In patients without underlying pathology, visceral pain in the GI tract is generated secondary to noxious stimuli (physical, chemical, or inflammatory) that activates a peripheral nerve. Although a full review of the pathogenesis of these disorders is beyond the scope of this article, we will briefly outline the proposed physiologic basis of disease to better understand current treatment strategies. The causes of functional abdominal pain disorders are not fully understood and likely are multifactorial. This article focuses on the most common functional abdominal pain disorders in adults and their presentation and management in the acute care setting. 4 These conditions include functional heartburn and dyspepsia, IBS, sphincter of Oddi disorders, functional anorectal pain, defecatory disorders, and functional abdominal pain disorders. The recently released Rome IV criteria cover 33 adult and 20 pediatric functional disorders. 3 The Rome Foundation is the major body that has been responsible for characterizing and classifying functional GI disorders. The term functional GI disorder refers to syndromes characterized by patient experience and symptoms, rather than structural and motility disorders that are classified in terms of organ morphology and function. 2 The ubiquity of these GI disorders along with the diagnostic uncertainly surrounding them means clinicians must understand their cause, presentation, diagnostic criteria, and approach to treatment. 1 These facts have major implications on healthcare costs: for example, the estimated annual per patient cost of irritable bowel syndrome (IBS) is $1,562 to $7,547 in direct costs and $791 to $7,737 in indirect costs. 1 The most common diagnoses made in all patients with gastrointestinal (GI) complaints in the ED in 2012 were functional and organic motility disorders. In 2010, abdominal pain accounted for more than 27 million healthcare visits with more than 10 million of those visits occurring in EDs. Abdominal pain is an extremely common complaint in the office and acute care settings.
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