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Author: Dr. Naresh Bhat, Chief of Gastroenterology, Aster CMI Hospital
India
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New Delhi, August 24, 2022:
Functional gastrointestinal disorders (FGIDs) are common disorders characterized by persistent and recurring GI symptoms. Many of them suffer because they do not get relief with standard prescriptions. It is estimated that more than 40% patients coming to GI OPD are diagnosed to have FGID.
The symptoms origin in the GI tract, but no structural or biochemical abnormalities are seen. Hence, all medical tests such as x-rays, CT scans, blood tests and endoscopic exams are normal. They are seen in many age groups – in children, toddlers and young adults and affect both men and women. The key word used to describe them is visceral hypersensitivity and Gut Brain Axis disorders.
This is because though symptoms originate in the gut they are greatly modulated by signals sent from the brain to the nerves in the gut. There is an interplay of the gut motility, gut microbiome, nerve transmitters in the GI tract and perception in the brain. Therefore the problem can start due to dietary factors or changes in the microbiome or even stressful events.
There are more than 20 functional GI disorders that can affect any part of the GI tract like esophagus, stomach, bile duct or intestines. Two of the most common types of FGIDs are Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD).
Irritable Bowel Syndrome (IBS): It is a group of symptoms that can affect the digestive system. It can cause pain in the abdomen, change in bowel habits and bloating. Symptoms may be recurring or persistent and easily suspected if longstanding. The challenge is however to exclude sinister diseases like Cancer, TB and Crohns disease. Hence it is not readily diagnosed in the older adults and those with anemia, weight loss, fever and recent onset of symptoms.
Functional Dyspepsia (FD): People with this disorder generally have upper abdomen bloating, burning and belching. It is one of the most common functional disorders. A diagnosis is often made after ensuring that a gastroscopy has excluded ulcer disease and cancer stomach. People with difficulty in swallowing, weight loss, anemia, vomiting and elderly are not likely to have Functional Dyspepsia.
How are FGIDs diagnosed?
Since routine tests generally show negative for people with FGIDs, these disorders cannot be based on test results. Rome Criteria are a set of criteria used to help make a diagnosis of a patient with an FGID (disorder of gut-brain interaction) and also classify the kind of disorder. Hence, the diagnosis is made when a patient’s combination of symptoms and other factors meet the Rome criteria for a specific functional disorder. An experienced doctor usually diagnoses the disorders based on the symptoms experienced by the patient for more than six months.
Also, the role of investigations which are done selectively after understanding the patient’s history is critical to diagnose FGIDs. This will help the doctor evaluate and exclude other conditions. These patients may frequently be also affected by migraine, fibromyalgia, pelvic pain and urinary disorders.
The greatest challenge is to avoid too many investigations and also to avoid missing serious disorders and this is where the experience and skills of the physician are important
Psychosocial aspects of FGIDs
It is important to understand that FGIDs are not psychiatric disorders and hence largely managed by gastroenterologists. However, psychological stress can exacerbate FGIDs symptoms. Various researches have been conducted to understand the psychological aspect of FGIDs. There is a bi-directional pathway between the brain and the GI tract, known as ‘brain gut axis’.
It is found that external stressors and emotions or thoughts can affect GI sensation, motility and secretion. In other words, the brain affects the gut. Also, psychosocial disturbances can amplify illness experience and can impair the quality of one’s life. Hence, patients with FGIDs have low quality of life and they are often anxious and depressed.
Treatments for FGID
The modalities of treatment vary and depend on the particular symptoms a person is experiencing. A sympathetic and patient listening and understanding his suffering is the first step. Reassuring the patients that they are suffering and need help plays a vital role. Symptomatic therapy for pain, constipation, bloating, nausea and diarrhea are used. Various neuro modulators which modify the signals from the gut and brain are often the mainstay of therapy. Breathing techniques, biofeedback therapy, yoga and meditation are extremely beneficial too. Rarely we need to use relaxation therapy, hypnosis or cognitive behavioral therapy, to help patients learn to better manage symptoms. Some dietary restrictions are used to minimize symptoms as and when indicated.
Almost 80-90 % of people with FGID have excellent relief of their symptoms and quality of life
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