Psychosomatic factors in gastrointestinal disorders.

Gastrointestinal functions such as food intake, propulsive peristalsis, inhibition of reflux, secretion, digestion and defecation are controlled by a complex autonomous neurohumoral system, which is influenced by higher cortical impulses. Life stress may modulate these impulses and in this way cause two types of gastrointestinal reactions. Psychophysiological reactions involve accentuations, inhibition or distortion of the pattern of function of gastrointestinal organs without changes in their structure. Examples of this type of reaction are often painful accentuation of bowel movements in patients with the irritable bowel syndrome, and increased gastric secretion elicited by emotional stress. Psychosomatic reactions lead to morphological changes in the end organ, e.g. activation of peptic ulcer or ulcerative colitis. Psychophysiological reactions may be important in the onset of symptoms in some functional diseases, e.g. in the irritable bowel syndrome. These patients need support from the physician, but specific psychiatric therapy is required only in cases with severe psychopathology, e.g. in patients with anorexia nervosa. The role of psychosomatic reactions in the development of organic gastrointestinal diseases is still unclear, as is the value of specific psychiatric therapy in the treatment of diseases such as peptic ulcer or ulcerative colitis. If this kind of therapy has some effect, it may be directed mainly towards subjective symptoms.