BENGALURU: Functional gastrointestinal disorders (FGID) are characterised by persistent gastrointestinal (GI) symptoms. Many suffer due to lack of relief from standard prescriptions. Over 40 per cent of the patients coming to the GI OPD are diagnosed with FGID.
Why does FGID occur?
Symptoms originate in the GI tract, but no structural or biochemical abnormalities are observed. Medical tests are normal. The keywords used to describe them are visceral hypersensitivity and Gut Brain Axis disorders as these symptoms, though originate in the gut, are modulated by signals from the brain to the nerves in the gut. There is an interplay of the gut motility, microbiome, nerve transmitters in the GI tract and perception in the brain.
So, the problem can start due to dietary factors or stressful events. Two of the most common types of FGID are Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD). IBS is a group of symptoms that can affect the digestive system, causing pain in the abdomen, change in bowel habits, and bloating. The challenge is to exclude sinister diseases like cancer, tuberculosis and Crohn’s disease. People with FD generally have upper abdomen bloating, burning and belching, which is one of the most com mon functional disorders. A diagnosis is done after ensuring that a gastrosco py has excluded ulcer dis ease and stomach cancer.
How is FGID diagnosed?
With routine tests showing negative for those with FGID, these disorders cannot be based on test results. Rome Criteria is used to help diagnose a patient with FGID, and also classify it. The diagnosis is made when a patient’s combination of symptoms and other factors meet the Rome criteria for a specific functional disorder. An experienced doctor usually diagnoses the disorders based on symptoms reported by the patient over six months. These patients may also frequently be affected by migraine, fibromyalgia, pelvic pain and urinary disorders.
Psychosocial aspects
It is important to understand that FGID is not a psychiatric disorder, and largely managed by gastroenterologists. But psychological stress can exacerbate FGID symptoms. There is a bi-directional pathway between the brain and the GI tract, known as the ‘brain gut axis’. It is found that external stressors and emotions or thoughts can affect GI sensation, motility and secretion. In other words, the brain affects the gut. Also, psychosocial disturbances can amplify illness experience and can impair quality of life.
Treatments
The modalities of treatment vary and depend on the symptoms. A sympathetic, patient listening, and understanding the suffering is the first step. Symptomatic therapy for pain, constipation, bloating, nausea and diarrhoea are used. Various neuro- modulators, which modify the signals from the gut and brain, are often the mainstay of therapy. Breathing techniques, biofeedback therapy, yoga and meditation are also beneficial too. Rarely, we need to use relaxation therapy, hypnosis or cognitive behavioural therapy. Around 80-90 per cent of people with FGID have shown excellent relief from their symptoms.
(The writer is chief of gastroenterology, Aster CMI Hospital)