How should we classify and treat patients with functional gastrointestinal disorders?

Understanding risk factors and heterogeneity and moving towards a mechanistic understanding of symptom genesis Major everyday challenges face clinicians handling functional gastrointestinal (GI) consultations. The symptoms reported by this largest group of GI patients can be extremely difficult to treat: this therapeutic deficit fundamentally reflects our limited understanding of their biological basis. Consequently, but problematically, currently applied classifications of functional GI disorders (FGIDs) are almost entirely symptom based. Indeed leading authorities have by consensus stated that the ‘functional bowel disorders are identified only by symptoms’, with treatment therefore based on explanation and reassurance, and drugs targeting the predominant symptoms [Longstreth et al. 2006]. Is such a nonmechanistic approach to medicine and therapeutics acceptable in the 21st century? Or is it simply inescapable at this time?

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