When Form Doesn’t Function: Functional Gastrointestinal Disorders

Architect Louis Sullivan coined the phrase “form follows function.” This became the battle cry of modernists in the early 1900’s against purely ornamental features of architecture. Decorative ornaments were considered superfluous. They believed that the design of an object should fit its intended purpose. The object should be functional. In the same way, there is an intended purpose for each organ of the digestive system.

Each organ of the digestive system is formed to contribute to a person's overall function and digestive health. When one or more organ(s) appear(s) to be normal in form but is not functioning as it was intended, then acute and chronic symptoms can develop into what is known as functional gastrointestinal disorder (FGID). FGID can lead to continuous and/or recurring abdominal pain and other bothersome symptoms that have a negative impact on the quality of life for those who are affected. The most common FGID is irritable bowel syndrome (IBS) which can cause abdominal pain with either diarrhea, constipation, or both. Another FGID is nonulcer dyspepsia, or functional dyspepsia, which causes post-prandial upper gastrointestinal symptoms (mainly epigastric pain, belching, and nausea) that mimics a stomach ulcer.

The underlying cause of FGID can be multifactorial with the brain-gut interaction playing an important role. The concept of brain-gut interaction does not mean that FGID is imaginary. Symptoms of FGID are very real and have their basis in the neurological interaction of the brain and gut; however, for some there is a psychological element of FGID that can arise from past trauma and bereavement. Mayo Clinic gastroenterologist, Dr. Adil Bharucha explains,

“Cognitive behavioral therapy can help patients relax, provide a sense of control over symptoms, and induce more parasympathetic activity. Diaphragmatic breathing exercises can help patients reduce belching, regurgitation, and vomiting.”

At Mayo Clinic, the evaluation of FGID includes tests that can further phenotype the underlying functional disorder, thereby individualizing the treatment of FGID. General approaches to management and treatment of FGID can include adjustments in diet and other lifestyle strategies including:

• Avoiding food that exacerbates symptoms. Though most people with FGID do not have a known food allergy, there are certain foods that trigger symptoms.
• Soluble fiber supplements can offer a low cost effective treatment for those with IBS based on constipation.
• Probiotics may be effective for those who symptoms include bloating and flatulence.
• Investigating whether there is sensitivity to gluten or FODMAP’s. For those with symptoms that are not improving, it may be worth undergoing testing for celiac disease. Even if celiac disease is not present, there are those who are affected by non-celiac gluten sensitivity and may benefit from eliminating gluten from their diets. Those whose symptoms persist may consider working with their physician and a dietitian to explore the role of FODMAP’s. FODMAP’s are carbohydrates that are Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polys. Intestinal bacteria ferment these carbohydrates and produce gas and increased fluid.

The Healthy Living Program at the Mayo Clinic’s campus in Rochester, Minnesota offers patients an “immersive wellness experience” with individualized diet plans and exercise programs suitable for those with gastrointestinal disorders. This customized program is aimed at improving symptoms and the overall quality of life of those who participate in this program.

Dr. Donald Hensrud, medical director of the Healthy Living Program says,

“Many people realize their health would improve if they changed their diet plans and physical activity, but saying it and doing it are two different things. Similarly, most physicians see patients who would benefit from lifestyle changes but are not able to implement those changes on their own. In the Healthy Living Program, multidisciplinary teams of experts work one-on-one to design individualized wellness plans and provide ongoing support so participants’ success continues after they return home and are immersed in the realities of their busy lives.”

When form does not function as it was intended, patients should work with their physician to determine the treatment plan that best suits them. There are many pharmacological and lifestyle options to help them manage their condition.

Connect with other patients talking about FGID, digestive health issues, and more:  Digestive Health

Resources:

• Nonparmacological Approaches to Management of Functional Gastrointestinal Disorders
• Healthy Living Program Offers New Approach to Functional GI Disorders
• What Exactly Is the FODMAP Diet? Dr. Wang Explains