Forty years have passed since the first meeting of Japanese Society of Psychosomatic Medicine on Digestive Diseases (JSPMDD) was held chaired by Dr. Tetsuya Nakagawa, professor emeritus of Kyushu University, in March, 1973. The memorial 80th meeting of JSPMDD was successfully held under the main theme of 'Evidence-based Psychosomatic Medicine on Digestive Diseases' cosponsored by the 54^<th> Annual Meeting of Japanese Society of Psychosomatic Medicine (JSPSM : President : Professor Kazuhiko Nakayama, Jikei University) on June 27^<th>, 2013 in Yokohama, Japan. The purposes of JSPMDD are as follows ; holding the meeting (2 times a year), publishing the official journal named 'Journal of Psychosomatic Medicine on Digestive Diseases' (JPDD) annually, nurturing of researchers, research promotion, etc. The meeting has consisted of general oral presentations and research theme organized by the secretary on duty. Recent theme has been in the line of brain-gut interaction related to functional gastrointestinal disorders (e.g., functional dyspepsia, irritable bowel syndrome). The 'Namiki Award' has been adjudged to the out-standing presentation at oral session, possibly leading to the development of the researchers on psychosomatic medicine of digestive diseases. The 20th volume of JPDD has been published by an on-line journal, and all of the full members of JSPMDD can easily access the articles through the web-site of JSPMDD (http://square.umin.ac.jp/JSPMDD/) with ID and password released from the secretariat. The multicenter placebo-controlled randomized double-blind study on the effect of tandospirone citrate (at a dose of 60 mg per day for 8 weeks) on symptoms of patients with functional dyspepsia was organized by JSPMDD and performed by the core members of JSPMDD, although the result was negative. Missions are reevaluated every 5 years and the next meeting of JSPMDD is planning to be, for the first time, jointly hosted by related scientific groups and societies including the Japanese Society of Neurogastroenterology and Motility in November, 2014. A close cooperation with JSPSM and developing the activities of JSPMDD are needed.

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Appetite and feeding behavior are the most important sense and behavior for the maintenance of one's life. Ghrelin is a peptide that has been discovered as an endogenous agonist of the promotion factor receptor for growth hormone secretion. Manifestation and secretion of ghrelin increase by fasting and decrease by ingestion, and the exogenously administered ghrelin increases appetite. In addition, it is involved in various actions such as growth, bowel motility, respiratory function, cardiac activity, carbohydrate metabolism, immunocompetence, affection, cognitive function and generation. Moreover, clinical applications of ghrelin to diseases such as anorexia nervosa, functional gastrointestinal symptoms and cancer cachexia are anticipated. In recent years, the fact that Rikkunshito has an effect to enhance ghrelin signal attracts researchers' attention. Ghrelin, which has various effects as physical and mental hormone, will rise its significance in psychosomatic medicine.

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Narrative is a polysemic term. It can mean words, story, storyteller, listener and their relationship depending on the situation. Narrative also provides our experience with meaning and makes it acceptable one. Unexpected digestive symptoms are unusual, uncomfortable experiences for a patient. We gastroenterologists usually try to find medical explanation (narrative) at first. However, another narrative is necessary when the medical explanation is not accepted by the patient. Psychosomatic medicine (Mind-body correlation theory) is one of the persuasive narratives. Additionally, we need more individual narrative which defines how, why, and in what way he or she is ill. We should facilitate to create alternative narratives that make sense for patients in the healthcare setting.

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Autism spectrum disorders (ASD) represent a group of complaints for which patients present at various medical departments with indefinite symptoms. We have presented and discussed a patient with male Asperger's disorder. Primarily, ASD patients suffer from body hypersensitivity, and in addition somatization may occur as a result of maladjustment to society because of communication disorder, and their insistence on sameness makes their physical symptoms more intractable. We have referred to this phenomenon as "the triple structure of somatization" in ASD patients. Because of this, the physical symptoms they suffer are likely to be prolonged, resulting in unnecessary and continuous visits to medical departments. In clinical settings, it is necessary to focus on maintaining a good relationship between the patient and the therapist, with mutual recognition of characteristics such as hypersensitivity, and avoiding any ambiguity of communication as far as possible.

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This paper examines the treatment progress of six patients with eating disorder (E. D.) who were treated primarily with supportive psychotherapy at an outpatient psychiatry clinic. Three patients had a good prognosis ; the other three did not recover. Their treatment progress is examined with the viewpoint of self-esteem as well. As for the recovered patients, one patient accomplished her goal of vocational self-realization. Another was able to gain interpersonal negotiations skills, attained by boosting her assertiveness. Still another was able to go back to work after tenacious involvement including supportive psychotherapy. On the other hand, recovery was not attained in the patients with compulsive personality disorder, depression due to abuse in the past, and developmental disorder. In order to empower self-esteem in patients, Christophe Andre advocates for improvement in three spheres: self-acceptance, interpersonal relationships, and one's behavior. Improvement in three spheres is similar to the main characteristics of the phenomena of recovery of E. D. Each can be attained through supportive psychotherapy.

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A 37-year-old woman was admitted to our hospital with severe hypokalemia and emaciation manifested by 11.2 of body mass index. She had the habit of self-induced vomiting and laxative use for 16 years and was diagnosed as eating disorder. Despite intravenous drip infusion and nutritional support, fever and dyspnea appeared on the 7th hospital day. Chest X-ray and computed tomography revealed bilateral pulmonary infiltration shadows and pleural effusion. Bacterial culture of the peripheral blood detected Bacillus cereus. Oxygenation had been getting worse gradually and the patient was diagnosed as adult respiratory distress syndrome (ARDS) based on Bacillus cereus sepsis. She received intensive care including ventilatory support, administration of neutrophil elastase inhibitor and antibiotics. After 3 days, her condition improved and she was weaned from ventilator. Although she had a poor insight into abnormality of eating with resistance to psychotherapy at first, experience of life-threatening condition changed her motivation to improve nutrition. She discharged with 13.7 of body mass index after the hospitalization for 3 months. The present case suggests that commensal bacteria-induced sepsis may cause ARDS in patients with eating disorder and that a near fatal experience may change the motivation for treatment.

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