Functional gastrointestinal disorders: psychological, social, and somatic features

Abstract

Background-Psychological, social, and extraintestinal (somatic) disturbances are prominent features of functional gastrointestinal disorders (FGID); little attention, however, has been given to diVerences in the nature of these disturbances in the various FGID subgroups. Aims-(1) To determine whether psychological, social, and extraintestinal factors are associated with specific FGID, and/or with the overall severity and extent of FGID disturbance (the number of coexistent FGID subgroups present in any individual); and (2) to determine whether chronic social stressors link gastrointestinal, extraintestinal, and emotional symptomatologies in FGID. Patients-One hundred and eighty eight outpatients, fulfilling standard criteria for one or more functional gastroduodenal or functional bowel disorders. Methods-Utilising detailed and objective interview and questionnaire methods, detailed gastrointestinal, extraintestinal, psychological, and social data were collected. Results-Chronic stressors and extraintestinal and emotional symptomatologies were prominent features of functional dyspepsia (FD) and irritable bowel syndrome (IBS) alone. These particular features were, however, highly specific for particular FD and/or IBS subgroups. The chronic threat component of social stressors predicted the nature and extent of multisystem (gastrointestinal, extraintestinal, and emotional) symptomatology. Conclusions-Notable diVerences between the various FGID subgroups support the symptom based classification of FGID. Chronic stressor provoked psychological and extraintestinal disturbance is most specific for the FD-IBS group of syndromes. (Gut 1998;42:414-420) Keywords: functional gastrointestinal disorders; psychosocial; extraintestinal symptoms; chronic stressThe functional gastrointestinal disorders (FGID) are common disorders in gastroenterology practice and in the community. Although several FGID syndromes may coexist in an individual patient, each syndrome can be reliably identified as a distinct and homogeneous entity.1 Psychological, social, 2-4 and extraintestinal (somatic) disturbances [5][6][7][8][9] are prominent features of FGID in general; whether such factors are distinctive of specific FGID syndromes or subgroups (distinct clusters of symptoms), or whether they reflect the overall severity and/or extent of functional gut disturbance (number of coexistent FGID syndromes), has received little attention. Furthermore, although social stressors that are severe, chronic, and threatening have been implicated in the development of FGID, 3 4 no study has previously assessed the relation of specific objective measures of social stressors to coexistent gastrointestinal, extraintestinal, and emotional symptomatologies in the FGIDs.Our specific aims were therefore, in a large group of patients with various functional gastroduodenal and functional bowel disorders, to determine: (1) the relative importance of specific psychological, social, and extraintestinal (somatic) factors to specific FGID, and/or to severe and e...

Prokinetic effect of gut‐oriented hypnosis on gastric emptying

“…5,10,11 In addition, dyspeptic patients score higher than controls in terms of anxiety, depression and neuroticism, suggesting that psychological factors may aggravate symptoms and that there may be a therapeutic role for psychological intervention. [13][14][15] Better established is the efficacy of treatment with gastrokinetic drugs. 9 Cisapride has been shown to accelerate gastric emptying and improve symptoms in functional dyspepsia.…”

“…[10][11][12] Patients with functional dyspepsia report higher rates of anxiety and depression and higher levels of exposure to chronic social stressors than other functional gut syndromes. 13,14 Encouraging results have been obtained by psychodynamic psychotherapy, 15 but this is a complex treatment requiring referral to a dedicated psychotherapist and may not be accepted by the patient. Hypnosis is a well known relaxation and stress management technique that has been used by gastroenterologists to treat irritable bowel syndrome and to decrease peptic ulcer relapse.…”

Pathophysiology and treatment of functional dyspepsia

“…It has been suggested that unremitting chronic stress may continue to increase the severity and extent of gastrointestinal, emotional, and extraintestinal symptoms over time. 93 A review of clinical trials of psychologic interventions for functional dyspepsia showed potential benefits in the treatment of functional dyspepsia. 94 A recent study in 95 consecutive patients with functional dyspepsia who had failed to respond to conventional pharmacologic treatments has shown that psychotherapy may have both short-and long-term beneficial effects in patients with functional dyspepsia.…”

Involvement of vasopressin 3 receptors in chronic psychological stress-induced visceral hyperalgesia in rats

“…Although the pathophysiological basis of IBS is incompletely understood, epidemiological and experimental data indicate an important role of altered brain-gut interactions in this disorder. For example, many studies have highlighted the importance of certain types of psychological stress in the onset, maintenance, and exacerbation of IBS symptoms (5,6,32,33). Furthermore, higher levels of anxiety, symptom-related anxiety, and comorbidity with anxiety disorders or depression are common in patients with IBS (32,33,49).…”