Speakers: Nicholas Talley (Australia), Annamaria Staiano (Italy), Marc Benninga (The Netherlands), Lukas van Oudenhove (Belgium)
“The definition of functional gastrointestinal disorders (FGIDs) as laid out in the Rome III criteria is now highly questionable.” This was the view expressed by Professor Nicholas Talley of the University of Newcastle, Australia when introducing his presentation on the Epidemiology of FGIDs and their overlap. He suggested that the term FGIDs is a misnomer, as the disorders are not “functional” and proposed that the disorders would be better described as syndromes of an “irritable gut”. He provided evidence that there is considerable overlap between FGIDs and transition from one disorder to another over time is the rule, not the exception. There are gaps in understanding of the epidemiology of chronic unexplained GI symptoms, and more work is needed to understand the global burden of all FGIDs. Professor Talley recommended that the concept of individual chronic FGIDs be removed from the Rome IV criteria, due to be reviewed in 2016.
Drs Annamaria Staiano and Marc Benninga continued the session by discussing FGIDs in children. Dr Staiano provided evidence for a link between FGIDs and anxiety among children, and for a strong familial aggregation of FGIDs which may be due to environmental, genetic and psychological factors. Dr Benninga identified that 20-30% of children with functional abdominal pain will continue to have FGIDs as adults. Parental response to a child’s symptom of pain and passive coping strategies play an important role in outcome, with increased attention leading to more frequent pain. For treatment, the therapeutic role of fibres, probiotics and antidepressants is limited and remains unclear. Conversely, there is evidence that hypnotherapy provided by a counsellor or via CD-Rom may lead to improved short- and long-term outcomes.
Dr Lukas van Oudenhove of Belgium, presented with a UEG Rising Star 2012 award, gave his presentation on research into Brain-gut interactions in visceral pain and disorders of food intake. Impaired sensory filtering of physiological stimuli, an impaired descending modulatory system, and a dysfunctional reward system are implicated in the model of FGIDs and food intake disorders compared with the healthy state. Increased cannabinoid-1 receptor activity in functional dyspepsia (FD) is found to play a role in visceral pain perception and regulation of food intake. Patients with FD have a lower pain threshold compared with controls in gastric distension studies, and anxiety leads to a perception of physiological GI symptoms at a lower intragastric pressure in FD patients compared with controls. Lastly, heightened anticipatory reward responses in the obese brain have been identified, with fatty acid intake associated with improvement in mood.