Approach to managing functional gastrointestinal disorders

Diagnosis of functional gastrointestinal disorders is primarily based on symptom patterns. Tests and investigations should be tailored to the patient but are often minimalBlack, 2020. Clinical features that warrant further investigation are listed in Clinical features that warrant further investigation of gastrointestinal symptoms.

Figure 1. Clinical features that warrant further investigation of gastrointestinal symptoms
  • family history of gastrointestinal cancer at a young age
  • family history of coeliac disease
  • older than 50 years at onset of symptoms
  • symptoms are of short duration (less than 3 months) or are progressive
  • significant weight loss
  • severe abdominal pain
  • fever
  • symptoms that interfere with sleep
  • evidence of gastrointestinal bleeding (rectal bleeding, haematemesis, positive faecal occult blood test)
  • significant abnormality on examination of abdomen
  • anaemia
  • evidence of inflammation on blood tests or stool samples
  • dysphagia (difficulty swallowing)
  • persistent vomiting
  • severe diarrhoea
  • evidence of malabsorption

Functional gastrointestinal disorders are frequently chronic and often poorly understood by patients and their healthcare providers. The severity of symptoms and impact on the patient’s quality of life can vary from inconvenience to major disruption. Many patients can be managed in the primary care setting using simple dietary and pharmacological measures, while others require referral to a gastroenterologist and a multidimensional approach. A multidimensional approach may include: