Functional gastrointestinal disease

　　Functional gastrointestinal diseases (FGIDs) are a group of functional gastrointestinal diseases, which are digestive system diseases caused by the interaction of physiological, psychological and social factors. So, how do functional gastrointestinal diseases occur? The following experts introduce the etiology of functional gastrointestinal diseases:

　　1. Psychological and social factors are an important cause of FGIDs

　　Psychological and social factors are closely related to FGIDs. Life stress events often induce or exacerbate FGIDs, and neurotic, emotional personality traits significantly affect the rate of patients seeking medical attention and the severity of symptoms, somatization symptoms are more common in FGIDs patients. FGIDs patients often have extraintestinal symptoms such as dyspnea, palpitations, chronic headaches, myalgia, and others. Mental disorders are also common in FGIDs patients, especially in patients with severe or refractory symptoms, with an incidence rate of 42% to 61%.

　　2. Psychological and social factors can affect and exacerbate the gastrointestinal manifestations of FGIDs patients

　　Anxiety, depression, fear, and other emotions can often lead to low gastrointestinal motility, while anger and disgust can lead to hyperdynamic reactions. For example, stress can significantly accelerate the oral-cecal transit time in diarrhea-type IBS, thereby aggravating diarrhea; it can slow down the oral-cecal transit time in constipation-type IBS, thereby aggravating constipation.

　　In addition to its clinical manifestations, functional gastrointestinal disease can also cause other diseases. Functional gastrointestinal disease is a digestive system disease caused by the interaction of physiological, psychological and social factors. Generally, there are no complications.

　　Functional gastrointestinal disease is a common disease of the digestive system and also a disease with a high rate of misdiagnosis. So, what are the clinical manifestations of functional gastrointestinal disease? The following experts introduce the clinical manifestations of functional gastrointestinal disease:

　　First, functional gastroduodenal disease

　　1. Functional dyspepsia must meet one or more of the following: postprandial fullness and discomfort, early satiety, epigastric pain, and epigastric burning sensation. The symptom description is accurate, unlike the various symptom descriptions in the Rome II diagnostic criteria, including epigastric discomfort, bloating, nausea, and other symptoms, the diagnostic concept is blurred, making it difficult for doctors to grasp.

　　2. Belching syndrome is divided into aerophagia and non-specific excessive belching, with loud sounds often accompanying belching.

　　3. Nausea and vomiting include chronic idiopathic nausea, functional vomiting, and cyclic vomiting syndrome. Chronic idiopathic nausea: episodes are frequent, not usually accompanied by vomiting; functional vomiting: vomiting occurs on average once or more times a week, and patients with rumination syndrome continuously or repeatedly regurgitate food recently eaten or swallowed, then vomit or chew and swallow it again, without dry heaves before regurgitation. The patients do not have esophageal motility disorders, nor do they have gastroesophageal reflux disease, and the esophageal 24-hour dynamic pH detection is normal.

　　Second, functional intestinal disease

　　1. Irritable bowel syndrome is divided into two subtypes, namely, the diarrhea-predominant type and the constipation-predominant type.

　　2. Functional bloating patients repeatedly experience a sense of bloating or visible abdominal distension, which is not functional dyspepsia. Most patients cannot clearly identify the location of bloating, and can be observed with the naked eye or felt through abdominal physical examination.

　　3. Functional constipation patients have no abdominal pain, are not irritable bowel syndrome constipation type, and must meet the following two points or more: at least 25% of the defecation feels difficult, at least 25% of the defecation is lumpy or hard, at least 25% of the defecation has a sense of uncleanness, at least 25% of the defecation has anal and rectal obstruction or blockage, at least 25% of the defecation needs manual assistance.

　　4. At least 75% of the defecation of functional diarrhea patients is soft (paste-like) or watery without abdominal pain.

　　5. Non-specific functional intestinal disease patients have intestinal symptoms, which are not caused by organic diseases and do not meet the diagnostic criteria for the above diseases.

　　Functional gastrointestinal disorders refer to a group of diseases with symptoms such as bloating, abdominal pain, diarrhea, and constipation in the digestive system, but lacking organic diseases (such as gastritis, enteritis, etc.) or other evidence. The incidence rate in the general population ranges from 23.5% to 74%. So, how to prevent functional gastrointestinal disorders? The following experts introduce the preventive measures for functional gastrointestinal disorders:

　　1. Maintain a good psychological state: having a broad mind, optimistic emotions, an open personality, and being tolerant in dealing with things is the best measure to prevent this disease.

　　2. Treatment of psychological disorders: all negative psychological factors that may cause this disease should be avoided as much as possible, especially for those with phobias or cancer phobias, the patient should understand that this disease is a functional disease and will not endanger life, so as to eliminate their concerns and enhance their confidence in curing the disease.

　　3. Treatment of neurological dysfunction: for those with nervousness, sedatives such as estazolam (formerly known as Surazepam), Baiziyangxin pills, and guavain can be given; for those with depression, amitriptyline and clomipramine can be used; for those with anxiety, oral dehydrochloromethylphenidate and alprazolam (Xianjing'an) can be used.

　　4. Treatment of gastrointestinal symptoms: for those with abdominal pain, atropine, scopolamine, and hyoscyamine can be used; if necessary, cycloheximide or opium can be used; for diarrhea, compound difenoxinate (phenylpiperazine), loperamide (Imodium), and other drugs can be used; for constipation, bisacodyl (Bisacodyl), phenolphthalein, glycerin suppositories, senna leaves, and rhubarb and sesame seed laxative pills can be used, and more vegetables and fruits should be eaten; for heartburn and acid regurgitation, omeprazole (Losec), nizatidine, and other drugs can be used; for bloating, domperidone (Motilium) and cimetidine can be used; for nausea and vomiting, metoclopramide (Maxolon) and trichloroanisole (chlorobutanol) can be used; for poor digestion, pepsin hydrochloride, pancreatin, and Xiangsha Yangwei pills can be used.

　　5. Diet regulation: eat small and frequent meals, consume nutritious and easily digestible foods, and avoid eating cold, hot, and刺激性 foods (such as ginger, scallion, garlic, chili, wasabi, etc.).

　　Traditional Chinese medicine treatment focuses on soothing the liver and regulating the qi, strengthening the spleen and transforming dampness, and regulating the stomach and spleen. Medicines such as Bupleurum Powder for Soothing the Liver, Sini Powder, Shenling Baizhu Powder, and Fuzi Liren Pill can be used.

　　The purpose of examining functional gastrointestinal disorders is to rule out organic diseases. Therefore, according to the patient's clinical manifestations, medical history, family history, and other factors, it is often necessary to perform multiple tests, including:

　　1. Laboratory tests

　　Blood and urine routine, fecal occult blood, biochemical routine, erythrocyte sedimentation rate, etc.; necessary tests include tuberculosis infection-related tests, tumor marker detection, endocrine tests, Helicobacter pylori (Hp) detection, etc.

　　2. Imaging examinations

　　Ultrasound, barium meal, barium enema, gastroscopy, CT, MRI, and PET-CT, capsule endoscopy, and enteroscopy, etc., as necessary.

　　3. Other

　　Esophageal pH, high-resolution impedance analysis, gastric emptying test, gastrointestinal emptying test, hydrogen breath test, anal sphincter pressure measurement, defecation imaging, etc.

　　In life, people often experience symptoms such as stomach pain, bloating, heartburn, and other adverse gastrointestinal phenomena, which are related to the surrounding environment, daily diet, and climatic changes. Functional gastrointestinal disorders refer to symptoms such as bloating, abdominal pain, diarrhea, and constipation in the digestive system. This disease is prone to recurrence, bringing烦恼 and inconvenience to people's lives and work. Let's take a look at what dietary considerations should be taken into account by patients with functional gastrointestinal disorders.

　　1. Pay attention to dietary hygiene

　　Almost all pathogens and carcinogens enter the body with food. Therefore, the primary measure to protect the digestive tract is to pay attention to dietary hygiene and not to eat or drink unclean food and water.

　　2. Have regular meals and eat at regular times

　　It is important to eat moderate portions at each meal, and to eat at regular times. At the designated time, regardless of whether one is hungry or not, one should主动进食，to avoid being either too hungry or too full. This can form a conditioned reflex, which is helpful for the secretion of digestive glands, and is more conducive to digestion and absorption, and helpful in preventing and treating gastrointestinal diseases.

　　3. Diversify food and match it reasonably

　　Choose appropriate food combinations based on the characteristics of different gastrointestinal diseases. Food types can be diverse, and should be reasonably matched; only in this way can nutrition be fully supplemented, to maintain the body's needs, and to promote the recovery from illness.

　　4. Eat less fried foods

　　Because these foods contain high levels of fat and are not easy to digest, eating too much will increase the burden on the digestive organs, causing poor digestion.

　　5. Eat less preserved foods

　　These foods contain more salt and certain carcinogens, and should not be eaten in large quantities.

　　6. Eat less cold and刺激性食物

　　Cold and刺激性强的食物对消化道黏膜具有较强的刺激作用，容易引起腹泻或消化道炎症。

　　7. Chewing slowly

　　Chewing slowly allows food to mix thoroughly with saliva, undergo initial digestion, and alleviate the burden on the gastrointestinal tract. At the same time, the more times one chews, the more saliva is secreted, and the alkaline substances and mucin proteins in saliva can neutralize the precipitates produced by stomach acid, adhere to the gastric mucosa, resist the corrosion of stomach acid, and have a protective effect on the gastric mucosa.

　　8. Appropriate temperature

　　The temperature of food should be 'not too hot and not too cold'. Overheated or cold food can stimulate the gastric mucosa after entering the stomach, which is not good for the gastric mucosa.

　　9. Choose the right time to drink water

　　The best time to drink water is in the morning on an empty stomach and one hour before each meal. Drinking water immediately after meals will dilute gastric juice, and using soup rice will also affect the digestion of food.

　　10. Do not smoke

　　Because smoking causes the contraction of gastric blood vessels, affecting the blood supply to gastric mucosal cells, reducing the resistance of the gastric mucosa and triggering gastric disease. Regular check-ups and, if necessary, gastroscopy should be performed.

　　Functional gastrointestinal disorders (FGIDs) are key to nourishing, with medication as a supplement, correcting the triggering factors for the cause. Below, experts introduce the treatment methods for functional gastrointestinal disorders:

　　First, under the premise of clear diagnosis,对症治疗 according to the corresponding disease classification.

　　Second, Psychological Treatment

　　Not only does it significantly reduce the mental symptoms of FGIDs patients and alleviate hypochondriacal psychology, but it also significantly improves intestinal and somatic symptoms, which is a supplement to routine medical treatment. For most patients with mild symptoms, psychological intervention is rarely given. For a few FGIDs with comorbid psychological diseases or stubborn symptoms, especially those with obvious psychological factors who prefer to spend a lot of time and energy on unnecessary examinations, complex psychological treatment plans need to be formulated. The goal of psychological treatment for FGIDs is not to cure the disease, but rather:

　　1. Eliminate patients' fear of the disease and build confidence in overcoming the disease.

　　2. Reduce the frequency and intensity of patients' psychological and emotional stress.

　　3. Alleviate clinical symptoms, reduce the frequency and severity of symptoms, and improve the quality of life.

　　4. Reduce the frequency of patients' repeated visits and alleviate social and economic pressure.

　　Third, Antianxiety and Antidepressant Treatment

　　For patients with FGIDs who have obvious mental or emotional depression and anxiety, antidepressants and anxiolytics will be helpful. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants, and antidepressants can alleviate the symptoms of FGIDs, with some patients experiencing symptom disappearance.