Vloeken in de (biopsychosociale) kerk. Dat doen Paul Enck en Nazar Mazurak van de afdeling

Psychosomatiek van de Universiteit van Tübingen met hun recent gepubliceerde artikel

Op basis van een analyse van 1.302 studies naar de gevolgen van darminfecties en andere infecties,

concluderen zij dat het effect van psychosociale factoren op de uitkomst, zeer beperkt/nihil is.

Hun analyse richtte zich met name op het prikkelbaar darmsyndroom en 'CVS' (gezien hun overlap)

De conclusie van de auteurs liegt er niet om:

Als hun bevindingen kloppen dan is de zoektocht naar psychologische en sociale factoren

die zouden verklaren waarom de één wel en de ander niet ziek wordt na een infectie, misleidend,

omdat die inspanningen afleiden van het onderzoek van de oorzaken van de biologische afwijkingen.

Zij stellen voor om, in lijn met de oorspronkelijke insteek van het (bio)psyschosociale model,

de biologische factoren weer op de eerste plaats te zetten, omdat die de ziekte(n) verklaren.

The "biology-first" hypothesis:

Functional disorders may begin and end with biology -

A scoping review.

Neurogastroenterol Motil. 2018 Jun 28:e13394. doi: 10.1111/nmo.13394.

Enck P, Mazurak N.

Key Points

• It is common knowledge that gastrointestinal infections can cause functional disturbances in the upper and lower gastrointestinal tract.
• We hypothesize that intestinal infections can also induce functional non-intestinal diseases and that non-intestinal infections can provoke chronic intestinal and extra-intestinal dysfunctions.
• This implies that the role of biological processes should be considered as domi­nant in a biopsychosocial model of certain functional gastrointestinal disorders.
• We called this the 'biology-first hypothesis' that needs further and future prospective validation.

Abstract

While it is generally accepted that

gastrointestinal infections can cause functional disturbances

in the upper and lower gastrointestinal tract-

known as postinfectious irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD)-

it has still not been widely recognized

that such an infection can also initiate functional non-intestinal diseases, and

that non-intestinal infections can provoke both intestinal and non-intestinal functional disturbances.

We conducted a scoping review of the respective literature and

-on the basis of these data- hypothesize that

medically unexplained functional symptoms and syndromes following an infection

may have a biological (genetic, endocrine, microbiological) origin, and

that psychological and social factors, which may contribute to the disease "phenotype,"

are secondary to this biological cause.

If this holds true,

then the search for psychological and social theories and factors

to explain why one patient develops a chronic functional disorder while another does not is

- at least for postinfectious states- misleading and

detracts from exploring and identifying the true origins of these essentially biological disorders.

The biopsychosocial model may, as the term implies,

always begin with biology, also for functional (somatoform) disorders.

Keywords:

biopsychosocial model; chronic fatigue syndrome; functional dyspepsia; irritable bowel syndrome; postinfectious; somatoform disorders

PMID: 29956418

DOI: 10.1111/nmo.13394