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The role of psychosocial factors and psychiatric disorders in functional dyspepsia

Abstract

In this Review, after a brief historical introduction, we first provide an overview of epidemiological studies that demonstrate an association between functional dyspepsia and psychological traits, states or psychiatric disorders. These studies suggest an important intrinsic role for psychosocial factors and psychiatric disorders, especially anxiety and depression, in the aetiopathogenesis of functional dyspepsia, in addition to their putative influence on health-care-seeking behaviour. Second, we describe pathophysiological evidence on how psychosocial factors and psychiatric disorders might exert their role in functional dyspepsia. Novel insights from functional brain imaging studies regarding the integration of gut–brain signals, processed in homeostatic–interoceptive brain regions, with input from the exteroceptive system, the reward system and affective and cognitive circuits, help to clarify the important role of psychological processes and psychiatric morbidity. We therefore propose an integrated model of functional dyspepsia as a disorder of gut–brain signalling, supporting a biopsychosocial approach to the diagnosis and management of this disorder.

Key Points

  • Epidemiological studies demonstrate a higher prevalence of anxiety and depression in patients with functional dyspepsia than in healthy individuals, suggesting an intrinsic role for these psychiatric disorders in the aetiopathogenesis of functional dyspepsia

  • Epidemiological evidence also suggests a role for personality traits, stressful life events in general (and sexual and physical abuse in particular) and other psychosocial factors in functional dyspepsia

  • Pathophysiological studies show that psychosocial factors and psychiatric disorders might exert their role in functional dyspepsia by modulating the processing of visceral signals in the brain and through descending pathways

  • The autonomic nervous system and stress hormone system are important brain–gut interfaces through which psychosocial factors and psychiatric comorbidity might influence gastric motor function, including accommodation and emptying

  • A biopsychosocial approach to the diagnosis and management of functional dyspepsia is warranted and empirically supported by an integrated model of functional dyspepsia as a disorder of brain–gut signalling

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Figure 1: Model of functional dyspepsia as a disorder of brain–gut signalling.
Figure 2: Schematic diagram illustrating the pathways through which psychosocial factors and psychiatric comorbidity might exert their role in functional dyspepsia.

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L. Van Oudenhove contributed to all aspects of this manuscript. Q. Aziz contributed to discussion of content and reviewing/editing of the manuscript before submission.

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Correspondence to Lukas Van Oudenhove.

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Supplementary information

Supplementary Table 1

Studies comparing levels of psychopathology between functional dyspepsia patients and healthy controls (DOC 138 kb)

Supplementary Table 2

Studies comparing levels of psychopathology between patients with functional dyspepsia and patients with other organic disease (controls) (DOC 76 kb)

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Van Oudenhove, L., Aziz, Q. The role of psychosocial factors and psychiatric disorders in functional dyspepsia. Nat Rev Gastroenterol Hepatol 10, 158–167 (2013). https://doi.org/10.1038/nrgastro.2013.10

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