Anxiety Induced Refractory Gastrointestinal Disorders

Functional gastrointestinal (GI) disorders are clinical syndromes characterized by chronic or relapsing GI symptoms in the absence of structural or biochemical abnormalities that can be identified following a standard diagnostic work-up. The irritable bowel syndrome (IBS) and functional dyspepsia (FD) are the best recognized functional bowel disorders and both these disorders are highly prevalent. FD is a very common clinical condition affecting one-third of the population. Neurotransmitters produced in the gastrointestinal (GI) tract regulate GI motility, blood flow, secretion and absorption. The enteric nervous system and central nervous system have direct effects on each other. The brain-gut connection (axis) seems to be a mechanism that links the psycho emotional state with GI dysfunction. In the majority of FD patients, treatment is symptom based (Figure 1). Depending on the most dominant symptom, acid inhibitory or prokinetic compounds are given but the results remain often unsatisfactory. There remains a substantial group of patients that do not respond to therapy. It is believed that psychosocial factors and abnormalities of gut function play a role in the manifestation and severity of symptoms [1-3]. GERD and its refractoriness to PPI treatment