Functional gastrointestinal disorder

Functional gastrointestinal disorder
Other namesDisorders of gut–brain interaction
SpecialtyGastroenterology

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.[1]

Classification

Terms such as functional colonic disease (or functional bowel disorder) refer in medicine to a group of bowel disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms. Other functional disorders relate to other aspects of the process of digestion.

The consensus review process of meetings and publications organised by the Rome Foundation, known as the Rome process, has helped to define the functional gastrointestinal disorders.[2] Successively, the Rome I, Rome II, Rome III and Rome IV proposed consensual classification system and terminology, as recommended by the Rome Coordinating Committee. These now include classifications appropriate for adults, children and neonates/toddlers.

The current Rome IV classification, published in 2016, is as follows:[1]

A. Esophageal disorders

B. Gastroduodenal disorders

C. Bowel disorders

D. Centrally mediated disorders of gastrointestinal pain

  • D1. Centrally mediated abdominal pain syndrome (CAPS)
  • D2. Narcotic bowel syndrome (NBS)/ Opioid-induced GI hyperalgesia

E. Gallbladder and sphincter of Oddi disorders

F. Anorectal disorders

  • F1. Fecal incontinence
  • F2. Functional anorectal pain
  • F3. Functional defecation disorders
    • F3a. Inadequate defecatory propulsion
    • F3b. Dyssynergic defecation

G. Childhood functional GI disorders: Neonate/Toddler

  • G1. Infant regurgitation
  • G2. Rumination syndrome
  • G3. Cyclic vomiting syndrome (CVS)
  • G4. Infant colic
  • G5. Functional diarrhea
  • G6. Infant dyschezia
  • G7. Functional constipation

H. Childhood functional GI disorders: Child/Adolescent

  • H1. Functional nausea and vomiting disorders
    • H1a. Cyclic vomiting syndrome (CVS)
    • H1b. Functional nausea and functional vomiting
      • H1b1. Functional nausea
      • H1b2. Functional vomiting
    • H1c. Rumination syndrome
    • H1d. Aerophagia
  • H2. Functional abdominal pain disorders
    • H2a. Functional dyspepsia
      • H2a1. Postprandial distress syndrome
      • H2a2. Epigastric pain syndrome
    • H2b. Irritable bowel syndrome (IBS)
    • H2c. Abdominal migraine
    • H2d. Functional abdominal pain ‒ NOS
  • H3. Functional defecation disorders
    • H3a. Functional constipation
    • H3b. Nonretentive fecal incontinence

Epidemiology

Functional gastrointestinal disorders are very common. Globally, irritable bowel syndrome and functional dyspepsia alone may affect 16–26% of the population.[1][3]

Research

There is considerable research into the causes, diagnosis and treatments for FGIDs. Diet, microbiome, genetics, neuromuscular function and immunological response all interact.[1] A role for mast cell activation has been proposed as one of the factors.[4][5]

See also

References

  1. 1 2 3 4 Drossman DA (2016). "Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV". Gastroenterology. 150 (6): 1262–1279. doi:10.1053/j.gastro.2016.02.032. PMID 27144617. S2CID 6441439.
  2. ↑ "Rome Foundation // Scoring Rome III Questionnaire using SAS".
  3. ↑ Sperber AD, Drossman DA, Quigley EM (2012). "The global perspective on irritable bowel syndrome: a Rome Foundation-World Gastroenterology Organisation symposium". Am. J. Gastroenterol. 107 (11): 1602–9. doi:10.1038/ajg.2012.106. PMID 23160283. S2CID 34208367.
  4. ↑ Wouters MM, Vicario M, Santos J (2015). "The role of mast cells in functional GI disorders". Gut. 65 (1): 155–168. doi:10.1136/gutjnl-2015-309151. PMID 26194403. It is well established that mast cell activation can generate epithelial and neuro-muscular dysfunction and promote visceral hypersensitivity and altered motility patterns in FGIDs, postoperative ileus, food allergy and inflammatory bowel disease.
  5. ↑ Bashashati, M; Moossavi, S; Cremon, C; Barbaro, MR; Moraveji, S; Talmon, G; Rezaei, N; Hughes, PA; Bian, ZX; Choi, CH; Lee, OY; Coëffier, M; Chang, L; Ohman, L; Schmulson, MJ; McCallum, RW; Simren, M; Sharkey, KA; Barbara, G (January 2018). "Colonic immune cells in irritable bowel syndrome: A systematic review and meta-analysis". Neurogastroenterology & Motility. 30 (1): e13192. doi:10.1111/nmo.13192. PMID 28851005. S2CID 33807711. Mast cells and CD3+ T cells are increased in colonic biopsies of patients with IBS vs non-inflamed controls
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