Functional gastrointestinal disorders intestinal tract constitute a group of heterogeneous (different in nature and origin) clinical conditions manifested various symptoms from the gastrointestinal tract and not accompanied by structural, metabolic or systemic changes. In the absence of an organic basis for the disease, such disorders significantly reduce the patient’s quality of life.
To make a diagnosis, symptoms must exist for at least six months with active manifestations for 3 months. It should also be remembered that the symptoms of gastrointestinal tract can overlap and overlap each other in the presence of other diseases not related to the gastrointestinal tract.
Causes of functional disorders of the gastrointestinal tract
There are 2 main reasons:
- Genetic predisposition. FGITs are often hereditary. This is confirmed by the frequent “family” nature of violations. During examinations, genetically transmitted features of the nervous and hormonal regulation of intestinal motility, the properties of receptors in the walls of the gastrointestinal tract, etc. are found to be similar in all (or across generations) family members.
- Mental and infectious sensitization. This includes transferred acute infections intestines, difficult conditions of a person’s social environment (stress, misunderstanding from loved ones, shyness, constant fears of various nature), physically difficult work, etc.
Symptoms of functional gastrointestinal disorders
Depends on the type of functional disorder:
- Irritable bowel syndrome (large and small) is a functional disorder characterized by the presence of abdominal pain or abdominal discomfort and combined with disturbances in defecation and transit of intestinal contents. To be diagnosed, symptoms must have existed for at least 12 weeks within the past 12 months.
- Functional bloating. It is a frequently recurring feeling of fullness in the abdomen. It is not accompanied by a visible enlargement of the abdomen and other functional gastrointestinal disorders. A bursting feeling should be observed at least 3 days a month for the last 3 months.
- Functional constipation is an intestinal disease of unknown etiology, manifested by constantly difficult, infrequent bowel movements or a feeling of incomplete release of feces. The dysfunction is based on a violation of intestinal transit, the act of defecation, or a combination of both at the same time.
- Functional diarrhea– a chronic syndrome with relapses, characterized by loose or unformed stools without pain and unpleasant sensations in a stomach. It is often a symptom of IBS, but in the absence of other symptoms, it is considered as an independent disease.
- Nonspecific functional bowel disorders - flatulence, rumbling, bloating or distension, a feeling of incomplete bowel movement, transfusion in the abdomen, an imperative urge to defecate and excessive discharge of gases.
Diagnosis of functional disorders of the gastrointestinal tract
Complete, comprehensive clinical and instrumental examination gastrointestinal organs. In the absence of detection of organic and structural changes and the presence of symptoms of dysfunction, a diagnosis of a functional disorder of the gastrointestinal tract is made.
Treatment of functional gastrointestinal disorders
Complex treatment includes dietary recommendations, psychotherapeutic measures, drug therapy, physiotherapeutic procedures.
General recommendations for constipation: abolition of constipation medications, foods that contribute to constipation, intake of large amounts of fluid, food rich in ballast substances (bran), physical activity and elimination of stress.
If diarrhea predominates, limit the intake of coarse fiber into the body and prescribe drug therapy(imodium).
With predominance pain antispasmodics and physiotherapeutic procedures are prescribed.
Prevention of functional disorders of the gastrointestinal tract
Increased stress resistance, positive outlook on life, decreased harmful influences on the gastrointestinal tract (alcohol, fatty, spicy foods, overeating, unsystematic eating, etc.). Specific prevention does not exist because no direct causative factors have been identified.
General information
Functional diseases of the gastrointestinal tract (including the intestines) directly correlate with functional disorders of all parts of the digestive tract. At the same time, changes of an organic nature (structural anomalies, inflammatory areas, infections, tumors) are not observed in the body. In order to clearly understand these causes of disorders, it is necessary to list the fundamental functions of the gastrointestinal tract:
- Motor. The mechanism comes into action after the activity of the muscles of the digestive tract itself. This can include the process of chewing, transporting food, swallowing and removing waste products from the body (undigested food debris);
- Secretory. This function consists in the generation of digestive juices: saliva, gastric juice+ hydrochloric acid, pancreatic secretions, bile, intestinal juice;
- Excretory function. Consists of special stages of release of special metabolic products into the gastrointestinal tract cavity (ammonia structures, salts heavy metals, toxins, etc.). The body then systematically removes the elements through the appropriate channels;
- Suction mechanism. Thus. Ensures a seamless integration process nutrients through the intestinal wall into the blood and lymph.
Each section of the gastrointestinal tract clearly fulfills its assigned task and regulates the digestion process. But in some situations this functionality may fail. As a result, a certain spectrum of symptoms arises and develops, which do not have clearly defined structural and organic disorders. What are the features of this process? What is the classification of intestinal diseases according to the ICD 10 scale?
Symptoms
The most common symptom of functional diseases of the stomach and intestines can be considered severe pain in the abdominal cavity. IN in this case spasms of the biliary tract + excessive activity of the parts of the absorptive organ are observed. In practice, patients complain of regular heartburn. This form of the disorder can occur during periods of both high and low acidity. The second most common symptom is sharp pain behind the sternum. The above-mentioned ailments indicate not only the occurrence of functional disorders, but also the presence of heart disease and other organs (see classification according to ICD No. 10).
Quite often, belching is related to functional disorders general. Also, this manifestation can be attributed to diseases of the stomach and duodenum. Frequent bloating, gag reflexes, nausea, lump in the throat. All this is part of the symptoms of functional intestinal disorders (types according to ICD 10).
Causes
Science, through practical research of the gastrointestinal tract, has established that low physical activity of a person is not associated with the manifestation of functional disorders. As a result, in the 80s the theory of psychogenic effects on the functional activity of the digestive organs was formed. The most interesting thing is that people who were susceptible to this type of disease did not have deviations in mental development. At the end of the 20th century, the main cause of pathological disorders and illnesses was the formation of nociceptive impulses. Also, the emergence of diseases significantly contributes to bad habits(tobacco smoking, drinking alcohol and carbonated drinks), neuropsychic factors and taking potent drugs medications. In most cases, a sick person views pain through the prism of social and interpersonal factors. Intestinal dysfunction can be systemic. These principles were the basis for the classification according to code No. 10.
Features of functional bowel disorders
Classification of diseases
A functional disorder includes in its group a clinical condition of a heterogeneous type (the region of the middle and lower gastrointestinal tract). Metabolic changes in the digestive organs are not observed. But certain complications during the course of the disease are still observed. The quality of life of patients is significantly reduced. Not only is there significant economic damage to a person (paid procedures, research, tests), but also temporary disability is observed.
In 2006, information on functional diseases of the digestive system was compiled. Thus, the materials of the Roman Consensus (FRC) were formed, namely:
- Functional bloating;
- Functional constipation;
- Functional diarrhea;
- Nonspecific bowel disorder functional type.
According to the principles of typing (ICD 10), the following codes for intestinal disease K58-59 are distinguished:
- Irritable bowel syndrome;
- IBS + diarrhea;
- IBS without diarrhea;
- Constipation;
- Functional diarrhea;
- Intestinal excitability of neurogenic type.
Functional type intestinal diseases occur when the functioning of the internal secretion organs is disrupted (intestinal regulation, endocrine type disruptions), allergic manifestations, the course of infectious and chronic diseases. In practice, patients experience severe irritability, excessive temperament, bad dream, changeable mood, frequent body sweating, systematic bloating, rumbling, cramping pain in the navel, prolonged constipation or loose stools. These features are included in the classification under No. 10.
The diagnosis of the disease can be formed only after a thorough diagnosis using various laboratory techniques. This can include endoscopic and radiological examination mechanisms.
Doctors say there is no excuse for a patient who refuses to see a doctor. Long-term patience and regular self-medication can only delay realization diagnostic procedures intestinal diseases. The patient should remember that functional disorders of the absorptive digestive organ transform over time into a progressive form of the disease. Guaranteed recovery of the patient can be achieved when competent diagnosis (according to ICD 10) is combined with rational doctor’s prescriptions. Strict implementation of the approved treatment regimen will contribute to the effective restoration of damaged segments of the digestive system.
Characteristics of functional disorders
The motor-evacuation function of the intestine is subjected to various disorders: intestinal dyskinesia, irritable bowel syndrome, dispersion of the absorptive organ.
- Intestinal dyskinesia is a functional disorder of the absorptive organ of the gastrointestinal tract, which is characterized by insufficient excretion of feces and prolonged constipation. When it is difficult to empty, complete absorption of water in the intestine occurs. Thus, the stool becomes hard. In this case, the process of defecation is a complex act of a reflex type. This should include the signal phase and the period of bowel movement itself. Conditioned (contraction of muscle fibers) and unconditioned (food intake) components are part of this effect. The defecation reflex is significantly abolished due to the artificial elimination of the urge to defecate (“no time”, “nowhere”, “quite dirty”). Disease is also the reason for the elimination of rhythmic urges internal organs. The rectum gradually loses its sensitivity and elasticity. As a result, constipation transforms into a chronic phenomenon.
- The activity and performance of the colon is directly related to a balanced diet. Foods rich in fiber (vegetables, fruits, roughage) affect the decrease in intestinal tone and motor activity, which over time leads to constipation. This circumstance can cause the formation of microcracks in the walls of the suction organ and aggravation of hemorrhoids. Unsystematic use of medications (including enema procedures) increases the occurrence of habitual constipation and provokes the development of proctosigmoiditis (inflammation of the mucous membrane + sigmoid colon).
- Irritable bowel syndrome is associated with motor and secretory functions intestines. This disorder is preceded by a number of factors: allergic, temperature, mechanical and neuro-emotional. IBS in most cases is a consequence of infectious, intoxicating and helminthic diseases. Dysentery, salmonellosis and other chronic inflammatory diseases can have a significant impact on the manifestation of functional intestinal disorders. IBS is closely correlated with prolonged psycho-emotional stress, physical stress, cooling and overheating of the body, various kinds colds. Functional illness is accompanied by sharp pain in the stomach, systematic urge to loose stools. Quite often I have mucus and diarrhea in my stool. The duration of attacks can range from 30 minutes to 24 hours. Short-term disorders are quite often associated with eating excesses and alcohol abuse. For example, consuming dairy products with cucumbers can cause intestinal upset (short-term diarrhea, rumbling, abdominal pain).
Mechanism of effective treatment
Treatment of irritable bowel syndrome (IBS - classification according to scheme No. 10) should be comprehensive and systemic. The dysfunction of the suction organ in each person is of a purely individual nature. System effective recovery includes dietary recommendations + psychotherapeutic methods + herbal medicine + physiotherapeutic procedures.
Today, medicine does not have a special diet for IBS. But certain rules for patients have been developed. Thus, patients are recommended to organize a balanced and high-quality diet. The diet plan should include cereals, root vegetables (fresh chickpeas, cabbage, carrots), fruits and cereals (buckwheat, oatmeal). Drinking plenty of fluids should not exceed more than 2 liters per day. Otherwise, intestinal dysfunction can be significantly aggravated. Products with essential oils(garlic, onion), refractory fats, whole milk, carbonated and alcoholic drinks are ingredients that should be avoided when preparing dishes.
Autogenic training is an effective mechanism for restoring intestinal function. Proven methods of psychotherapeutic influence, hypnotic sessions and other options for influencing the patient’s consciousness are also used.
If clinical picture IBS has hints of constipation, so you should follow dietary recommendations. Unjustified prescription of laxatives can cause complications. Let's consider the main recommendations:
- Complete absence of fixative type drugs (antacids, opiates, cholestyramines, antidepressants, contraceptives);
- Minimizing foods that affect the formation of constipation (baked goods, sweets, tea, cocoa);
- Drinking a decent amount of liquid (kefir, mineral water, non-concentrated juices);
- Elimination of excessive physical activity+ psychological stress.
Wheat bran is an excellent intestinal balance. In most cases, bran is prescribed 1 teaspoon per day. The dose is gradually increased to 3 (three times a day) until a laxative effect is formed. Crushed grain particles are brewed with boiling water (up to 20 minutes) and consumed warm strictly before a meal. In case of poor acceptance of this product by the body, an effective alternative would be to use a medicine from the seeds of Plantago ovata (mucofalk) 4 tsp. granules per 24 hours + synthetic disaccharide lactulose (up to 60 ml per day). Thus, intestinal motility is effectively regulated and ammonia is efficiently removed from the body.
If diarrhea predominates in IBS, it is necessary to use imodium (loperamide) from 2 to 4 mg per day. If pain occurs, it is necessary to opt for antispasmodic medications (Dicetel, Duspatalin, Spasmomen, Otilonin, Bromide, Buscopan, etc.).
A functional disorder is a disease where one or more body functions are not normal, but the problem does not have obvious organic causes and does not result from stress or psychological problems. Functional disorders can be difficult to diagnose and treat, and may require a diagnosis from multiple physicians to ensure that the patient has the underlying disease. It is important to know that although the reasons may be psychological, he did not achieve these symptoms, and the patient experiences real physiological problems, even if the cause is difficult to determine.
A common example of a functional disorder is chronic pain without a known cause. Some people develop chronic pain in response to inflammation or injury, and in their cases, the origins of the condition are easy to understand. Other people may experience chronic pain for no apparent reason. They do not have an underlying medical condition or history of injury that could explain the pain, but the sensation of pain is genuine and the patient experiences relief from pain management, electrical nerve stimulation, and other measures.
Some mental illness may be associated with functional impairment. Patients with depression may experience symptoms such as sharp pain or joint pain or fatigue, without clear physiological reason, such as injury or lack of sleep. People may also experience changes in brain function in combination with psychological problem, although this condition does not necessarily cause brain abnormalities.
In certain medical specialties, the term “functional disorder” can be used to in various ways, and this can lead to confusion. For orthopedic surgeons, such disorders represent birth defects development bone tissue, and they do not have an origin in the form of a developmental problem. When they use this term, it does not mean that the patient has acquired medical problem for no known reason.
Treatment of functional disorders may be possible without any narrowing of the cause, and in some cases, doctors may attribute conditions with potential organic reasons to unknown sources because the emphasis is on treatment rather than finding out why the patient developed the condition in the first place. For patients who are not sure what the doctor is saying when she uses this term, it may be helpful to seek clarification. It may also be important for patients to ensure that they are taking appropriate measures to avoid future episodes of illness or impairment.
The medical term functional intestinal disorders usually combines pathologies when several functions are disrupted, mainly in the middle and lower parts of the intestinal tract, caused by organic, biochemical, and abnormal (tumor) changes. The symptoms of the condition are varied and depend on the causes of the pathology. The condition is not diagnosed standard methods, but requires a more in-depth analysis carried out in a complex. Therapy is prescribed depending on the causes and prevailing symptoms of the disorder. With early response, the prognosis is favorable.
What kind of pathology is this?
Bowel dysfunction is classified as pathological process, occurring in the gastrointestinal tract and associated with changes in the performance of the organ. The functions of the lower and middle intestines are predominantly disordered, which is manifested by constant abdominal pain, discomfort, bloating and other disturbances in the behavior of the organ in the absence of known factors.
In older children and infants, the nature of intestinal dysfunction is infectious or non-infectious. Only a pediatrician can determine the cause and select treatment.
Classification
Intestinal dysfunction, depending on the predominant symptom, is divided into the following types:
- functional constipation, diarrhea or flatulence;
- functional abdominal pain.
In turn, each type is divided into the following subtypes:
- Disorder characterized by diarrhea:
- with mucus admixtures 2-4 times a day, more often in the morning or after breakfast;
- with a sudden, irresistible urge to defecate;
- with a retreat at night.
- Disorder manifested as constipation:
- lasting 2 days or more;
- alternately occurring after diarrhea;
- with a feeling incomplete emptying, ribbon-like stools or “sheep feces”-type masses.
- Abdominal-dominant dysfunction pain syndrome and flatulence, characterized by:
- cramping pain with increased gas formation;
- pain when palpating spasmodic areas of the intestine;
- discomfort that increases with the urge to go to the toilet and decreases after defecation.
Main symptoms of disorders
When intestinal function is disrupted, the following characteristic symptoms appear:
Chronic intestinal dysfunction is manifested by arthritis, malfunction of cardio-vascular system, stone formation in the kidneys, the appearance frequent seizures, fluctuations in blood pressure and the development of VSD (dystonia). In each case, the symptoms are different, so it is impossible to have all the symptoms at the same time.
Characteristic manifestations in an infant or an older patient:
- decreased immunity;
- weakness, lethargy;
- irritability;
- marked inattention.
Causes and factors of functional bowel disorder
Unspecified functional bowel disorder can be triggered by two main factors:
- exogenous, that is, external, often caused by psycho-emotional disruptions;
- endogenous, that is, internal, developing against the background of a decrease in visceral sensitivity, weak motor activity intestines.
Reasons for children
Provocateurs problems in adults
The main cause of irritable bowel syndrome is stress and an intense lifestyle; there are a number of provoking factors that prevent the intestinal tract from functioning normally:
- chronic fatigue, stress;
- neuroses, hysteria;
- violation of the usual diet;
- unhealthy daily menu;
- not drinking enough;
- long-term use of antibiotics;
- dysbacteriosis;
- infections, poisoning;
- gynecological problems in women;
- hormonal imbalances during menopause, pregnancy, menstruation.
Diagnostics
For a thorough examination, you need to contact a specialist.
If suspicious discomfort appears in the intestines, you should contact a specialist for a thorough examination of the body. You need to consult a therapist, who will identify a specialist for further examination. We are talking about a gastroenterologist, nutritionist, proctologist, neurologist, psychotherapist. Unspecified functional bowel disorder is diagnosed as follows:
- consultations with specialists in narrow fields;
- physical examination, evaluation of complaints;
- general tests of urine, blood, feces (detailed coprogram);
- colonoscopy, rectoscopy, irrigoscopy;
The impaired function is diagnosed, as well as the provoking factor is established, based on modern exclusion methods.
Pathology therapy
An important reminder for anyone suffering from intestinal dysfunction is to avoid self-indulgence. Any self-medication is fraught with serious consequences and worsening symptoms. Successful therapy counts correct definition causative factor and its effective elimination. It is important to stabilize the functioning of all organs of the digestive tract.
General rules
Therapy intestinal disorder based on radical change lifestyle and nutrition. To do this, patients are advised to adhere to the following rules:
- Don't be nervous, avoid stressful situations.
- Regularly relax, meditate, take a warm bath.
- Play sports and do simple exercises if your job is sedentary (prevention of constipation).
- Quit alcohol, coffee, smoking.
- Walk more often fresh air, rest.
- Consume lactic acid bacteria and probiotic products (fermented yoghurts, cheeses, kefir).
- Avoid snacking in bars and restaurants with a dubious reputation.
- Limit consumption of fresh fruits and vegetables if you have diarrhea.
- Do abdominal massage, perform aerobic exercise.
Speaking about psychosomatics, we can consider it within the framework positive psychotherapy from three positions: in a narrow, broad and comprehensive sense.
Psychosomatics in the narrow sense
This is a specific scientific and medical direction, which establishes relationships between mental experiences and body reactions. People often ask about what specific conflicts and events in which people lead to certain diseases, which result in organopathological changes. This includes somatic diseases and functional disorders of the body, the occurrence and course of which depends primarily on psychosocial circumstances. First of all, we are talking about well-known stress diseases, such as stomach ulcers, ulcers duodenum, functional heart disorders, headaches, colitis, rheumatic diseases, asthma, etc. In this case, we can distinguish two groups:
a) Functional disorders
In this case, the violation occurs at the level of neurovegetative and hormonal regulation of the functions of individual organ systems (cf.: “Model of conflict in positive psychotherapy as applied to psychosomatic medicine”, 1 part, chapter 3, Fig. 1). This is confirmed by the release of hormones (catecholamines) from the adrenal medulla in response to exciting events, which, along with other manifestations, contributes to the emergence of feelings of heat, sweating, anxiety, etc.
People have long been aware of these relationships, which are reflected in such proverbs as: “Anger hits the stomach”, “He has a flood of bile”, “This makes him sick”, “The hair stands on end from horror” (cf.: “Sayings” and folk wisdom", Part II, Ch. 1-39).
b) Organic disorders
To a certain extent, anger simply eats into the organ, which leads to pathological changes that are detected objectively. The latter can be expressed in a wide variety of diseases: skin changes(for example, eczema), changes in the mucous membranes (for example, ulcers), corresponding complications in the form of bleeding, gastric perforation, etc. As psychosomatic studies show, any of the organ systems can undergo such changes. Diseases also called psychosomatosis are often the body’s primary reaction to a conflict experience that can be associated with an organopathological condition. The patient does not talk about his experience, he reports only the symptom. Such diseases are often the result of chronic vegetative overstrain, which, under appropriate circumstances, leads to “organism”.
This is where psychotherapy begins. Treatment in this case is primarily not organic disease, but the entire network of relationships that contribute to the occurrence of the disease. The alternative to treating these diseases either as a somatic pathology or only psychotherapeutically from this point of view ceases to be a problem. On the one hand, the doctor’s task is to control the course of the disease and prevent its dangerous progression; on the other hand, psychotherapy solves the problem of identifying negatively influencing factors of the external world and thus reduces the patient’s overstrain. Of course, such a process involves the cooperation of the somatic physician, psychotherapist and his family.
Conclusion. The classical diseases of psychosomatic medicine described above belong to the group of psychosomatics in the narrow sense of the word. It is impossible to strictly distinguish between mental, psychosomatic and purely somatic diseases. They are interpreted as multifactorial manifestations. As we will see later, this applies not only to psychosomatic diseases in the narrow sense of the word. In principle, it is considered advisable to adhere to a multifactorial approach in the etiology, therapy and prognosis of any disease.
