🧠 Chapter 389: Disorders of Brain-Gut Interaction (Functional GI Disorders)

Nelson Textbook of Pediatrics 22nd Edition — Disorders of brain-gut interaction (DBGI) (formerly functional GI disorders) are common conditions without identifiable organic cause, diagnosed by Rome IV criteria. Categories: infant/toddler (infant regurgitation, colic, functional constipation, functional diarrhea, dyschezia) and child/adolescent (functional dyspepsia, IBS, abdominal migraine, functional abdominal pain NOS, rumination syndrome, cyclic vomiting syndrome, aerophagia). Management: reassurance, dietary changes, gut-directed behavioral therapy, pharmacotherapy (cyproheptadine, amitriptyline, peppermint oil, probiotics).

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📋 30 Clinical Scenarios — Functional GI Disorders (Rome IV)

📇 High‑Yield Review Cards (Brain-Gut Disorders)

🩺 Clinical Presentations: Functional GI Disorders (Rome IV)

Select a presentation for diagnostic criteria (Rome IV) and management.

📋 Stepwise Approach to Functional GI Disorders

🔑 Key Principles — Disorders of Brain-Gut Interaction (Nelson Ch.389)
• Diagnosis: Based on Rome IV symptom-based criteria; no organic cause after appropriate evaluation.
• Infant regurgitation: Peak at 4 months, resolves by 12 months. Reassurance, no treatment.
• Infant colic: >3 hours/day, >3 days/week, for >3 weeks. Reassurance, swaddling, probiotics (L. reuteri) may help.
• Functional constipation: Treat with disimpaction + maintenance (PEG 3350).
• IBS: Abdominal pain associated with defecation or change in stool form. Treat: dietary (fiber, low FODMAP), peppermint oil, cognitive behavioral therapy (CBT).
• Functional dyspepsia: Postprandial fullness, early satiety, epigastric pain. Treat: acid suppression (PPI), cyproheptadine, prokinetics.
• Abdominal migraine: Paroxysmal episodes of intense periumbilical pain with anorexia, nausea, vomiting, headache. Treat: cyproheptadine, amitriptyline, propranolol (prophylaxis).
• Rumination syndrome: Effortless regurgitation, rechewing, reswallowing. Treat: diaphragmatic breathing, behavioral therapy.

    ⚡ Reflex Prompts — Functional GI Disorders

    📖 Disorders of Brain-Gut Interaction — Core Summary