Behavioral gastroenterology: An emerging system and new frontier of action

Índice de calidad de vida percibida en pacientes con trastornos gastrointestinales funcionales en Buenos Aires, Argentina

Los trastornos gastrointestinales funcionales (tgf) son enfermedades crónicas que configuran un problema relevante en la salud pública, asociados en investigaciones previas a una peor calidad de vida. El objetivo del presente trabajo fue estudiar la calidad de vida en pacientes que acuden a un servicio de neurogastroenterología en un hospital de Argentina ycompararlo con población control. Para ello, se realizó un estudio cuantitativo y transversal incluyendo población clínica diagnosticada con algún tgf (n = 35) y una muestra control sin diagnóstico de tgf (n = 37). Se encontraron diferencias significativas entre personas con tgf y sujetos control, χ² (1, n = 70) = 30.23, p < .001 en todas las subdimensiones de la escala de calidad de vida (mqli), exceptuando satisfacción espiritual (pe). Similar a investigaciones previas, los resultados de este estudio sugieren que, en Argentina —al igual que en otros países—, los individuos con tgf muestran una peorpercepción de calidad de vida que la población general. Estos hallazgos podrían contribuir al diseño de intervenciones que contemplen variables biopsicosociales, con el objetivo de una mejoría integral en la calidad de vida de las personas que padecen estos trastornos.

Role of serum amitriptyline concentration and CYP2C19 polymorphism in predicting the response to low-dose amitriptyline in irritable bowel syndrome

BACKGROUND

Low-dose amitriptyline (AMT) is an effective treatment for diarrhea-dominant irritable bowel syndrome (IBS-D). Its efficacy depends upon its serum concentration and the patient's CYP2C19 genotype.

AIMS

To identify the association between serum AMT and nortriptyline (NT) concentration and CYP2C19 polymorphism and the clinical response in IBS-D patients.

METHODS

Ninety IBS-D patients were treated of AMT for 6 weeks. Efficacy was evaluated by the results of the Adequate Relief question each week and an IBS severity scoring system (IBS-SSS) at 0, 3, and 6 weeks. CYP2C19 genotyping was performed by direct sequencing. AMT and NT steady-state serum concentrations were detected by high-performance liquid chromatography.

RESULTS

The CYP2C19 polymorphism exhibited a significant influence on the NT serum concentration but did not predict the clinical efficacy of AMT for treating IBS-D. The NT steady-state and dose-corrected serum concentrations were significantly correlated with an improvement in the IBS-SSS score after 6 weeks, whereas the AMT serum concentration was not correlated with clinical improvement. The cut-off NT steady-state serum concentration of 2.91 ng/ml may help distinguish responders from non-responders.

CONCLUSIONS

NT serum concentration but not CYP2C19 polymorphism may be correlated with the clinical efficacy of AMT for treating IBS-D, and such a response may occur at the upper NT threshold of 2.91 ng/ml.

Psychosomatic Disorders in Patients with Gastrointestinal Diseases: Single-Center Cross-Sectional Study of 1186 Inpatients

OBJECTIVE

To investigate the prevalence of anxiety and depression in hospitalized patients in the Department of Gastroenterology and to explore the risk factors affecting psychosomatic conditions in patients with digestive disorders.

METHODS

Patients hospitalized with gastrointestinal diseases were enrolled by the Department of Gastroenterology of Xiangya Hospital of Central South University from November 2017 to June 2018 and completed a cross-sectional questionnaire survey. According to anxiety/nonanxiety, depression/nondepression, the subjects were divided into two groups, respectively, and the risk factors of anxiety/depression were analyzed.

RESULTS

A total of 1186 patients were included in this study. The overall detection rate was 20.74% for anxiety symptoms alone, 31.78% for depressive symptoms alone, 13.99% for both anxiety and depressive symptoms, and 38.53% for either depression or anxiety symptoms. The prevalence of anxiety symptoms was higher in female than in male patients and inversely correlated with levels of education. There was no significant difference in the detection rate of anxiety and depression between patients with functional and organic digestive diseases. Sleep quality and quality of life were inversely correlated with the severity of anxiety and depression. Notably, among the patients with abnormal psychological conditions, only 7.6% of them were willing to receive psychological treatment. Gender, sleep quality, and life quality are independent risk factors for anxiety and depression symptoms for inpatients with gastrointestinal diseases.

CONCLUSION

Paying more attention to the education level, sleep quality, and quality of life in patients with gastrointestinal diseases will help doctors to identify the risk of psychological abnormalities and improve medical care.

A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

Health psychology is multidisciplinary, with researchers, practitioners, and policy makers finding themselves needing at least some level of competency in a variety of areas from psychology to physiology, public health, and others. Given this multidisciplinary ontology, prior attempts have been made to establish a framework for understanding the role of biological, psychological, and socio-environmental constructs in disease development, maintenance, and treatment. Other models, however, do not explain how factors may interact and develop over time. The aim here was to apply and adapt the 3P model, originally developed and used in the treatment of insomnia, to couch the biopsychosocial model in a way that explains how diseases develop, are maintained, and can be treated. This paper outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions (the 3Ps) and provides examples of how this model may be adapted and applied to a number of health-related diseases or disorders including chronic pain, gastrointestinal disorders, oral disease, and heart disease. The 3P framework can aid in facilitating a multidisciplinary, theoretical approach and way of conceptualizing the study and treatment of diseases in the future.