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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.
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