Functional gastrointestinal disorders: advances in understanding and management
Open accessAbstract
Gastrointestinal symptoms are highly prevalent, but many people who have them will have no organic explanation for their symptoms. Most of these people will be labelled as having a functional gastrointestinal disorder, such as irritable bowel syndrome, functional dyspepsia, or functional constipation. These conditions affect up to 40% of people at any one point in time, and two-thirds of these people will have chronic, fluctuating symptoms. The pathophysiology of functional gastrointestinal disorders is complex, but involves bidirectional dysregulation of gut-brain interaction (via the gut-brain axis), as well as microbial dysbiosis within the gut, altered mucosal immune function, visceral hypersensitivity, and abnormal gastrointestinal motility. Hence, nomenclature refers to the conditions as disorders of gut-brain interaction. Psychological comorbidity is common; however, whether or not this predates, or is driven by, symptoms is not clear. Patients with functional gastrointestinal disorders can feel stigmatised, and often this diagnosis is not communicated effectively by physicians, nor is education provided. Prompt identification and treatment of these conditions is crucial as they have a considerable impact on health-care systems and society as a whole because of repeated consultations, unnecessary investigations and surgeries, prescriptions and over-the-counter medicine use, and impaired health-related quality of life and ability to work. Symptom-based criteria are used to make a diagnosis, with judicious use of limited investigations in some patients. The general principles of treatment are based on a biopsychosocial understanding and involve management of physical symptoms and, if present, psychological comorbidity. In the future, treatment approaches to functional gastrointestinal disorders are likely to become more personalised, based not only on symptoms but also underlying pathophysiology and psychology.
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Patients with IBS are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, and inappropriate prescribing of opioids.
“Furthermore, patients are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, 121 and inappropriate prescribing of opioids.90”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [90]
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Ford, A., Lacy, B., & Talley, N. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1607547 · Cited by 11 · see citing works
Self-citationUnmet needs of patients with irritable bowel syndrome
Hepatology, T. L. G. &. (2018) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(18)30236-x · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 5
- Rome IV journal articles. https://theromefoundationorg/rome-iv/rome-iv-journal- articles/.
- Agreus L, Svardsudd K, Talley NJ, Jones MP, Tibblin G. Natural history of gastroesophageal reflux disease and functional abdominal disorders. Am J Gastroenterol 2001; 96: 2905-14.
- Palsson OS, Whitehead WE, van Tilburg MA, et al. Rome IV diagnostic questionnaires and tables for investigators and clinicians. Gastroenterology 2016; 150: 1481- 91.
- Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 2016; 150: 1355-67.
- Zheng L, Lai Y, Lu W, et al. Pinaverium reduces symptoms of irritable bowel syndrome in a multi-center, randomized controlled trial. Clin Gastroenterol Hepatol 2015; 13: 1285-92.
Cited by
Sorted by citations
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A. D., Eugenicos, M. P., et al. (2021) · Gut · doi:10.1136/gutjnl-2021-324598 · Cited by 547 · see citing works
Self-citationAlcohol-associated bowel disease: new insights into pathogenesis
Maccioni, L., Fu, Y., Horsmans, Y., Leclercq, I., Stärkel, P., Kunos, G., & Gao, B. (2023) · eGastroenterology · doi:10.1136/egastro-2023-100013 · Cited by 69 · see citing works
Arif, T. B., Ali, S. H., Bhojwani, K. D., Sadiq, M., Siddiqui, A. A., Ur-Rahman, A., Khan, M. Z., Hasan, F., & Shahzil, M. (2025) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002994 · Cited by 50 · see citing works
Ng, R. W. Y., Chen, Z., Yang, L., Wong, O. W. H., Leung, A. S. Y., Tsui, K. W., Kwok, N. M. W., Tang, L. H. Y., Cheung, P. M. H., Chan, P. K. S., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-04303-x · Cited by 10 · see citing works
“Functional intestinal disorder is a spectrum of chronic gastrointestinal disorders characterized by symptoms or signs of abdominal pain, bloating, distention and bowel habit abnormalities, including irritable bowel syndrome (IBS) 14 .”
Ashraf, M. U., Akhouri, D., Bhardwaj, D., & Siddiqui, B. (2023) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001800 · Cited by 8 · see citing works
- Authors
- Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C.
- Affiliations
- University of Leeds (GB)
- University of North Carolina at Chapel Hill (US)
- Hunter Medical Research Institute (AU)
- Rome Foundation (US)
- Corresponding author
- Ford, Alexander C
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 396
- Issue
- 10263
- Pages
- 1664-1674
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W3092191049
- Cited by
- 605
- References
- 98
- Citations by year
- 2026: 131 · 2025: 118 · 2024: 129 · 2023: 98 · 2022: 84 · 2021: 44
- FWCI
- 9.76
- Type
- journal article
- Language
- en
- Open access
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- functional gastrointestinal disorders, irritable bowel syndrome, functional dyspepsia, functional constipation, gut-brain axis, dysbiosis, visceral hypersensitivity, gastrointestinal motility, mucosal immunity, psychological comorbidity, symptom-based diagnosis, biopsychosocial model, personalized treatment, health-related quality of life
- MeSH terms
- Brain, Dyspepsia, Gastrointestinal Diseases, Humans, Quality of Life, Irritable Bowel Syndrome
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