Society, brain and gut--a psychosocial approach to dyspepsia

Common denominators in the etiology of psychosocially induced ill health--in the gastrointestinal tract and elsewhere--flow from discrepancies between human ability, needs, and expectations on the one hand, and environmental demands, opportunities, and individual perception of these on the other. Pathogenic mechanisms include emotional reactions (anxiety, depression, hypochondria), behavioural reactions (abuse of alcohol, drugs, and tobacco, destructive and self-destructive behaviour, and resistance to prevention, therapy and rehabilitation), and physiological reactions (neuroendocrine and immunological). Through these mechanisms, psychosocial stressors can precipitate ill health, influence well-being, and modify the outcome of health action. Interacting variables (coping, social support) can buffer these effects. One of the targets of such influences is the gastrointestinal tract. Present knowledge concerning socio-psycho-gastrointestinal interrelationships is far from conclusive. Some of its implications for therapeutic approaches to gastrointestinal patients are discussed.