Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
Neurogastroenterol Motil. 2018 Oct;30(10):e13394. doi: 10.1111/nmo.13394. Epub 2018 Jun 28.
While it is generally accepted that gastrointestinal infections can cause functional disturbances in the upper and lower gastrointestinal tract-known as postinfectious irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD)-it has still not been widely recognized that such an infection can also initiate functional non-intestinal diseases, and that non-intestinal infections can provoke both intestinal and non-intestinal functional disturbances. We conducted a scoping review of the respective literature and-on the basis of these data-hypothesize that medically unexplained functional symptoms and syndromes following an infection may have a biological (genetic, endocrine, microbiological) origin, and that psychological and social factors, which may contribute to the disease "phenotype," are secondary to this biological cause. If this holds true, then the search for psychological and social theories and factors to explain why one patient develops a chronic functional disorder while another does not is-at least for postinfectious states-misleading and detracts from exploring and identifying the true origins of these essentially biological disorders. The biopsychosocial model may, as the term implies, always begin with biology, also for functional (somatoform) disorders.
虽然人们普遍认为胃肠道感染会在上消化道和下消化道引起功能紊乱，即感染后肠易激综合征（PI-IBS）和功能性消化不良（PI-FD），但人们仍然没有广泛认识到这种感染也会引发非肠道功能疾病，非肠道感染也会引起肠道和非肠道功能紊乱。我们对相关文献进行了范围性综述，并基于这些数据假设，感染后出现的无法用医学解释的功能性症状和综合征可能具有生物学（遗传、内分泌、微生物学）起源，而可能促成疾病“表型”的心理和社会因素是继发于这种生物学原因。如果这是正确的，那么寻找心理和社会理论以及因素来解释为什么一个患者会发展为慢性功能性障碍而另一个患者不会，对于感染后状态至少是具有误导性的，并且会阻碍对这些本质上是生物学障碍的真正起源的探索和识别。正如其名称所示，对于功能性（躯体形式）障碍，生物因素也始终是心理社会模式的起点。
