Functional Gastrointestinal Disorder

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2021-01-18

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Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

Classification

Terms such as functional colonic disease (or functional bowel disorder) refer in medicine to a group of bowel disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms. Other functional disorders relate to other aspects of the process of digestion.

The consensus review process of meetings and publications organised by the Rome Foundation, known as the Rome process, has helped to define the functional gastrointestinal disorders. Successively, the Rome I, Rome II, Rome III and Rome IV proposed consensual classification system and terminology, as recommended by the Rome Coordinating Committee. These now include classifications appropriate for adults, children and neonates/toddlers.

The current Rome IV classification, published in 2016, is as follows:

A. Esophageal disorders

A1. Functional chest pain
A2. Functional heartburn
A3. Reflux hypersensitivity
A4. Globus
A5. Functional dysphagia

B. Gastroduodenal disorders

B1. Functional dyspepsia
- B1a. Postprandial distress syndrome (PDS)
- B1b. Epigastric pain syndrome (EPS)
B2. Belching disorders
- B2a. Excessive supragastric belching
- B2b. Excessive gastric belching
B3. Nausea and vomiting disorders
- B3a. Chronic nausea vomiting syndrome (CNVS)
- B3b. Cyclic vomiting syndrome (CVS)
- B3c. Cannabinoid hyperemesis syndrome (CHS)
B4. Rumination syndrome

C. Bowel disorders

C1. Irritable bowel syndrome (IBS)
- IBS with predominant constipation (IBS-C)
- IBS with predominant diarrhea (IBS-D)
- IBS with mixed bowel habits (IBS-M)
- IBS unclassified (IBS-U)
C2. Functional constipation
C3. Functional diarrhea
C4. Functional abdominal bloating/distension
C5. Unspecified functional bowel disorder
C6. Opioid-induced constipation

D. Centrally mediated disorders of gastrointestinal pain

D1. Centrally mediated abdominal pain syndrome (CAPS)
D2. Narcotic bowel syndrome (NBS)/ Opioid-induced GI hyperalgesia

E. Gallbladder and sphincter of Oddi disorders

E1. Biliary pain
- E1a. Functional gallbladder disorder
- E1b. Functional biliary sphincter of Oddi disorder
E2. Functional pancreatic sphincter of Oddi disorder

F. Anorectal disorders

F1. Fecal incontinence
F2. Functional anorectal pain
- F2a. Levator ani syndrome
- F2b. Unspecified functional anorectal pain
- F2c. Proctalgia fugax
F3. Functional defecation disorders
- F3a. Inadequate defecatory propulsion
- F3b. Dyssynergic defecation

G. Childhood functional GI disorders: Neonate/Toddler

G1. Infant regurgitation
G2. Rumination syndrome
G3. Cyclic vomiting syndrome (CVS)
G4. Infant colic
G5. Functional diarrhea
G6. Infant dyschezia
G7. Functional constipation

H. Childhood functional GI disorders: Child/Adolescent

H1. Functional nausea and vomiting disorders
- H1a. Cyclic vomiting syndrome (CVS)
- H1b. Functional nausea and functional vomiting
  - H1b1. Functional nausea
  - H1b2. Functional vomiting
- H1c. Rumination syndrome
- H1d. Aerophagia
H2. Functional abdominal pain disorders
- H2a. Functional dyspepsia
  - H2a1. Postprandial distress syndrome
  - H2a2. Epigastric pain syndrome
- H2b. Irritable bowel syndrome (IBS)
- H2c. Abdominal migraine
- H2d. Functional abdominal pain ‒ NOS
H3. Functional defecation disorders
- H3a. Functional constipation
- H3b. Nonretentive fecal incontinence

Epidemiology

Functional gastrointestinal disorders are very common. Globally, irritable bowel syndrome and functional dyspepsia alone may affect 16–26% of the population.

Research

There is considerable research into the causes, diagnosis and treatments for FGIDs. Diet, microbiome, genetics, neuromuscular function and immunological response all interact. A role for mast cell activation has been proposed as one of the factors.

Functional Gastrointestinal Disorder

Classification

Epidemiology

Research

See also