gastro_reflux - Gastrointestinal D i s e a s e A Z I M H ....

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Unformatted text preview: Gastrointestinal D i s e a s e A Z I M H . J I W A N I , M D GASTROINTESTINAL complaints account for a considerable pro- portion of a family physician's con- sultations' and ofthese,lessthanhalf are ever shown to have asignificant organic basis.The rest,usuallyaftera fairlythoroughclinicalandlaboratory evaluation, are labelled as being of neurotic origin. Their bearers are thought of as neurotics, hypochon- driacsormalingerersandaretreatedas such.Intermsofmorbidity andnum- ber of work hours lost they rank secondonlytoupperrespiratoryinfec- tionsandtrauma.2 All gastrointestinal diseases have psychological and somatic aspects;it would be useful to think ofdisturb- ances infunctionofthetractasbeing basictosymptomproduction,whether this be primarily organically or emotionally induced. Our considera- tion willbe mainly for those aspects which are a resultofemotional stress or personality defects,where thecon- ditionisreversible. An expressionofanorganicdisease dependsnot onlyon thenatureofthe underlying pathological process but also on the patient'spersonality,his adaptability and his stress situations. The degreeofneed forexpressionor repression of thisdisease at thispar- ticular time would alsoinfluence the outcome.3I A purely 'functional'diseasemani- fests itself through psychophysio- logical changes in themotor,vascular and secretoryactivitiesofthegastroin- testinal tract. This interplaybetween psyche and soma is seen in other system diseases,butnowhereasclearly as in gastroenterology. As William James puts it,"The abdomen isthe soundingboardoftheemotions". Historically, functional gastroin- testinal disease is a relatively new SUMMARY Despitetheirprevalence,functional disturbancesofthe gastrointestinaltractinresponsetostressareoften disregardedorunrecognized.The natureofthesedisturbances, particularlytheirritablebowel syndrome, isdiscussedand anoutline oftreatmentprogramsgiven,stressingtheneed forpsychotherapy. Dr.Jiwanihasjustcompleted aresidencyinfamilymedicineat theToronto General Hospitaland planstoenterfamilypractice inBritishColumbia. Addressforreprints:Atwood Clinic,Williams Lake,B.C. reaction pattern. It isasyet uncom- mon in certain underdeveloped countries.5 The 'effort syndrome' or neurocirculatory asthenia of World War Iwas replaced by neurotic dys- pepsiaduringWorldWar 2.Laterstill, the main site of reaction shifted furtherdown thealimentarytract;the most common modern functional gastrointestinaldisorderistheirritable colonsyndrome. Pathophysiology To a large extent, themechanisms involvedinfunctionalsymptoms area resultofmotor, vascular orsecretory changes centrally related to corti- cohypothalamic influence and peri- pherally mediated by autonomic and perhapshumoralagents....
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This note was uploaded on 05/12/2010 for the course PSYCHOLOGY vp taught by Professor Assistant during the Spring '10 term at École Normale Supérieure.

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gastro_reflux - Gastrointestinal D i s e a s e A Z I M H ....

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