Translational Research Centre for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, University of Leuven, Herstraat 49, O&N 1, bus 701, B-3000, Belgium.
Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):158-67. doi: 10.1038/nrgastro.2013.10. Epub 2013 Jan 29.
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.
在这篇综述中，在简要的历史介绍之后，我们首先概述了表明功能性消化不良与心理特征、状态或精神障碍之间存在关联的流行病学研究。这些研究表明，除了对寻求医疗服务行为的潜在影响外，心理社会因素和精神障碍，尤其是焦虑和抑郁，在功能性消化不良的发病机制中具有重要的内在作用。其次，我们描述了关于心理社会因素和精神障碍如何发挥其在功能性消化不良中的作用的病理生理学证据。关于肠道-大脑信号整合的功能脑成像研究的新见解，这些信号在稳态-内脏感知脑区域中处理，同时接收来自外感受系统、奖励系统以及情感和认知回路的输入，有助于阐明心理过程和精神发病率的重要作用。因此，我们提出了功能性消化不良的综合模型，作为一种肠道-大脑信号传递障碍，支持对这种疾病的诊断和管理的生物-心理-社会方法。
