Psychosocial aspects of the functional gastrointestinal disorders

Abstract

The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroenterology practice and comprise a major portion of primary care. Psychosocial factors are important in these disorders with regard to: (1) their eVects on gut physiology; (2) their modulation of the symptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper provides a review and consensus of the existing literature by gastroenterologists, psychiatrists, psychologists, physiologists, and health services investigators. Evidence is provided to support the biopsychosocial model as a basis for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physiology, symptom presentation, health behavior, and outcome is oVered. Features of motility, personality, abuse history, health concerns, and treatment-seeking diVer between patients with FGID and healthy controls, but they are not specific to FGID. They occur in other patients with chronic medical conditions and/or psychiatric disorders. Review of treatment trials indicates clear support for psychotherapeutic treatments, especially in the long term, as well as some evidence for the benefit of antidepressants in FGID, even in the absence of improvements in mood. (Gut 1999;45(Suppl II):II25-II30)

Helicobacter pylori Infection Impacts on Functional Dyspepsia in Thailand

“…Psychological distress has been widely accepted as an important factor of FD (Haug et al, 1995;Drossman et al, 1999;Locke et al, 2004). Several studies showed that the anxiety, depression and somatoform disorders were the most common psychiatric problems found in patients with FD (Magni et al, 1987;Haug et al, 1994).…”

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

“…Th is study used a standard questionnaire to assess Valsalva maneuver-related activities including constipation ( 15 ), vomiting ( 16 ), and cough ( 17 ), and also assess alcohol consumption ( 18 ) and use of NSAID ( 13,14 ) in the week preceding inclusion in the study. A trained study nurse, who was blinded to the results of the endoscopy, met all subjects within 24 h post-endoscopy to provide instructions to complete the questionnaire.…”

“…Constipation was defi ned according to the modifi ed Rome II criteria ( 15 ) and was diagnosed if subjects had at least two of the following constipation symptoms in the week directly preceding the study: straining, lumpy or hard stool, sensation of incomplete evacuation, sensation of anorectal obstruction / blockage, or manual maneuvers to facilitate defecation during at least 25 % of defecations or fewer than three defecations per week. Severity of constipation was indicated by calculation of a symptom score based on the number of constipation symptoms.…”

Cigarette Smoking and its Association with Overlapping Gastroesophageal Reflux Disease, Functional Dyspepsia, or Irritable Bowel Syndrome

“…FD is a disorder in which upper abdominal symptoms occur in the absence of organic disease that explains them (5). Patients with FD complain of meal-induced dyspeptic symptoms such as postprandial fullness and early satiation, and/or epigastric pain or burning sensation according to the Rome III criteria (5). IBS is characterized by abdominal pain or discomfort, and is associated with disturbed defecation (5).…”

“…GERD is caused by an abnormal reflux of gastric contents into the esophagus and is characterized by bothersome symptoms such as heartburn and acid regurgitation (4). FD is a disorder in which upper abdominal symptoms occur in the absence of organic disease that explains them (5). Patients with FD complain of meal-induced dyspeptic symptoms such as postprandial fullness and early satiation, and/or epigastric pain or burning sensation according to the Rome III criteria (5).…”