Functional gastrointestinal (GI) and motility disorders are collectively the most common GI conditions diagnosed by gastroenterologists (physicians specializing in GI diseases) and primary care physicians. These conditions include irritable bowel syndrome (IBS), chronic constipation, chronic diarrhea, atypical chest pain, and fecal incontinence. Functional GI disorders have a worldwide prevalence and affect up to 20% of the population. In the US alone, 30 to 60 million people suffer from functional GI disorders. The word “functional” refers to the fact that these conditions cannot (yet) be reliably diagnosed using blood tests, imaging studies, tissue samples, or other forms of objective biological evidence; that is, they cannot be easily explained by anatomic or structural abnormalities. Instead, these conditions are principally diagnosed by relying on the patient report of their symptoms, and by ruling out other conditions that might mimic the symptoms.
Functional GI disorders are chronic or recurring medical conditions that can affect any part of the entire GI tract from the esophagus to the colon. Functional GI Diseases are comprised of a number of GI diseases including functional or atypical chest pain, irritable bowel syndrome (IBS), functional dyspepsia, chronic constipation, gastroesophageal reflux disease (GERD) and fecal incontinence.
IBS alone accounts for 12% of all diagnoses in primary care practices, and Functional GI Diseases as a group account for over 40% of diagnoses made by gastroenterologists in their clinical practices.
In these conditions, the stomach and bowel may not function normally and causes symptoms that can range from heartburn, difficulty swallowing food, nausea and vomiting, abdominal pain, bloating, gas, diarrhea and constipation. Often these symptoms are so severe as to cause disruption to the quality of life of the patient.
Functional GI disorders affect children, adults, women and men – everyone can be affected, although the conditions occur three times more often in women. Doctors frequently have difficulty distinguishing these diseases from other GI diseases such as celiac disease and inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis, and also gynecologic conditions such as endometriosis, ovarian cancer and chronic pelvic pain; this further complicates making a definitive diagnosis. Symptoms intensify during the menstrual cycle and during the peri-menopausal period. Children and young adults affected by these conditions often suffer their entire lives with pain and discomfort.
Functional GI disorders can seriously impair the quality of life and daily functioning of patients. These diseases have a comparable quality of life as diabetes, end-stage kidney failure and depression. Despite advances in modern medicine, it remains extremely rare to achieve a full cure in patients with these conditions. In addition to affecting quality of life, the functional GI disorders can also diminish productivity on the job. As a group, these disease cost society untold billions of dollars in opportunity costs from lost or diminished work. Adults report 10-14 hours of lost work productivity per week and 3-4% work time missed. Many patients report that their daily functioning, social activities and personal relationships are severely impacted by their conditions. We found that patients report an average decrease in quality of life of 25%. In addition, affected children frequently miss school due to their symptoms.
Some research indicates that patients with Functional GI disorders have increased sensitivity of their bowels. Research also shows that these patients may have disturbances in the communication pathways between the brain and bowel; this can result in abnormal bowel function. Disturbances in any part of these communication pathways and networks can cause lead to GI disease and symptoms. Although the cause of Functional GI disorders like IBS is not completely understood, we have been able to establish risk factors for these conditions. For example, we now know these conditions can be hereditary, and that certain genes can predispose a person to get them. Also, traumatic events early in life (e.g., abuse) can increase the vulnerability of an individual to get these conditions. Studies also indicate that chronic stress and/or intestinal infections (e.g., food poisoning) can trigger the onset of symptoms.
There are currently no definitive tests that can diagnose these diseases. They are diagnosed by patient symptoms, but unfortunately, many other diseases can cause similar symptoms. This makes the diagnosis uncertain at best. For example, IBS is characterized by abdominal pain and diarrhea, but patients with colon cancer, Crohn’s disease, colitis, and celiac disease also report these same symptoms. Many people with these diseases do not seek health care because they do not think doctors can help them. When patients do seek medical attention, the diagnosis takes 3 years on average, and patients see 3 doctors before a proper diagnosis is made.
Treatment has multiple components that include education about the medical condition, diet and lifestyle changes, medications (over the counter remedies and prescription), behavioral treatments (hypnosis, cognitive behavioral therapy, mindfulness meditation, etc). Treatment is normally based on a patient’s symptoms, particularly those that are most bothersome.
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