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Abstract

Some patients with more severe disorders of gut-brain interaction (DGBI) will fail to improve with gut-directed therapies and dietary change. Some of them will require use of central neuromodulators, and many will benefit from psychological therapies. The importance of a biopsychosocial model for functional gastrointestinal disorders is discussed. The significance of anxiety, depression, and early life trauma in determining the severity of functional GI disorders is reviewed. The incidence of psychiatric abnormalities in patients with IBS and other FGIDs is examined. The benefit of different psychological therapies for managing DBGIs is evaluated.

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References

  1. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129. https://doi.org/10.1126/science.847460.

    Article  CAS  PubMed  Google Scholar 

  2. Drossman DA. Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med. 1998;60:258. https://doi.org/10.1097/00006842-199805000-00007.

    Article  CAS  PubMed  Google Scholar 

  3. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17(2):131–9. https://doi.org/10.5056/jnm.2011.17.2.131.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43:256. https://doi.org/10.1136/gut.43.2.256.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Walker LS, Garber J, Smith CA, Van Slyke DA, Claar RL. The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain. J Consult Clin Psychol. 2001;69:85. https://doi.org/10.1037/0022-006X.69.1.85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861. https://doi.org/10.1136/gut.47.6.861.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ford MJ, Miller PM, Eastwood J, Eastwood MA. Life events, psychiatric illness and the irritable bowel syndrome. Gut. 1987;28:160. https://doi.org/10.1136/gut.28.2.160.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Creed F, Guthrie E. Psychological factors in the irritable bowel syndrome. Gut. 1987;28:1307. https://doi.org/10.1136/gut.28.10.1307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Toner BB, Garfinkel PE, Jeejeebhoy KN. Psychological factors in irritable bowel syndrome. Can J Psychiatr. 1990;35:158.

    Article  CAS  Google Scholar 

  10. Osterberg E, Blomquist L, Krakau I, Weinryb RM, Asberg M, Hultcrantz R. A population study on irritable bowel syndrome and mental health. Scand J Gastroenterol. 2000;35(3):264–8.

    Article  CAS  PubMed  Google Scholar 

  11. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140. https://doi.org/10.1053/gast.2002.32392.

    Article  PubMed  Google Scholar 

  12. Lydiard RB. Irritable bowel syndrome, anxiety, and depression: what are the links? J Clin Psychiatry. 2001;62(Suppl 8):38–45; discussion 46–7. http://www.ncbi.nlm.nih.gov/pubmed/12108820. Accessed 28 Aug 2016.

    PubMed  Google Scholar 

  13. Lee S, Wu J, Ma YL, Tsang A, Guo W-J, Sung J. Research article: irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study. Aliment Pharmacol Ther. 2009;30:643. https://doi.org/10.1111/j.1365-2036.2009.04074.x.

    Article  CAS  PubMed  Google Scholar 

  14. Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113(11):828–33.

    Article  CAS  PubMed  Google Scholar 

  15. Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G, Glogau L. Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med. 1996;58:4. https://doi.org/10.1097/00006842-199601000-00002.

    Article  CAS  PubMed  Google Scholar 

  16. Drossman DA. Abuse, trauma, and GI illness: is there a link. Am J Gastroenterol. 2011;106:14. https://doi.org/10.1038/ajg.2010.453.

    Article  PubMed  Google Scholar 

  17. Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry. 1993;150:1502. https://doi.org/10.1176/ajp.150.10.1502.

    Article  CAS  PubMed  Google Scholar 

  18. Lackner JM, Brasel AM, Quigley BM, et al. The ties that bind: perceived social support, stress, and IBS in severely affected patients. Neurogastroenterol Motil. 2010;22:893. https://doi.org/10.1111/j.1365-2982.2010.01516.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Drossman DA, Whitehead WE, Toner BB, et al. What determines severity among patients with painful functional bowel disorders? Am J Gastroenterol. 2000;95:974. https://doi.org/10.1016/S0002-9270(00)00728-0.

    Article  CAS  PubMed  Google Scholar 

  20. Van Oudenhove L, Levy RL, Crowell MD, et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders. Gastroenterology. 2016;150(6):1355–1367e2. https://doi.org/10.1053/j.gastro.2016.02.027.

    Article  Google Scholar 

  21. Neal KR, Barker L, Spiller RC. Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut. 2002;51:410. https://doi.org/10.1136/gut.51.3.410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Levy RL, Whitehead WE, Walker LS, et al. Increased somatic complaints and health-care utilization in children: effects of parent IBS status and parent response to gastrointestinal symptoms. Am J Gastroenterol. 2004;99:2442. https://doi.org/10.1111/j.1572-0241.2004.40478.x.

    Article  PubMed  Google Scholar 

  23. Drossman DA. Redux: do little bellyachers grow up to become big bellyachers? Clin Gastroenterol Hepatol. 2014;12:2033. https://doi.org/10.1016/j.cgh.2014.06.009.

    Article  PubMed  Google Scholar 

  24. Drossman DA, Leserman J, Li Z, Keefe F, Hu YJ, Toomey TC. Effects of coping on health outcome among women with gastrointestinal disorders. Psychosom Med. 2000;62:309. https://doi.org/10.1097/00006842-200005000-00004.

    Article  CAS  PubMed  Google Scholar 

  25. Drossman DA, McKee DC, Sandler RS, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988;95(3):701–8.

    Article  CAS  PubMed  Google Scholar 

  26. Young SJ, Alpers DH, Norland CC, Woodruff RA. Psychiatric illness and the irritable bowel syndrome. Practical implications for the primary physician. Gastroenterology. 1976;70(2):162–6.

    Article  CAS  PubMed  Google Scholar 

  27. Sperber AD, Drossman DA. Review article: the functional abdominal pain syndrome. Aliment Pharmacol Ther. 2011;33(5):514–24. https://doi.org/10.1111/j.1365-2036.2010.04561.x.

    Article  CAS  PubMed  Google Scholar 

  28. Törnblom H, Drossman DA. Centrally targeted pharmacotherapy for chronic abdominal pain. Neurogastroenterol Motil. 2015;27(4):455–67. https://doi.org/10.1111/nmo.12509.

    Article  PubMed  Google Scholar 

  29. Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381–96. https://doi.org/10.1146/annurev-med-012309-103958.

    Article  CAS  PubMed  Google Scholar 

  30. Drossman DA, Ringel Y, Vogt BA, et al. Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome. Gastroenterology. 2003;124:754. https://doi.org/10.1053/gast.2003.50103.

    Article  PubMed  Google Scholar 

  31. Seminowicz DA, Labus JS, Bueller JA, et al. Regional gray matter density changes in brains of patients with irritable bowel syndrome. Gastroenterology. 2010;139(1):48–57.e2. https://doi.org/10.1053/j.gastro.2010.03.049.

    Article  PubMed  Google Scholar 

  32. Jones MP, Dilley JB, Drossman D, Crowell MD. Brain-gut connections in functional GI disorders: anatomic and physiologic relationships. Neurogastroenterol Motil. 2006;18:91. https://doi.org/10.1111/j.1365-2982.2005.00730.x.

    Article  CAS  PubMed  Google Scholar 

  33. Dekel R, Drossman DA, Sperber AD. The use of psychotropic drugs in irritable bowel syndrome. Expert Opin Investig Drugs. 2013;22(3):329–39. https://doi.org/10.1517/13543784.2013.761205.

    Article  CAS  PubMed  Google Scholar 

  34. Dorn SD, Palsson OS, Thiwan SIM, et al. Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. Gut. 2007;56(9):1202–9. https://doi.org/10.1136/gut.2006.117390.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Clouse RE, Lustman PJ. Use of psychopharmacological agents for functional gastrointestinal disorders. Gut. 2005;54(9):1332–41. https://doi.org/10.1136/gut.2004.048884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lackner JM, Ma CX, Keefer L, et al. Type, rather than number, of mental and physical comorbidities increases the severity of symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2013;11:1147. https://doi.org/10.1016/j.cgh.2013.03.011.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sperber AD, Dekel R. Irritable bowel syndrome and co-morbid gastrointestinal and extra-gastrointestinal functional syndromes. J Neurogastroenterol Motil. 2010;16:113. https://doi.org/10.5056/jnm.2010.16.2.113.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ford AC, Quigley EMM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350–65; quiz 1366. https://doi.org/10.1038/ajg.2014.148.

    Article  CAS  PubMed  Google Scholar 

  39. Lackner JM, Mesmer C, Morley S, Dowzer C, Hamilton S. Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol. 2004;72:1100. https://doi.org/10.1037/0022-006X.72.6.1100.

    Article  PubMed  Google Scholar 

  40. Lydiard RB, Greenwald S, Weissman MM, Johnson J, Drossman DA, Ballenger JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiatry. 1994;151:64. https://doi.org/10.1176/ajp.151.1.64.

    Article  CAS  PubMed  Google Scholar 

  41. Spiegel BMR, Khanna D, Bolus R, Agarwal N, Khanna P, Chang L. Understanding gastrointestinal distress: a framework for clinical practice. Am J Gastroenterol. 2011;106:380. https://doi.org/10.1038/ajg.2010.383.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Levy RL, Langer SL, Walker LS, et al. Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol. 2010;105:946. https://doi.org/10.1038/ajg.2010.106.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Toner BB, Segal ZV, Emmott S, et al. Cognitive-behavioral group therapy for patients with irritable bowel syndrome. Int J Group Psychother. 1998;48:215.

    Article  CAS  PubMed  Google Scholar 

  44. Hunt MG. Reclaim your life from IBS. New York: Sterling; 2016.

    Google Scholar 

  45. Keefer L. Extinguishing fear of gastrointestinal symptoms to treat functional gastrointestinal disorders. Clin Gastroenterol Hepatol. 2016;14:1559. https://doi.org/10.1016/j.cgh.2016.07.004.

    Article  PubMed  Google Scholar 

  46. Bremner JD. Does stress damage the brain. Biol Psychiatry. 1999;45:797. https://doi.org/10.1016/S0006-3223(99)00009-8.

    Article  CAS  PubMed  Google Scholar 

  47. Perera TD, Park S, Nemirovskaya Y. Cognitive role of neurogenesis in depression and antidepressant treatment. Neuroscientist. 2008;14:326. https://doi.org/10.1177/1073858408317242.

    Article  PubMed  Google Scholar 

  48. Brunoni AR, Lopes M, Fregni F. A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol. 2008;11(8):1169–80. https://doi.org/10.1017/S1461145708009309.

    Article  CAS  PubMed  Google Scholar 

  49. Blankstein U, Chen J, Diamant NE, Davis KD. Altered brain structure in irritable bowel syndrome: potential contributions of pre-existing and disease-driven factors. Gastroenterology. 2010;138(5):1783–9. https://doi.org/10.1053/j.gastro.2009.12.043.

    Article  PubMed  Google Scholar 

  50. Mayer EA, Brunnhuber S. Gastrointestinal disorders. Handb Clin Neurol. 2012;106:607–31. https://doi.org/10.1016/B978-0-444-52002-9.00036-X.

    Article  PubMed  Google Scholar 

  51. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150:1262. https://doi.org/10.1053/j.gastro.2016.02.032.

    Article  Google Scholar 

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Sobin, W.H. (2019). The Gut-Brain Connection and Its Significance to Gastroenterologists. In: Sobin, W. (eds) Using Central Neuromodulators and Psychological Therapies to Manage Patients with Disorders of Gut-Brain Interaction. Springer, Cham. https://doi.org/10.1007/978-3-030-18218-2_1

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  • DOI: https://doi.org/10.1007/978-3-030-18218-2_1

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