Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
Department of Gastroenterology and Hepatology, School of Medicine, University of Mostar Clinical Hospital, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina.
Int J Environ Res Public Health. 2024 Feb 18;21(2):237. doi: 10.3390/ijerph21020237.
Functional dyspepsia is a common functional disorder of the gastrointestinal tract that is responsible for many primary care visits. No organic changes have been found to explain its symptoms. We hypothesize that modern lifestyles and environmental factors, especially psychological stress, play a crucial role in the high prevalence of functional dyspepsia and metabolic syndrome. While gastrointestinal tract diseases are rarely linked to metabolic disorders, chronic stress, obesity-related metabolic syndrome, chronic inflammation, intestinal dysbiosis, and functional dyspepsia have significant pathophysiological associations. Functional dyspepsia, often associated with anxiety and chronic psychological stress, can activate the neuroendocrine stress axis and immune system, leading to unhealthy habits that contribute to obesity. Additionally, intestinal dysbiosis, which is commonly present in functional dyspepsia, can exacerbate systemic inflammation and obesity, further promoting metabolic syndrome-related disorders. It is worth noting that the reverse is also true: obesity-related metabolic syndrome can worsen functional dyspepsia and its associated symptoms by triggering systemic inflammation and intestinal dysbiosis, as well as negative emotions (depression) through the brain-gut axis. To understand the pathophysiology and deliver an effective treatment strategy for these two difficult-to-cure disorders, which are challenging for both caregivers and patients, a psychosocial paradigm is essential.
功能性消化不良是一种常见的胃肠道功能障碍,导致许多人需要到初级保健机构就诊。目前尚未发现任何器质性变化可以解释其症状。我们假设现代生活方式和环境因素,特别是心理压力,在功能性消化不良和代谢综合征的高发中起着至关重要的作用。虽然胃肠道疾病很少与代谢紊乱相关,但慢性应激、肥胖相关的代谢综合征、慢性炎症、肠道菌群失调和功能性消化不良之间存在显著的病理生理关联。功能性消化不良常与焦虑和慢性心理压力相关,可激活神经内分泌应激轴和免疫系统,导致不健康的习惯,从而促进肥胖。此外,功能性消化不良中常见的肠道菌群失调也会加重全身炎症和肥胖,进一步促进代谢综合征相关疾病。值得注意的是,这种关联是双向的:肥胖相关的代谢综合征可以通过触发全身炎症和肠道菌群失调,以及通过脑-肠轴引发负面情绪(抑郁),从而加重功能性消化不良及其相关症状。为了理解这两种难以治愈的疾病的病理生理学,并为这些疾病提供有效的治疗策略,这对医护人员和患者来说都是挑战,心理社会范式是必不可少的。
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