Whitehead W E
Division of Digestive Diseases, University of North Carolina at Chapel Hill 27599-7080, USA.
Gastroenterol Clin North Am. 1996 Mar;25(1):21-34. doi: 10.1016/s0889-8553(05)70363-0.
Increased numbers of psychiatric diagnoses and increased levels of psychological distress are seen in the majority of medical clinic patients with gastrointestinal motility disorders. In IBS, psychological symptoms are believed to be comorbid conditions, which do not cause the motility disorder but which do influence the patient's decision to consult a physician. In functional dyspepsia, psychological symptoms are present in many patients, but their role is not known; the available data suggest that psychological symptoms do not predict which patients will consult a physician. Among constipated patients, anxiety is believed to contribute to the development and course of pelvic floor dyssynergia by increasing pelvic floor muscle tension. Constipated patients without physiologic abnormalities to explain their constipation appear to have more psychological symptoms than those with delayed colonic transit, but there is significant psychological distress even in patients with slow transit constipation. Psychological symptoms do not seem to predict which constipated patients will consult a physician. There is an increased incidence of psychiatric diagnoses in patients with esophageal motility disorders as well, but the role that these psychological symptoms play in the course of the disorder is not known. Patients with the most common gastrointestinal motility disorders, IBS and dyspepsia, report experiencing more stressful life events, and IBS patients appear to show a greater increase in gastrointestinal symptoms when exposed to stressors. Laboratory studies document that acute psychological stressors do alter gastric, small bowel, and colonic motility, and patients with IBS appear to show a greater change in colonic and ileal motility with stress than healthy controls. Greater reactivity has not been demonstrated for the esophagus or stomach, however, and it has not been demonstrated for other gastrointestinal motility disorders. A characteristic of many patients who consult gastroenterologists for IBS and other motility disorders is a tendency to report multiple somatic complaints (including many nongastrointestinal complaints) and to overuse medical resources. This pattern of behavior is referred to as somatization or abnormal illness behavior. One source of abnormal illness behavior is childhood social learning, which occurs (1) when parents provide gifts or special privileges to a child who reports somatic symptoms or (2) when parents model abnormal illness behaviors themselves.
在大多数患有胃肠动力障碍的门诊患者中，精神疾病诊断数量增加，心理困扰程度加剧。在肠易激综合征（IBS）中，心理症状被认为是共病情况，它不会引发动力障碍，但会影响患者咨询医生的决定。在功能性消化不良中，许多患者存在心理症状，但其作用尚不清楚；现有数据表明，心理症状无法预测哪些患者会咨询医生。在便秘患者中，焦虑被认为会通过增加盆底肌肉张力，促使盆底失协调的发生和发展。没有生理异常来解释便秘的患者似乎比结肠传输延迟的患者有更多心理症状，但即使是慢传输型便秘患者也存在明显的心理困扰。心理症状似乎无法预测哪些便秘患者会咨询医生。食管动力障碍患者的精神疾病诊断发生率也有所增加，但这些心理症状在该疾病过程中所起的作用尚不清楚。患有最常见胃肠动力障碍（IBS和消化不良）患者报告称经历了更多压力性生活事件，并且IBS患者在接触应激源时，胃肠道症状似乎会有更大程度的增加。实验室研究证明，急性心理应激源确实会改变胃、小肠和结肠的动力，与健康对照相比，IBS患者在应激时结肠和回肠动力的变化似乎更大。然而，尚未证明食管或胃有更大的反应性，其他胃肠动力障碍也未得到证实。许多因IBS和其他动力障碍而咨询胃肠病学家的患者的一个特点是，倾向于报告多种躯体不适（包括许多非胃肠道不适）并过度使用医疗资源。这种行为模式被称为躯体化或异常疾病行为。异常疾病行为的一个来源是儿童期的社会学习，它发生在以下情况：（1）父母向报告躯体症状的孩子提供礼物或特殊待遇；（2）父母自己表现出异常疾病行为。
