Cited by 512Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Biopsychosocial Aspects of Functional Gastrointestinal Disorders: How Central and Environmental Processes Contribute to the Development and Expression of Functional Gastrointestinal Disorders

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Van Oudenhove, Lukas, Levy, Rona L., Crowell, Michael D., Drossman, Douglas A., Halpert, Albena D., Keefer, Laurie, Lackner, Jeffrey M., Murphy, Tasha B., Naliboff, Bruce D.·2016·Gastroenterology

DOI 10.1053/j.gastro.2016.02.027PMC PMC8809487

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Abstract

In this paper, we provide a general framework for understanding the functional gastrointestinal disorders (FGID) from a biopsychosocial perspective. More specifically, we provide an overview of the recent research on how the complex interactions of environmental, psychological, and biological factors contribute to the development and maintenance of the FGID. We emphasize that considering and addressing all these factors is a conditio sine qua non for appropriate treatment of these conditions. First, we provide an overview of what is currently known about how each of these factors - the environment, including the influence of those in an individual's family, the individual's own psychological states and traits, and the individual's (neuro)physiological make-up - interact to ultimately result in the generation of FGID symptoms. Second, we provide an overview of commonly used assessment tools which can assist clinicians in obtaining a more comprehensive assessment of these factors in their patients. Finally, the broader perspective outlined earlier is applied to provide an overview of centrally acting treatment strategies, both psychological and pharmacological, which have been shown to be efficacious to treat FGID.

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Semen, M. O., Lychkovska, O. L., Kaminskyy, D. V., Yavorskyi, O., Semen, K. O., & Yelisyeyeva, O. P. (2023) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm22019 · Cited by 11
Translation and validation of the Ukrainian version of the visceral sensitivity index for patients with irritable bowel syndrome
Neverovskyi, A., Shypulin, V. P., & Mikhn`ova, N. (2023) · Gastroenterology Review · doi:10.5114/pg.2023.131391 · Cited by 10
“It was shown that comorbidity of functional GI disorders with depression is seen in about 30% of patients, and with anxiety – in about 30–50% [8, 9].”
BackgroundMethodInfluential
Physiological and Psychological Factors Contribute to Real-Time Esophageal Symptom Reporting in Patients With Refractory Reflux
Guadagnoli, L. A., Abber, S. R., Geeraerts, A., Geysen, H., Pauwels, A., Tack, J. F., Oudenhove, L. V., & Vanuytsel, T. (2024) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003033 · Cited by 7
Gastrointestinal health: An investigation of mediating effects on mood and quality of life
Ross, E. J., Vivier, H., Cassisi, J. E., & Dvorak, R. D. (2020) · Health Psychology Open · doi:10.1177/2055102920974524 · Cited by 8
“Taken together, the biopsychosocial model and the GBA provides the theoretical underpinnings of how psychological stress and cognitive-affective processes are potential risk factors for the experience of GI symptoms in emerging adults (Drossman et al., 2002; Van Oudenhove et al., 2016).”
Background
Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia
Selim, A., Salem, S. S., Albasher, N., Bakrmom, G., Al-Anzi, S. K., & Jradi, H. (2021) · Clinical Nursing Research · doi:10.1177/10547738211020437 · Cited by 8
“IBS patients have frequent stressors and higher perception of stress intensity when compared to controls and consequently show higher psychological stress (Berens et al., 2019; Roohafza et al., 2016; Weaver et al., 2018).”
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Self-citation
Experiences of Irritable Bowel Syndrome Patients in a Virtual Yoga Program: Qualitative Findings from a Clinical Trial
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Anxiety disorders and the gut microbiota: a bibliometric and visual analysis
Guo, L., Ding, Q., Li, Q., Zheng, D., Guo, L., Cao, X., & Mou, Q. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1517508 · Cited by 9
Autonomic Nervous System and Disorders of Gut–Brain Interaction
Essner, B. S., Osgood, P. T., Pérez, M. E., & Fortunato, J. E. (2025) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2025.05.002 · Cited by 6
Comparison of Pelvic Floor Dysfunction in Women with Ulcerative Colitis and Healthy Population
Soheilipour, M., far, B. T., Fadaei, R., & Adibi, P. (2024) · Middle East Journal of Digestive Diseases · doi:10.34172/mejdd.2024.384 · Cited by 6
Extragastrointestinal Symptoms and Sensory Responses During Breath Tests Distinguish Patients With Functional Gastrointestinal Disorders
Wilder‐Smith, C. H., Drewes, A. M., Materna, A., & Olesen, S. S. (2020) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000192 · Cited by 6
“Wilder-Smith et al. However, the in ﬂ uences of psychological factors and intestinal distension have been extensively reported in earlier studies (26,39,45).”
BackgroundResult
The growing gap between demand and availability of clinical psychology in Paediatric Gastroenterology: a retrospective analysis of clinical routine care
Wong, E., Heuschkel, R. B., Lindsay, C., Benson, S., & Zilbauer, M. (2020) · European Journal of Pediatrics · doi:10.1007/s00431-020-03825-y · Cited by 6
Major depressive disorder and the risk of irritable bowel syndrome: A Mendelian randomization study
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“A proposed biopsychosocial medicine model, the brain–gut axis, investigating a bidirectional neurohumoral communication system between the brain and the gut, has envisaged a focal point for exploring the association between gut disorders and psychological disorders (Van Oudenhove et al., 2016).”
Background
One More Tool in the Tool Belt: A Qualitative Interview Study Investigating Patient and Clinician Opinions on the Integration of Psychometrics Into Routine Testing for Disorders of Gut-Brain Interaction
Law, M., Bartlett, E., Sebaratnam, G., Pickering, I., Simpson, K., Keane, C., Daker, C., Gharibans, A. A., O’Grady, G., Andrews, C. N., et al. (2024) · Cureus · doi:10.7759/cureus.67155 · Cited by 7
The Spanish version of the esophageal hypervigilance and anxiety score shows strong psychometric properties: Results of a large prospective multicenter study in Spain and Latin America
Daniel Cisternas, C., Taft, T., Carlson, D. A., Glasinovic, E., Monrroy, H., Rey, P., Hani, A. C., Ardila‐Hani, A., Leguizamó, A. M., Bilder, C. R., et al. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14102 · Cited by 6
Psycho-gastroenterology
Shoji, T., Endo, Y., & Fukudo, S. (2018) · Springer eBooks · doi:10.1007/978-981-13-1074-4_9 · Cited by 6
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Alvira, M. S. V., Ossa, L. M. A., & Poveda, E. (2022) · Revista Colombiana de Gastroenterología · doi:10.22516/25007440.899 · Cited by 11
Somatic symptom disorder in patients with irritable bowel syndrome or ulcerative colitis – Cross-sectional baseline findings from the SOMA.GUT-RCT
Peters, L., Matysiak, A., Hübener, S., Lohse, A. W., Nestoriuc, Y., Maehder, K., & Löwe, B. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112395 · Cited by 7
A multidisciplinary approach to the management of disorders of gut-brain interaction: psychopharmacology, psychotherapy, and diet
Flores, F. J. B., Tamez, J. A. G., Winkelman, T., Flores, R. B., & Madva, E. N. (2025) · Frontiers in Gastroenterology · doi:10.3389/fgstr.2025.1637172 · Cited by 8
Emotion Regulation Difficulties as Moderators in the Relation Between Perceived Stress and the Severity of Somatic Symptoms
Selvi, K., & Bozo, Ö. (2023) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-023-00520-3 · Cited by 6
Psychological comorbidities are more prevalent amongst pregnant and postpartum patients with irritable bowel syndrome
Luo, Y., Luo, C. L., Meislin, R., Yang, E., & Zhang, X. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14800 · Cited by 5
S1-Leitlinie der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) zur funktionellen Dyspepsie (Reizmagen), einer Disorder of Gut-Brain Interaction (DGBI)
Storr, M., Andresen, V., Frieling, T., Gschossmann, J. M., Keller, J., Langhorst, J., Pehl, C., Stengel, A., Tebbe, J. J., Wiemer, K., et al. (2025) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2518-1430 · Cited by 5
“Hierbei sollten frühzeitig eine Diagnoseüber-mittlung (als Verdachtsdiagnose) stattfinden sowie dann patho-genetisch relevante Faktoren eruiert und benannt sowie in ein biopsychosoziales Gesamtkonstrukt eingefügt werden [67].”
Patterns of Functional Gastrointestinal Disorders Among Children in Makkah City: A Single Institutional Experience
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“criteria identified 20 pediatric-related disorders, with a distinction made between younger (infant/toddler) and older (child/adolescent) children [7,8].”
Background
An Innovative Model of ISS ‐Based Multiple Fractures and Gastrointestinal Dysfunction Related to c‐Kit Protein Expression on Interstitial Cells of Cajal
Meng, S., Fan, M., Qian, J., Zhang, J., Xu, H., Zheng, Y., Zhao, W., Shan, L., & Huang, J. (2023) · Orthopaedic Surgery · doi:10.1111/os.13599 · Cited by 5
“Second, the influence of psychological factors in humans on gastrointestinal function cannot be reproduced in experimental animals.(24,25) Third, multiple fractures are often high-energy injuries, which could not be simulated by our modeling method.”
Background
“A source of empowerment and well-being”: Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders
Högström, S., Eriksson, M. H., Mörelius, E., & Duberg, A. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1040713 · Cited by 8
Tuina treatment for children and adults with functional dyspepsia: a meta-analysis and systematic review of randomized controlled trials
Tao, Z., Cao, Z., Liu, Q., Luo, X., Zhang, G., Fang, S., Du, S., Yang, Y., & Wei, W. (2023) · Journal of Acupuncture and Tuina Science · doi:10.1007/s11726-023-1400-6 · Cited by 5
Somatization Mediates the Relationship Between Childhood Trauma and Pain Ratings in Patients with Irritable Bowel Syndrome
Schubach, A., Quigley, B. M., Lackner, J. M., & Gudleski, G. D. (2024) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001974 · Cited by 5
Self-citation
Identifying Novel Subtypes of Functional Gastrointestinal Disorder by Analyzing Nonlinear Structure in Integrative Biopsychosocial Questionnaire Data
Park, S.-Y., Bae, H., Jeong, H.-Y., Lee, J. Y., Kwon, Y. K., & Kim, C.-E. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13102821 · Cited by 5
“However, conventional medical treatment for FGIDs is generally ineffective [4], possibly due to a one-size-fits-all approach.”
Background
Impact of Opioid and Cannabis Use on Low‐Dose Amitriptyline Efficacy in Cyclical Vomiting Syndrome: A Real‐World Study in the United Kingdom
Butt, M. F., Cefalo, F., Sbarigia, C., Dhali, A., & Corsetti, M. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.70007 · Cited by 5
Vortioxetine treatment for major depressive disorder with the co-morbidity of irritable bowel syndrome with diarrhoea: a case report
Aydın, O., & Ünal‐Aydın, P. (2017) · Psychiatry and Clinical Psychopharmacology · doi:10.1080/24750573.2017.1387403 · Cited by 5
“IBS is derived from biological, psychological, and social factors and has no universally effective medical treatment [1].”
The Positive Effect of Mindfulness Rivals the Negative Effect of Neuroticism on Gastrointestinal Symptoms
Beath, A., Mcdonald, K., Osborn, T. C., & Jones, M. P. (2018) · Mindfulness · doi:10.1007/s12671-018-1019-8 · Cited by 5
Effects of cognitive-behavioral stress management training in individuals with functional somatic symptoms – an exploratory randomized controlled trial
Markert, C., Gomm, C., Ehlert, U., Gaab, J., & Nater, U. M. (2019) · Stress · doi:10.1080/10253890.2019.1625329 · Cited by 5
Perceptions of Pain Treatment in Pediatric Patients With Functional Gastrointestinal Disorders
Hale, A. E., Smith, A., Christiana, J. S., Burch, E., Schechter, N. L., Beinvogl, B. C., Paul, F., Henaghan, A. S., Logan, D. E., & Nurko, S. (2020) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000832 · Cited by 5
Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS)
Longstreth, G. F., Wong, C. P., & Chen, Q. (2020) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2020.04.190328 · Cited by 5
“Consideration of the psychosocial background and prior health care-seeking behavior, including amplified reporting of multiple symptoms and consultation(24,25) is particularly important in patients with severe pain.(26,27) However, based on clinical and laboratory findings alone(8) both primary physicians and gastroen…”
Efficacy of Kolofort in Combined Functional Gastroenterological Pathology: an Open Study
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The Potential Antistress and Gastroprotective Effects of Berberine in Immobilization Stress Induced Gastric Ulcer in Rats
Salem, H. R., Kora, M. A. M., & Khodir, S. A. (2023) · Bulletin of Egyptian Society for Physiological Sciences · doi:10.21608/besps.2022.147058.1126 · Cited by 5
Dynamics of Somatic and Comorbid Mental Disorders (Distress, Anxiety, Somatisation and Depression) in Patients with Irritable Bowel Syndrome during Therapy with Alimemazine: Results of an Non-Interventional Observational Programme (“Terra”)
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Evaluation of subcortical structure volumes in patients with non-specific digestive diseases
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119 PSYCHOMETRIC PROFILING OF PATIENTS WITH CHRONIC GASTRODUODENAL SYMPTOMS USING BODY SURFACE GASTRIC MAPPING PHENOTYPES
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Authors: Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., Lackner, J. M., Murphy, T. B., & Naliboff, B. D.
Affiliations: University of Washington (US)
Mayo Clinic (US)
University of North Carolina at Chapel Hill (US)
Boston Medical Center (US)
Mount Sinai Hospital (US)
State University of New York (US)
University of California, Los Angeles (US)
Corresponding author: Levy, Rona L.
ORCID: Levy, Rona L.
Crowell, Michael D.
Drossman, Douglas A.
Keefer, Laurie
Lackner, Jeffrey M.
Murphy, Tasha B.
Naliboff, Bruce D.
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2016-05
Volume: 150
Issue: 6
Pages: 1355-1367.e2
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2016.02.027
PMC: PMC8809487
OpenAlex: W2344812785
Cited by: 512
References: 110
Citations by year: 2026: 49 · 2025: 58 · 2024: 54 · 2023: 52 · 2022: 59 · 2021: 63 · 2020: 51 · 2019: 47 · 2018: 35 · 2017: 38 · 2016: 6
FWCI: 45.98
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Gastroenterology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Allergan
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK077738)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: functional gastrointestinal disorders, biopsychosocial model, environmental factors, psychological factors, family influence, psychological characteristics, neurophysiological factors, psychological assessment instruments, pharmacotherapy, psychological intervention, treatment options

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Biopsychosocial Aspects of Functional Gastrointestinal Disorders: How Central and Environmental Processes Contribute to the Development and Expression of Functional Gastrointestinal Disorders

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