Functional Bowel Disorders

Question 1

What is non-ulcer dyspepsia?

Answer 1

Dyspeptic type pain with no ulcer on endoscopy, probably not a single disease

Question 2

How would you diagnose non-ulcer dyspepsia?

Answer 2

With careful history and examination- family history

Question 3

How is non-ulcer dyspepsia managed?

Answer 3

If H. Pylori positive, treat infection
If ALARM signs present give endoscopy
If both negative then treat symptomatically

Question 4

What are the functional causes of vomiting and nausea?

Answer 4

Drugs 
Pregnancy 
Migraine 
Cyclical vomiting syndrome 
Alcohol

Question 5

What is psychogenic vomiting?

Answer 5

Idiopathic vomiting often with no preceding nausea

Can be self induced, overlap with bulimia

Question 6

What are the clinical features of irritable bowel syndrome?

Answer 6

Abdominal pain (very variable)
Altered bowel habit 
Abdominal bloating 
Belching wind and flatus 
Mucus

Question 7

What criteria are required for a diagnosis of irritable bowel syndrome?

Answer 7

A compatible history and normal physical examination

Question 8

What investigations are useful when querying irritable bowel syndrome?

Answer 8

Blood analysis (FBC, U&Es, LFTs, Ca, CRP, TFTs, coeliac serology)
Stool culture
Fecal calprotectin
FIT testing

Question 9

How is IBS differentiated from IBD?

Answer 9

Calprotectin released by inflamed gut mucosa and so is present in IBD but not IBS

Question 10

How is irritable bowel syndrome managed?

Answer 10

Dietetic review
Pharmacological interventions-
Antidepressants in moderate to severe cases
Low doses of amitriptyline (milder cases)
Cognitive behaviour therapy
Hypnotherapy
Brief interpersonal psychotherapy

Question 11

What are the causes of IBS?

Answer 11

Altered motility 
Visceral hypersensitivity 
Stress
Anxiety 
Depression