[Therapeutic approach in psychosomatic gastroenterology (author's transl)]

The therapeutic approach in psychosomatic medicine requires the somatician to keep psychological factors in mind and the psychiatrist to recall the somatic complaint. The therapeutic attitude will be different according to the psychofunctional problem or an authentic psychosomatic disease. However, in every case, the total patient must be considered and a good doctor-patient relationship must be established. Thanks to this relationship, the doctor can better understand the emotional and intellectual aspects of his patient and therefore plan his therapeutic purposes. Thus it takes into consideration the following: 1. reducing the anxiety by explaining to the patient the possible correlations between his complaints and emotional factors; 2. adopting a supportive attitude; 3. offering to the patient the possibility to explain verbally certain repressed ideas (ventilation psychotherapy); 4. manipulating, if necessary, the milieu in which the patient lives (treatment centered on the environment); 5. starting a deep rooted psychotherapy in certain cases. The problem of psychosomatic diseases in gastro-enterology, like duodenal ulcer and hemorragic ulcerative colitis, is discussed in more details. Concerning duodenal ulcer, one can distinguish between two levels of psychotherapy: 1. psychological approach for the gastro-enterologist with a proper background in the psychological approach of patients; 2. psychotherapy. Anyway, the treatment of this disease is always multidimensional, utilizing both psychological and drug treatment. Concerning hemorragic ulcerative colitis, supportive psychotherapy is crucial during the acute phase. It takes effect by an entire affective relationship with the patient and the all therapeutic team. During a remission, the therapist must provide the patient with the type of relationship he desires, and be available to the patient. In some cases, a deep psychotherapy should be used, even in conjunction with somatic care.