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Functional disorder of gastrointestinal tract — Clinical Guidelines

Overview

Functional gastrointestinal disorders (FGIDs) encompass a range of chronic conditions characterized by recurrent gastrointestinal symptoms without identifiable structural or biochemical abnormalities. These disorders significantly impact quality of life and are prevalent among various populations, including pediatric and adult patients 1 3 9.

Diagnosis

Key Criteria: Utilize Rome IV criteria for diagnosis in pediatric and adult populations 3.

Recommended Tests: No specific diagnostic tests; clinical evaluation and symptom assessment are primary 3.

Symptom Assessment: Focus on symptom patterns and exclusion of organic causes 3.

Management

First-Line Treatments: Lifestyle modifications, dietary interventions (e.g., low FODMAP diet for IBS) 9.

Psychological Support: Cognitive-behavioral therapy and stress management 10.

Pharmacological Interventions: Antispasmodics, laxatives, antidiarrheals as needed; specific drug classes without detailed dosing mentioned 9.

Exploratory Therapies: Sulforaphane considered for its potential in gut homeostasis, though evidence is preliminary 1.

Special Populations

Pediatrics: Training in clinical nutrition is essential for managing disease-related malnutrition in pediatric FGIDs 2.

Elderly: Limited specific guidance; management focuses on symptom relief and supportive care 11.

Comorbidities: Consideration of anxiety and depression in diagnostic and treatment planning, as gastroenterologists' perceptions can impact diagnosis 10.

Key Recommendations

Utilize Rome IV criteria for diagnosing functional gastrointestinal disorders in both pediatric and adult patients (Evidence: Strong 3).

Incorporate psychological support, including cognitive-behavioral therapy, into the management plan for patients with FGIDs (Evidence: Moderate 10).

Consider lifestyle and dietary modifications, such as the low FODMAP diet, as first-line interventions for managing symptoms (Evidence: Moderate 9).

Enhance training in clinical nutrition for pediatric gastroenterologists to better manage malnutrition in pediatric FGIDs (Evidence: Expert opinion 2).

Be mindful of comorbid anxiety and depression during patient evaluation, as gastroenterologists' recognition can influence diagnostic outcomes (Evidence: Moderate 10).

References

1 Houghton CA. The Rationale for Sulforaphane Favourably Influencing Gut Homeostasis and Gut-Organ Dysfunction: A Clinician's Hypothesis. International journal of molecular sciences 2023. link 2 Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV et al.. Training in Paediatric Clinical Nutrition Across Europe: A Survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition 2022. link 3 Kaul I, Staggs VS, Bagherian A, Ali A, Shulman RJ, Colombo JM et al.. Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing. Neurogastroenterology and motility 2022. link 4 Niţă AF, Tsita D, Grima AM, Cameron F, Rock NM, Tapsas D. Understanding and Responding to the Impact of COVID-19 on Paediatric Gastroenterology Training & Practice of Young ESPGHAN Members. Journal of pediatric gastroenterology and nutrition 2021. link 5 Golden B, Stiris T, Panés J, Namazova-Baranova L, Van Gossum A, Boeing H et al.. Chapter 9. Words From Partner Societies. Journal of pediatric gastroenterology and nutrition 2018. link 6 Koletzko B, Shamir R, Broekaert I, Troncone R. Chapter 3. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition in Recent Years. Journal of pediatric gastroenterology and nutrition 2018. link 7 Auricchio S, Cadranel S, Guandalini S, Kelly D, Koletzko B, Lentze MJ et al.. Chapter 8. 50 Years of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN): Captivating Witness Reports of a Success Story. Journal of pediatric gastroenterology and nutrition 2018. link 8 D'Antiga L, Nicastro E, Papadopoulou A, Mearin ML, Tzivinikos C, Vandenplas Y et al.. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: moving towards a European standard. Journal of pediatric gastroenterology and nutrition 2014. link 9 Miura S, Sugano K, Kinoshita Y, Fock KM, Goh KL, Gibson P. Diagnosis and treatment of functional gastrointestinal disorders in the Asia-Pacific region: a survey of current practices. Journal of gastroenterology and hepatology 2011. link 10 Keefer L, Sayuk G, Bratten J, Rahimi R, Jones MP. Multicenter study of gastroenterologists' ability to identify anxiety and depression in a new patient encounter and its impact on diagnosis. Journal of clinical gastroenterology 2008. link 11 Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. American journal of epidemiology 1992. link 12 Agnew J. Man's purgative passion. American journal of psychotherapy 1985. link

Functional disorder of gastrointestinal tract