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Functional Gastrointestinal Illness

By

Stephanie M. Moleski

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Often, no objectively measurable structural or physiologic abnormality for gastrointestinal complaints is found, even after extensive evaluation. Such patients are said to have functional illness, which accounts for 30 to 50% of referrals to gastroenterologists.

Functional GI disorders are disorders of the gut-brain interaction. Some evidence suggests that such patients have visceral hypersensitivity, a disturbance of nociception in which they experience discomfort caused by sensations (eg, luminal distention, peristalsis) that other people do not find distressing. Functional disorders are classified by symptoms related to a combination of not only visceral hypersensitivity but also motility disturbance, altered microbiota, mucosal and immune function, and central nervous system processing (1 General references Often, no objectively measurable structural or physiologic abnormality for gastrointestinal complaints is found, even after extensive evaluation. Such patients are said to have functional illness... read more ).

Many referring physicians and GI specialists find functional GI complaints difficult to understand and treat, and uncertainty may lead to frustration and judgmental attitudes. An effective physician–patient interaction reduces health care–seeking behavior by the patient. Physicians should acknowledge the patient's symptoms and provide empathy. Physicians should avoid ordering repeated studies or multiple drug trials for insistent patients with inexplicable complaints because this may promote symptom anxiety and health care–seeking behavior (2 General references Often, no objectively measurable structural or physiologic abnormality for gastrointestinal complaints is found, even after extensive evaluation. Such patients are said to have functional illness... read more ). When symptoms are not suggestive of serious illness, the physician should wait rather than embark on another diagnostic or therapeutic plan. In time, new information may direct evaluation and management. Functional complaints are sometimes present in patients with physiologic disease (eg, peptic ulcer Peptic Ulcer Disease A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more Peptic Ulcer Disease , esophagitis); such symptoms may not remit even when a physiologic illness is addressed. In some patients, testing (eg, CT) may identify incidental abnormalities that are unrelated to the symptoms.

General references

  • 1. Drossman DA: Functional gastrointestinal disorders: History, pathophysiology, clinical features, and Rome IV. Gastroenterology 150:1262–1279, 2016. doi: 10.1053/j.gastro.2016.02.032

  • 2. Drossman DA: 2012 David Sun Lecture: Helping your patient by helping yourself: How to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol 108:521–528, 2013. doi: 10.1038/ajg.2013.56

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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