What Is a Functional Gastrointestinal Disorder (FGID)?


By Jeffrey Lazarus, MD, FAAP on May 5, 2020
Author, Controlling Your Gut Feelings Blog



Historically, traditional medicine has divided gastrointestinal problems into 2 main categories:

  1. Organic diseases
  2. Functional disorders

Organic GI diseases are those for which a specific diagnosis can be proven by an abnormal
physical examination, lab test, or biopsy result. Examples of these include ulcerative colitis,
Crohn’s disease, and other inflammatory bowel diseases.

Functional disorders, known as Functional Gastrointestinal Disorders (FGID), are not diseases. Which means that the bowels are not functioning correctly and there is no damage to the bowels, like there would be if there was disease.

What is Functional Gastrointestinal Disorder (FGID)?

In functional GI disorders, the exam and all lab results are basically normal, but the symptoms
are still quite real. All diagnostic tests are negative, including blood tests, ultrasound and endoscopy. In addition, all radiographic studies are negative, including CT scans and x-ray studies such as upper GI series and lower GI series. Additional tests may be ordered and these, too, will turn out to have normal results.

Examples of functional GI disorders include:

  • Irritable Bowel Syndrome (IBS),
  • Functional Abdominal Pain (FAP)
    • Similar to visceral hypersensitivity
  • Abdominal Migraine (AM)
  • Functional Dyspepsia (FD), and
  • Cyclic Vomiting Syndrome (CVS).

And, of course, there is a strong mind-body connection. When we are upset emotionally, it
affects us physically, and vice versa. So, any condition, organic or functional, really is a
neurological-biological-psychological-physiological-behavioral, and sometimes social problem.
Medical research has demonstrated that virtually every patient with a functional GI disorder
also has anxiety which contributes to the problem.

What is Irritable Bowel Syndrome (IBS)?

IBS can cause vomiting, diarrhea, pain, constipation, and/or nausea. Irritable Bowel Syndrome (IBS) is a functional disorder, not a disease. Which means that the bowels are not working correctly and there is no damage to the bowels, like there would be if there was disease.

Parents should know that BIS in children and IBS in teenagers is common, yet goes undetected because it’s misunderstood.

IBS is characterized by chronic abdominal pain and altered bowel habits. There may be vomiting, constipation, and/or diarrhea. IBS is a condition in which patients, including kids and teens, experience vomiting, diarrhea, constipation, abdominal pain, and/or nausea. It is a particularly frustrating problem because there are no medications that have been shown to cure it.

What is Functional Abdominal Pain (FAP)?

With functional abdominal pain (FAP), patients experience pain and/or nausea, yet there is
nothing physically wrong to explain the problem. A typical example of FAP is a child who
experiences a stomachache Monday through Friday mornings, is fine on the weekends, and
then, on Monday morning, the stomachache starts again. Again, there is nothing physical to
explain the pain or nausea. And, these symptoms are REAL! The child is not merely faking
them to get out of going to school. But, unconsciously, it is probably related to an issue causing
school avoidance. Perhaps the child has a learning problem. Or maybe there is a bully, or a
mean teacher, at school. This is probably the child’s unconscious way of escaping going to
school that day.

What is Visceral Hypersensitivity?

Visceral hypersensitivity is when patients react to sensations in their intestines in a far more
extreme way than other people do.

And, as my friend and colleague, Marianne Ault-Riché, LCSW* taught me, when she has a child
with this type of problem, she tells her, “You have a very smart tummy! That tummy ache is a signal that something is upsetting you.” And, when the child is able to make that connection, it is very helpful, because then the child can understand that there is nothing seriously wrong,
and that they can now learn some coping skills in order to be able to deal with the problem and be able to attend school.

What is Abdominal Migraine?

An abdominal migraine is just like a headache migraine, only it is in the abdomen. It has a
beginning, a middle, and an end. And, typically, there is an “aura” of some sort: a signal that
the abdominal migraine is about to start. And, when children and adolescents can recognize
this, the aura can then become the signal to use her self-hypnosis strategies to prevent the
abdominal migraine from happening.

What is Functional Dyspepsia?

Functional dyspepsia, or FD, used to be referred to as “heartburn.” It typically occurs right after
eating, and can cause symptoms of discomfort, pain, fullness, bloating, or nausea. I treat
patients with FD the same way I treat patients with abdominal migraine, as these episodes are
also temporary, with a beginning, a middle, and an end.

What is Cyclic Vomiting Syndrome (CVS)?

Patients with cyclic vomiting syndrome (CVS) have severe nausea and vomiting that can last for
days at a time. Then, they are fine for a while (days or weeks), then the CVS episodes recur.
As it happens, there is no medication that can treat functional GI disorders. And, the best
treatments for them have been proven to be medical hypnosis and cognitive behavioral
therapy (CBT).

About Medical Hypnosis?

Now, when we use the term “hypnosis,” I would imagine you might be thinking about people
with the swinging watch and movies and cartoons that make it look like someone is controlling
someone else’s mind. And, there is no such thing as mind control! I can’t control your mind
any more than you could control mine!

With medical hypnosis, also known as hypnotherapy, guided imagery, or visualization, patients
choose a specific therapeutic goal, such as, “I want to have better control over that nausea, or
vomiting, or diarrhea.” Then, we help them to create an empowering experience, in their
minds, that allows them to realize that they have the ability to do things that they previously
were not aware that they could do.

About Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy, or CBT, is an approach that helps patients to identify their
negative thoughts and emotions, and talk back to those thoughts with positive thoughts. And
when we change the way we think, we change the way we feel. CBT has been shown to be the
best treatment for anxiety and depression.

Controlling Your Gut Feelings” is a home video program developed by Dr. Jeffrey Lazarus, MD, FAAP that I have developed for patients
with FGIDs. It incorporates medical hypnosis techniques, cognitive behavioral therapy
strategies, and powerful motivational tools that have been proven, by evidence-based medical
research, to help patients with these problems.