Functional gastrointestinal disorders: psychological, social, and somatic features

Abstract

Background: Psychological, social, and extraintestinal (somatic) disturbances are prominent features of functional gastrointestinal disorders (FGID); little attention, however, has been given to differences in the nature of these disturbances in the various FGID subgroups.

Aims: (1) To determine whether psychological, social, and extraintestinal factors are associated with specific FGID, and/or with the overall severity and extent of FGID disturbance (the number of coexistent FGID subgroups present in any individual); and (2) to determine whether chronic social stressors link gastrointestinal, extraintestinal, and emotional symptomatologies in FGID.

Patients: One hundred and eighty eight outpatients, fulfilling standard criteria for one or more functional gastroduodenal or functional bowel disorders.

Methods: Utilising detailed and objective interview and questionnaire methods, detailed gastrointestinal, extraintestinal, psychological, and social data were collected.

Results: Chronic stressors and extraintestinal and emotional symptomatologies were prominent features of functional dyspepsia (FD) and irritable bowel syndrome (IBS) alone. These particular features were, however, highly specific for particular FD and/or IBS subgroups. The chronic threat component of social stressors predicted the nature and extent of multisystem (gastrointestinal, extraintestinal, and emotional) symptomatology.

Conclusions: Notable differences between the various FGID subgroups support the symptom based classification of FGID. Chronic stressor provoked psychological and extraintestinal disturbance is most specific for the FD-IBS group of syndromes.

Figure 1

Distribution of chronic stressors (n=451) across seven life stress categories; percentages represent the relative frequency of each category of chronic stressors (as a proportion of all chronic stressors).

Figure 2

Graphic representation of the three way linear relation between emotional symptoms (anxiety, depression), the number of FGID subgroups present in an individual, and the number of extraintestinal symptoms (EIS); and the effects on each of these dimensions of chronic social stressor threat. Probability values are shown for each linear relation determined from Pearson correlation analysis.