The functional gastrointestinal disorders and the Rome II process

Man should strive to have his intestines relaxed all the days of his life. Moses Maimonides, AD 1135–1204 A good set of bowels is worth more to a man than any quantity of brains. Josh Billings (Henry Wheeler Shaw), AD 1818–1885 For centuries, physicians and historians have recognized that it is common for maladies to afflict the intestinal tract, producing symptoms of pain, nausea, vomiting, bloating, diarrhea, constipation, difficult passage of food or feces, or any combination.1When these symptoms are experienced as severe, or when they impact on daily life, those afflicted often attribute the symptoms to an illness and seek medical care. Traditionally, the physicians caring for these patients will search for inflammatory, infectious, neoplastic, and other structural abnormalities to make a specific diagnosis and offer specific treatment. Yet as has been common in medical practice,2 when no structural etiology is found, the patient is diagnosed as having “functional” symptoms and is treated symptomatically. Until recently, the limited scientific knowledge about the pathophysiology of these symptoms, and the need to diagnose by excluding “organic” disease, has led physicians to feel uncertain about the legitimacy of these symptoms as bona fide disorders.3 Some have felt insecure in their ability to manage patients with these conditions, and might even avoid caring for patients with these complaints. But over the past two decades, two important processes have occurred to legitimize these conditions, and to increase attention toward the research and clinical care of patients with functional gastrointestinal disorders (FGID). The first has been a shift in conceptualizing these disorders from a disease-based, reductionistic model, where the effort is directed toward identifying a single underlying biological etiology, to a more integrated, biopsychosocial model of illness.4 5 The latter model allows for symptoms to be understood as physiologically