bubble_chart Overview

Gastrointestinal dysfunction, a general term for a group of gastrointestinal syndromes, often has a background of psychological factors. It is primarily characterized by disordered gastrointestinal motility without pathological anatomical evidence of organic {|###|} sexually transmitted disease {|###|} changes, and therefore does not include gastrointestinal dysfunction caused by other systemic diseases. The clinical manifestations mainly involve abnormalities in the gastrointestinal tract related to eating and excretion, and are often accompanied by other functional symptoms such as {|###|} insomnia {|###|}, anxiety, distractibility, {|###|} forgetfulness {|###|}, nervousness, {|###|} headache {|###|}, etc. Gastrointestinal dysfunction is quite common, but there is currently a lack of precise statistics on its incidence domestically. Among the functional disorders of various organs, gastrointestinal cases are the most frequent, predominantly seen in young and middle-aged adults.

bubble_chart Etiology

The pathogenesis of this disease has not yet been uniformly understood. Psychological factors play a significant role in its onset and progression, such as excessive fatigue, emotional stress, family conflicts, and difficulties in life and work. If these issues remain unresolved for a long time, they can interfere with the normal activities of higher nerves, leading to brain-gut axis dysfunction and subsequently causing gastrointestinal disorders. Suggestion and autosuggestion are the primary disease causes, and patients often exhibit disturbances in gastrointestinal myoelectric activity and motility.

Dietary imbalances, frequent use of laxatives, or enemas can all constitute adverse stimuli, promoting the occurrence and progression of this condition.

bubble_chart Clinical Manifestations

The onset is mostly gradual, with a prolonged course that may persist for years or involve recurrent episodes. The clinical manifestations are primarily gastrointestinal symptoms, which may be localized to the pharynx, esophagus, or stomach, but intestinal symptoms are the most common. These may also be accompanied by other common symptoms of functional neurological disorders.

The following describes several common types of gastrointestinal dysfunction:

(1) Globus Hystericus. Globus hystericus is a subjective sensation of an unclear object or lump causing discomfort such as fullness, pressure, or obstruction at the level of the cricoid cartilage in the lower pharynx. It is likely related to dysfunction of the pharyngeal muscles or the upper esophageal sphincter. Traditional Chinese medicine refers to it as "globus hystericus." This condition is more common in menopausal women. Patients often have psychological factors contributing to the onset, exhibit obsessive tendencies, and frequently perform swallowing actions in an attempt to relieve symptoms. In reality, symptoms disappear during eating, with no dysphagia or long-term weight loss. Examinations reveal no organic

pathology or foreign bodies in the pharynx or esophagus.

(2) Diffuse Esophageal Spasm. This involves intense, non-propulsive, and sustained contractions in the middle and lower esophagus, leading to diffuse narrowing. Typical symptoms include painless, slow, or sudden dysphagia and/or retrosternal pain. Symptoms are easily triggered by distractions during meals or consumption of excessively cold or hot food. Episodes are often brief, lasting from a few minutes to ten minutes, and can be relieved by drinking water or belching. Chest pain may radiate to the back, scapular region, and upper arms, occasionally accompanied by bradycardia and vasovagal syncope, sometimes making it difficult to distinguish from cardiac colicky pain. Barium swallow X-rays may show weakened peristalsis in the lower two-thirds of the esophagus, with intense, uncoordinated, non-propulsive contractions, presenting a beaded or spiral narrowing of the esophageal lumen. Esophageal manometry reveals simultaneous contractions, repetitive contractions, and high-amplitude non-propulsive contraction waves in the upper, middle, and lower esophagus after swallowing, while the lower esophageal sphincter pressure is usually normal and can relax. Treatment may include calcium channel blockers such as nifedipine or diltiazem, as well as nitroglycerin derivatives. Endoscopic pneumatic or hydrostatic dilation of the esophagus can restore normal peristalsis, and most cases do not require surgical intervention.

(3) Psychogenic Vomiting. This often occurs in young women, presenting as chronic recurrent vomiting triggered by psychological factors. It typically occurs suddenly shortly after eating, usually without significant nausea. The vomiting volume is small, and patients can resume eating immediately afterward without affecting appetite or food intake, with no notable nutritional deficiencies in most cases. It may be accompanied by hysterical traits, such as exaggeration, affectation, suggestibility, sudden onset, and complete normalcy during intervals, hence also termed hysterical vomiting. Psychotherapy may be effective for some patients.

(4) Psychogenic Belching (Aerophagia). Patients experience recurrent, continuous belching in an attempt to relieve abdominal discomfort and bloating, which they attribute to gastrointestinal gas. In reality, this is due to the unconscious repeated swallowing of large amounts of air, resulting in incessant belching. This condition also has hysterical characteristics and often occurs in the presence of others. {|108|}(5) Anorexia Nervosa. This is a condition characterized by anorexia, severe weight loss, and amenorrhea without an organic basis. It has a prevalence of 10% among young women in Western countries. Patients often restrict their diet or refuse food due to a fear of gaining weight and damaging their body image. They may become emotionally isolated, avoid relatives, and, despite significant weight loss, still perceive themselves as overweight. They may engage in excessive physical activity, take appetite suppressants, or even use diuretics and laxatives. Weight loss can progress to a cachectic state. Patients often exhibit neuroendocrine dysfunction, manifesting as amenorrhea, hypotension, bradycardia, hypothermia, and anemia or edema. According to the Mayo Clinic research group, patients with anorexia nervosa exhibit various electrophysiological and neurohormonal abnormalities, such as increased gastric dysrhythmias, impaired antral contractions, and significantly delayed gastric emptying of solid foods. These disturbances may be related to symptoms such as pre-meal satiety, early fullness, and postprandial discomfort or stomach distension.

(6) Irritable Bowel Syndrome (IBS) is characterized primarily by changes in bowel habits and is the most common functional gastrointestinal disorder. In Western countries, it accounts for 50% of gastroenterology outpatient visits. Patients are mostly aged between 20 and 50, with very few cases of initial onset in the elderly. It is more prevalent in women (female-to-male ratio of 2–5:1). Previously, this condition was referred to as spastic colon, irritable colon syndrome, mucous colitis, allergic colitis, or colonic dysfunction, but these terms have been abandoned because the syndrome involves no inflammatory changes and is not limited to the colon. The 1988 Rome International Conference proposed that the definition of irritable bowel syndrome (IBS) should include: ① abdominal pain relieved by defecation and associated with changes in stool frequency and consistency, or (and) ② abnormal defecation, with two or more of the following manifestations: altered stool frequency, altered stool consistency, abnormal defecation process, sensation of incomplete evacuation, or mucus in the stool. Patients often experience abdominal bloating and discomfort.

Although the mechanism of disease in IBS remains unclear, both clinical and laboratory evidence suggest that IBS is a disorder of intestinal motility. Patients exhibit characteristic abnormalities in colonic myoelectric activity, manifested by an increase in 3 cycles/min slow waves. In patients with predominant abdominal pain and constipation, short spike bursts (SSBs, associated with regulating colonic segmental contractions and delaying defecation) increase, reaching 170-240% of normal levels. In contrast, patients with painless diarrhea show a reduction in SSBs. IBS patients with predominant abdominal pain exhibit elevated intracolonic pressure, up to 10 times normal, while those with painless diarrhea have normal or reduced pressure. In patients with constipation, abdominal distension, and fullness, small intestine transit is delayed, whereas in those with predominant diarrhea, transit is accelerated, accompanied by an increase in migratory motor complexes. IBS patients demonstrate heightened colonic sensitivity to various stimuli (including food, balloon distension, neurohormones such as acetylcholine, β-receptor blockers, and gastrin). After eating, sigmoidorectal motor activity is delayed but significantly prolonged, lasting up to 3 hours (compared to 50 minutes in normal individuals). These patients also exhibit poor tolerance to rectal balloon distension, with reduced thresholds for contraction and pain, as well as increased contraction amplitude and duration. Studies on psychological disturbances suggest that dysregulation of the brain-gut axis underlies these myoelectric and motor abnormalities.

Clinical manifestations often include spasmodic abdominal pain (most commonly in the lower left abdomen, with palpable, tender, and firm sigmoid colon during episodes) and constipation, or chronic constipation with intermittent diarrhea. Abdominal pain is typically relieved after defecation. Bowel movements often occur after breakfast and rarely during sleep. Stool may be accompanied by large amounts of mucus but no blood. Symptom onset is frequently associated with stress. Patients generally appear well, without weight loss. Symptoms such as loss of appetite, weight loss, rectal bleeding, fever, or nocturnal diarrhea usually indicate other organic diseases rather than IBS.

bubble_chart Diagnosis

The clinical characteristics of gastrointestinal dysfunction, particularly the fluctuation of symptoms with emotional changes and the temporary alleviation of symptoms through psychological treatments such as suggestive therapy, suggest the possibility of this condition.

It must be emphasized that organic diseases, especially malignant lesions of the gastrointestinal tract, must be ruled out before diagnosing this condition. Taking IBS as an example, most patients are emotionally tense and present with numerous complaints during consultations, often speaking incessantly. Some even write down their symptoms on paper for fear of omission. Doctors should first listen patiently to and analyze the patient's complaints, conduct a thorough physical examination, and perform routine tests, including complete blood count, erythrocyte sedimentation rate, stool routine, fecal occult blood, parasite eggs and bacterial culture, fiber colonoscopy, and double-contrast barium enema. Conditions such as colorectal cancer, inflammatory bowel disease, diverticulitis, and dysentery should be excluded. For patients with persistent abdominal pain accompanied by weight loss, a full gastrointestinal barium meal should be performed to rule out Crohn's disease. Those with persistent postprandial upper abdominal pain should undergo gallbladder ultrasound. If pancreatic disease is suspected, abdominal CT and amylase tests should be conducted. For suspected lactase deficiency, a lactose tolerance test should be performed. Small intestinal mucosal biopsy should be done to exclude small intestinal mucosal diseases, and colonic mucosal biopsy should be performed to exclude colitis. After a preliminary diagnosis of this condition, close follow-up is necessary to ensure the accuracy of the diagnosis over time.

Neurogenic vomiting must be differentiated from chronic gastric diseases, vomiting of pregnancy, uremia, and intracranial space-occupying lesions. Neurogenic anorexia should be distinguished from stomach cancer, early pregnancy reactions, and hypofunction of the pituitary or adrenal cortex.

bubble_chart Treatment Measures

(1) Psychotherapy Effective in two-thirds of patients. The key to treating functional gastrointestinal disorders lies in alleviating psychological barriers and regulating organ function. If a patient suspects or worries about having a certain disease, targeted examinations by a doctor to dispel doubts and stabilize emotions can itself be a therapeutic approach.

(2) Supportive Therapy Unless the patient is in very poor general condition, bed rest is usually unnecessary. A regular lifestyle and appropriate physical activity can enhance constitution and accelerate the recovery of nervous function. Patients with nervous anorexia accompanied by severe malnutrition, or those who experience diarrhea from nasogastric tube feeding, require intravenous nutrition. High-fiber foods can alleviate symptoms in IBS patients.

(3) Drug Therapy Short-term administration of tricyclic antidepressants Yaodui is useful for patients with pronounced psychiatric symptoms. For IBS patients with spasmodic abdominal pain, anticholinergic drugs such as dicyclomine (10–20mg, 3–4 times/day) can reduce postprandial abdominal pain and urgency to defecate. The calcium antagonist Duspatalin (50mg, 3 times/day) can decrease the postprandial increase in spike potential activity. Oil of Wild Mint (0.2ml taken before meals) relaxes smooth muscles and provides some relief for abdominal pain. Loperamide (Imodium, 2mg, 4 times/day) is effective for diarrhea-predominant IBS.

(4) Chinese Medicine Therapy

1. Nervous Vomiting If vomiting occurs without other symptoms, Minor Pinellia and Poria Decoction with modifications can be used to stop vomiting and is effective for mild cases.

2. Aerophagia Inula and Hematite Decoction with modifications can be used for treatment.

3. Irritable Bowel Syndrome If symptoms include abdominal pain with diarrhea, hypochondriac distension, and a wiry pulse, indicating liver-spleen disharmony, Pain and Diarrhea Vital Formula with modifications can be used. If symptoms include early morning borborygmus and diarrhea, cold abdomen and limbs, a pale tongue, and a thin wiry pulse, indicating spleen-kidney yang deficiency, Aconite Middle-Regulating Decoction combined with Four Miracle Pill with modifications can be used for treatment.

(5) Other Therapies Acupuncture, physiotherapy, and other methods may sometimes be effective and can be applied based on specific circumstances.

bubble_chart Prognosis

After treatment, gastrointestinal dysfunction may still recur, but it generally does not seriously affect overall health. Patients with severe malnutrition and cachectic neurogenic anorexia have a poorer prognosis, with a mortality rate of 5%.