Comorbidity of Psychological Symptoms in FGIDs

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Stress and psychological factors play a major role in the pathophysiology and clinical presentation of IBS. Stress may be central (eg, psychological distress) or peripheral (eg, infection, surgery) in origin. Patients with IBS report more lifetime and daily stressful events, including abuse, compared with patients with organic GI conditions or healthy individuals. A thorough history usually uncovers that stress is strongly associated with symptom onset, exacerbation, and severity in IBS.

A large proportion of patients with IBS or other functional bowel disorders have coexistent psychological disturbances, particularly those with severe symptoms or those seen in tertiary care referral centers. Psychosocial factors have been recognized to modify the illness experience and influence health care utilization and treatment outcome. These psychosocial factors include a history of emotional, sexual or physical abuse, stressful life events, chronic social stress, anxiety disorders, or maladaptive coping styles. However, the psychological profiles of individuals with IBS who have not sought health care for their GI symptoms are similar to those of healthy individuals. Thus, although psychosocial factors are not etiologic to IBS, they appear to influence health care seeking, illness behavior, and treatment response. Currently, the role of psychosocial factors and stress in FGIDs has been conceptualized in the following manner: adverse life experiences (past and present) influence (1) stress responsiveness, (2) physiological responses, and (3) susceptibility to developing and exacerbating FGIDs via amplification of brain-gut interactions.

The beneficial effects of psychotropic agents is most likely due to their effects on pain modulation (eg, tricyclic antidepressants [TCAs]) and, treatment of comorbid psychological symptoms (eg, higher doses of TCAs and selective serotonin reuptake inhibitors [SSRIs]).

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