Concluding Comments

The gut has its own intrinsic nervous system and is in active communication with the brain and central nervous system. Therefore, it is not especially surprising to note that disorders of gastrointestinal function exist in the absence of evidence of tissue damage, with the relationship between FGIDs and gastrointestinal diseases such as Crohn's disease perhaps being analogous to that between common psychiatric disorders such as anxiety or mood disorders and neurological diseases such as multiple sclerosis. FGIDs are indeed common, impairing, and strongly associated with anxiety and depressive disorders; new treatments share common features with treatment regimens that are successful in the management of emotional disorders and migraine headache. Psychiatric symptoms and disorders, particularly depression, are also commonly comorbid with gastrointestinal diseases such as IBD and hepatitis C, sometimes in relation to associated treatments such as corticosteroids and interferon alpha.

The recognition and management of comorbid psychopathology are relevant given its potential to negatively impact disease course via effects on regimen adherence, lifestyle adaptations, and patho-physiology of the disease process itself. Future research should attempt to link the course of gastrointestinal disease with that of comorbid psycho-pathology. Gastrointestinal disease can present challenges to the psychopharmacologist via effects on drug absorption, distribution, biotransformation, and excretion.

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