Gut 1999;45(Suppl 2):II25-II30 ( September )

Psychosocial aspects of the functional gastrointestinal disorders

D A Drossman^a, F H Creed^b, K W Olden^c, J Svedlund^d, B B Toner^e, W E Whitehead^f

^a Chair, Committee on Psychosocial Factors of the Functional Gastrointestinal Disorders, Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome II), University of North Carolina, Chapel Hill, NC, USA, ^b Co-Chair, Committee on Psychosocial Factors of the Functional Gastrointestinal Disorders, Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome II), University of Manchester, Manchester, UK, ^c Mayo Clinic- Scottsdale, Scottsdale, AZ, USA, ^d Sahlgrenska University Hospital, Göteborg, Sweden, ^e Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada, ^f Professor of Medicine, University of North Carolina, Chapel Hill, NC, USA

Correspondence to: Douglas A Drossman, MD, Division of Digestive Diseases, 726 Burnett-Womack Bldg, CB #7080, University of North Carolina, Chapel Hill, NC 27599-7080, USA. Email: drossman{at}med.unc.edu

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 effects 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 offered. Features of motility, personality, abuse history, health concerns, and treatment-seeking differ 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.


Keywords: functional gastrointestinal disorders; psychologic assessment; psychiatric diagnosis; psychosocial factors; health-related quality of life; psychological treatment; psychopharmacological treatment; Rome II

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© 1999 by Gut
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