Functional gastrointestinal disorders (FGIDs) are digestive disorders that arise from the interaction of physiological, psychosocial and social factors and are very common in clinical practice. Psychosocial factors play an important role in the pathogenesis of FGIDs, affecting not only patients’ gastrointestinal physiology, symptom expression and disease behavior, but also their quality of life, consultation requirements and medical costs. Psychotherapy and anti-anxiety-depression treatment can significantly improve the symptoms and pathophysiological abnormalities in patients with FGIDs. Psychosocial factors are closely related to FGIDs, in order to reduce the patient’s painful journey to the clinic! It is urgent to enhance the understanding of the role of psychosocial factors in FGIDs! Functional gastrointestinal disorders (FGIDs) are clinical syndromes with chronic and recurrent GI symptoms, but lacking evidence of anatomical, biochemical and pathological changes.FGIDs are common in both the population and patients attending the clinic, with a reported prevalence of 40% to 60% in patients attending gastroenterology specialists in Western countries. Although no large-scale epidemiological data are available in China, FGIDs are also very common in clinical practice! The treatment of these diseases is still difficult for physicians because the pathophysiology of FGIDs is not fully understood. In recent years, the transformation of the medical model of pathogenesis from a simplified biological model to an integrated biopsychosocialmode1 has increased our knowledge and understanding of FGIDs, and more attention has been paid to the importance of psychological abnormalities and social stress in the pathogenesis of the disease. 1. Psychosocial factors are important in the pathogenesis of FGIDs In long-term studies, it has been recognized that psychosocial factors are closely related to FGIDs. Patients with FGIDs often have extra-gastrointestinal symptoms, such as dyspnea, panic attacks, chronic headaches, and myalgia. Psychiatric disorders are also common in patients with FGIDs, especially in those with severe or persistent symptoms, with a prevalence of 42-61%. two of the most common disorders in FGIDs are functional dyspepsia (FD) and irritable bowel syndrome (IBS).
The common psychiatric abnormalities in patients with FD are anxiety, depression, and somatization disorders, with about 80% of
FD patients have mental abnormalities, while only 25% of patients with organic dyspepsia. 40% to 50% of IBS patients also have psychological disorders, 80% of IBS patients have episodes and exacerbations related to psychological factors and incorrect understanding of the disease, such as the belief that the stool must be formed, otherwise it is abnormal, IBS patients with mental abnormalities are mostly depression, followed by anxiety and somatization. IBS patients are mostly depressed, followed by anxiety and somatization disorders. 2, psychosocial factors can affect and aggravate the gastrointestinal performance of patients with FGIDs Anxiety, depression and fear can often lead to low gastrointestinal motility, while anger and disgust can lead to a high motility response. For example, stress can significantly accelerate the oral and cecum passage time in diarrheal IBS, thus aggravating diarrhea; slow down the oral and cecum passage time in constipated IBS, aggravating constipation. Psychosocial factors not only affect the gastrointestinal function of patients with FGIDs. Patients with FGIDs have a reduced quality of life, which is partly related to FGIDs symptoms, but mainly related to psychological factors. Repeated medical visits by patients with FGIDs are significantly associated with psychosocial factors, such as excessive anxiety and depression, and excessive worry about the disease. The prevalence of psychological disorders was significantly different in the IBS-visiting versus non-visiting population, depending mainly on patients’ perception and self-evaluation of the disease, while the former was associated with maladaptive behavior to the disease. This is manifested as a lack of awareness of gastrointestinal symptoms, overestimation of disease severity, and even suspicion of incurable disease resulting in more concern and anxiety symptoms in IBS patients, leading to frequent health care seeking behavior. Repeatedly seeking medical treatment will increase medical costs, and it is reported that the medical costs of patients with FGIDs can be reduced by at least 25% after psychotherapy. 3, psychotherapy, anti-anxiety and depression treatment can improve the symptoms and pathophysiological abnormalities of patients with FGIDs. For most patients with mild symptoms, psychological interventions are rarely given. The few FGIDs with co-morbidities or persistent symptoms of psychological disorders, especially those patients with significant psychological factors who prefer to spend a lot of time and effort on repeated unnecessary tests, need to develop complex psychological treatment programs. The goal of psychotherapy for FGIDs is not to cure the disease, but to: (1) eliminate the patient’s fear of the disease and build confidence in overcoming it; (2) reduce the frequency and intensity of the patient’s psycho-emotional stress; (3) alleviate clinical symptoms, reduce the frequency and severity of symptom attacks, and improve the quality of life; (4) reduce the number of repeated visits to the clinic. Reducing social and economic stress. For patients with FGIDs who have significant mental or emotional depression and anxiety, antidepressants and anxiolytics will be helpful. Selective 5-hydroxytryptamine reuptake inhibitors (SSRI) are the most commonly used antidepressants, and antidepressants can reduce the symptoms of FGIDs, and some patients’ symptoms disappear. Psychotherapy not only makes patients with FGIDs have significantly reduced psychiatric symptoms and hypochondria, but also significantly improves intestinal and somatic symptoms, which is a complement to conventional medical treatment and has a fairly good development prospect, especially for patients with refractory FGIDs. The implementation of psycho-psychological treatment should be tailored to the individual. The corresponding treatment plan should be formulated according to each patient’s specific situation. And timely adjustment according to the feedback. Psycho-psychotherapy for FGIDs is more effective through close cooperation between psychiatrists, family physicians, and gastroenterologists. And psycho-psychotherapy requires a certain quality of psycho-psychology for the therapist, and a certain time of practical training before entering clinical practice. In conclusion, FGIDs, as a typical disease of the biopsychosocial medicine model, has an increasing incidence, which seriously affects the quality of life of patients and greatly increases medical costs. Efforts must be made to popularize the close relationship between psychiatric and psychological factors, stress and life events and the onset of FGIDs, thus reducing the patient’s pungent journey to the clinic!