Next Sunday, May 29 is World Digestive Health Day. Dr. Mearin Manrique, Digestive System specialist, director of this service at Centro Medico Teknon and member of Top Doctors, talks to us about what digestive health currently means.
Health and Digestive Health
The concept of health has changed significantly in recent decades. For a long time it was thought that health was the absence of disease, and that the absence of bodily injury implied a healthy state. Fortunately, however, this way of thinking has changed and nowadays the concept of HEALTH includes other important aspects. In fact, the World Health Organization (WHO) states that “health is a state of physical, mental and social well-being and not merely the absence of disease or infirmity”.
Something similar has happened in Digestive Health. Patients no longer go to a Digestive specialist only when they vomit repeatedly, have blood in their stool or notice a lump in their abdomen. They also do so when they have poor digestion, bloating or abnormal bowel movements. In addition, their visit to the doctor is often aimed at preventing, not just diagnosing, possible digestive diseases. In short, patients do not only go to the doctor when they are seriously ill, but they want to have better digestive health, a better quality of life, and to prevent the onset of disease.
Under this heading of Digestive Health there are some aspects that are worth reviewing briefly such as: quality of life, the biopsychosocial model, the brain-intestinal axis, or the difference between organic and functional disorders.
What is meant by Quality of Life?
The term quality of life (QOL) is now commonly used. Its meaning is intuitively understood, and the desire to improve QoL is inherent to human beings. However, the emergence of the concept as such, and the concern for its systematic and scientific evaluation, is relatively recent. It is only 60 years since the term began to be popularized and has now become a concept used in a wide range of fields such as health, education, economics, politics and the world of services in general.
There is no universally accepted definition of quality of life, due to the large number of aspects to be assessed in human existence (economic, work, family, sexual, expectations, etc.). According to the WHO, QOL is “an individual’s perception of his or her place in existence, in the context of the culture and value system in which he or she lives, and in relation to his or her goals, expectations, norms, and concerns. It is a very broad concept that is influenced in a complex way by physical health, psychological state, level of independence, social relationships, as well as the relationship with the essential elements of the environment”.
Underlying the biopsychosocial model of thinking is the attempt to change the conception that diseases have a single biological etiology in order to understand them in a more complex and integrative way. With this approach, digestive symptoms can be understood as physiologically multifactorial (inflammation of an organ, alterations in digestive movements, increased sensitivity, etc.) and modifiable by sociocultural and psychosocial influences. Therefore, the disease would have multiple causes, and its effects would also be multiple.
To understand this biopsychosocial conception of digestive symptoms, in which there is an interaction between biological, psychological and social variables, the “general systems theory” has been adopted. According to this theory, all levels of a system are hierarchically related to each other and changes at any level affect all the others. Thus, health, disease, and medical care are conceived as a set of interrelated processes. Such a conception entails certain clinical implications, such as, for example, that in the diagnostic process the interactive role of biological, psychological and social factors should be considered when assessing health or disease. Finally, the importance of the patient-physician relationship should be emphasized, since, as we know, a good relationship can improve compliance with treatment and its effectiveness, as well as shorten the time needed to obtain the desired effect.
Is there a Brain-Gut Axis?
The influence of emotional factors on digestive discomfort is undeniable. Suffice it to say that in the digestive tract there are almost as many neurons as in the brain, which is why it has been called the “intestinal brain” or “second brain”. In addition, increased knowledge of the nervous regulation of the digestive tract and symptomatic perception has led to a better understanding of the interrelationships between emotional factors and digestive functions. The digestive tract and the brain are closely connected and integrated, in a bidirectional manner, through the autonomic nervous system and the hormonal system that controls stress (hypothalamic-pituitary-adrenal axis). Thus, when there is an alteration in this “conversation between the nervous system and the digestive system”, as occurs in some patients with depression or anxiety disorders, gastrointestinal symptoms may appear. On the other hand, central and peripheral levels of corticotropin influence motor and digestive functions, mainly through the sympathetic autonomic nervous system, making it an important connecting pathway between affective conditioning and digestive tract responses (and vice versa).
What are functional digestive disorders and how do they differ from organic ones?
For many years physicians and society have divided patients into two distinct groups: “those who have something” and “those who have nothing”. We have been like the apostle Thomas: we needed to see in order to believe; to put our hand in the wound or, at least, to see the ulcer or the tumor in the endoscopy. If we did not see the lesion, then the patient had nothing. What a naive and, at the same time, overbearing conclusion. It is not that the damage is absent: it is that the method of observation fails. Most stars “did not exist” until the telescope was invented, and the cell was “an invention” of the microscope. Reality is forceful and persevering, but a certain methodology is needed to understand it.
Neurotransmitters, visceral hypersensitivity phenomena, microinflammation and the mechanisms of intercommunication between the nervous and digestive systems are not visible to the naked eye, but they do not cease to exist. In the past, the physician was concerned with ruling out “serious lesions”; this left the patient more at ease, but just as upset. Without risking any great mistake, it can be said that the history of functional digestive disorders (in which there is no apparent cause) has been characterized by insufficient pathophysiological knowledge, by the lack of interest shown by the scientific community and by the lack of understanding on the part of many health professionals.
In the future it is unlikely that any difference will be made between organic and non-organic diseases, visible and non-visible lesions. It is true that the patient with functional digestive disorders does not die of his disorder, but it is also true that it makes his life very difficult.