functional gastroenterology

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Overview.

A group of syndromes characterized by chronic or recurrent gastrointestinal symptoms that cannot be explained pathologically, such as foreign body sensation in the pharynx, belching, burning sensation of fullness, abdominal pain, constipation, and diarrhea, and accompanied by psychosocial and mental anomalies that are closely related to the onset of psychosocial factors.

Definition

  • Functional gastrointestinal disease is a group of chronic, recurrent gastrointestinal symptoms, without organic lesions of the gastrointestinal tract functional diseases.
  • It mainly includes functional dyspepsia, irritable bowel syndrome and functional constipation, etc., the former two diseases are more common.

    • Epidemiology

    Prevalence

  • The prevalence of functional dyspepsia and irritable bowel syndrome worldwide is 19%-41% and 10%-22% respectively.
  • The prevalence of functional dyspepsia and irritable bowel syndrome in China is 19%-37% and 5.6%-7.3% respectively, slightly lower than the world average.

    • Gender distribution

    Female is slightly higher than male, which may be related to psychological factors.

    Causes

    Causes

    The cause of functional gastrointestinal disorders has not been clearly defined, but may be related to the following factors.

    Visceral hypersensitivity

    May be the main cause of this disease. It manifests as hypersensitivity of the gastrointestinal tract to external stimuli with central sensory hypersensitivity.

    Dynamic disorders of the gastrointestinal system

    Delayed gastric emptying, accelerated and slowed intestinal passage time may be inextricably linked to the disease.

    Gastrointestinal infections

  • Acute gastrointestinal infections may be associated with some functional gastrointestinal disorders and may predispose to the disease.
  • Pathogens include bacteria and parasites, and common ones include Shigella, Salmonella and Giardia lamblia.

    • Psychological factors

    The incidence of the disease is high in people with mental abnormalities, which may be accompanied by anxiety, depression, and disturbed sleep habits.

    Others

    Genetic and food factors may be associated with some functional gastrointestinal disorders.

    Pathogenesis

    The pathogenesis of functional gastrointestinal disorders is not known, but may be related to digestive tract dynamics disorders, abnormal gut-brain interaction, visceral hypersensitivity, and changes in intestinal flora.

    Symptoms

  • Functional gastroenteropathy involves sites including the esophagus, stomach and duodenum, intestines, biliary tract, and anus.
  • Symptoms vary, with a predominantly chronic onset and recurrent or chronic prolongation of symptoms over a period of years to decades.

    • Typical symptoms

    Hysterical globus pallidus

    The manifestation of foreign body sensation in the pharynx, often make swallowing movements in order to relieve the symptoms, and in severe cases, dysphagia without imaging abnormalities can occur.

    Belching

    Often repeated episodes of continuous belching in an attempt to relieve abdominal discomfort and fullness.

    Functional dyspepsia

  • Presence of a feeling of early satiety, which manifests itself as being full after just a small amount of food has been eaten.
  • Post-meal fullness, epigastric pain, and burning sensation in the upper abdomen.

    • Irritable Bowel Syndrome

    Abdominal pain or abdominal discomfort, diarrhea, constipation, bloating, heartburn, early satiety, nausea, and vomiting.

    Accompanying Symptoms

    Most of them are accompanied by different degrees of mental symptoms, such as insomnia, anxiety, depression, fear, suspicion, nervousness, and hostility, etc., but they are not psychological disorders.

    Consultation

    Conditions that require medical attention

    If the following symptoms occur over a long period of time, it is recommended that you seek medical attention to avoid delays.

  • Unexplained diarrhea, constipation, or alternating between the two.
  • Unexplained abdominal pain, especially pain in the upper abdomen around the umbilicus.
  • Epigastric discomfort, belching and flatulence.
  • Satiety after eating a little food.
  • Feeling of fullness after eating.
  • Pain behind the sternum with burning sensation.

    • Recommended Department of Medicine

    A visit to the Department of Gastroenterology is recommended.

    Preparation for Consultation

    If there are no special circumstances, you need to register through the hospital’s official website, official app, 114 and other regular channels, prepare your social security card (medical insurance card) and other medical documents, bring your previous medical documents, and apply for a record for those who seek medical treatment in a different place.

    What questions the doctor may ask

  • What’s wrong? How long has it been going on?
  • Any abdominal pain or discomfort in the abdomen? If so, what are the location, nature and duration of the pain, and what are the relieving factors for each?
  • Is there bloating? If so, under what conditions is it relieved?
  • Are there any changes in bowel movements from normal? For example, the number of bowel movements, the nature of the feces, etc.
  • Have you eaten unclean food or drunk unsanitary water recently?
  • Have you taken any medications recently? For example, salicylates, etc.
  • Have you suffered from intestinal diseases in the past?
  • Has anyone in the family experienced similar symptoms?
  • Have you had any relevant examinations?
  • Is there any history of drug allergies, etc.?

    • Questions you can ask your doctor

  • What are the reasons for these symptoms?
  • Are there any tests needed?
  • What treatment is needed for Functional Gastrointestinal Disorder?
  • Do I need to be hospitalized for Functional Gastrointestinal Disorder?
  • Do I need to pay attention to my daily life?
  • Can Functional Gastrointestinal Disorder be cured on its own?
  • Can Functional Gastrointestinal Disease be cured? How long does it take?
  • Are there any after-effects of Functional Gastrointestinal Disease?

    • Diagnosis

    Diagnosis

    Functional Gastrointestinal Disease (FGD) is diagnosed according to the Rome IV criteria.

    Medical history

    A history of anxiety, depression, disturbed sleep habits, and a family history of confirmed diagnosis of the disease is important in the diagnosis of functional gastrointestinal disorders.

    Clinical manifestations

    The presence of the following symptoms may assist the doctor in diagnosing the disease.

  • Unexplained diarrhea, constipation, or alternating between the two.
  • Unexplained abdominal pain, especially in the epigastric region around the umbilicus.
  • Epigastric discomfort, belching and flatulence.
  • Early satiety and discomfort of fullness after eating.
  • Retrosternal pain with burning sensation.

    • Laboratory Tests

    Blood tests
  • Routine blood tests: help in the identification of infectious gastrointestinal diseases.
  • Blood biochemistry: can rule out abnormalities in hepatobiliary and pancreatic function.
    • Fecal occult blood test

    Fecal occult blood test can be used to detect the presence of red blood cells in feces, and then determine whether there is gastrointestinal bleeding.

    Helicobacter pylori test
  • Helicobacter pylori test is suitable for patients who do not have epigastric mass, vomiting, vomiting blood, black stool and other manifestations.
  • The urea breath test is one of the “gold standard” methods for detecting H. pylori, and is non-invasive and highly accurate, and is widely used in clinical practice.

    • The principle is to use radioactive ¹³C, ¹⁴C-labeled urea (oral) will be broken down by the urease enzyme produced by H. pylori, thus producing and exhaling CO2, through the measurement of CO2 concentration to determine the presence of H. pylori infection. 4, endoscopy

    The main use of endoscopy is to rule out other organic diseases.

    Differential Diagnosis

    Gastric cancer

    Similarity: both may present with decreased appetite, epigastric discomfort, fullness and anemia.

    Difference: with the progress of gastric cancer, the symptoms gradually worsen, and obstruction and metastasis may also appear. Differential diagnosis can be made through endoscopy and tissue biopsy.

    Peptic ulcer

    Similarity: chronic epigastric pain and other symptoms can be seen in both cases.

    Differences: Peptic ulcer is characterized by regular and periodic pain in the upper abdomen, while functional gastrointestinal disease pain is rarely regular and is dominated by dyspeptic symptoms. Differential diagnosis can be made relying on endoscopy.

    Inflammatory bowel disease

    Similarities: both may present with abdominal pain, diarrhea, and fever.

    Differences: Inflammatory bowel disease diarrhea is characterized by mucous blood stools, while functional gastrointestinal disease is usually watery stools. Enteroscopy can also be used for differential diagnosis.

    Treatment

    General treatment

    Dietary adjustments

    Frequency of meals

    Small and frequent meals are needed to avoid eating large amounts of food at one time to increase the burden on the digestive tract. It is recommended to eat 6 meals per day.

    Dietary considerations

    Avoid oily and stimulating foods, choose foods that are easy to digest and rich in protein and vitamins.

    Dietary contraindications

    Alcohol, coffee and strong tea need to be prohibited during treatment.

    Others

    Medication management

    Need to stop taking non-steroidal anti-inflammatory drugs, if you have to take, please consult your doctor or pharmacist.

    Education

    Doctors and family members need to help the patient recognize and understand the condition so that he/she will not be overly anxious.

    Smoking

    Smoking needs to be prohibited during treatment and cessation of smoking is recommended after treatment.

    Medication

  • Generally follow the doctor’s instructions to choose drugs to reduce visceral sensitivity (such as 5-hydroxytryptamine receptor antagonists, etc.), inhibit gastric acid secretion drugs, gastric mucous membrane protective agents, gastrointestinal power to promote the drug, regulate the intestinal flora of drugs, antispasmodic and antidiarrheal drugs, and may need to use antibiotics for antibiotic treatment.
  • In the presence of significant mental or emotional depression and anxiety, antidepressants and anxiolytics may be used for treatment.
  • If H. pylori infection is present, H. pylori eradication therapy should also be performed.
  • All medications should be used as prescribed and should not be adjusted in dosage or discontinued on their own.

    • Drugs to reduce visceral sensitization

    Opioids

    Can reduce visceral pain and effectively inhibit gastrointestinal motility.

    5-hydroxytryptamine receptor antagonists

    Common drugs include ondansetron, which can effectively inhibit gastrointestinal hypersensitivity.

    Alpha-adrenergic drugs

    Can effectively increase intestinal compliance and improve abdominal pain and other related symptoms.

    Drugs that inhibit gastric acid secretion

  • It is suitable for patients with persistent pain in the epigastrium and obvious burning sensation.
  • Drugs that inhibit gastric acid secretion include proton pump inhibitors, such as omeprazole, rabeprazole, lansoprazole, epprazole, etc.; H2 receptor blockers, such as cimetidine, ranitidine, famotidine, etc.

    • Gastric mucosa protective agents

    Protective drugs for gastric mucosa include aluminum and bismuth, which can form high viscosity sol in acidic environment and form a strong protective film on the surface of gastric mucosa.

    Drugs to promote gastrointestinal dynamics

  • May improve epigastric symptoms associated with meals.
  • The main symptoms of epigastric fullness, early satiety and belching are often prioritized.
  • Commonly used drugs include domperidone and mosapride.
  • They need to be taken before meals.
  • Adverse reactions such as diarrhea and abdominal pain may occur, which can usually be relieved on their own after stopping the drug.

    • Intestinal Flora Regulators

  • The main way to regulate intestinal flora is to take oral probiotics. Probiotics can correct the intestinal flora imbalance, and have a certain effect on functional gastrointestinal diseases.
  • At present, the main commonly used bifidobacteria, lactobacillus, bacillus licheniformis and bacillus cereus.

    • Antispasmodic and antidiarrheal drugs

    Antispasmodics
  • The commonly used drug is scopolamine.
  • There are obvious peripheral anticholinergic effect, can relax smooth muscle, effectively improve intestinal spasm.
    • Antidiarrheal drugs
  • Antidiarrheal drugs can stop diarrhea by reducing intestinal peristalsis to protect the intestine from irritation. It is a commonly used drug for functional gastrointestinal diseases.
  • Commonly used antidiarrheal medications for this disease include loperamide, montelukast, eliminatocardia, lichen planus, and others.
  • Antidiarrheal drugs should be used as prescribed by the doctor.

    • Antibacterial drugs not absorbed by the intestinal tract

    Antimicrobials that are not absorbed in the gut (e.g., rifaximin) may improve the symptoms associated with irritable bowel syndrome, and may be used for antibacterial therapy as prescribed.

    Antidepressant and anxiety treatment

  • For people with obvious psychiatric and psychological disorders, antipsychotic drugs can be chosen as prescribed by the doctor, and should be taken consistently for at least 3 to 6 months.
  • Drugs used for anti-anxiety mainly include selective 5-hydroxytryptamine reuptake inhibitors (SSRI), 5-hydroxytryptamine-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants, newer anxiolytics, benzodiazepines, and so on.
    • SSRIs

    Sertraline, paroxetine, fluoxetine, fluvoxamine, citalopram, escitalopram.

    SNRI drugs

    Venlafaxine, duloxetine, desvenlafaxine, milnacipran, levomilnacipran.

    Tricyclic antidepressants

    Clomipramine, doxepin, amitriptyline, promethazine.

    Newer anxiolytics

    Buspirone, Tandospirone.

    Anti-anxiety Chinese medicines

    Free San, Ning Shen An Zhi Tablets, Xie Yu An Shen Granules, Free Pills, Zhu Sha An Shen Pills.

    Other Classes

    Benzodiazepines, Glutathione, etc.

    Helicobacter pylori eradication treatment

  • The most important treatment for H. pylori infection is H. pylori quadruple therapy, which includes a proton pump inhibitor, two antimicrobial drugs and bismuth.
  • The regular course of treatment is 10 to 14 days.

    • Psychotherapy

    Role of psychotherapy

    Psychotherapy can significantly reduce anxiety, depression and other emotions, which in turn can improve gastrointestinal symptoms.

    Common methods of psychotherapy

    The main methods include psychodynamic therapy, thought therapy and hypnotherapy.

    Prognosis

    Cure

  • The therapeutic effect of functional gastrointestinal disease is related to age, the presence of complications, and the timing of treatment.
  • Early and standardized treatment can reduce the occurrence of complications and improve the prognosis.

    • Harmfulness

    Functional gastrointestinal disease, if not treated timely and scientifically, can develop complications such as gastric ulcers, which can seriously affect the quality of life.

    Daily life

    Daily life

  • Eat regularly, have meals on time, do not overeat, and may eat more meals in smaller portions.
  • Do not eat spicy, fried, raw and cold food or hot food, such as chili peppers, barbecue, doughnuts.
  • Do not eat unwashed fruits and vegetables and spoiled food.
  • Prohibit smoking and drinking.
  • Maintain a good state of mind and reduce the frequency and intensity of psycho-emotional stress.

    • Prevention

  • Maintain a positive and optimistic state of mind and avoid prolonged exposure to adverse emotions such as anxiety and depression.
  • Adopt good dietary habits and avoid starving or overeating.