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Functional Gastrointestinal Disorder : Psychosomatic Review


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Presentasi ini ditampilkan untuk kalangan dokter umum pada acara seminar medis untuk dokter di RS OMNI Alam Sutera

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Functional Gastrointestinal Disorder : Psychosomatic Review

  1. 1. Functional Gastrointestinal Disorder : Psychosomatic Overview Andri Psychosomatic Clinic Omni Hospital Faculty of Medicine UKRIDA Academy of Psychosomatic Medicine American Psychosomatic Society @mbahndi
  2. 2. Outline • • • • • Terminology Classification Pathophysiology Psychosomatic approach Treatment
  3. 3. A. Terminology • Functional Versus Organic • Advantages : o Research of psychological factor of Functional Gastrointestinal Disorder (FGID) o Multidiscipline and Liaison : psychiatrist and gastroenterologist o Biopsychosocial model of gastroenterology • Disadvantages : o o o o Separation of Mind and Body Interest of psychological aspect of disease waned Miss-perception : functional = psychiatric problem Ignore psychiatric disorder in organic disease vice versa
  4. 4. Definition of FGID • Chronic and recurrent symptoms of the gastrointestinal (GI) tract: o Pain, nausea, vomiting, diarrhea, constipation bloating, • Without detectable structural biochemical abnormalities or 4
  5. 5. Classification : Rome Criteria Rome Committees: Multinational Working Teams Symptom-based diagnostic criteria: Rome I 1994 Rome II 1999 Rome III 2006 5
  6. 6. Classification FGIDs ( classified by anatomic region) (A) Esophageal (B) Gastroduodenal (B1: FD) (C) Bowel (C1: IBS) (D) Functional abdominal pain (E) Biliary (F) Anorectal. 6
  7. 7. FGID—biopsychosocial model 7
  8. 8. Distress Stres Fisik (Radang,tumor,infeksi,trauma) Stres Psikis HIPOTALAMUS Sistem Saraf Otonom Simpatis Parasimpatis Eustress HPA Aksis Kortisol GABA System Monoamine System •Serotonin •Dopamin •Norepineprin Skema 1. Menjelaskan tentang efek stres terhadap tubuh dan otak. Disarikan dari berbagai sumber oleh dr Andri,SpKJ tahun 2012
  9. 9. Major Causes of Dyspepsia Williams 1988 (n=1386) Stanghellini 1996 (n=1057) Heikkinen 1996 (n=766) % of Patients with Diagnosis 60 50 40 30 20 10 0 Gastric Cancer Peptic Ulcer Esophagitis/ GERD Functional Dyspepsia 9
  10. 10. Ilustrasi Kasus • Perempuan usia 35 tahun sudah sekitar 1 tahun belakangan ini mengeluh nyeri perut atas disertai rasa seperti ingin muntah. Pemeriksaan obyektif tidak menemukan adanya kelainan. Oleh dokternya diresepkan racikan : o o o o o Librax ½ tablet Dogmatil 25mg Alprazolam 0.15mg Sertraline 15mg Serenace 0.5mg
  11. 11. Diagnostic process FD remains a diagnosis of exclusion: • Careful history and physical examination • Upper endoscopy is necessary • The others: exclusion of chronic peptic ulcer disease, gastroesophageal reflux disease, esophagitis, pancreatico-biliary disease malignancy 11
  12. 12. 12
  13. 13. Differential Diagnosis • GERD: Heartburn is the predominant symptom Upper endoscopy Prolonged esophageal pH monitoring Twenty-four hour esophageal pH monitoring • IBS: overlap symptom - Bloating or frequent defecation 13
  14. 14. Treatment • The goal is to accept, diminish, and cope with symptoms rather than eliminate them. • The most important aspects o explanation that the symptoms are not imaginary o evaluation of relevant psychosocial factors, o dietary advice 15
  15. 15. Pharmacological therapies • H. pylori therapy ? controversial • Acid suppression and prokinetic agents (digestive agents) ? may help • Gut analgesics ? Relaxants of the nervous system of the gut may be beneficial, but do not use Benzodiazepine • Antidepressant? SNRI, TCA May help 16
  16. 16. Management of Ulcer-like Functional Dyspepsia Ulcer-like Symptoms Dominant Education/lifestyle modification Test Hp + - Eradicate Hp Trial of acid suppression Reassess Success Failure Investigate Trial of prokinetic 17
  17. 17. Management of Dysmotility-like Functional Dyspepsia Dysmotility-like Symptoms Dominant Educate/lifestyle modification Trial of prokinetic medication Success Failure Continue with cyclic therapy Investigate Test H. pylori Gastroscopy or UGI + - Eradicate Success Failure Consider H2 antagonists, tricyclics 18
  18. 18. Role of psychosocial factors 1)Psychological stress exacerbates GI symptoms. 2)Psychological disturbances modify the experience of illness and illness behaviors such as health care seeking. 3) Psychosocial factors affect health status and clinical outcome. 19
  19. 19. Take Home Message • Dyspepsia : Organic and Functional • Clinical Practice : Functional > 50% • Pay attention of Psychosocial aspect of functional gastrointestinal disorder • Rationale use of drug, do not use benzodiazepine to eliminate symptoms • Coping with the symptoms and a good diet are always be recommendation