The Functional Gastrointestinal Disorders and the Rome III Process, Gastroenterology, 2006

Throughout recorded history, and alongside structural
diseases of the intestinal tract, are maladies
that have produced multiple symptoms of pain, nausea,
vomiting, bloating, diarrhea, constipation, or difficult
passage of food or feces.1 Although structural diseases can
be identified by pathologists and at times cured by
medical technology, the nonstructural symptoms that we
describe as “functional” remain enigmatic and less amenable
to explanation or effective treatment. Often considered
“problems of living,” there are physiological,
intrapsychic, and sociocultural factors that amplify perception
of these symptoms so they are experienced as
severe, troublesome, or threatening, with subsequent
impact on daily life activities. Those suffering from such
symptoms attribute them to an illness and self-treat or
seek medical care. Traditionally trained physicians then
search for a disease (inflammatory, infectious, neoplastic
and other structural abnormalities) in order to make a
diagnosis and offer treatment specific to the diagnosis. In
most cases,2 no structural etiology is found, the doctor
concludes that the patient has a “functional” problem,
and the patient is evaluated and treated accordingly.
This clinical approach results from a faulty conceptualization
of functional gastrointestinal disorders (FGIDs)
and in the inaccurate, demeaning and potentially harmful
implications that some physicians, patients, and the
general public attribute to them.3 Some clinicians feel ill
at ease when making a diagnosis of an FGID because they
are trained to seek pathology.4 In a random sample
survey of 704 members of the American Gastroenterological
Association,5 the most common endorsement of
a functional gastrointestinal (GI) disorder was “ . . .. no
known structural (ie, no pathological or radiological)
abnormalities, or infectious, or metabolic causes” (81%).
Next came “a stress-disorder” (57% practitioners and
34% academicians and trainees), and last was a “motility
disorder” (43% practitioners and 26% academicians/
trainees.6 A more recent survey of international investigators
agreed that in their countries, physicians view the
FGIDs as psychological disorders or merely the absence
of organic disease and often ascribe pejorative features to
the patient.3 Some physicians deny the very existence of
the functional GI disorders,7 whereas others exhibit dismissive
or negative attitudes toward patients.4,8,9 Some
physicians may pursue unneeded diagnostic studies to
find something “real”,10 resulting in increased health care
costs and possibly inappropriate care.11 These types of
beliefs and behaviors can “delegitimize” the FGIDs and
the patients who experience them.

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