Liu Zhaoxia
Gastroenterology Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 150001 Harbin, Heilongjiang, China.
Actas Esp Psiquiatr. 2025 Aug;53(4):914-926. doi: 10.62641/aep.v53i4.1852.
Functional gastrointestinal disorders (FGIDs) encompass a group of disorders characterized by chronic or recurrent gastrointestinal symptoms, while anxiety disorders comprise a class of mental disorders primarily characterized by excessive anxiety and fear. Comorbidity of FGIDs and anxiety disorders has been frequently observed in clinical practice; however, the complex bidirectional relationship between these two disorders remains poorly understood. This review aimed to explore the bidirectional relationship between FGIDs and anxiety disorders, elucidate potential pathophysiological mechanisms, and propose novel diagnostic and therapeutic strategies. Through a review of recent literature, significant reciprocal factors that influence these two disorder categories have been identified. The prevalence of anxiety disorders among FGID patients is substantially higher than that in the general population; additionally, FGID symptoms are more prevalent in individuals with anxiety disorders. The core mechanisms underlying this bidirectional relationship likely involve dysfunction of the brain-gut axis, resulting from nervous, endocrine, and immune system dysfunction. Furthermore, intestinal dysbiosis, genetic factors, and early life stress may play crucial roles in this process. In terms of therapeutic strategies, innovative interventions for the effective management of comorbid FGIDs and anxiety disorders are proposed. Specifically, pharmacological interventions, including the use of selective 5-hydroxytryptamine (5-HT3) receptor antagonists and antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can alleviate both gastrointestinal and anxiety symptoms, while psychological interventions, such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), have also shown efficacy in the reduction of anxiety while significantly improving FGID symptoms. Furthermore, modulation of the gut microbiota through various interventions, such as administration of probiotics and low-Fermentable Oligo-, Di-, Mono-saccharides And Polyols (FODMAP) diets, has also been highlighted as a promising direction for future treatment. Given the collected evidence, the most effective approach would most likely be an integrated therapeutic model, which combines pharmacological, psychological, microbiota modulation, and lifestyle management through a multidisciplinary approach, all of which aim to deliver personalized, comprehensive treatment plans. In summary, the current review elucidates the bidirectional relationship, pathophysiological mechanisms, and novel therapeutic strategies for the treatment of comorbid FGIDs and anxiety disorders, proposing an integrative diagnostic approach that emphasizes screening for anxiety disorders in FGID patients and assessing gastrointestinal symptoms in patients with anxiety disorders. This comprehensive review aimed to provide a theoretical foundation for clinical practice and illuminate directions for future research, ultimately seeking to improve diagnostic and treatment outcomes and quality of life enhancement for this population.
功能性胃肠疾病（FGIDs）包括一组以慢性或复发性胃肠道症状为特征的疾病，而焦虑症是一类主要以过度焦虑和恐惧为特征的精神障碍。FGIDs与焦虑症的共病在临床实践中经常被观察到；然而，这两种疾病之间复杂的双向关系仍未得到充分理解。本综述旨在探讨FGIDs与焦虑症之间的双向关系，阐明潜在的病理生理机制，并提出新的诊断和治疗策略。通过对近期文献的综述，已经确定了影响这两类疾病的重要相互作用因素。FGID患者中焦虑症的患病率显著高于一般人群；此外，FGID症状在焦虑症患者中更为普遍。这种双向关系的核心机制可能涉及脑-肠轴功能障碍，这是由神经、内分泌和免疫系统功能障碍引起的。此外，肠道微生物失调、遗传因素和早期生活压力可能在这一过程中起关键作用。在治疗策略方面，提出了有效管理FGIDs与焦虑症共病的创新干预措施。具体而言，药物干预，包括使用选择性5-羟色胺（5-HT3）受体拮抗剂和抗抑郁药，如选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs），可以缓解胃肠道和焦虑症状，而心理干预，如认知行为疗法（CBT）和基于正念的减压疗法（MBSR），在减轻焦虑的同时也显示出对改善FGID症状有效。此外，通过各种干预措施调节肠道微生物群，如给予益生菌和低可发酵寡糖、二糖、单糖和多元醇（FODMAP）饮食，也被强调为未来治疗的一个有前景的方向。鉴于所收集的证据，最有效的方法很可能是一种综合治疗模式，它通过多学科方法将药物、心理、微生物群调节和生活方式管理结合起来，所有这些都旨在提供个性化的综合治疗方案。总之，当前的综述阐明了FGIDs与焦虑症共病的双向关系、病理生理机制和新的治疗策略，提出了一种综合诊断方法，强调对FGID患者进行焦虑症筛查，对焦虑症患者评估胃肠道症状。这一全面综述旨在为临床实践提供理论基础，并为未来研究指明方向，最终寻求改善这一人群的诊断和治疗结果以及提高生活质量。
