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Efficient diagnosis of suspected functional bowel disorders

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 498–507 (2008)Cite this article

Abstract

Functional bowel disorders (FBDs) are common disorders that are characterized by various combinations of abdominal pain and/or discomfort, bloating and changes in bowel habits. At present, diagnosing FBDs often incurs considerable health-care costs, partly because unnecessary investigations are performed. Patients are currently diagnosed as having an FBD on the basis of a combination of typical symptoms, normal physical examination and the absence of alarm features indicative of an organic gastrointestinal disease. Basic laboratory investigations, such as a complete blood count, measurement of the erythrocyte sedimentation rate and serological tests for celiac disease, are useful in the initial evaluation. No further investigations are needed for most patients who have typical symptoms and no alarm symptoms. The most important alarm symptoms include signs of gastrointestinal bleeding, symptom onset above 50 years of age, a family history of colorectal cancer, documented weight loss and nocturnal symptoms. The presence of alarm symptoms obviously does not exclude an FBD, but further investigation is needed before confirmation of the diagnosis. For patients with predominant and severe diarrhea, a more thorough diagnostic work-up should normally be considered, including colonoscopy with colonic biopsies and a test for bile-acid malabsorption.

Key Points

  • A positive diagnosis of a functional bowel disorder (FBD) should be made using symptom-based diagnostic criteria and the absence of alarm features

  • Limited blood testing (e.g. complete blood count, erythrocyte sedimentation rate, measurement of endomyseal antibodies or tissue transglutaminase antibodies) is often useful in the clinical evaluation of patients with suspected FBDs

  • Further investigations are normally only needed in the presence of specific symptoms and/or findings

  • Extraintestinal symptoms of FBDs are common and seldom need specific investigation

  • The diagnosis of an FBD seems to be stable over time, although specific symptoms can vary considerably

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Figure 1: Proposed diagnostic algorithm for use in patients who have suspected functional bowel disorders.

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Acknowledgements

D Lie, University of California, Orange, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. J Gunnarsson is a Clinical and Research Fellow in Gastroenterology and Hepatology and M Simrén is working as Consultant in the Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,

    Jenny Gunnarsson

  2. M Simrén is also Associate Professor in Gastroenterology at the University of Göteborg, Göteborg, Sweden.,

    Magnus Simrén

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Gunnarsson, J., Simrén, M. Efficient diagnosis of suspected functional bowel disorders. Nat Rev Gastroenterol Hepatol 5, 498–507 (2008). https://doi.org/10.1038/ncpgasthep1203

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