Functional digestive disorders, especially irritable bowel syndrome, are becoming increasingly important in Western societies. The reasons for this are their high prevalence and the high economic, social and personal cost. Many of these patients occupy primary care and gastroenterology consultations, and the available therapeutic possibilities are limited.

It has been thought for decades that functional digestive disorders were an exclusive problem of developed societies; somehow, the price to pay for “well-being”. Epidemiological studies show us that perhaps this is not exactly true. For example, a frequency of irritable bowel syndrome has been reported in developing countries, similar to Western societies. Thus, a high incidence has been observed in population subgroups, such as 43.5% among medical students in Nigeria, and 9% among young people in Brazil, although studies aimed at the general population show discrepant results, with a low prevalence of 2.3% in Singapore and 3% in Iran.

The work of Bujanda and collaborators published in this issue of Anales de Medicina Interna,  largely the result of the personal and selfless effort of the authors to collaborate in an exceptionally deficient health area, shows us that functional digestive disorders represent a large number of digestive queries also in this area. This invites reflection and leads us to think about what changes are the social importance that can be granted to it and in some way shows us that the problem of functional digestive disorders is found in the personal and social sense of “well-being” and health”. In a society like ours where medicine’s understanding of “omnipotence” prevails. Our fears and concerns centre around “cancer,” it is logical to think that “well-being and health” are the optimal capacity to develop all the desired physical, personal and social functions in a developing society, where the leading cause of mortality is maternal. Child mortality and where cancer is probably not a relevant problem (because it is difficult to reach the age to suffer from it), the concept of “health and well-being” is perhaps to maintain them to survive. Somehow, “quality of life” versus just “life”. Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of society, but by the personal and social importance given to these symptoms. They are the optimal capacity to develop all the desired physical, personal and social functions in a developing society, where the leading cause of mortality is maternal. Child mortality and where cancer is probably not a relevant problem (because it is difficult to reach the age to suffer from it), the concept of “health and well-being” is perhaps to maintain them to survive. Somehow, “quality of life” versus just “life”. Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of society, but by the personal and social importance given to these symptoms. They are the optimal capacity to develop all the desired physical, personal and social functions in a developing society, where maternal mortality is the leading cause. Child mortality and where cancer is probably not a relevant problem (because it is difficult to reach the age to suffer from it), the concept of “health and well-being” is perhaps to maintain them to survival. Somehow, “quality of life” versus just “life”. Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of society, but by the personal and social importance given to these symptoms. Where the leading cause of mortality is maternal and child mortality and where cancer is probably not a relevant problem (because it is difficult to reach the age to suffer from it), the concept of “health and well-being” is perhaps to maintain the ability to westernization. Somehow, “quality of life” versus just “life.” Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of society, but by the personal and social importance given Where symptoms. Where the leading cause of mortality is maternal and child mortality and where cancer is probably not a relevant problem (because it is difficult to reach the age to suffer from it), the concept of “health and well-being” is perhaps to maintain the ability to exist. Somehow, “quality of life” versus just “life”. Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of the city, but by the personal and social importance given to these symptoms—probably to maintain the ability to exist. Somehow, “quality of life” versus just “life.” Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization of society, but by the personal and social importance given to these symptoms. Is pIt can maintain the ability to exist? Somehow, “quality of life” versus just “life.” Going back to the beginning, it seems that functional digestive disorders are not caused by development, by the westernization society, but by the personal and social importance given to these symptoms.

Undoubtedly, their diagnosis is the first problem of functional digestive disorders in a society like ours. There is no unanimously accepted diagnostic algorithm, especially concerning the diagnostic studies that must be performed, but there is a consensus regarding its clinical diagnosis. The work of Bujanda et al. indirectly raises an interesting question: are the diagnostic criteria valid in a developing population? Although the work does not allow us to answer this question and presents methodological limitations (derived undoubtedly from the medium’s shortcomings), its results once again invite reflection. It is noteworthy how the application of the clinical criteria for irritable bowel syndrome and functional dyspepsia makes it possible to classify patients reasonably, and this occurs in a population of relatively young patients (mean age 37 years); in our clinical practice, with a limited additional diagnostic study, it would be enough to accept the diagnosis of functional disorder. For example, more than a quarter of the patients clinically classified as having a functional condition studied for parasites in faeces were finally diagnosed with intestinal parasitosis. This high incidence suggests that the clinical criteria for diagnosing a functional disorder are insufficient in developing countries and that it may be necessary to routinely perform a faecal parasite study on all patients with digestive symptoms. This problem is linked to the social and hygienic-sanitary conditions of the environment. Once again, it indicates that the priorities of medical action in developing countries must also address more basic aspects than medical diagnosis and treatment.

The third aspect raised by the study by Bujanda et al. is the possible participation of parasitic infestations in the pathogenesis and pathophysiology of functional disorders. The origin of functional digestive disorders is unknown, and the pathophysiological hypotheses are based on three pillars: the presence of alterations in visceral perception, the existence of alterations in digestive motility and changes in emotional reactivity. There is evidence to indicate that these three factors are closely related, especially the connection between the central nervous system and the enteric nervous system (which controls digestive function), constituting what is known as the brain-enteric axis. The possible role played by infections in the genesis of irritable bowel syndrome has been pointed out. Thus, it has been proven that patients who have suffered from gastroenteritis have an increased risk of subsequently suffering from irritable bowel syndrome. However, it is not the infection that seems responsible for the symptoms’ genesis. A prospective study has shown that the development of irritable bowel syndrome in patients with gastroenteritis is fundamentally related to psychological factors. These results highlight, if possible, the great importance of the psychic sphere (emotional reactivity, psychopathological states, stress) in digestive functioning, not only in specific disorders that we have all suffered in times of acute but, more importantly, to determine permanent malfunction states. This inadequate reactivity has been related to inflammatory factors, significantly an increase in the population of mast cells. There is no prior information regarding the possible role that parasitic infestations may play in the genesis of irritable bowel syndrome. Still, the truth is that certain parasitic infections are used to create experimental models of digestive function disorders. This indicates parasites’ potential to generate visceral motor and sensory alterations beyond the acute infection. Significantly an increase in the population of mast cells. There is no prior information regarding the possible role that parasitic infestations may play in the genesis of irritable bowel syndrome. Still, the truth is that certain parasitic infections are used to create experimental models of digestive function disorders. This indicates parasites’ potential to generate visceral motor and sensory alterations beyond the acute infection. Significantly an increase in the population of mast cells. There is no prior information regarding the possible role that parasitic infestations may play in the genesis of irritable bowel syndrome. Still, the truth is that certain parasitic infections are used to create experimental models of digestive function disorders. This indicates parasites’ potential to generate visceral motor and sensory alterations beyond the acute infection.

In short, the work of Bujanda et al. makes us part of the reality of digestive pathology in a disadvantaged health area such as Guatemala, conveying their surprise at the abundance of functional digestive pathology. It also suggests that the diagnostic study could be different, being necessary to rule out intestinal parasitosis and pointing out the possibility that parasitosis could have some relationship with the subsequent development of irritable bowel syndrome.