYNDROME
Management
• Reassure the patient
• Dietary alteration by avoid legume with
increase fibers wheat-free diet lactose free
• Treatment of the predominant symptoms
Stool-Bulking Agents for constipation pred.
High-fiber diets and bulking agents (bran)
Colonic Antispasmodics used for pain or
diarrhea predominant IBS as (mebeverine)
Tricyclic Antidepressant Drugs
mood-elevating effects, antidepressent
Decrease whole-gut transit, indicative of a
motor inhibitory effect. Tricyclic agents may
also alter visceral afferent neural function
Serotinin receptor antagonists
• 5HT3 receptor antagonist such as
alosetron
• used for diarrhea predominent
• reduces perception of painful visceral
stimulation in IBS.
• It also induces rectal relaxation, increases
rectal compliance
• And delays colonic transit
The selective serotonin reuptake inhibitor
(SSRI)
Like (paroxetine)
New antidepressant drugs
accelerates orocecal transit, raising the
possibility that this drug class may be useful
in constipation-predominant patients.
Antiflatulence Therapy
• seldom satisfactory, except in obvious
aerophagia or disaccharidase deficiency.
• Patients should be advised to eat slowly;
avoid chewing gum or drinking carbonated
beverages; and avoid consuming artificial
sweeteners, legumes, and foods of the
cabbage family.
• Simethicone, antacids, and activated
charcoal have all been tried, usually with
disappointing results.
IRRITABLE BOWEL
SYNDROME
IRRITABLE BOWEL
SYNDROME
Prognosis
• Most patients have a relapsing and
remitting course.
• Exacerbations often follow stressful life
events, and change in the diet and irregular
toilet habits.
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Functional Bowel

They recommend to test and treat patient with FD for

Upper gastrointestinal disorders

• Irritable bowel syndrome (IBS) is a

• Approximately 20% of the general

Recurrent abdominal pain or discomfort at

1. Improvement with defecation

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