Systems-Based Integration of Gastrointestinal and Urological Disorders: A Multisystem Approach to Clinical Complexity in Internal Medicine
DOI:
https://doi.org/10.64784/154Palavras-chave:
Multimorbidity, systems medicine, gastrointestinal disorders, urological disorders, microbiota, metabolic syndrome, systemic inflammation, gut–kidney axis, clinical complexity, integrated careResumo
Clinical complexity in internal medicine has increasingly shifted from isolated organ-based disease models toward integrative, systems-based approaches. This review analyzes the interaction between gastrointestinal and urological systems as a representative model of multisystem disease. A narrative synthesis of high-impact literature was conducted, focusing on shared pathophysiological mechanisms, including systemic inflammation, metabolic dysregulation, microbiota alterations, neuroautonomic dysfunction, and organ crosstalk. The findings demonstrate that gastrointestinal and urological disorders frequently coexist and are interconnected through dynamic biological networks rather than independent processes. Multimorbidity emerges as a central framework in which conditions influence each other’s progression and clinical expression. The gut–kidney–bladder axis, along with the role of the microbiome and metabolic syndrome, provides key insights into these interactions. Furthermore, integrated care approaches show a clear advantage over fragmented management, improving clinical outcomes through coordinated and mechanism-based strategies. These results support the need for a paradigm shift in internal medicine toward systems-based thinking, particularly in clinical and educational settings. The integration of gastrointestinal and urological perspectives offers a more comprehensive understanding of disease and contributes to more effective, patient-centered care.
Referências
Bajaj, J. S. (2019). Alcohol, liver disease and the gut microbiota. Nature Reviews Gastroenterology & Hepatology, 16(4), 235–246. https://doi.org/10.1038/s41575-018-0099-1
Camilleri, M., & Bharucha, A. E. (2021). Gastrointestinal dysfunction in neurologic disease. Seminars in Neurology, 41(2), 198–211. https://doi.org/10.1055/s-0041-1726069
Chapple, C. R., Osman, N. I., Birder, L., van Koeveringe, G. A., Oelke, M., Nitti, V. W., & Drake, M. J. (2020). The underactive bladder: A new clinical concept? European Urology, 78(3), 351–358. https://doi.org/10.1016/j.eururo.2020.03.020
Coyne, K. S., Wein, A. J., Tubaro, A., Sexton, C. C., Thompson, C. L., Kopp, Z. S., & Aiyer, L. P. (2020). The burden of lower urinary tract symptoms. BJU International, 125(2), 236–243. https://doi.org/10.1111/bju.14940
Dzau, V. J., McClellan, M. B., McGinnis, J. M., et al. (2021). Vital directions for health and health care. JAMA, 325(3), 241–242. https://doi.org/10.1001/jama.2020.26717
Fan, Y., & Pedersen, O. (2021). Gut microbiota in human metabolic health and disease. Nature Reviews Microbiology, 19(1), 55–71. https://doi.org/10.1038/s41579-020-0433-9
Gacci, M., Sebastianelli, A., Salvi, M., De Nunzio, C., Tubaro, A., & Maggi, M. (2020). Metabolic syndrome and lower urinary tract symptoms. European Urology Focus, 6(2), 322–330. https://doi.org/10.1016/j.euf.2019.02.010
Gratzke, C., Bachmann, A., Descazeaud, A., Drake, M. J., Madersbacher, S., Mamoulakis, C., & Oelke, M. (2021). EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms. European Urology, 79(1), 109–127. https://doi.org/10.1016/j.eururo.2020.08.033
Hood, L., & Flores, M. (2021). A personal view on systems medicine and the emergence of P4 medicine. New Biotechnology, 60, 97–102. https://doi.org/10.1016/j.nbt.2020.03.004
Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R. H., & Spechler, S. J. (2022). ACG clinical guideline for gastroesophageal reflux disease. The American Journal of Gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538
Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG clinical guideline: Management of irritable bowel syndrome. The American Journal of Gastroenterology, 116(1), 17–44. https://doi.org/10.14309/ajg.0000000000001036
Meijers, B., & Evenepoel, P. (2021). The gut–kidney axis. Kidney International, 99(6), 1245–1253. https://doi.org/10.1016/j.kint.2021.02.027
Nicholson, J. K., Holmes, E., Kinross, J., et al. (2012). Host–gut microbiota metabolic interactions. Science, 336(6086), 1262–1267. https://doi.org/10.1126/science.1223813
Thomas-White, K., Brady, M., Wolfe, A. J., & Mueller, E. R. (2020). The bladder microbiome. Nature Reviews Urology, 17(9), 519–530. https://doi.org/10.1038/s41585-020-0345-2
Tilg, H., Zmora, N., Adolph, T. E., & Elinav, E. (2020). The intestinal microbiota fuelling metabolic inflammation. Nature Reviews Immunology, 20(1), 40–54. https://doi.org/10.1038/s41577-019-0198-4
Tinetti, M. E., & Fried, T. R. (2020). The end of the disease era. The American Journal of Medicine, 133(3), 289–290. https://doi.org/10.1016/j.amjmed.2019.11.009
Vaziri, N. D., & Zhao, Y. Y. (2021). Altered gut microbiome in chronic kidney disease. Kidney International, 99(6), 1238–1244. https://doi.org/10.1016/j.kint.2020.10.040
Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2020). Managing patients with multimorbidity in primary care. BMJ, 368, l6964. https://doi.org/10.1136/bmj.l6964
Younossi, Z. M., Corey, K. E., Lim, J. K., & Ahmed, A. (2021). Clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 73(1), 373–385. https://doi.org/10.1002/hep.31327
Zulman, D. M., Asch, S. M., Martins, S. B., Kerr, E. A., Hoffman, B. B., & Goldstein, M. K. (2021). Quality of care for patients with multiple chronic conditions. Journal of General Internal Medicine, 36(1), 135–142. https://doi.org/10.1007/s11606-020-06256-7
