| Abstract | Funkcionalni poremećaji gastrointestinalnog sustava obuhvaćaju široki spektar poremećaja s kroničnim i rekurentnim simptomima koji znatno narušavaju kvalitetu života, a nisu jasno povezani sa strukturnim ili biokemijskim abnormalnostima koje bi bile jednostavno dokazive. Zbog svoje visoke prevalencije često se susreću u ordinacijama liječnika obiteljske medicine i specijalista gastroenterologije. Klasificirani su prema Rimskim IV kriterijima s obzirom na dio gastrointestinalnog sustava koji zahvaćaju i specifičnost simptoma. Pravilno postavljanje dijagnoze funkcionalnog poremećaja gastrointestinalnog sustava važno je zbog kompleksnosti liječenja i izbjegavanja nepotrebnih invazivnih pretraga i postupaka, posebice zbog njihove povezanosti s psihološkim poremećajima poput anksioznosti i depresije. Ovaj rad nudi pregled potencijalne patogeneze, kliničke slike, dijagnostike i liječenja nekoliko poremećaja klasificiranih po Rimskim IV kriterijima. Najpoznatiji funkcionalni poremećaj gastrointestinalnog sustava je sindrom iritabilnog crijeva karakteriziran kroničnom abdominalnom boli i promjenama u navikama crijeva. Njegovo liječenje usko je povezano s mehanizmima koji se smatraju potencijalnim uzrokom poremećaja te uključuje promjenu životnog stila i prehrane, fizičku aktivnost, te pokušaj isključivanja laktoze, glutena, hrane koja proizvodi plinove te fermentirajućih oligosaharida, disaharida, monosaharida i poliola iz prehrane. Preporuča se unos topivih, a izbjegavanje netopivih vlakana. Ako navedeni načini ne djeluju, u farmakološkoj terapiji primjenjuju se laksativi, antidijaroici, sekvenstranti žučnih kiselina, lijekovi s djelovanjem na 5-hidroksitriptaminske receptore, spazmolitici i triciklički antidepresivi te antibiotici i probiotici. Funkcionalni poremećaj žučnog mjehura je rijedak, a opcije liječenja su konzervativna kontrola simptoma ili kirurška kolecistektomija. Sindrom ruminacije karakterizira postprandijalna regurgitacija hrane bez prateće mučnine. Glavno liječenje temeljeno je na dijafragmalnom disanju, a u težim slučajevima koristi se 'biofeedback' terapija i baklofen. Proctalgia fugax je benigni poremećaj s intermitentnim epizodama rektalne boli te obično ne zahtijeva terapiju. Kod kompleksnijih slučajeva koriste se lokalni spazmolitici, a limitirane studije pokazale su korisnost salbutamola i injekcija botulinum toksina. |
| Abstract (english) | Functional gastrointestinal disorders include a broad spectrum of disorders with chronic and recurrent symptoms which significantly lower the quality of life and are not clearly related to structural or biochemical abnormalities which would be easy to detect. Due to their high prevalence, they are commonly encountered in doctor’s offices, both family medicine and specialists of gastroenterology. They are classified by Rome IV criteria based on their location in the gastrointestinal system and specific symptoms. Diagnosis of the right disorder is important due to complexity of treatment and to avoid unnecessary testing and procedures, especially because of their link with psychological disorders such as anxiety and depression. This paper offers an overview of potential pathogenesis, clinical presentation, diagnostic, and treatment of a few disorders classified by Rome IV criteria. The most known functional gastrointestinal disorder is irritable bowel syndrome, characterized by chronic abdominal pain and alternations in bowel movement. Its treatment is closely related to mechanisms considered as its potential causes and includes changes in lifestyle, diet, physical activity, and attempts to exclude lactose, gluten, gas-producing food, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols from the diet. Higher intake of soluble fibres is recommended, and insoluble fibres should be avoided. If these methods fail in treatment, next step is pharmacological treatment using laxatives, antidiarrheals, bile acid sequestrants, drugs with effect on 5-hydroxytryptaminic receptors, antispasmodics, tricyclic antidepressants, antibiotics, and probiotics. Functional gallbladder disorder is rare, and its treatment options include conservative method of symptom control and surgical cholecystectomy. Rumination syndrome presents as postprandial regurgitation of food without nausea. Its main treatment is diaphragmic breathing, while more severe cases are treated with biofeedback therapy and baclofen. Proctalgia fugax is a benign disorder with intermittent episodes of rectal pain and it does not usually require therapy. More complex cases are treated by local antispasmodics, and there are a few smaller studies that suggest the usefulness of salbutamol and botulinum toxin injections. |
