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. 1999 Sep;45(Suppl 2):II43–II47. doi: 10.1136/gut.45.2008.ii43

Functional bowel disorders and functional abdominal pain

W Thompson, G Longstreth, D Drossman, K Heaton, E Irvine, S Muller-Lissner
PMCID: PMC1766683  PMID: 10457044

Abstract

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.


Keywords: functional bowel disorder; functional constipation; functional diarrhea; irritable bowel syndrome; functional abdominal pain; functional abdominal bloating; Rome II

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Selected References

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  1. Afzalpurkar R. G., Schiller L. R., Little K. H., Santangelo W. C., Fordtran J. S. The self-limited nature of chronic idiopathic diarrhea. N Engl J Med. 1992 Dec 24;327(26):1849–1852. doi: 10.1056/NEJM199212243272605. [DOI] [PubMed] [Google Scholar]
  2. CHAUDHARY N. A., TRUELOVE S. C. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med. 1962 Jul;31:307–322. [PubMed] [Google Scholar]
  3. Camilleri M., Prather C. M. The irritable bowel syndrome: mechanisms and a practical approach to management. Ann Intern Med. 1992 Jun 15;116(12 Pt 1):1001–1008. doi: 10.7326/0003-4819-116-12-1001. [DOI] [PubMed] [Google Scholar]
  4. Drossman D. A. Chronic functional abdominal pain. Am J Gastroenterol. 1996 Nov;91(11):2270–2281. [PubMed] [Google Scholar]
  5. Drossman D. A., Li Z., Andruzzi E., Temple R. D., Talley N. J., Thompson W. G., Whitehead W. E., Janssens J., Funch-Jensen P., Corazziari E. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569–1580. doi: 10.1007/BF01303162. [DOI] [PubMed] [Google Scholar]
  6. Drossman D. A., Whitehead W. E., Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology. 1997 Jun;112(6):2120–2137. doi: 10.1053/gast.1997.v112.agast972120. [DOI] [PubMed] [Google Scholar]
  7. Everhart J. E., Go V. L., Johannes R. S., Fitzsimmons S. C., Roth H. P., White L. R. A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci. 1989 Aug;34(8):1153–1162. doi: 10.1007/BF01537261. [DOI] [PubMed] [Google Scholar]
  8. Harvey R. F., Mauad E. C., Brown A. M. Prognosis in the irritable bowel syndrome: a 5-year prospective study. Lancet. 1987 Apr 25;1(8539):963–965. doi: 10.1016/s0140-6736(87)90304-7. [DOI] [PubMed] [Google Scholar]
  9. Heaton K. W., Radvan J., Cripps H., Mountford R. A., Braddon F. E., Hughes A. O. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992 Jun;33(6):818–824. doi: 10.1136/gut.33.6.818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Johnsen R., Jacobsen B. K., Førde O. H. Associations between symptoms of irritable colon and psychological and social conditions and lifestyle. Br Med J (Clin Res Ed) 1986 Jun 21;292(6536):1633–1635. doi: 10.1136/bmj.292.6536.1633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kames L. D., Rapkin A. J., Naliboff B. D., Afifi S., Ferrer-Brechner T. Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain. Pain. 1990 Apr;41(1):41–46. doi: 10.1016/0304-3959(90)91107-T. [DOI] [PubMed] [Google Scholar]
  12. Kay L., Jørgensen T., Jensen K. H. The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors. J Intern Med. 1994 Jul;236(1):23–30. doi: 10.1111/j.1365-2796.1994.tb01115.x. [DOI] [PubMed] [Google Scholar]
  13. Klauser A. G., Mühldorfer B. E., Voderholzer W. A., Wenzel G., Müller-Lissner S. A. Polyethylene glycol 4000 for slow transit constipation. Z Gastroenterol. 1995 Jan;33(1):5–8. [PubMed] [Google Scholar]
  14. Kruis W., Thieme C., Weinzierl M., Schüssler P., Holl J., Paulus W. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology. 1984 Jul;87(1):1–7. [PubMed] [Google Scholar]
  15. Longstreth G. F. Irritable bowel syndrome and chronic pelvic pain. Obstet Gynecol Surv. 1994 Jul;49(7):505–507. doi: 10.1097/00006254-199407000-00027. [DOI] [PubMed] [Google Scholar]
  16. Longstreth G. F. Irritable bowel syndrome. Diagnosis in the managed care era. Dig Dis Sci. 1997 Jun;42(6):1105–1111. doi: 10.1023/a:1018864915375. [DOI] [PubMed] [Google Scholar]
  17. Manning A. P., Thompson W. G., Heaton K. W., Morris A. F. Towards positive diagnosis of the irritable bowel. Br Med J. 1978 Sep 2;2(6138):653–654. doi: 10.1136/bmj.2.6138.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. O'Donnell L. J., Virjee J., Heaton K. W. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ. 1990 Feb 17;300(6722):439–440. doi: 10.1136/bmj.300.6722.439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Probert C. S., Emmett P. M., Cripps H. A., Heaton K. W. Evidence for the ambiguity of the term constipation: the role of irritable bowel syndrome. Gut. 1994 Oct;35(10):1455–1458. doi: 10.1136/gut.35.10.1455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sandler R. S., Drossman D. A. Bowel habits in young adults not seeking health care. Dig Dis Sci. 1987 Aug;32(8):841–845. doi: 10.1007/BF01296706. [DOI] [PubMed] [Google Scholar]
  21. Suarez F. L., Savaiano D. A., Levitt M. D. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med. 1995 Jul 6;333(1):1–4. doi: 10.1056/NEJM199507063330101. [DOI] [PubMed] [Google Scholar]
  22. Talley N. J., Gabriel S. E., Harmsen W. S., Zinsmeister A. R., Evans R. W. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology. 1995 Dec;109(6):1736–1741. doi: 10.1016/0016-5085(95)90738-6. [DOI] [PubMed] [Google Scholar]
  23. Taub E., Cuevas J. L., Cook E. W., 3rd, Crowell M., Whitehead W. E. Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci. 1995 Dec;40(12):2647–2655. doi: 10.1007/BF02220455. [DOI] [PubMed] [Google Scholar]
  24. Thompson W. G. Gender differences in irritable bowel symptoms. Eur J Gastroenterol Hepatol. 1997 Mar;9(3):299–302. doi: 10.1097/00042737-199703000-00015. [DOI] [PubMed] [Google Scholar]
  25. Voderholzer W. A., Schatke W., Mühldorfer B. E., Klauser A. G., Birkner B., Müller-Lissner S. A. Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol. 1997 Jan;92(1):95–98. [PubMed] [Google Scholar]
  26. Wald A., Caruana B. J., Freimanis M. G., Bauman D. H., Hinds J. P. Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Dig Dis Sci. 1990 Apr;35(4):481–487. doi: 10.1007/BF01536923. [DOI] [PubMed] [Google Scholar]
  27. Whitehead W. E., Crowell M. D., Bosmajian L., Zonderman A., Costa P. T., Jr, Benjamin C., Robinson J. C., Heller B. R., Schuster M. M. Existence of irritable bowel syndrome supported by factor analysis of symptoms in two community samples. Gastroenterology. 1990 Feb;98(2):336–340. doi: 10.1016/0016-5085(90)90822-i. [DOI] [PubMed] [Google Scholar]
  28. van der Sijp J. R., Kamm M. A., Nightingale J. M., Britton K. E., Mather S. J., Morris G. P., Akkermans L. M., Lennard-Jones J. E. Radioisotope determination of regional colonic transit in severe constipation: comparison with radio opaque markers. Gut. 1993 Mar;34(3):402–408. doi: 10.1136/gut.34.3.402. [DOI] [PMC free article] [PubMed] [Google Scholar]

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