Functional GI Disorders

Question 1

Functional GI Comorbidities:

Answer 1

• Other functional GI disorders
• Fibromyalgia
• Chronic Fatigue
• Anxiety, depression, other mental health diagnosis
• Headaches
• Sleep disturbance
• Other pain syndromes

Question 2

Risk Factors

Answer 2

• Visceral hypersensitivity
• Dysmotility
• Early life stress/current stress
• Changes in gut microbiome (recent infections)
• Genetics
• Environment

Question 3

Number of parental ailments

Answer 3

-If parent has lots of health issues, patient is more likely to have functional GI disorders

Question 4

Mechanism of functional GI disorders

Answer 4

• Central Neuronal Sensitization: increased spontaneous firing and decreased threshold for firing.
• Sensitization of sensory neurons: increased afferent signaling from the intestines.
• Heightened HPA axis: corticotropin releasing factor alters motility and pain thresholds

Question 5

Biopsychosocial Conceptual Model

Answer 5

Early life
Psychosocial Factors
Physiology
FGID
Outcome

Question 6

How to Diagnose FAP

Answer 6

• Limiting testing.
• Evaluate for red flags, weight loss, change in growth velocity, delayed puberty, GI bleeding, severe vomiting/diarrhea, fever, +FHx.
  Initial screening: CBC, ESR/CRP, Hemoccult, celiac, CMP, lipase, UA, stool for infx/inflammation.

Question 7

Treatment

Answer 7

• Hypnotherapy works: decreased intensity of pain.
• Dietary: less clear fiber, lactose free, elimination of other foods. minimal to no benefit unless lactose intolerant.
• FODMAP diet: some benefit with decreased pain.
• Antibiotics: RIfaximin: some benefit (but also benefit to placebo).