Upper GI complaints include chest pain (see Symptoms of Cardiovascular Disorders: Chest Pain), chronic and recurrent abdominal pain, dyspepsia, lump in the throat, halitosis (see Symptoms of Dental and Oral Disorders: Halitosis), hiccups, nausea and vomiting, and rumination. Some upper GI complaints represent functional illness (ie, no physiologic cause found after extensive evaluation―see Approach to the GI Patient: Functional GI Illness).
Lower GI complaints include constipation, diarrhea, gas and bloating, abdominal pain (see also Acute Abdomen and Surgical Gastroenterology: Acute Abdominal Pain), and rectal pain or bleeding (see Anorectal Disorders). As with upper GI complaints, lower GI complaints result from physiologic illness or represent a functional disorder (ie, no radiologic, biochemical, or pathologic abnormalities are found even after extensive evaluation). The reasons for functional symptoms are not clear. Evidence suggests that patients with functional symptoms may have disturbances of motility, nociception, or both; ie, they perceive as uncomfortable certain sensations (eg, luminal distention, peristalsis) that other people do not find distressing.
No bodily function is more variable and subject to external influences than defecation. Bowel habits vary considerably from person to person and are affected by age, physiology, diet, and social and cultural influences. Some people have unwarranted preoccupation with bowel habits. In Western society, normal stool frequency ranges from 2 to 3/day to 2 to 3/wk. Changes in stool frequency, consistency, volume, or composition (ie, presence of blood, mucus, pus, or excess fatty material) may indicate disease.
Last full review/revision July 2012 by Norton J. Greenberger, MD