Gastrointestinal Disorders


Common GI Disorders


Resources for Families

Advisory Committee

Publication Information


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Gastrointestinal (GI) disorders are common secondary conditions of developmental disabilities. The four most prevalent disorders, which are described in detail in this document, are gastroesophageal reflux disease, gastritis, chronic constipation, and chronic diarrhea.

Many treatments are available to relieve symptoms of gastrointestinal disorders. It is important to note, however, that many of these treatments fail to cure the underlying problem. Because the patient may not experience pain or discomfort, it is possible for internal damage to continue without the physician’s knowledge, which can lead to serious conditions if not addressed.

The recommendations presented in this document are in addition to the normal medical care provided to an individual without gastrointestinal disorders. All recommendations can be addressed through clinical examination by the primary care provider, unless otherwise noted.


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Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a chronic, progressive disorder involving the backward flow of gastroduodenal contents into the esophagus. GERD is the most common serious condition of the gastrointestinal (GI) tract. It is caused by (1) a defective lower esophageal sphincter; (2) a gastric emptying disorder; or (3) failed esophageal peristalsis.

GERD affects 15-20% of the developmentally disabled population.

Return to the index for a full document on GERD.



Gastritis is an inflammatory reaction in the stomach, typically involving the mucosa. Symptoms include epigastric distress (often aggravated by eating), anorexia, nausea with or without vomiting, and hiccups.


  • Helicobacter pylori or other bacterial infection
  • Duodeno-gastric reflux (DGR) (reflux of bile salts and pancreatic enzymes into the stomach)
  • Viral infection
  • Medications such as steroids
  • Mucosal injury by a noxious chemical agent
  • Stress ulceration (hypovolemia, hypoxia)
  • Gastric mucosal atrophy

Possible Complications

  • Gastrointestinal bleeding
  • Peptic ulceration
  • Atrophic gastritis
  • Gastric mucosal atrophy
  • Gastric cancer


DGR is diagnosed by isotopic gastric emptying studies. H. pylori infection may be diagnosed by endoscopic biopsy with CLO test and histopathological exam.


Almost all treatment is outpatient, except for severe hemorrhagic gastritis caused by stress ulceration. Most cases clear spontaneously when the cause has been identified and treated, although H. pylori infection may require a repeated course of treatment.


  • Antacids in liquid form (one hour after meals and at bedtime)
  • H2 receptor antagonists (cimetidine, ranitidine, famotidine, or nizatidine)
  • Sucralfate
  • Prostaglandins (misoprostol)
  • Light, soft diet
  • Parenteral fluid and electrolyte supplements if vomiting prevents food intake
  • No caffeine or smoking
  • No noxious chemical agents (drugs and alcohol)
  • Repeat gastroscopy after 6 weeks if gastritis is severe

Duodeno-gastric reflux (DGR) :

  • Prokinetic agents
  • Cholestyramine
  1. pylori infection:
  • Triple-therapy: bismuth subsalicylate plus metronidazole plus amoxicillin. Tetracycline can be safely substituted for amoxicillin in adolescents and adults.
  • Dual-therapy: amoxicillin and metronidazole;
  • Dual-therapy: omeprazole plus amoxicillin; or
  • Short course (1 week): metronidazole, omeprazole, and clarithromycin bid (90% effective)

Chronic Constipation

Chronic constipation is a condition in which the stool accumulates, hardens, blocks up, and/or is difficult to expel, which may lead to three or more days between bowel movements. Chronic constipation is a symptom of an underlying problem and an issue for many people with developmental disabilities.

Return to the index for a full document on Chronic Constipation.

Chronic Diarrhea


Chronic diarrhea is characterized by the frequent passage of unformed, watery stools for more than three to four weeks.


Inflammatory diarrhea: inflammatory bowel disease, radiation enterocolitis, eosinophilic gastroenteritis, HIV/AIDS

Osmotic diarrhea: pancreatic insufficiency, bacterial overgrowth, celiac disease, lactase deficiency, Whipple’s disease, abetalipoproteinemia, short bowel syndrome, medications (colchicine, neomycin, para-aminosalicylic acid)

Factitious: laxative abuse

Secretory diarrhea: carcinoid syndrome, Zollinger-Ellison syndrome, vasoactive intestinal peptide-secreting pancreatic adenomas, medullary carcinoma of thyroid, villous adenoma of rectum, microscopic colitis, choleraic diarrhea

Altered intestinal motility: irritable bowel syndrome, fecal impaction, neurologic diseases, diabetes

Idiopathic diarrhea: unknown cause

Signs and Symptoms

  • Frequent loose stools
  • Fever
  • Abdominal pain
  • Weight loss
  • Tenesmus
  • Weakness
  • Nausea

Possible Complications

  • Dehydration
  • Malnutrition
  • Death

Laboratory/Diagnostic Procedures

  • Thorough history and medical exam
  • Stool: ova, parasites, leukocytes, fat, osmolality, occult blood
  • Serum: electrolytes, blood count, iron, vitamins B12 and D, folate, PT, albumin, cholesterol, carotene
  • D-xylose absorption test
  • Barium enema, KUB
  • Colonoscopy for inflammatory lesions, blood in stool or iron deficiency
  • Colonic biopsies for inflammatory diarrhea


Phase I: Lifestyle and Diet Modifications

  • Recommend fluids with electrolyte supplementation
  • Advise to avoid gluten products, sorbitol, lactose-containing products
  • Avoid or decrease medications that may cause diarrhea
  • Maintain thorough record of frequency and characteristics of stool
  • Maintain record of food and fluid intake
  • Observe for mucous, blood, undigested food, and small chunks in stool
  • Protect skin with barrier/protective ointment

Phase II: Medication (if lifestyle and diet modifications not effective)

  • Hydrophilic agents (psyllium)
  • Opiates for secretory diarrhea only
  • Diphenoxylate-atropine or loperamide
  • Kaolin-pectin
  • Octreotide for carcinoid syndrome; Omeprazole for Zollinger-Ellison syndrome
  • Indomethacin for carcinoma of thyroid and villous adenomas
  • H1 and H2 receptor antagonists for systemic mastocytosis
  • Cholestyramine for bile salt malabsorption; Lactase for lactose intolerance


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Peer-reviewed Journal Articles/Academies

Donowitz, M, et al. (1995). Evaluation of Patients with Chronic Diarrhea. New England Journal of Medicine, 332(11) 725-729.

Kuipers, E.J. (1997). Helicobacter Pylori and the Risk and Management of Associated Diseases: Gastritis, Ulcer Disease, Atrophic Gastritis and Gastric Cancer. Alimentary Pharmacology and Therapeutics, 11(1), 71-88.

Lipsky, M.S., Adelman, M. (1993). Chronic Diarrhea: Evaluation and Treatment. American Family Physician, 48(8),1461-1466.

Mertz, H. et al. (1999). Symptoms and Physiology in Severe Chronic Constipation. American Journal of Gastroenterology, 94(1), 131-138.

Nyam, D.C. et al. (1997). Long-term Results of Surgery for Chronic Constipation. Diseases of the Colon and Rectum, 40(3), 273-279.

Orchard, J.L. et al. (1995). Upper Gastrointestinal Tract Bleeding in Institutionalized Mentally Retarded Adults: Primary Role of Esophagitis. Archives of Family Medicine, 4(1) 30-33.

Projansky R. et al. (1994). Symptomatic H. Pylori Infection in Young Patients With Severe Neurologic Impairment. Journal of Pediatrics, 125, 750-752.

Tramonte, S.M. et al. (1997). The Treatment of Chronic Constipation in Adults: A Systematic Review. Journal of General Internal Medicine, 12(1) 15-24.

Van Zanten, V. (1998). Adding Once-daily Omeprazole 20mg to Metronidazole/Amoxicillin Treatment for Helicobacter pylori Gastritis. American Journal of Gastroenterology, 93, 5-10.

Special Interest Groups/Other Publications

Frank, D. (1999). Constipation. In M.R. Dambro (Ed.) Griffith’s 5 Minute Clinical Consult. (pp. 260-261.) Baltimore: Lippincott Williams & Wilkins.

Hoy, Douglas M. MD. (1999). Gastritis. In M.R. Dambro (Ed.) Griffith’s 5 Minute Clinical Consult (pp. 420-421.) Baltimore: Lippincott Williams & Wilkins.

Kastner, T. (1997). Helicobacter Pylori Infection in Institutional Settings. Exceptional Health Care (November).

Lewis, J.H. (1999). In M.R. Dambro (Ed.) Griffith’s 5 Minute Clinical Consult (pp. 422-423.) Baltimore: Lippincott Williams & Wilkins.

Neff, G.W., Sim, S. (1999). Diarrhea, Chronic.. In M.R. Dambro (Ed.) Griffith’s 5 Minute Clinical Consult.(pp. 318-319.) Baltimore: Lippincott Williams & Wilkins.

Smith Consultant Group and McGowan Consultants. (1998). Gastroesophageal Reflux Disease. In M.L. Snyder,(Ed.) Health and Wellness Reference Guide. (pp. 215-220.) Neri Productions, State of Tennessee Commission on Compliance.

Starrett, Andrea L. MD. 1991. In: Developmental Disabilities in Infancy and Childhood. Eds: Capute, Arnold J. and Pasquale J. Accardo. Baltimore: Paul H. Brookes Publishing Co., Inc., pp. 184-185.


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American Digestive Health Foundation, 800-668-5237

American Gastroenterological Association (AGA), 301-654-2055,

California Department of Developmental Services, 916-654-1690,

California Regional Centers, 916-654-1958,

Digestive Disease Week, 609-848-1000,

International Foundation for Functional Gastrointestinal Disorders, 888-964-2001,

Intestinal Disease Foundation, 412-261-5888

National Digestive Diseases Clearinghouse, 212-685-3440

National Institute of Diabetes, Digestive and Kidney Diseases,

Society of American Gastrointestinal Endoscopic Surgeons (SAGES), 310-314-2404


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Theodore A. Kastner, M.D., M.S.

Felice Weber Parisi, M.D., M.P.H.

Romie Holland, M.D.

Patrick J. Maher, M.D.

Howard L. Wolfinger, Jr., M.D.


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Funded by a grant from the California Department of Developmental Services

For more information, contact:

Center for Health Improvement

1330 21st Street, Suite 100

Sacramento, CA 95814

(916) 901-9645

This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.