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Appendix A: The Rome III Diagnostic Criteria for the Functional Gastrointestinal Disorders. IN: Drossman, D., ed. Understanding the Irritable Gut: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc. 2008. pp 183-199.

This appendix is from a book that helps doctors and patients better understand functional gastrointestinal disorders (FGIDs), with text based on information developed by the Rome Foundation to identify, classify, and treat these disorders. This appendix presents the Rome criteria for the diagnoses of FGIDs; the criteria were developed by teams of experts to define patients for scientific study and help practicing doctors more precisely identify the disorders. The disorders covered include functional heartburn, functional chest pain of presumed esophageal origin, functional dysphagia, globus, functional dyspepsia, postprandial distress syndrome, epigastric pain syndrome, belching disorders, chronic idiopathic nausea, functional vomiting disorders, cyclic vomiting syndrome (CVS), rumination syndrome in adults, irritable bowel syndrome, functional bloating, functional constipation, functional diarrhea, functional abdominal pain syndrome (FAPS), functional gallbladder and Sphincter of Oddi disorders, functional fecal incontinence, functional anorectal pain, and functional defecation disorders. The diagnostic criteria for both childhood and adult FGIDs are included, although the remainder of the appendix only focuses on adult disorders. Readers are cautioned that the criteria are not meant for self-diagnosis and that a confident diagnosis can only be safely arrived at after a careful history and physical examination by a doctor. The diagnostic criteria are scheduled to be updated again in 2012.

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Bowel Incontinence And Aging. Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 12p.

Bowel incontinence occurs when the loss of control of gas, liquid stool, or solid stool is enough to cause discomfort or distress. This brochure considers the relationship between bowel incontinence and aging, noting that many aging-related factors can make a loss of bowel control more likely. The authors review the causes of incontinence; the effect of age on continence; the neurophysiology of the bowel control system; symptoms that may accompany bowel incontinence, such as diarrhea, constipation, and pain; and strategies to treat and manage bowel incontinence, including biofeedback. The authors describe bowel retraining, which teaches new skills to develop a regular and predictable schedule for having bowel movements. The brochure encourages readers to talk with their health care provider about bowel incontinence, noting that no matter what the cause of incontinence, dietary and bowel retraining measures can often help. The brochure concludes with a description of the activities of the International Foundation for Functional Gastrointestinal Disorders (IFFGD).1 figure. 2 references.

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Celiac Disease. Bethesda, MD: American College of Gastroenterology. 2008. 6 p.

This fact sheet provides basic information about celiac disease and its diagnosis. Designed to help increase health care providers’ and patients’ index of suspicion about the disease, the fact sheet describes how the intestine reacts to gluten, the epidemiology of celiac disease, the primary symptoms, diagnostic tests used to confirm the presence of the disease, and treatment with a gluten-free diet. A final section considers the complications of celiac disease, all of which can be avoided by following a gluten-free diet. The most common symptoms of celiac disease include abdominal pain, bloating and gas, diarrhea, stools that may float or smell unusually bad, weight loss, poor growth or weight loss in children, and anemia. Other symptoms or complications include weakness, tiredness, low vitamin levels, bone and joint pains, osteoporosis, and a chronic skin rash. Diagnostic tests used include blood tests and an endoscopic biopsy of the small bowel. The fact sheet includes a brief list of grains that contain gluten and must be avoided, as well as a list of frequently overlooked foods that often contain gluten. A full-color illustration of the intestinal villi is included. A list of 10 websites that have more information concludes the fact sheet. 4 figures.

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Norovirus Outbreak in an Elementary School: District of Columbia, February 2007. Morbidity and Mortality Weekly Report. 56(51): 1340-1343. January 2008.

This article reports on a norovirus outbreak in an elementary school in the District of Columbia in February 2007. The school nurse reported that 27 students and two staff members had become ill during February 4–8 with nausea, vomiting, and diarrhea; because symptoms lasted less than 48 hours, a viral etiology was suspected. The District of Columbia Department of Health recommended two preinvestigation interventions, which were implemented on the evening of February 8: more thorough hand washing, and bleach cleaning of all shared environmental surfaces with a diluted household bleach solution. This article summarizes the subsequent investigation of the outbreak, which suggested that noncleaned computer equipment (i.e., keyboards and mice) and person-to-person contact resulted in illness. The appended editorial note mentions this is the first report of a norovirus detected on a computer mouse and keyboard, which highlights the difficulty in identifying and properly disinfecting all possible environmental sources of norovirus during outbreaks. Person-to-person contact likely played a role in this outbreak. The editor provides details about how to disinfect surfaces such as those found in the classroom. 1 figure. 1 table. 10 references.

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What I Need to Know About My Child’s Urinary Tract Infection. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 16 p.

This booklet helps parents understand the problem of urinary tract infections (UTIs) in children and how it can be managed. Written in nontechnical language, the booklet describes the anatomy and function of the urinary tract, the definition of a UTI, symptoms, how to know when to contact a health care provider for UTI symptoms, diagnostic strategies used to confirm the presence of a UTI, treatment options, prevention tips, recurrent UTIs, and questions to ask the pediatrician or urologist about the child’s UTI. Symptoms of a UTI include fever, fussiness and irritability, refusal to eat, diarrhea, vomiting, cloudy or foul-smelling urine, burning urination, back or stomach pain, nighttime or daytime wetting in older children, and blood in the urine. Diagnosis is usually based on a urine sample. Generally, a UTI will be treated successfully with an antibiotic. Most UTIs can be prevented with good bathroom habits, especially for girls. The booklet includes a list of organizations through which readers can get additional information about urinary tract infections. A final section briefly describes the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC). The booklet is illustrated with black-and-white line drawings. 7 figures.

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Functional Gastrointestinal Disorders: Nature and Diagnosis. IN: Drossman, D., ed. Understanding the Irritable Gut: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc. 2008. pp 33-94.

This section of six chapters is from a book that helps doctors and patients better understand functional gastrointestinal disorders (FGIDs), with text based on information developed by the Rome Foundation to identify, classify, and treat these disorders. This section begins with Chapter 5, which outlines the diagnostic strategies and classification for FGIDs. Chapter 6 focuses on irritable bowel syndrome (IBS), the most studied FGID and the one that has validated diagnostic criteria. Chapter 7 covers functional constipation, which must be differentiated from organic disorders, some of which are themselves uncommon and poorly understood. Chapter 8 discusses functional diarrhea, not because it is common, but rather because it may be diagnosed only after meticulous testing for known causes of chronic diarrhea. Chapter 9 covers functional dyspepsia, a condition that is difficult to define and was often called nonulcer dyspepsia. The Rome process has made the diagnosis more inclusive and has altered the classification, subtypes, and criteria of functional dyspepsia. Chapter 10 describes the functional esophageal disorders, which are among the few FGIDs that are best diagnosed by exclusion. Chapter 11 reviews the functional anorectal disorders and Chapter 12 covers the remaining disorders not discussed previously. Each chapter includes black-and-white and color illustrations and concludes with a brief list of recommended sources for more information.

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Graves' Disease. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 8 p.

This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes Graves’ disease, the most common cause of hyperthyroidism in the United States. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs. In Graves’ disease, the immune system makes antibodies called thyroid-stimulating immunoglobulin (TSI) that attach to thyroid cells. TSI mimics the action of thyroid-stimulating hormone (TSH) and stimulates the thyroid to make too much thyroid hormone. The diagnosis and treatment of Graves’ disease is often performed by an endocrinologist, a doctor who specializes in the body’s hormone-secreting glands. The fact sheet reviews the symptoms of Graves’ disease, the condition called Graves’ ophthalmopathy, who is likely to develop Graves’ disease, diagnostic approaches to Graves’ disease, and treatment options, including radioiodine therapy, medications, surgery, and eye care. Common symptoms of hyperthyroidism include nervousness or irritability, heat intolerance, rapid and irregular heartbeat, frequent bowel movements or diarrhea, weight loss, and goiter. Graves’ ophthalmopathy is characterized by inflammation and a buildup in tissue and fat behind the eye socket, causing the eyeballs to bulge. Graves’ disease is most often treated with radioiodine therapy, which gradually destroys the cells of the thyroid gland. The fact sheet concludes with a list of six resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure.

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Hyperthyroidism. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 8 p.

This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes hyperthyroidism, a disorder that results when the thyroid gland produces more thyroid hormone than the body needs. The fact sheet is written in a question-and-answer format and covers the anatomy and function of the thyroid, the causes of hyperthyroidism, Graves’ disease, thyroid nodules, thyroiditis, iodine ingestion, overmedicating with thyroid hormone, the symptoms of hyperthyroidism, who is at risk for developing hyperthyroidism, hyperthyroidism in the aging population, diagnostic tests to confirm the presence of thyroid disease, the thyroid-stimulating hormone (TSH) test, pregnancy and hyperthyroidism, and how hyperthyroidism is treated, including antithyroid drugs, radioiodine therapy, and thyroid surgery. Some symptoms of hyperthyroidism include nervousness or irritability, fatigue or muscle weakness, trouble sleeping, heat intolerance, hand tremors, rapid and irregular heartbeat, frequent bowel movements or diarrhea, weight loss, mood swings, and goiter, an enlarged thyroid that can cause the neck to look swollen. Treatment depends on the cause and severity of the hyperthyroidism. The aim of treatment is to bring thyroid hormone levels to a normal state, thus preventing long-term complications and relieving uncomfortable symptoms. The fact sheet concludes with a list of six resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure. 1 table.

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Medication Induced Constipation And Diarrhea. Practical Gastroenterology. 32(5): 12-28. May 2008.

This article reviews the problems of constipation and diarrhea that occur as a side effect of medication use. The authors note that medication-induced constipation and diarrhea are frequent side effects that contribute to the costs of health care for evaluation and management and also contribute to patient morbidity. The diagnosis is often delayed due to poor association of symptom onset with the use of a medication. The authors define constipation; discuss its epidemiology, economic impact, and risk factors; consider diagnostic and treatment issues; and discuss the treatment of constipation in the setting of chronic opioid use. The next section covers the definition and mechanisms of medication-induced diarrhea, antibiotic-associated diarrhea, diarrhea associated with protease inhibitors, and chemotherapy-induced diarrhea. The authors conclude by encouraging health care providers to have a high index of suspicion when patients present with constipation or diarrhea and to obtain a detailed medication history of all medications taken in the past 2 months; this approach can avoid multiple diagnostic tests. High-risk patient populations for medication-induced diarrhea or constipation include the elderly, nursing home or long-term care residents, patients with chronic pain, those with prolonged hospitalization, and those being treated with broad spectrum antibiotics. 3 figures. 2 tables. 35 references.

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Understanding the Irritable Gut: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc. 2008. 240 p.

This book helps doctors and patients better understand functional gastrointestinal disorders (FGIDs), with text based on information developed by the Rome Foundation to identify, classify, and treat these disorders. The book includes 17 chapters in three sections: About the Functional Gastrointestinal Disorders, the Nature and Diagnosis of the Functional Gastrointestinal Disorders, and Managing the Functional Gastrointestinal Disorders. Chapter 1 explains FGIDs and how their symptoms can be used to classify them into individual syndromes. Chapter 2 explains that FGIDs are extremely common throughout the world and that, although never fatal, they can trouble patients periodically throughout their lives. Chapter 3 outlines the anatomy and normal functioning of the gastrointestinal tract, and the gut's nervous system and its interaction with the brain. Chapter 4 briefly summarizes what is known about gut malfunctioning and other influences that may be responsible for functional gut symptoms. The chapters in the second section cover the diagnosis of FGIDs, functional constipation, functional diarrhea, functional dyspepsia, functional esophageal disorders, functional anorectal disorders, and less common FGIDs. The final section begins with a chapter about the general treatment measures that are suitable for any FGIDs, including common-sense advice about diagnosis, diet, lifestyle, and the management of stress. The final chapters cover the importance of a successful therapeutic relationship, the role of randomized clinical trials, and treatment options for specific FGIDs. An appendix presents the Rome criteria for the diagnoses of FGIDs. A second appendix describes some of the tests commonly used in the investigation of FGIDs. The book provides a detailed glossary of related terms and a subject index.

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