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Efficient diagnosis of suspected functional bowel disorders.

Review article
Authors Jenny Gunnarsson
Magnus Simrén
Published in Nature clinical practice. Gastroenterology & hepatology
Volume 5
Issue 9
Pages 498-507
ISSN 1743-4386
Publication year 2008
Published at Institute of Medicine, Department of Internal Medicine
Pages 498-507
Language en
Links dx.doi.org/10.1038/ncpgasthep1203
Subject categories Gastroenterology and Hepatology

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.

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