Trastornos funcionales digestivos y dolor abdominal: abordaje biopsicosocial / Digestive functional disorders and abdominal pain: biopsychosocial approach

Los pacientes que padecen trastornos funcionales gastrointestinales (TFG) son muy difíciles de tratar por el desconocimiento de la etiología de la enfermedad y las numerosas variables que se asocian a la misma. Esta revisión propone algunas estrategias para su manejo. El manejo inicial incluye tratamientos dirigidos a los síntomas y abordajes psicológicos como terapias breves dirigidas, entre otras cosas, a clarificar miedos a enfermedades graves. También se describe la importancia de explicarle al paciente en forma clara y precisa la fisiopatología de sus síntomas. El tratamiento de los TFG con antidepresivos ha mostrado efectividad, aún en ausencia de depresión

[The patient with refractory functional disorders of the gastrointestinal tract]. / El paciente digestivo funcional refractario: un desafío a la relación médico-paciente.

A group of patients with functional disorders of the gastrointestinal tract, manifest symptoms that are chronic, severe and invalidating. Their refractoriness to different treatments is a great challenge for physicians. They normally have a severe psychological and social dysfunction and an abnormal behavior towards their disease. All these factors lead these patients to perpetuate their illness condition. On the other hand, physicians usually have a negative reaction to their demands, leading to a non-satisfactory patient-physician relationship and to the failure of the healing process. Training in the systemic, biopsychosocial model of diseases and in interpersonal communication skills is required for an adequate management of these patients.

[Differences in the stress symptoms rating scale in Spanish between patients with irritable bowel syndrome (IBS) and healthy controls]. / Diferencias en la escala de gravedad de síntomas de estrés en español entre pacientes con síndrome de intestino irritable (SII) y controles sanos.

UNLABELLED: Irritable bowel syndrome (IBS) can be explained by the interrelation of cognitive components such as illness behavior, emotional such as depression and anxiety, behavioral such as environmental stressors, and physiologic such as pain modulation alterations. The stress symptom rating (SSR) scale is being used in physiologic studies in IBS, but differences between IBS patients and healthy controls in the basal condition is unknown. AIMS: To determine the basal differences in the SSR-Spanish between IBS patients and controls, and between IBS patients according to bowel-habit predominance. METHODS: Forty consecutive IBS-Roma 1 patients [M: 28 (78%), F:8(22.2%), 42.6 +/- 2.7 years] and 36 healthy volunteers paired by gender and age [M: 28 (78%), F:8 (22.2%); 36.7 +/- 2.1 years] were included. IBS were classified as constipation, diarrhea, or alternating. All completed the SSR prior to the medical visit. Mean group values of the different SSR parameters were compared by ANOVA. A p < 0.05 was considered significant. RESULTS: Compared with controls, IBS patients reported higher anxiety (p = 0.005), attention (p = 0.04) fatigue (p = 0.04), and lower arousal (p = 0.003). There were no differences in stress and anger either in IBS patients according to bowel-habit predominance. CONCLUSIONS: Under basal conditions, there are differences in anxiety, weakness, attention, and arousal between IBS patients and controls that correspond to intrinsic characteristics of IBS independent of bowel-habit predominance. Higher anxiety is in agreement with psychological comorbidity, higher attention with hypervigilance, and fatigue and lower arousal with sleep disturbances known to be present in IBS. Absence of differences in stress and anger under basal conditions suggests that SSR-Spanish is a good instrument to evaluate response to stress during physiologic paradigms.

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.

Síndrome de intestino irritable / Irritable bowel syndrome

Irritable bowel syndrome is a functional disease with highly variable symptoms and difficult to diagnose. The clinical picture is fundamental to reach a correct diagnosis and discard other gastrointestinal diseases. Its etiology is not well known; psychological problems and stress probably play an important role in the development of the disease. Irritable bowel syndrome impairs the quality of life of patients and is a frequent cause of consultation in primary care. Its therapy is basically symptomatic and requires psychological support. The physician must warn his/her patients that immediate results are rarely obtained and that a prolonged clinical follow up may be necessary

[Association between irritable intestinal syndrome and depressive symptoms in a population of high socioeconomical level of Lima]. / Asociación entre síndrome de intestino irritable y síntomas depresivos en una población de nivel socioeconómico alto de Lima.

Irritable Small Bowel (ISB) is the most common disorder in the gastroenterological practice. On the other hand, depression, is also common, and can produce somatic symptoms that could mislead the physician with respect to bowel diseases, particularly of the digestive system. The main objective of this work was to determine the relationship between lower digestive tract symptoms and symptoms of depression in a population of high socio-economic status in five districts of Lima. A cross-sectional study on the prevalence of lower digestive tract symptoms and symptoms of depression was carried out, together with a case-control study to evaluate the relationship between lower digestive tract symptoms and symptoms of depression. It included 300 individuals. The Beck Inventory for Depression and the Manning Criteria for ISB were used. Significant association (p<0.05) between lower digestive tract symptoms and symptoms of mild depression was found, with a OR=10.9 and significant statistical association between symptoms of moderate depression and lower digestive tract symptoms (p=0.01 and OR=3.48). It is concluded that there is a connection between lower digestive tract symptoms and symptoms of depression, in a population of high socio-economic status in five districts of Lima.

[The patient with irritable bowel syndrome. A difficult patient?]. / Paciente con síndrome de intestino irritable. Un paciente difícil?

The treatment of patients with Irritable Bowel Syndrome has not been very successful because of the number of variations that are associated with the illness. Some of them are: Depression and Anxiety, intensity of the symptoms and colonic hypersensitivity, all this, added to the unknown etiology of the illness. This review expects to bring a global vision of the difficulty that has existed for Medicine or psychology to bring the best treatment to these patients. Diverse investigations had obtained successful results with different psychotherapeutic approaches (Hypnotherapy, Psychoanalysis, cognitive therapy, multicomponent therapy, etc.). Nevertheless these present methodological errors that put in doubt those results. It is thought that interdisciplinary treatment would be a good option for these patients.

Terapia cognitivo-comportamental e sindrome de colon irritavel / Cognitive-behavioral therapy and irritable bowel syndrome

O tratamento para a sindrome de colon irritavel atraves da terapia cognitivo-comportamental tem sido considerado eficaz por estudos metodologicos controlados , implicando a reducao dos sintomas intestinais e pscologicos, promovendo a aquisicao de...

Irritable bowel syndrome: clinical and psychopathological correlations.

Irritable bowel syndrome is a common disorder in gastroenterology consultations. Our objectives were to assess patients' psychic functioning, the relationships between psychopathology and pain, the degree of psychopathology in constipated and diarrheic subgroups, and if previous abdominal surgery was related to pain intensity. Forty-five gastroenterological outpatients, both sexes, were studied. Patients were grouped as predominantly constipated, predominantly diarrheic, or alternating constipation and diarrhea. After diagnosis, patients had: Psychologist half-guided interviews, Bender Visuomotor Gestalt Test, Hammer Graphic Tests, and Rorschach Psychodiagnostic Tests. The last one showed that 78% suffered from distortion in reality perception; 100% thought away from reality and had a deficit in organizing capability, synthesis, and integration. Within psychological gnosiology, these patients would be diagnosed as borderline personalities and this would imply an overlapping of neurotic and psychotic functioning. Affective vulnerability and overadjustment to environment were found, and this finding is an original one to the best of our knowledge.

Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults.

OBJECTIVES: To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominal pain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment. METHODS: Patients with RAP (n = 76) and control subjects (n = 49) completed a telephone interview; measures included the Bowel Disease Questionnaire, the Functional Disability Inventory, the Life Events Questionnaire, the Family Inventory of Life Events, the Center for Epidemiological Studies Depression Scale, the Self-Perception Profile for Adolescents, and the Health Resources Inventory. RESULTS: Five years after the initial evaluation, patients with RAP reported significantly more episodes of abdominal pain than did control subjects, as well as significantly higher levels of functional disability, school absence, and clinic visits for abdominal distress. Female patients with RAP were more likely than female control subjects to meet the Manning criteria for IBS. Among patients with RAP, higher levels of IBS symptoms were associated with significantly greater functional disability, more clinic visits, more life stress, higher levels of depression, and lower academic and social competence. CONCLUSION: Female patients with a history of RAP may be at increased risk of IBS during adolescence and young adulthood. Among adolescents and young adults with a history of RAP, IBS symptoms are likely to be associated with high levels of disability and health service use.

Abdominal pain and irritable bowel syndrome in adolescents: a community-based study.

OBJECTIVES: This study was undertaken to determine (1) the prevalence of gastrointestinal symptoms including abdominal pain in a community-based population of adolescents, (2) whether a subgroup of these subjects have symptoms resembling Irritable bowel syndrome (IBS), and (3) whether anxiety and depression are more commonly found in adolescents with IBS-type symptoms compared with unaffected adolescents. METHODS: We collected data by administration of a gastrointestinal symptoms questionnaire, State-Trait Anxiety Inventory, and Children's Depression Inventory to middle school and high school students. RESULTS: A total of 507 subjects participated (mean age of middle school students 12.6 years; mean age of high school students 15.6 years). Abdominal pain was noted by 75% of all students. The pain occurred weekly in 13% to 17% of the subjects and was severe enough to affect activities in approximately 21%. Irritable bowel syndrome-type symptoms were noted by 17% of high school students and 8% of middle school students (p <0.01) who reported abdominal pain (n = 381), representing 14% and 6% of all high school and middle school students (p <0.005), respectively. Anxiety and depression scores were significantly higher for students with IBS-type symptoms compared with those without symptoms. Eight percent of all students had seen a physician for abdominal pain in the previous year. These visits were correlated with abdominal pain severity, frequency, duration, and disruption of normal activities but not with anxiety, depression, gender, family structure, or ethnicity. CONCLUSION: Recurrent abdominal pain and symptoms of IBS are commonly noted in a community-based adolescent population and frequently result in use of health care resources. Health care providers who work with this age group need to be able to recognize the symptom complex associated with IBS, as well as the possible relationship to anxiety and depression.

Registro de observaçöes de pesquisa clínica do IGESP-IBEPEGE / Records of clinical research of the Instituto de Gastroenterologia de Säo Paulo - IGESP and the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE

Exercícios clínico-patológicos do Centro Médico e Cirúrgico - CMC - do Instituto de Gastroenterologia de Säo Paulo - IGESP e do Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE, discutidos segundo a Psicologia médica, visäo sócio-psicossomática. Organizaçäo de José Fernandes Pontes