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Abstract
The gut-brain axis refers to the bidirectional communication between gut and brain mediated via neuro-humeral signals. Functional gastrointestinal diseases consist of varying combinations of chronic or recurrent symptoms with no identifiable physiologic, biochemical, infectious, anatomic, or structural cause. With significant overlap, symptoms were attributed to four major regions: esophagus (42%), gastroduodenum (26%), bowel (44%), and anorectum (26%). In general, symptom reporting declined with increasing age, and low socioeconomic status was associated with increased symptom reporting.
The functional GI disorders encompass those related to the esophagus (heartburn, atypical chest pain, dysphagia, globus,), gastroduodenum (nonulcer dyspepsia, belching, .nausea and vomiting, rumination syndrome in adults), bowel (irritable bowel syndrome, constipation, diarrhea, bloating/excessive gas, chronic abdominal pain), pancreaticobiliary tree (pancreaticobiliary dyskinesia, pancreatitis), and anorectum (proctalgia fugax, levator syndrome). The unifying pathophysiology for functional GI disorders is probably a primary disorder of gut motility. With no specific gold standard to assist in identification, these disorders require comprehensive histories, physical examinations, and laboratory studies. Diagnostic criteria for functional disorders based on clinical research have enhanced diagnostic certainty and the ability to make a positive diagnosis rather than a diagnosis of exclusion.
The functional GI diseases share similar biopsychosocial models and a close relationship of psychophysiologic effect. Stress, anxiety, depression, and heightened emotional states affect symptom production and response . The seeking of medical attention for functional symptoms may be prompted by increased frequency or severity of symptoms, or fear of serious illness. Individuals with functional complaints who seek medical attention have significant psychiatric disorders more frequently diagnosed than those who do not seek care. Psychologic factors influence the decision to seek health care, and examining the motivation for an office visit is a key step in evaluation and management.