Functional dyspepsia: Are psychosocial factors of relevance?
Functional dyspepsia: Are psychosocial factors of relevance?
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DOI：
10.3748/wjg.v12.i17.2701
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发表时间：
2006-05-07
影响因子：
4.3
通讯作者：
Dinan, Timothy G.
中科院分区：
文献类型：
--
作者：
Barry, Sandra;Dinan, Timothy G.
功能性消化不良（FD）的发病机制尚不清楚，表现出多样性，因此没有得到充分的理解。与其他功能性胃肠疾病类似，研究表明这种常见的诊断与心理社会因素和精神病发病率之间存在关联。概念化FD综合征中这些因素的相关性需要应用疾病的生物心理社会模型。使用这种范式，大脑和肠道之间的相互交流失调是症状产生、解释和恶化的核心。对各种心理状态的神经生物学相关性的欣赏和理解也是相关的。社会心理因素主要通过寻求医疗保健的动机对FD产生影响的观点也仍然存在。鉴于现有证据支持更内在的病因联系，这似乎是一个过于一维的断言。不断发展的理解的致病机制和异质性的综合征将有助于有效的管理。共病精神疾病需要用常规疗法治疗。承认FD中的心理社会变量的相关性，其程度是受变化的影响，有评估和管理的影响。现有的证据表明，心理治疗可能有利于FD患者，特别是那些慢性症状。FD患者使用精神药物的理由是显而易见的，但迄今为止支持使用抗抑郁药物治疗的证据基础有限。(C)2006年，WJG出版社。All rights reserved.
The pathogenesis of Functional Dyspepsia (FD) remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intrinsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to variation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited. (C) 2006 The WJG Press. All rights reserved.