functional GI disorders

Question 1

what are functional GI disorders ?

Answer 1

a disorder compromising symptoms arising in the mid or lower GIT that are not associated with anatomic or biochemical defects

Question 2

what are the 3 most common functional GI disorders ?

Answer 2

IBS
functional dyspepsia
constipation

Question 3

what is irritable bowel syndrome?

Answer 3

is a GIT syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause

Question 4

what are the subtype of IBS?

Answer 4

IBS with constipation
IBS with diarrhea
Mixed IBS
Unsubtyped IBS

Question 5

what criteria is used for IBS?

Answer 5

Rome IV criteria

Question 6

what is the time period required to fulfil the criteria of IBS?

Answer 6

for the past 3 months with symptom onset at least 6 months prior to diagnosis

Question 7

what are the criteria to diagnose IBS by the Rome IV criteria ?

Answer 7

1. abdominal pain at least once a week in the last 3 months which is associated with at least 2 of:
   - pain related to defecation
   - associated with a change in stool frequency
   - associated with a change in form of stool

Question 8

what is the cause of the diarrhea if the diarrhea wakes the patient up?

Answer 8

organic and not functional

Question 9

what are some alarming or atypical symptoms that are not compatible with IBS ?

Answer 9

rectal bleeding
nocturnal or progressive abdominal pain
weight loss
anemia, elevated inflammatory markers or electrolyte disturbances

Question 10

what does the diagnostic evaluation mainly depend on ?

Answer 10

whether the predominant symptom is diarrhea or constipation

Question 11

if the predominant symptom is diarrhea what are the diagnostic approaches ?

Answer 11

stool cultures
celiac disease screening
24 hour stool collection if malabsorption is suspected
colonscopy or flexible sigmoidoscopy

Question 12

if the predominant symptom is constipation what are the diagnostic approaches ?

Answer 12

colonoscopy or flexible sigmoidoscopy

Question 13

what is the treatment approach to IBS ?

Answer 13

patient education 
dietary modification n
diarrhea management 
constipation management 
pain management

Question 14

what are some of the dietary modifications required ?

Answer 14

FODMAPs restriction 
gluten avoidance 
lactose avoidance 
food allergies testing 
dietary fibre 
and physical activity should be encouraged

Question 15

in patients who have IBS-C and failed a trial of soluble fibre what is the next best step ion management ?

Answer 15

osmotic laxatives
chloride channel activators lubiprostone
5HT4 R

Question 16

what is the management in patients with IBS-D?

Answer 16

anti-diarrhoea agents: loperamide
bile acid sequestrants: cholestyramine
5HT3 R antagonist: Alosetronn

Question 17

what is the side effect of alosetron ?

Answer 17

ischemic colitis

Question 18

what are the managments of pain and bloating ?

Answer 18

antispasmodics
antidepressants
probiotics rifaximin

Question 19

what is the best step in management for refractory patients?

Answer 19

behavioural therapy

fecal microbiota transplantation

Question 20

what is functional dyspepsia?

Answer 20

predominant epigastric pain lasting at least 1 month and can be associated with other symptoms such as heartburn but the primary complain is epigastric pain

Question 21

what is the best approach to a patient above the age of 60 that has dyspepsia ?

Answer 21

endoscopy should be performed

Question 22

what is the best approach to a patient below the age of 60 that has dyspepsia ?

Answer 22

H.pylori test and irradication of HP
if it is not related to H.pylori then administer PPI
if that doesn’t work then prescribe TCA
as a last resort consider psychotherapy