Functional Dyspepsia and the Irritable Bowel Syndrome

Abstract

Functional dyspepsia and the irritable bowel syndrome cause gastrointestinal symptoms in up to 15% of adults in most parts of the world. The term functional dyspepsia largely describes epigastric fullness, early satiety, epigastric pain or epigastric “burning”, while the term irritable bowel syndrome describes abdominal pain associated with changes in the frequency of defecation and the appearance of stools. The pathogenesis of symptoms appears to vary in different individuals but includes psychosocial distress, psychiatric disorders, genetic factors, visceral hypersensitivity, activation of mucosal immunity, altered gastrointestinal motility, dietary factors and changes in the intestinal microbiome and intestinal permeability. Although investigations to exclude non-functional disorders will be needed in many patients, the challenge is to emerge with a positive diagnosis of a functional disorder without extensive or repeated endoscopic or radiological procedures. Management is facilitated by an effective doctor-patient relationship and may include psychological assessment and counselling, stress-reduction techniques, exercise programmes and dietary advice such as the low-FODMAP diet. Medication will be needed in some patients but needs to be individualized because of wide variation in gastrointestinal symptoms and the presence or absence of significant psychiatric disorders.