Summary
The functional gastrointestinal disorders (FGID) are the most frequent clinical conditions seen in practice. The FGID are associated with significant work absenteeism, impaired quality of life and increased medical costs. Most patients also suffer from psychosocial problems. Therefore it is important to define the patient's complaints in terms of a biopsychosocial disorder rather than just a medical illness. Physicians must acknowledge the relevance of the psychosocial aspects to prepare the patient for a referral to a specialist (in psychosomatic medicine or a psychotherapist) and to get the patient interested in the psychological factors involved as well as further explore their cause. Most of the research on psychotherapy in FGID to date has focused on the irritable bowel syndrome, and different methods of treatments have been studied (e. g., cognitive-behavioral therapy, dynamic psychotherapy, hypnotherapy, and relaxation). Randomised controlled studies have shown that psychotherapy is superior to conventional medical therapy. Hypnotherapy seems to be very successful. Predictors of a positive response to psychological treatment generally are: (1) awareness that stress exacerbates their bowel symptoms, (2) mild anxiety or depression, (3) the predominant bowel symptom is abdominal pain or diarrhea and not constipation, (4) the abdominal pain waxes and wanes in response to eating, defecation, or stress rather than being constant pain, and (5) the symptoms are of relatively short duration. Psychotherapy is initially relatively expensive because it requires multiple, long sessions. However, its benefits persist or even increase over time, and in the long run, there may be a reduction in clinic visits and health care costs which offsets the initial cost of psychological treatment.
Zusammenfassung
Funktionelle gastrointestinale Störungen (FGIS) stellen die häufigsten Erkrankungen in den ärztlichen Ordinationen dar. Die FGIS sind mit häufiger Arbeitsunfähigkeit, Verminderung der Lebensqualität und hohen medizinischen Kosten verbunden. Die meisten Patienten leiden unter psychosozialen Problemen. Deshalb ist es wichtig, die Beschwerden der Betroffenen in Bezug auf ihre bio-psycho-soziale Situation zu beurteilen und ihr Zustandsbild nicht allein als biomedizinische Krankheit zu definieren. Betreuende Ärzte und Ärztinnen sollten die Relevanz der psychosozialen Aspekte erkennen, damit sie die Betroffenen für eine Überweisung zu Spezialisten (Psychosomatiker/innen, Psychotherapeut/inn/en) vorbereiten und dafür interessieren bzw. motivieren können, beteiligte psychologische Faktoren weiter explorieren zu lassen. Die meisten Forschungsergebnisse zu Psychotherapie bei FGIS fokussieren auf das Reizdarmsyndrom, wobei verschiedenen Therapiemethoden (z. B. Verhaltenstherapie, Psychodynamische Therapie, Hypnotherapie oder Entspannungstechniken) untersucht wurden. Randomisiert kontrollierte Psychotherapie- Studien mit Nachuntersuchung zeigen eine deutliche Überlegenheit der Psychotherapien gegenüber den konventionell medikamentösen Therapien. Enorm erfolgreich scheint die "gut-directed" Hypnose zu sein. Positives Ansprechen auf Psychotherapie allgemein ist wahrscheinlich, wenn: (1) Stress die Symptome verstärkt oder auslöst, (2) milde Angst und Depression vorhanden ist, (3) das vorherrschende Symptom Schmerz und Durchfall, und nicht Verstopfung ist, (4) der Schmerz sich mit Nahrungsaufnahme, Defäkation oder Stress verändert und nicht konstant vorhanden ist, und (5) das Beschwerdebild noch relativ kurz andauert. Psychotherapie ist zu Beginn relativ teuer, denn sie bedarf mehrerer längerer Sitzungen. Ihr Erfolg bleibt aber bestehen oder verstärkt sich langfristig sogar, da die Arztbesuche und medizinischen Kosten auf Dauer reduziert und dadurch die Kosten der Psychotherapie wieder eingebracht werden können.
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Moser, G. Funktionelle gastrointestinale Störungen. Wien Med Wochenschr 156, 435–440 (2006). https://doi.org/10.1007/s10354-006-0323-4
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DOI: https://doi.org/10.1007/s10354-006-0323-4
Keywords
- Functional gastrointestinal disorders
- Stress
- Psychosomatic medicine
- Irritable bowel syndrome
- Psychotherapy