Abstract
Functional bowel disorders are highly prevalent disorders found worldwide. These disorders have the potential to affect all members of society, regardless of age, gender, race, creed, color or socioeconomic status. Improving our understanding of functional bowel disorders (FBD) is critical as they impose a negative economic impact to the global health care system in addition to reducing quality of life. Research in the basic and clinical sciences during the past decade has produced new information on the epidemiology, etiology, pathophysiology, diagnosis and treatment of FBDs. These important findings created a need to revise the Rome III criteria for FBDs, last published in 2006. This manuscript classifies the FBDs into five distinct categories: irritable bowel syndrome (IBS); functional constipation (FC); functional diarrhea (FDr); functional abdominal bloating/distention (FAB/D); and unspecified FBD (U-FBD). Also included in this article is a new sixth category, opioid induced constipation (OIC) which is distinct from the functional bowel disorders (FBDs). Each disorder will first be defined, followed by sections on epidemiology, rationale for changes from prior criteria, clinical evaluation, physiologic features, psychosocial features and treatment. It is the hope of this committee that this new information will assist both clinicians and researchers in the decade to come.
Highlights
Functional Bowel Disorders ClassificationFunctional bowel disorders (FBDs) are a spectrum of chronic gastrointestinal disorders, attributable to the middle or lower gastrointestinal tract, characterized by the following predominant symptoms or signs: abdominal pain, abdominal bloating, abdominal distension and bowel habit abnormalities
These recommendations are based on normative data from population studies and from clinical studies demonstrating that a large proportion of irritable bowel syndrome (IBS) patients have bowel movements that are within the normal range of stool consistency[3]
Serotonin concentrations correlated positively with rectal sensory thresholds and inversely with stool frequency. These findings suggest that, in addition to playing a role in colonic transit, serotonin’s influence on rectal sensitivity may play a role in decreasing perception and evacuation of rectal contents in patients with functional constipation (FC)
Summary
Functional bowel disorders (FBDs) are a spectrum of chronic gastrointestinal disorders, attributable to the middle or lower gastrointestinal tract, characterized by the following predominant symptoms or signs: abdominal pain, abdominal bloating, abdominal distension and bowel habit abnormalities (which include constipation, diarrhea, or mixed constipation and diarrhea). Functional abdominal bloating (FAB) and distension (FAD) should be classified as a single entity (FAB/D) they encompass two different symptoms/signs: Abdominal bloating is the subjective sensation of abdominal pressure, fullness, and/or gassiness, while distention is the objective and measurable increase in abdominal girth These conditions may exist independently they frequently coincide in the same individual.[9, 10] The distinct nature of these disorders is demonstrated by research showing that only 50-60% of patients with bloating have abdominal distension and the correlation between abdominal bloating and an increase in abdominal girth is poor.[11, 12] Further research may allow FAB and FAD to be considered separate entities
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