What are functional gastrointestinal disorders?

Functional disorders are those in which the gastrointestinal (GI) tract looks normal but doesn’t work properly. They are the most common problems according to gastrointestinal disorders specialist that affecting the GI tract (including the colon and rectum). Constipation and irritable bowel syndrome (IBS) are two common examples.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (also called spastic colon, irritable colon, or nervous stomach) is a condition in which the colon muscle contracts more often than in people without IBS. Certain foods, medicines, and emotional stress are some factors that can trigger IBS.

Symptoms of IBS include:

• Abdominal pain and cramps
• Excess gas
• Bloating
• Change in bowel habits such as harder, looser, or more urgent stools than normal
• Alternating constipation and diarrhea

Treatment includes:

• Avoiding caffeine
• Increasing fiber in the diet
• Monitoring which foods trigger IBS (and avoiding these foods)
• Minimizing stress or learning different ways to cope with stress
• Sometimes taking medicines as prescribed by your healthcare provider

Structural Gastrointestinal Disorders According to Gastrointestinal Disorders Specialist

Gallstones

Gallstones affect 20 percent of women and 10 percent of men, or approximately 20 million adult Americans. Each year nearly 600,000 patients undergo surgery to have their gallbladders removed, at an estimated cost of over $5 billion dollars. Most gallstones are solid masses, primarily of cholesterol. Gallstones develop in the gallbladder or less often in the bile ducts leading from the liver to the small intestine. Most patients with gallstones never develop symptoms. However, some patients will develop symptoms of mid- or right-upper abdominal pain that may lead to complications such as acute cholecystitis and pancreatitis. Gallstones are rarely associated with gallbladder cancer.
Once a patient has been diagnosed with symptomatic gallstones, treatment options by a liver specialist doctor include surgery by open cholecystectomy or laparoscopic cholecystectomy, watchful waiting, or oral bile acid therapy in patients who cannot tolerate surgery. Laparoscopic cholecystectomy, introduced in the United States in 1988, has fast become the most popular treatment for gallstones. This procedure uses a miniature video camera and several specialized instruments, which are inserted into the patient’s abdomen through tiny incisions. Viewing the gallbladder on an external television monitor, the surgeon uses these instruments to dissect, clamp, and remove the gallbladder without opening the abdomen. The procedure has several advantages over open surgery: less postoperative pain and disability, a shorter hospital stay, and a quicker recovery period, resulting in less time lost from work. While most patients with symptomatic gallstones are candidates for laparoscopic cholecystectomy, the surgery is not recommended for patients with abdominal inflammation (peritonitis), acute pancreatitis, end-stage cirrhosis of the liver, or gallbladder cancer. Women in the third trimester of pregnancy should not undergo laparascopic cholecystectomy because of risk of damage to the fetus.

Gastroesophageal Reflux Disease and Related Disorders

Gastroesophageal reflux disease (GERD) is a digestive condition that affects nearly one-third of the American population according to gastrointestinal disorders specialist. GERD is the backward flow of the stomach’s contents into the esophagus. The lower esophageal sphincter (LES), the muscle that lies at the base of the esophagus and the stomach and helps keep food in the stomach, is usually weak in a patient with GERD.
Heartburn, which is characterized by burning pain that radiates through the chest, neck, and throat, is the most common symptom of GERD. Heartburn may occur when a person with GERD eats, bends, or lies down. Antacids may provide temporary relief from heartburn.
Doctors also believe that diet and lifestyle habits, hiatal hernia, obesity, and pregnancy contribute to GERD. Certain foods,including chocolate, fried or fatty foods, and alcohol may weaken the LES, permitting reflux and heartburn.
A complete clinical history is the cornerstone of the evaluation of GERD. Depending on the nature and severity of symptoms, patients may undergo an endoscopy or upper GI series. If baseline diagnostic tests prove inconclusive, a patient’s doctor may rarely order a 24-hour pH monitoring test to assess the episodes of reflux and type of activity associated with the symptoms.
Lifestyle modifications such as eliminating cigarettes and avoiding high-fat foods may be key to effective antireflux treatment for patients. Patients who do not respond to lifestyle changes alone may find relief if antacid treatment is added. Antacids such as Tums and Gaviscon neutralize stomach acid for relatively short periods of time. Therefore, patients may need to take them frequently, usually 1 to 3 hours after meals and at bedtime, depending on the severity of their symptoms.
Histamine 2 (or H2-blockers), which suppress acid, are also prescribed to relieve symptoms of GERD. The H2-remedies currently available include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine HCl (Zantac). H2-remedies, are now available to patients without a prescription. They may be taken from one to four times a day.
To treat resistant reflux symptoms, doctors may use higher or more frequent doses of H2-blockers, or switch to a more potent inhibitor of gastric acid secretion such as an acid pump inhibitor, or recommend antireflux surgery. For convenience and effectiveness, doctors are likely to prescribe an acid pump inhibitor to treat severe cases of GERD.
Omeprazole (Prilosec, Losec, or Antra), approved by the Food and Drug Administration (FDA) in 1989, is the first acid pump inhibitor to dramatically inhibit an enzyme, H+(hydrogen), K+(potassium)-ATPase, from producing stomach acid; lansoprazole (Prevacid) has also recently been approved. Recent studies show that omeprazole and lansoprazole provide complete relief of severe GERD symptoms within approximately 1 to 2 weeks.
Some patients with severe GERD or young patients who require continuous medical therapy may be good candidates for surgery. However, all patients should be given a trial of intensive medical therapy first. GERD is a chronic condition, but with diligence and careful medical evaluation and treatment, GERD patients can find relief.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) refers to two chronic intestinal disorders: Crohn’s disease and ulcerative colitis. IBD affects between 2 to 6 percent of Americans or an estimated 300,000 to 500,000 people. The causes of Crohn’s disease and ulcerative colitis are not known, but a leading theory suggests that some agent, perhaps a virus or bacterium, alters the body’s immune response, triggering an inflammatory reaction in the intestinal wall. The onset for both diseases peaks during young adulthood. An individual with either disease may suffer persistent abdominal pain, bowel sores, diarrhea, fever, intestinal bleeding, or weight loss.
If your doctor thinks you have either Crohn’s disease or ulcerative colitis, a variety of procedures and tests such as endoscopy and barium GI studies are available to confirm disease. Once diagnosed, treatment options may include medications, dietary changes, and sometimes surgery, to remove diseased bowel.
Remission is possible in either condition, but both persist over an individual’s lifetime.

Crohn’s Disease

Crohn’s disease primarily involves the small bowel and the colon. It may cause the intestinal wall to thicken, which may narrow the bowel channel and block the intestinal tract. About 90 percent of patients with Crohn’s disease experience frequent and progressive symptoms of abdominal pain, diarrhea, and weight loss. The most commonly used drugs to treat Crohn’s are sulfasalazine, prednisolone, mesalamine, metronidazole, and azathioprine.
If a patient does not respond to oral medications, the doctor may recommend surgery. Although surgery relieves chronic symptoms, Crohn’s disease often recurs at the location where the healthy parts of the bowel were rejoined. The length of time that a Crohn’s patient is in remission is not predictable.

Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory disorder affecting the inner lining of the large intestine. The inflammation originates in the lower colon and spreads through the entire colon. Blood in the stool is the most common and distinct symptom of ulcerative colitis. As with Crohn’s disease, doctors diagnose ulcerative colitis by conducting a complete physical exam and other procedures such as barium enema and endoscopy.
Patients with mild or severe ulcerative colitis are initially treated with sulfasalazine. Other experimental drugs to treat ulcerative colitis include budesonide, tixocortol pivalate enema, and beclomethasone dipropionate enema. Despite new therapies, an estimated 20 to 25 percent of ulcerative colitis patients will need surgery. Surgery cures ulcerative colitis and most patients can go on to lead normal lives.