Biopsychosocial Aspects of Functional Gastrointestinal Disorders

Lukas Van Oudenhove; Michael D Crowell; Douglas A Drossman; Albena D Halpert; Laurie Keefer; Jeffrey M Lackner; Tasha B Murphy; Bruce D Naliboff; Rona L Levy

doi:10.1053/j.gastro.2016.02.027

Biopsychosocial Aspects of Functional Gastrointestinal Disorders

Gastroenterology. 2016 Feb 18:S0016-5085(16)00218-3. doi: 10.1053/j.gastro.2016.02.027. Online ahead of print.

Authors

Lukas Van Oudenhove¹, Michael D Crowell², Douglas A Drossman³, Albena D Halpert⁴, Laurie Keefer⁵, Jeffrey M Lackner⁶, Tasha B Murphy⁷, Bruce D Naliboff⁸, Rona L Levy⁷

Affiliations

¹ Laboratory for Brain-Gut Axis Studies (LABGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium.
² Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA.
³ Professor Emeritus of Medicine and Psychiatry, University of North Carolina, Center for Education and Practice of Biopsychosocial Care LLC, Drossman Gastroenterology PLLC, Chapel Hill, NC, USA.
⁴ Center for Digestive Disorders, Boston Medical Center, USA, Pentucket Medical Associates, Haverhill, MA, USA.
⁵ Division of Gastroenterology, Ichan School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Behavioral Medicine Clinic, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, State University of New York, NY, USA.
⁷ Behavioral Medicine Research Group, School of Social Work, University of Washington, Seattle, WA, USA.
⁸ Center for Neurobiology of Stress, Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Abstract

In this paper, we provide a general framework for understanding the functional gastrointestinal disorders (FGID) from a biopsychosocial perspective. More specifically, we provide an overview of the recent research on how the complex interactions of environmental, psychological, and biological factors contribute to the development and maintenance of the FGID. We emphasize that considering and addressing all these factors is a conditio sine qua non for appropriate treatment of these conditions. First, we provide an overview of what is currently known about how each of these factors - the environment, including the influence of those in an individual's family, the individual's own psychological states and traits, and the individual's (neuro)physiological make-up - interact to ultimately result in the generation of FGID symptoms. Second, we provide an overview of commonly used assessment tools which can assist clinicians in obtaining a more comprehensive assessment of these factors in their patients. Finally, the broader perspective outlined earlier is applied to provide an overview of centrally acting treatment strategies, both psychological and pharmacological, which have been shown to be efficacious to treat FGID.

Keywords: Adverse life events; anxiety; cognitive behavioral therapy; depression; exposure treatments; hypnosis; somatic symptom disorder.

Grants and funding

U01 DK077738/DK/NIDDK NIH HHS/United States