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

1. Functional
Gastrointestinal Disorder :
Psychosomatic Overview
Andri
Psychosomatic Clinic Omni Hospital
Faculty of Medicine UKRIDA
Academy of Psychosomatic Medicine
American Psychosomatic Society
@mbahndi

2. Outline
•
•
•
•
•
Terminology
Classification
Pathophysiology
Psychosomatic approach
Treatment

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. 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. Classification : Rome Criteria
Rome Committees:
Multinational Working Teams
Symptom-based diagnostic criteria:
Rome I 1994
Rome II 1999
Rome III 2006
5

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. FGID—biopsychosocial model
7

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. 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. 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. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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