Diagnosing Functional Gastrointestinal Disorders: What to Consider

Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)

Rome Criteria

FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)

FGDs

A comprehensive list as described by the Rome III criteria (Ami D. Sperber et al., 2021)

Functional Esophageal Disorders

• Functional heartburn
• Functional chest pain believed to be of esophageal origin
• Functional dysphagia
• Globus

Functional Gastroduodenal Disorders

• Unspecified excessive belching
• Functional dyspepsia – includes postprandial distress syndrome and epigastric pain syndrome.
• Chronic idiopathic nausea
• Aerophagia
• Functional vomiting
• Cyclic vomiting syndrome
• Rumination syndrome in adults

Functional Bowel Disorders

• Irritable bowel syndrome – IBS
• Functional constipation
• Functional diarrhea
• Unspecified functional bowel disorder

Functional Abdominal Pain Syndrome

• Functional abdominal pain – FAP

Functional Gallbladder and Sphincter of Oddi Disorders

• Functional gallbladder disorder
• Functional biliary Sphincter of Oddi disorder
• Functional pancreatic Sphincter of Oddi disorder

Functional Anorectal Disorders

• Functional fecal incontinence
• Functional Anorectal Pain – includes chronic proctalgia, Levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax.
• Functional Defecation Disorders – include dyssynergic defecation and inadequate defecatory propulsion.

Childhood Functional GI Disorders

Infant/Toddler (Jeffrey S. Hyams et al., 2016)

• Infant colic
• Functional constipation
• Functional diarrhea
• Cyclic vomiting syndrome
• Infant regurgitation
• Infant rumination syndrome
• Infant dyschezia

Childhood Functional GI Disorders:

Child/Adolescent

• Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
• Abdominal Pain-Related Functional GI Disorders include:

1. functional dyspepsia
2. IBS
3. Abdominal migraine
4. Childhood functional abdominal pain
5. Childhood functional abdominal pain syndrome

• Constipation – functional constipation
• Incontinence – nonretentive fecal incontinence

Diagnosis

Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.

Treatment

Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)

• Physical therapy
• Nutritional and dietary adjustments
• Stress management
• Psychotherapy
• Medication
• Biofeedback

Eating Right To Feel Better

References

Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. doi.org/10.1016/S0140-6736(20)32115-2

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. doi.org/10.5056/jnm16214

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. doi.org/10.1053/j.gastro.2020.04.014

Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. doi.org/10.1053/j.gastro.2016.02.015

Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. doi.org/10.7861/clinmed.2020-0980