Management of functional gastrointestinal disorders

Abstract

Functional gastrointestinal (GI) disorders (eg irritable bowel syndrome and functional dyspepsia) are very common conditions which are associated with very poor quality of life and high healthcare utilisation. They are caused by disorders of GI functioning, namely altered gut sensitivity, motility, microbiota, immune functioning and central nervous system processing. They cause chronic symptoms throughout the gut (eg pain, dyspepsia and altered bowel habit), all of which are made worse by maladaptive patient behaviours, stress and psychological comorbidity. Management involves a biopsychosocial approach involving changes in lifestyle and diet, addressing coexisting psychological comorbidity and using medication to treat underlying pathophysiology. Pharmacological treatment with antispasmodics, neuromodulators, motility agents and antidepressants is effective. Psychotherapy in motivated individuals is equally effective. Success of treatment is increased by a good doctor-patient relationship and so this needs to be taken into account during the consultation.

Keywords: functional disorders; functional dyspepsia; gastrointestinal; irritable bowel syndrome; pain.

Fig 1.

Biopsychosocial model of functional gastrointestinal disorders. CNS = central nervous system; ENS = enteric nervous system; FGID = functional gastrointestinal disorders.

Fig 2.

Algorithms for pharmacological management of irritable bowel syndrome and functional dyspepsia. a) Irritable bowel syndrome. Dotted red boxes identify medications that are useful for more than one symptom in IBS-D, dotted blue boxes identify medications that are useful for combination symptoms in IBS-C. b) Functional dyspepsia. Dotted blue boxes identify medicines that target for both nutrient tolerance and pain. PPI = proton pump inhibitor; SNRI = serotonin noradrenergic reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.