Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls

Relationships between emotional states, bipolar disorder, and gastrointestinal disorders: A two-sample Mendelian randomization study

BACKGROUND

Functional gastrointestinal symptoms are frequently observed in patients with bipolar affective disorder, but the causal relationship between these conditions remains unclear. To establish causality, this study utilized Mendelian randomization (MR) with data from large-scale genomic research. The investigation aimed to elucidate the relationship between emotional states, bipolar disorder, and functional gastrointestinal disorders (FGIDs).

METHODS

Summary statistics from GWAS were utilized for mood swings (UK biobank, N = 451,619), irritable mood (UK biobank, N = 373,733), bipolar disorder (UK biobank, N = 352,006),functional dyspepsia (FinnGen biobank, N = 194,071), and irritable bowel syndrome (UK biobank, N = 486,601). All GWAS summary statistics were derived from individuals of European ancestry. The primary analysis employed the inverse variance-weighted method for Mendelian randomization (MR). Additionally, we conducted tests for heterogeneity and pleiotropy to ensure the robustness of our results.

RESULTS

A suggestive positive causal relationship was identified between mood swings-related conditions and IBS using the inverse variance-weighted (IVW) method [mood swings-IBS: OR/95%CI: 3.221(2.417,4.294), P(1.42E-15); irritable mood-IBS: OR/95%CI: 1.881(1.615,2.191), P(4.56E-16); bipolar disorder-IBS: OR/95%CI: 1.003(1.001,1.006), P(0.009)]. For functional dyspepsia, a suggestive positive causal relationship was observed with mood swings [mood swings-FD: OR/95%CI: 2.827(1.124,7.109), P(0.027)]. In the reverse analysis, causal relationship was observed between IBS and emotional states [IBS and mood swings: OR/95%CI: 1.030(1.021,1.040), P(1.10E-10); IBS and irritable mood: OR/95%CI: 1.064(1.041,1.087), P(2.58E-08)].

CONCLUSIONS

Mood swings, irritable mood, and bipolar disorder were associated with an increased risk of functional gastrointestinal disorders (FGIDs). Additionally, reverse analysis revealed a causal relationship between irritable bowel syndrome (IBS) and both mood swings and irritable mood. These findings suggest that targeted emotional interventions may be beneficial for patients with FGIDs. Further research is warranted to explore the relationship between mood instability-related disorders and FGIDs, particularly IBS.

Comparing the prevalence and association between anxiety, depression and gastrointestinal symptoms in gastroparesis versus functional dyspepsia: A systematic review and meta-analysis

OBJECTIVE

To determine the prevalence and associations between anxiety/depression, and gastrointestinal (GI) symptoms across gastroparesis and functional dyspepsia.

METHODS

Twenty adult studies were identified through systematic searches of three databases (PubMed, CINAHL and PsycINFO) in September 2023. Meta-analysis was performed to estimate the pooled prevalence rates of anxiety and depression across gastroparesis and functional dyspepsia, and to determine whether the associations of anxiety/depression and gastrointestinal (GI) symptoms differ in gastroparesis versus functional dyspepsia.

RESULTS

The overall pooled prevalence rate for anxiety was similar (χ2(1) = 2.45, p = .12) in gastroparesis (49%) and functional dyspepsia (29%). The overall pooled prevalence rate for depression in gastroparesis (39%), and functional dyspepsia (32%) was also similar (χ2(1) = 0.81, p = .37). No significant relationship between anxiety and GI symptoms (r = 0.11) or depression and GI symptoms (r = 0.16) was found in gastroparesis, whilst significant, though weak, positive relationships between anxiety and GI symptoms (r = 0.30) and depression and GI symptoms (r = 0.32) were found in functional dyspepsia. The association between GI symptoms and anxiety, but not depression, across gastroparesis and functional dyspepsia was found to be significant (χ2(1) = 5.22, p = .02).

CONCLUSION

Contributing to ongoing debate as to whether gastroparesis and functional dyspepsia are interchangeable syndromes, this review found that anxiety and depression prevalence was similar in both conditions. Psychological assessment and the utilisation of effective and holistic care in both conditions is therefore warranted.

Epidemiology of functional dyspepsia and gastroparesis as diagnosed in Flemish-Belgian primary care: A registry-based study from the Intego database

BACKGROUND

Dyspepsia is a prevalent condition in the general population. Besides organic causes, the differential diagnosis of dyspepsia includes functional dyspepsia (FD) and gastroparesis (GP) which share similar pathophysiological mechanisms and clinical presentation. So far, no study investigated the prevalence of FD and GP in a primary care in Belgium.

METHODS

Data were obtained from Intego, a Flemish-Belgian general practice-based morbidity registration network. From 586,164 patients between 2000 and 2021, we selected patients with ICD-10 code for FD and GP. Patients with organic gastrointestinal diseases were excluded. We determined demographics and comorbidities of FD/GP. For prevalence and incidence calculation, we included those who consulted their general practitioners at least once in the given year. Pair-wise comparison was conducted to access the impact of comorbidities on risk of FD/GP.

KEY RESULTS

Between 2011 and 2021, the prevalence of FD/GP ranged from 1.03% to 1.21%. The incidence of FD/GP ranged from 109 to 142 per 100,000 adults. In total 5242 cases of FD/GP were identified. These cases shared commonly coexisting diagnoses of gastroesophageal reflux disease (18.8%), irritable bowel syndrome (17.1%), and chronic constipation (18.7%). Patients with somatization/anxiety/depression had significantly higher risk of FD/GP, compared to the control (OR 1.38, 95% CI 1.19-1.61, p < 0.01).

CONCLUSIONS AND INFERENCES

The prevalence (1.03%-1.21%) and incidence (109-142/100,000) of FD/GP in primary care over last decade appear to conflict with epidemiological research in the general population. The discrepancies suggest a potential lack of awareness of FD and GP among physicians and/or patients in Flemish-Belgium.

Índice de calidad de vida percibida en pacientes con trastornos gastrointestinales funcionales en Buenos Aires, Argentina

Los trastornos gastrointestinales funcionales (tgf) son enfermedades crónicas que configuran un problema relevante en la salud pública, asociados en investigaciones previas a una peor calidad de vida. El objetivo del presente trabajo fue estudiar la calidad de vida en pacientes que acuden a un servicio de neurogastroenterología en un hospital de Argentina ycompararlo con población control. Para ello, se realizó un estudio cuantitativo y transversal incluyendo población clínica diagnosticada con algún tgf (n = 35) y una muestra control sin diagnóstico de tgf (n = 37). Se encontraron diferencias significativas entre personas con tgf y sujetos control, χ² (1, n = 70) = 30.23, p < .001 en todas las subdimensiones de la escala de calidad de vida (mqli), exceptuando satisfacción espiritual (pe). Similar a investigaciones previas, los resultados de este estudio sugieren que, en Argentina —al igual que en otros países—, los individuos con tgf muestran una peorpercepción de calidad de vida que la población general. Estos hallazgos podrían contribuir al diseño de intervenciones que contemplen variables biopsicosociales, con el objetivo de una mejoría integral en la calidad de vida de las personas que padecen estos trastornos.

Eosinophils, Hypoxia-Inducible Factors, and Barrier Dysfunction in Functional Dyspepsia

Functional dyspepsia (FD) is a highly prevalent disorder of gut-brain interaction (DGBI), previously known as a functional gastrointestinal disorder. Characterized by early satiety, postprandial fullness, and/or epigastric pain or burning, diagnosis depends on positive symptomatology and exclusion of obvious structural diseases. A subtle inflammatory phenotype has been identified in FD patients, involving an increase in duodenal mucosal eosinophils, and imbalances in the duodenal gut microbiota. A dysregulated epithelial barrier has also been well described in FD and is thought to be a contributing factor to the low-grade duodenal inflammation observed, however the mechanisms underpinning this are poorly understood. One possible explanation is that alterations in the microbiota and increased immune cells can result in the activation of cellular stress response pathways to perpetuate epithelial barrier dysregulation. One such cellular response pathway involves the stabilization of hypoxia-inducible factors (HIF). HIF, a transcriptional protein involved in the cellular recognition and adaptation to hypoxia, has been identified as a critical component of various pathologies, from cancer to inflammatory bowel disease (IBD). While the contribution of HIF to subtle inflammation, such as that seen in FD, is unknown, HIF has been shown to have roles in regulating the inflammatory response, particularly the recruitment of eosinophils, as well as maintaining epithelial barrier structure and function. As such, we aim to review our present understanding of the involvement of eosinophils, barrier dysfunction, and the changes to the gut microbiota including the potential pathways and mechanisms of HIF in FD. A combination of PubMed searches using the Mesh terms functional dyspepsia, functional gastrointestinal disorders, disorders of gut-brain interaction, duodenal eosinophilia, barrier dysfunction, gut microbiota, gut dysbiosis, low-grade duodenal inflammation, hypoxia-inducible factors (or HIF), and/or intestinal inflammation were undertaken in the writing of this narrative review to ensure relevant literature was included. Given the findings from various sources of literature, we propose a novel hypothesis involving a potential role for HIF in the pathophysiological mechanisms underlying FD.

Association of duodenal eosinophilia with Helicobacter pylori-negative functional dyspepsia

BACKGROUND AND STUDY AIMS

The pathogenesis of functional dyspepsia (FD) is complex and still remains to be established. Recent studies support duodenal inflammation with increased infiltration of eosinophils and a higher level of systemic cytokines among patients with FD. These findings may help to understand the underlying pathophysiology of FD. The aim of this study was to evaluate the association between duodenal eosinophilia and FD.

PATIENTS AND METHODS

A total of 84 patients (42 cases of FD and 42 subjects without dyspepsia as control, mean age 31 years, 56% female) were recruited for this prospective observational study. FD was diagnosed by validated Bangla version of the ROME III criteria. Patients with no symptoms of FD who were referred for upper gastrointestinal endoscopy for other reasons were included as control. Biopsy specimens were taken from the second part (D2) of the duodenum of all participants. The eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. The association between duodenal eosinophilia (defined as ≥22/5HPF a priori) and FD was assessed.

RESULT

Significantly increased duodenal eosinophil count was found in patients with FD than patients without dyspepsia (p = 0.001). 57.1% of patients with FD had duodenal eosinophilia. A significant positive association was found between duodenal eosinophilia and FD (OR = 5.67, 95% CI 1.92-17.2, p = 0.001). A positive association was also observed between duodenal eosinophilia and postprandial distress syndrome (OR = 5.54, 95% CI 0.86-45.24, p = 0.036). A higher odds ratio was noticed among those who complain of early satiety.

CONCLUSION

A significant positive association was found between duodenal eosinophilia and FD especially among those with postprandial distress syndrome. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of FD.

DA-9701 (Motilitone): A Multi-Targeting Botanical Drug for the Treatment of Functional Dyspepsia

Functional dyspepsia (FD) is the most common functional gastrointestinal disorder (FGID). FD is characterized by bothersome symptoms such as postprandial fullness, early satiety, and epigastric pain or burning sensations in the upper abdomen. The complexity and heterogeneity of FD pathophysiology, which involves multiple mechanisms, make both treatment and new drug development for FD difficult. Current medicines for FD targeting a single pathway have failed to show satisfactory efficacy and safety. On the other hand, multicomponent herbal medicines that act on multiple targets may be a promising alternative treatment for FD. DA-9701 (Motilitone), a botanical drug consisting of Corydalis Tuber and Pharbitidis Semen, has been prescribed for FD since it was launched in Korea in 2011. It has multiple mechanisms of action such as prokinetic effects, fundus relaxation, and visceral analgesia, which are mediated by dopamine D₂ and several serotonin receptors involved in gastrointestinal (GI) functions. In clinical studies, DA-9701 has been found to be beneficial for improvement of FD symptoms and GI functions in FD patients, while showing better safety compared to that associated with conventional medicines. In this review, we provide updated information on the pharmacological effects, safety, and clinical results of DA-9701 for the treatment of FGIDs.

Attentional and physiological processing of food images in functional dyspepsia patients: A pilot study

The food-related behavior of functional dyspepsia has been attracting more interest of late. This pilot study aims to provide evidence of the physiological, emotional, and attentional aspects of food processing in functional dyspepsia patients. The study was performed in 15 functional dyspepsia patients and 17 healthy controls after a standard breakfast. We measured autonomic nervous system activity using skin conductance response and heart rate variability, emotional response using facial electromyography, and visual attention using eyetracking during the visual stimuli of food/non-food images. In comparison to healthy controls, functional dyspepsia patients showed a greater craving for food, a decreased intake of food, more dyspeptic symptoms, lower pleasantness rating of food images (particularly of high fat), decreased low frequency/high frequency ratio of heart rate variability, and suppressed total processing time of food images. There were no significant differences of skin conductance response and facial electromyography data between groups. The results suggest that high level cognitive functions rather than autonomic and emotional mechanisms are more liable to function differently in functional dyspepsia patients. Abnormal dietary behavior, reduced subjective rating of pleasantness and visual attention to food should be considered as important pathophysiological characteristics in functional dyspepsia.

Somatic Complaints Are Significantly Associated with Chronic Uninvestigated Dyspepsia and Its Symptoms: A Large Cross-sectional Population Based Study

BACKGROUND/AIMS

Somatization may influence persistence and severity of symptoms in gastrointestinal diseases. Some studies suggest that somatization is associated with chronic uninvestigated dyspepsia (CUD); however, the association is unclear. We aimed to determine the association between the profiles of somatic complaints with CUD and its symptoms.

METHODS

In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 31-items questionnaire. Patients with CUD were identified by the Rome III diagnostic criteria. Profiles of somatic complaints were derived from factor analysis. Logistic regression analysis was used to assess the relationship between extracted profiles with CUD and its symptoms.

RESULTS

CUD, bothersome postprandial fullness, early satiation, and epigastric pain or burning was identified in 723 (15.2%), 384 (8.1%), 302 (6.3%), and 371 (7.8%) of the study population. The frequency of all 31 somatic complaints was significantly higher in patients with CUD compared with controls (P < 0.001), and the most frequent was severe fatigue (45.1%). The profiles of somatic complaints were extracted in 4 domains, including "psychological", "gastrointestinal", "neuro-skeletal", and "pharyngeal-respiratory". The psychological (OR, 1.49; 95% CI, 1.44-1.54), gastrointestinal (OR, 2.22; 95% CI, 2.09-2.37), neuro-skeletal (OR, 1.52; 95% CI, 1.44-1.59), and pharyngeal-respiratory (OR, 2.09; 95% CI, 1.94-2.25) profiles were significantly associated with greater odds of CUD.

CONCLUSIONS

CUD and its symptoms are strongly associated with higher levels of somatic complaints and their related extracted profiles. This perhaps explains that why it can be difficult to treat, however further prospective investigations are required to confirm these associations.

Perceived stress as a risk factor for peptic ulcers: a register-based cohort study

Background

The association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori. This study examined whether high perceived everyday life stress was associated with an increased risk of either receiving a triple treatment or being diagnosed with a peptic ulcer.

Methods

Cohen’s perceived stress scale measured the level of stress in a general health survey in 2010 of 17,525 residents of northern Jutland, Denmark, and was linked with National Danish registers on prescription drugs and hospital diagnoses. Cox proportional hazard regression was used to estimate the risk of either receiving a triple treatment or being diagnosed in a hospital with a peptic ulcer, in relation to quintiles of stress levels.

Results

A total of 121 peptic ulcer incidents were recorded within 33 months of follow-up. The lowest stress group had a cumulative incidence proportion of either receiving triple treatment or being diagnosed with peptic ulcer of approximately 0.4%, whereas the highest stress group had a cumulative incidence proportion of approximately 1.2%. Compared with that of the lowest stress group, those in the highest stress group had a 2.2-fold increase in risk of either receiving triple treatment or being diagnosed with peptic ulcer (HR 2.24; CI 95% 1.16:4.35) after adjustment for age, gender, socioeconomic status, non-steroid anti-inflammatory drug use, former ulcer and health behaviours. There was no difference in risk between the four least stressed quintiles. Subgroup analysis of diagnosed peptic ulcer patients revealed the same pattern as the main analysis, although the results were not significant.

Conclusion

The highest level of perceived everyday life stress raised the risk of either receiving triple treatment or being diagnosed with peptic ulcer during the following 33 months more than twice compared with that of the lowest level of perceived stress.

Increased Duodenal Eosinophil Degranulation in Patients with Functional Dyspepsia: A Prospective Study

Functional dyspepsia (FD) is a functional gastrointestinal disorder diagnosed by symptom-based criteria. It has been said that duodenal immune activation plays a role in the pathogenesis of FD. The primary aims of the study were to compare the total number of duodenal eosinophil and evaluate the eosinophil degranulation rate, number of duodenal degranulated eosinophil and mast cell between patients with FD and healthy subjects. We enrolled 96 patients with FD and 24 healthy controls at Sir Run Run Shaw Hospital. The total number of eosinophil was comparable in the second portion of duodenum (D2) and duodenal bulb (D1) between patients with FD and healthy controls (all P > 0.05). Significant higher eosinophil degranulation positive rate in D2 (P = 0.003) and a trend towards higher in D1 (P = 0.084) were observed in patients with FD compared with healthy controls. Moreover, the number of duodenal degranulated eosinophil in patients with FD were significantly increased than healthy controls in D1(9.8 ± 6.3 vs 2.9 ± 2.1 per HPF, P = 0.0002) and a trend towards increase in D2 (10.7 ± 7.7 vs 5.3 ± 0.9 per HPF, P = 0.077), respectively. However, degranulated mast cells in patients with FD were almost same with healthy controls. Increased eosinophils degranulation in duodenum play an important role in pathogenesis of FD.

Association of Psychological Characteristics and Functional Dyspepsia Treatment Outcome: A Case-Control Study

This study was to investigate the association of psychological characteristics and functional dyspepsia treatment outcome. 109 patients who met the criteria for FD were enrolled. Eysenck Personality Questionnaire (EPQ), Symptom Checklist 90 (SCL90), and the Pittsburgh Sleep Quality Index (PSQI) were used to measure personality, psychological symptoms, and sleep quality in our patients. Leeds Dyspepsia Questionnaire (LDQ) was used to assess dyspeptic symptoms at baseline and after eight weeks of treatment. The LDQ scores change after therapy, and the degraded rate of LDQ was used to assess the prognosis of patients. Logistic regression model was used to assess the effect of the personality, psychological symptoms, and sleep quality on the prognosis of patients. Our result revealed that poor sleep quality (OR = 7.68, 95% CI 1.83–32.25) and bad marriage status (OR = 1.22, 95% CI 1.10–1.36) had the negative effect on the prognosis of FD, while extroversion in personality traits (OR = 0.86, 95% CI 0.76–0.96) had positive effect on the prognosis of FD. We should pay attention to the sleep quality, the personality, and the marriage status of FD patients; psychological intervention may have benefit in refractory FD.

Helicobacter pylori infection impacts on functional dyspepsia in Thailand

BACKGROUND

Helicobacter pylori (H. pylori) is a well known major cause of gastric cancer and even when asymptomatic infected patients are at elevated risk. Functional dyspepsia (FD) is also one of the most common gastrointestinal diseases, which greatly impacts the quality of life. H. pylori infection and psychosocial stress are frequently associated with FD but limited studies have confirmed the relationships, especially in Southeast Asian countries. Here we aimed to investigate the prevalence and impact of H. pylori infection, anxiety and depression on Thai FD patients.

MATERIALS AND METHODS

This cross-sectional study was conducted in a tertiary care center in Thailand, during February 2013-January 2014. All FD patients were diagnosed and categorized by Rome III criteria into epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS) groups. The Hospital Anxiety and Depression Scale was used to evaluate psychological status. The presence of H. pylori was defined as positive with H. pylori culture, positive rapid urease test or positive histology.

RESULTS

Three hundred FD patients were included, 174 (58%) female. Overall mean age was 54.8+15.1 years. There were 192 (64%) patients with PDS and 108 (36%) with EPS. H. pylori infection was demonstrated in 70 (23.3%) patients. Anxiety and depression were documented in 69 (23%) and 22 (7.3%), respectively. H. pylori infection, anxiety and depression were significantly higher in PDS than EPS patients (27.1% vs 16.7%; p=0.04; OR=1.86; 95%CI=1.01-3.53 and 29.7% vs 11.1%; p=0.0002; OR=3.4; 95%CI=1.7-7.1 and 10.4% vs 1.9%; p=0.006; OR=6.2; 95%CI=1.4-38.9, respectively).

CONCLUSIONS

H. pylori infection, anxiety and depression were commonly found in Thai FD patients and more prevalent in PDS than EPS. H. pylori eradication might be the key to success for the treatment of Thai FD patients and prevent the development of gastric cancer.

Cerebral responses to puncturing at different acupoints for treating meal-related functional dyspepsia

BACKGROUND

To investigate the similarities and differences in cerebral responses to puncturing at different acupoints for treating meal-related functional dyspepsia (FD).

METHODS

Twenty right-handed FD patients were enrolled and randomized divided into two groups. Each patient received 20 sessions' electro-acupuncture treatment. The acupoints used in Group A were four acupoints on the Stomach Meridian, and the acupoints used in Group B were four acupoints on the Gallbladder Meridian. PET-CT scans were performed before and after acupuncture treatment to record the changes of cerebral glycometabolism.

KEY RESULTS

After treatment, the dyspepsia symptoms and the quality of life (QOL) of the patients in each group were significantly improved (p < 0.05) and there was insignificant difference in efficacy between the two groups (p > 0.05). In Group A, deactivation in brainstem, bilateral anterior cingulate cortex (ACC) and cerebellum, left superior medial frontal gyrus, orbital frontal cortex (OFC), and thalamus, etc., and activation in bilateral middle cingulate cortex (MCC), precuneus and lingual gyrus, etc. were observed. In Group B, deactivation in brainstem, bilateral thalamus, putamen, ACC, postterior cingulate cortex, hippocampus and cerebellum, etc., and activation in bilateral MCC, precuneus, left OFC, etc. were observed (p < 0.05, Family-wise error corrected).

CONCLUSIONS & INFERENCES

Different acupoints have similar clinical efficacy but relatively different cerebral responses. The influence on the sensory transduction regions (brainstem and thalamus) and visceral modulation regions might be the common mechanism of different acupoints treating for FD, and the modulation on some emotion/cognition-related areas (e.g., prefrontal cortex) is the potential difference between the different acupoints.

Pretreatment prediction of symptom response to proton pump inhibitor therapy

BACKGROUND AND AIM

This prospective pilot study investigated whether it is possible to predict the therapeutic response in both the early phase (1 week) and sustained phase (4 weeks) before starting proton pump inhibitor (PPI) therapy for functional dyspepsia (FD) or non-erosive reflux disease (NERD).

METHODS

We administered rabeprazole 10 mg for 4 weeks to NERD/FD patients, who also answered a modified version of the Frequency Scale for Symptoms of gastroesophageal reflux disease (GERD) (FSSG), which added a pain score to the FSSG. Total score (TS), reflux score (RS), dysmotility score (DS), and pain score (PS) were analyzed. Symptom improvement was defined as ≥ 50% improvement in each score.

RESULTS

We enrolled 83 patients (age [mean ± SD] 50.8 ± 15.8 years, 29 males, 54 females), of whom 62 could be classified into four groups: achieved symptom improvement within 1 week and maintained it for 4 weeks (Early-R, 40.3%); achieved symptom improvement within 1 week but lost it after 4 weeks (Temp-R, 9.7%); did not achieve symptom improvement within 1 week but did after 4 weeks (Late-R, 9.7%); and no improvement (Non-R, 40.3%). Mean TS, RS, DS, and PS in the Non-R group were significantly higher than in the Early-R group (23.9, 10.5, 11.0, and 2.4 vs 14.3, 6.8, 6.4, and 1.2). However, the Temp-R, Late-R, and Non-R groups could not be distinguished by TS, RS, or DS.

CONCLUSION

The magnitude of the pretreatment modified FSSG score seemed to be associated with the response at 1 week and 4 weeks.

Emotion regulation, internalizing symptoms and somatic complaints in pediatric survivors of acute lymphoblastic leukemia

OBJECTIVES

This study aimed to examine whether respiratory sinus arrhythmia (RSA)-a physiological index of children's emotion regulation-moderates the relation between cancer diagnosis and internalizing problems in children.

METHODS

Participants were twenty-two 7-12-year survivors of acute lymphoblastic leukemia and 20 age-matched controls. RSA was calculated from cardiac interbeat interval using spectral time-series analysis. t-Scores on the Child Behavior Checklist Anxious/Depressed, Withdrawn/Depressed, and Somatic Complaints subscales were computed.

RESULTS

Respiratory sinus arrhythmia moderated the relation between diagnostic status and both child somatic complaints and withdrawn/depressed symptoms. The positive association between diagnostic status and somatic complaints was significant for children with low RSA but not significant for children with high RSA. This association was also significant for withdrawn/depressed symptoms. Low RSA was associated with more somatic complaints and withdrawn/depressed symptoms for children with cancer but not for control participants.

CONCLUSIONS

Children who have poor emotion regulation abilities may be more vulnerable to the range of stressors associated with the diagnosis, treatment, and survivorship of cancer. Behavioral interventions targeting emotion regulation skills may reduce internalizing symptoms in this population.

From ischochymia to gastroparesis: proposed mechanisms and preferred management of dyspepsia over the centuries

Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.

High degree of duodenal inflammation in Nigerians with functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a heterogeneous disorder associated with diverse pathophysiological mechanisms, including immune activation and low-grade mucosal inflammation. Genetic factors, physiological functions, and environmental factors may determine the relative importance of various pathophysiological mechanisms. This study was designed to determine the histological alterations in the duodenal mucosa of Nigerian patients with FD.

METHODS

Consecutive patients with dyspepsia seen over a 27-month period in two gastrointestinal endoscopy facilities in Enugu, South-East Nigeria were further evaluated with upper gastrointestinal endoscopy and duodenal mucosal biopsies if no lesion was found in the upper gastrointestinal tract. Patients with heartburn and/or regurgitation who did not have any dyspeptic symptoms and did not have any lesion in the upper gastrointestinal tract on endoscopy were presumed to have non-erosive reflux disease (NERD) and they served as controls. The control subjects also had duodenal biopsies. The histopathological findings in the cases and controls were compared.

RESULTS

There were 68 patients with FD and 52 patients with NERD. The total inflammatory score was 242 in FD and 66 in NERD (Mann-Whitney U =1168, P=0.0011). Similarly, the scores for chronic inflammation, gastric metaplasia, neutrophilic activity, eosinophilic infiltration, and Helicobacter pylori were significantly higher in FD than NERD.

CONCLUSION

Functional dyspepsia is associated with a high degree of inflammation in the duodenal mucosa. This may reflect the high prevalence of gastrointestinal infections in a tropical environment such as Nigeria. These findings may have therapeutic potential that further studies might elucidate.

Impact of sleep disorders, quality of life and gastric emptying in distinct subtypes of functional dyspepsia in Japan

Background/Aims

The association between clinical symptoms, gastric emptying, quality of life and sleep disorders in distinct functional dyspepsia (FD) patients has not been studied yet in detail.

Methods

We enrolled 79 FD patients (postprandial distress syndrome [PDS], n = 65; epigastric pain syndrome [EPS], n = 47; EPS-PDS overlap, n = 33) and 44 healthy volunteers. Gastric motility was evaluated. We used Rome III criteria to evaluate clinical symptoms and State-Trait Anxiety Inventory (STAI) scores to determine anxiety status. Sleep disorder was evaluated using the Pittsburgh Sleep Quality Index scores.

Results

There were no significant differences in age, sex and Helicobacter pylori positivity between FD subtypes and healthy volunteers. The scores of Glasgow dyspepsia severity scores (GDSS), SF-8 and Pittsburgh Sleep Quality Index (PSQI) in distinct subtypes of FD patients were significantly different from those in healthy volunteers. However, there were not significant differences in these scores, Tmax and T_1/2 among 3 subtypes of FD patients. PSQI score was significantly (P = 0.027, P = 0.002 and P = 0.039, respectively) associated with GDSS among EPS, PDS and EPS-PDS overlap patients. In addition, 8-item short form health survey (SF-8; Physical Component Score and Mental Component Score) was significantly associated with global PSQI score in PDS and EPS-PDS overlap patients. In contrast, SF-8 (Mental Component Score) only was significantly linked to global PSQI score in EPS patients.

Conclusions

Prevalences for sleep disorders, gastric motility and quality of life in 3 subtypes of FD patients were similar levels. In PDS and EPS-PDS overlap patients, SF-8 was significantly associated with global PSQI score.

Impact of sleep disorders in Japanese patients with functional dyspepsia (FD): nizatidine improves clinical symptoms, gastric emptying and sleep disorders in FD patients

BACKGROUND AND AIMS

The association between functional dyspepsia (FD) and sleep disorders has yet to be studied in detail. The aim of this study is to evaluate the risk factors associated with sleep disorders and the clinical response to nizatidine therapy for sleep disorders in Rome III-based FD patients.

METHODS

We enrolled 94 FD patients and 52 healthy volunteers. We used Rome III criteria to evaluate upper abdominal symptoms, and the Self-Rating Questionnaire for Depression scores to determine depression status. Sleep disorder was evaluated using Pittsburgh Sleep Quality Index (PSQI) scores, and degree of anxiety by the State-Trait Anxiety Inventory. Gastric motility was evaluated. Thirty-four FD patients were treated with nizatidine (300 mg/day) or placebo for 4 weeks in a crossover trial. The primary end point of this study was to determine whether nizatidine could improve clinical symptoms and sleep disorders in FD patients.

RESULTS

The global PSQI score for FD patients was significantly (P < 0.001) higher compared with healthy volunteers. There were significant correlations between global PSQI scores and total Gastrointestinal Symptom Rating Scale and Self-Rating Questionnaire for Depression scores (P < 0.001, P < 0.0001, respectively) in FD patients than in healthy volunteers. We found significant relationships between subjective sleep quality and both Tmax and T1/2 values in FD patients. Nizatidine significantly improved certain clinical symptoms, gastric emptying, and global PSQI score compared with placebo treatment.

CONCLUSION

Sleep disorders in FD patients correlated significantly with both clinical symptoms of dyspepsia and depression compared with healthy volunteers. Nizatidine significantly improved gastroesophageal reflux symptoms, gastric emptying, and sleep disorders in FD patients.

Regional brain structural abnormality in meal-related functional dyspepsia patients: a voxel-based morphometry study

Background and Aims

Brain dysfunction in functional dyspepsia (FD) has been identified by multiple neuroimaging studies. This study aims to investigate the regional gray matter density (GMD) changes in meal-related FD patients and their correlations with clinical variables, and to explore the possible influence of the emotional state on FD patients’s brain structures.

Methods

Fifty meal-related FD patients and forty healthy subjects (HS) were included and underwent a structural magnetic resonance imaging scan. Voxel-based morphometry analysis was employed to identify the cerebral structure alterations in meal-related FD patients. Regional GMD changes' correlations with the symptoms and their durations, respectively, have been analyzed.

Results

Compared to the HS, the meal-related FD patients showed a decreased GMD in the bilateral precentral gyrus, medial prefrontal cortex (MPFC), anterior cingulate cortex (ACC) and midcingulate cortex (MCC), left orbitofrontal cortex (OFC) and right insula (p<0.05, FWE Corrected, Cluster size>50). After controlling for anxiety and depression, the meal-related FD patients showed a decreased GMD in the bilateral middle frontal gyrus, left MCC, right precentral gyrus and insula (p<0.05, FWE Corrected, Cluster size>50). Before controlling psychological factors, the GMD decreases in the ACC were negatively associated with the symptom scores of the Nepean Dyspepsia Index (NDI) (r = −0.354, p = 0.048, Bonferroni correction) and the duration of FD (r = −0.398, p = 0.02, Bonferroni correction) respectively.

Conclusions

The regional GMD of meal-related FD patients, especially in the regions of the homeostatic afferent processing network significantly differed from that of the HS, and the psychological factors might be one of the essential factors significantly affecting the regional brain structure of meal-related FD patients.

Evaluation of Helicobacter pylori eradication and drug therapy in patients with functional dyspepsia

The aim of this study was to assess the effect of Helicobactor pylori (H. pylori) infection and drug therapy on functional dyspepsia (FD) symptoms and gastrointestinal eosinophil count. In this study, 215 continuous FD patients fulfilling Rome III criteria were enrolled. The patients were divided into a H. pylori-positive group and a H. pylori-negative group. The H. pylori-positive group was divided into H. pylori-eradicated and H. pylori-uneradicated groups following H. pylori-eradication treatment, and the H. pylori-negative group was randomly divided into esomeprazole and teprenone treatment groups. The symptom scores of the esomeprazole group were significantly lower compared with those of the teprenone group at week 6 but not at baseline and week 2. Compared with the H. pylori-uneradicated group, eosinophil counts in the antrum and body were significantly reduced in the H. pylori-eradicated group at week 6. The number of gastric eosinophil clusters was significantly higher in the H. pylori-positive group than in the H. pylori-negative group. Eradication was associated with gastric eosinophil counts but did not affect duodenal eosinophil levels. Neither esomeprazole nor teprenone treatments reduced eosinophil levels in the stomach and duodenum of H. pylori-negative patients.

Effect of acute stress on immune cell counts and the expression of tight junction proteins in the duodenal mucosa of rats

Background/Aims

Duodenal immune alterations have been reported in a subset of patients with functional dyspepsia (FD). The aim of this study was to investigate the effect of acute stress on immune cell counts and the expression of tight junction proteins in the duodenal mucosa.

Methods

Twenty-one male rats were divided into the following three experimental groups: 1) the nonstressed, control group, 2) the 2-hour-stressed group, and 3) the 4-hour-stressed group. Eosinophils, mast cells and CD4⁺ and CD8⁺ T lymphocytes in the duodenal mucosa were counted. The protein and mRNA expressions of occludin and zonula occludens-1 (ZO-1) were examined.

Results

Eosinophils, mast cells and CD8⁺ T lymphocyte counts did not differ between the stressed and control groups. The number of CD4⁺ T lymphocytes and the protein and mRNA expressions of occludin and ZO-1 were significantly lower in the 4-hour-stressed group compared with the control group. The plasma adrenocorticotrophic hormone and cortisol levels of the 4-hour-stressed group were significantly higher than those of the control group.

Conclusions

Acute stress reduces the number of CD4⁺ T lymphocytes and the expression of tight junction proteins in the duodenal mucosa, which might be associated with the duodenal immune alterations found in a subset of FD patients.

Impact of shiftwork on irritable bowel syndrome and functional dyspepsia

Disturbances in biological rhythms could lead to unfavorable health impact. This study aimed to evaluate the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) in rotating shift workers, and to determine the factors that have significant association with the prevalence of FD and IBS. The research had been carried out among nurses and nursing assistants working at Ewha Womans University Mokdong Hospital between December 2010 and February 2011. The subjects completed self-reported questionnaires, including the quality of the sleep and the level of stress. The prevalence of FD and IBS defined by ROME III criteria, and factors associated the disorders in rotating shift workers were compared with those of day workers. A total of 207 subjects were included in the study with 147 rotating shift workers (71.0%), and 60 (29.0%) day workers. The prevalence of IBS in rotating shift workers was higher than that in day workers (32.7% vs 16.7%, P = 0.026). However, no significant difference in the prevalence of FD was observed between the two groups (19.7% vs 20.0%, P = 0.964). In the multivariate analysis, the risk factors for IBS were rotating shift work (OR, 2.36; 95% CI, 1.01-5.47) and poor sleep quality (OR, 4.13; 95% CI, 1.82-9.40), and the risk factors for FD were poor sleep quality (OR, 2.31; 95% CI, 1.01-5.28), and severe stress (OR, 2.19; 95% CI, 1.06-4.76). A higher prevalence of IBS among rotating shift workers could be directly associated with the circadian rhythm disturbance. The circadian rhythm disturbance may be related with the pathogenesis of IBS.

Effect of DA-9701, a novel prokinetic agent, on stress-induced delayed gastric emptying and hormonal changes in rats

BACKGROUND

DA-9701 is a novel prokinetic agent formulated with Pharbitis Semen and Corydalis Tuber. This study aimed to evaluate the effect of DA-9701 on stress-induced delay in gastric emptying and changes in plasma adrenocorticotropic hormone and ghrelin levels in rats.

METHODS

Changes in gastric emptying in response to different durations of stress were evaluated. Gastric emptying was compared between the following groups: (i) nonstressed vehicle- or DA-9701-treated group, (ii) nonstressed vehicle- or mosapride-treated group, (iii) 2-h stressed vehicle- or DA-9701-treated group, and (iv) 2-h stressed vehicle- or mosapride-treated group. Water immersion restraint stress was used as the stressor. DA-9701 or mosapride at 3 mg kg(-1) was administered to the rats after subjecting them to 2-h stress, and then gastric emptying was measured using the phenol red method.

KEY RESULTS

Gastric emptying was significantly delayed in the 2-h stressed group compared with the nonstressed group. Mosapride administration resulted in significant recovery from the stress-induced delay in gastric emptying. Gastric emptying in the rats that underwent 2-h stress followed by DA-9701 administration was not significantly different from that in the nonstressed group. The plasma adrenocorticotropic hormone and active ghrelin levels in the 2-h stressed group were significantly higher than those in the nonstressed group. These increases were significantly inhibited by DA-9701.

CONCLUSIONS & INFERENCES

The administration of DA-9701 improved delayed gastric emptying and inhibited the hormonal changes induced by stress, suggesting that DA-9701 can be used as a gastroprokinetic agent for the treatment of delayed gastric emptying, particularly that associated with stress.

The role of psychosocial factors and psychiatric disorders in functional dyspepsia

In this Review, after a brief historical introduction, we first provide an overview of epidemiological studies that demonstrate an association between functional dyspepsia and psychological traits, states or psychiatric disorders. These studies suggest an important intrinsic role for psychosocial factors and psychiatric disorders, especially anxiety and depression, in the aetiopathogenesis of functional dyspepsia, in addition to their putative influence on health-care-seeking behaviour. Second, we describe pathophysiological evidence on how psychosocial factors and psychiatric disorders might exert their role in functional dyspepsia. Novel insights from functional brain imaging studies regarding the integration of gut-brain signals, processed in homeostatic-interoceptive brain regions, with input from the exteroceptive system, the reward system and affective and cognitive circuits, help to clarify the important role of psychological processes and psychiatric morbidity. We therefore propose an integrated model of functional dyspepsia as a disorder of gut-brain signalling, supporting a biopsychosocial approach to the diagnosis and management of this disorder.

The val66met polymorphism of brain-derived neurotrophic factor is associated with human esophageal hypersensitivity

BACKGROUND

Recent evidence implicates brain-derived neurotrophic factor (BDNF) in visceral hypersensitivity and pain in functional gastrointestinal disorders. We hypothesized that presence of the val66met polymorphism in the BDNF gene would be linked to increased esophageal sensitivity to electrical stimulation.

METHODS

A total of 39 healthy volunteers (20 males, mean age 30) compliant with inclusion criteria after screening procedures were genotyped for BDNF polymorphisms and completed an Hospital Anxiety and Depression Scale (HADS) questionnaire. Sensory (ST) and pain (PT) thresholds in the proximal (PE) and distal (DE) esophagus were determined using electrical stimuli to a swallowed intraluminal catheter with bipolar electrodes by an investigator blinded to the subjects' genotype. For comparison, somatic ST and PT (hand and foot) were also tested. HADS scores together with esophageal and somatic thresholds were then correlated with BDNF polymorphism status.

KEY RESULTS

Eleven of 39 (28%) volunteers had at least one Met allele (Met carriers). When compared with Val/Val, Met carriers had lower esophageal PT (Median PT [mA]: Val/Val vs Met carriers, PE; 49.4 vs 44.3, P = 0.033, DE: 63.8 vs 55.4, P = 0.045) with higher proportion of Val/Val subjects in the upper quartile for PT in both PE (P = 0.021) and DE (P = 0.033), yet similar somatic PT (Median PT [mA] Hand; 33.6 vs 38.0, P = 0.22, Foot; 44.7 vs 44.0, P = 0.48). Sensitivity results were independent of anxiety (P = 0.66) and depression (P = 0.33) scores.

CONCLUSIONS & INFERENCES

val66met BDNF polymorphisms are associated with increased esophageal sensitivity to experimental electrical stimulation. Thus, BDNF genotype may be a useful biomarker for electrical sensitivity in the healthy human esophagus.

Dyspepsia is strongly associated with major depression and generalised anxiety disorder - a community study

BACKGROUND

The relationship between dyspepsia and psychiatric comorbidity such as anxiety and depression is poorly defined. Previous studies have been limited by lack of standardised diagnostic criteria.

AIM

To examine the prevalence and comorbidity of dyspepsia as defined by Rome III (6-month duration) with DSM-IV-TR generalised anxiety disorder (GAD) and major depressive episodes (MDE) in the general population.

METHODS

A random population-based telephone survey was done using a questionnaire on symptoms of Rome III Dyspepsia, DSM-IV-TR GAD and MDE and their chronological relationship.

RESULTS

Of the 2011 respondents 8.0% currently had Rome III Dyspepsia, 3.8% reported GAD and 12.4% reported MDE respectively. Dyspeptic subjects had a twofold increased risk of GAD (OR = 2.03, 95% CI: 1.06-3.89, P < 0.001) and a threefold increased risk of MDE (OR = 3.56, 95% CI: 2.33-5.43, P < 0.001). MDE and GAD most often coincided with dyspepsia in onset. Dyspepsia (OR = 2.48, 95% CI: 1.65-3.72 P < 0.001), MDE (OR = 2.39, 95% CI: 1.64-3.46, P < 0.001) and female sex (OR = 1.65, 95% CI: 1.21-2.23, P < 0.001) independently predicted frequent medical consultations. GAD independently predicted high investigation expenditure (OR = 4.65, 95% CI: 1.15-18.70, P = 0.03).

CONCLUSIONS

With stringently adopted Rome III and DSM-IV-TR criteria, dyspepsia was strongly associated and often coincident in onset with generalised anxiety disorder and major depressive episodes in the community. Excessive healthcare utilisation should alert clinicians to risk of psychiatric comorbidity.

Functional Dyspepsia Treatment Trial (FDTT): a double-blind, randomized, placebo-controlled trial of antidepressants in functional dyspepsia, evaluating symptoms, psychopathology, pathophysiology and pharmacogenetics

BACKGROUND

Functional dyspepsia (FD) is a common problem affecting up to 10-25% of individuals. FD accounts for significant health care costs and affects quality of life but has no definitive treatment.

OBJECTIVES

The Functional Dyspepsia Treatment Trial (FDTT) aims to test whether treatment with an antidepressant (amitriptyline or escitalopram) leads to improvement of symptoms in patients with moderate to severe FD.

DESIGN

The FDTT is an international multicenter, parallel group, randomized, double-blind, placebo-controlled trial to evaluate whether 12 weeks of treatment with escitalopram or amitriptyline improves FD symptoms compared to treatment with placebo. Secondly, it is hypothesized that acceleration of solid gastric emptying, reduction of postprandial satiation, and enhanced gastric volume change with a meal will be significant positive predictors of short- and long-term outcomes for those on antidepressants vs. placebo. The third aim is to examine whether polymorphisms of GNβ3 and serotonin reuptake transporter influence treatment outcomes in FD patients receiving a tricyclic antidepressant, selective serotonin reuptake inhibitor therapy, or placebo.

METHODS

The FDTT enrollment began in 2006 and is scheduled to randomize 400 patients by the end of 2012 to receive an antidepressant or placebo for 12 weeks, with a 6-month post-treatment follow-up. The study incorporates multiple validated questionnaires, physiological testing, and specific genetic evaluations. The protocol was approved by participating centers' Institutional Review Boards and an independent Data Safety Monitoring Board was established for monitoring to ensure patient safety and a single interim review of the data in December 2010 (ClinicalTrials.gov number NCT00248651).

Dyspepsia: organic versus functional

Dyspepsia is the medical term for difficult digestion. It consists of various symptoms in the upper abdomen, such as fullness, discomfort, early satiation, bloating, heartburn, belching, nausea, vomiting, or pain. The prevalence of dyspepsia in the western world is approximately 20% to 25%. Dyspepsia can be divided into 2 main categories: "organic" and "functional dyspepsia" (FD). Organic causes of dyspepsia are peptic ulcer, gastroesophageal reflux disease, gastric or esophageal cancer, pancreatic or biliary disorders, intolerance to food or drugs, and other infectious or systemic diseases. Pathophysiological mechanisms underlying FD are delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distension, altered duodenal sensitivity to lipids or acids, altered antroduodenojenunal motility and gastric electrical rhythm, unsuppressed postprandial phasic contractility in the proximal stomach, and autonomic nervous system-central nervous system dysregulation. Pathogenetic factors in FD are genetic predisposition, infection from Helicobacter pylori or other organisms, inflammation, and psychosocial factors. Diagnostic evaluation of dyspepsia includes upper gastrointestinal endoscopy, abdominal ultrasonography, gastric emptying testing (scintigraphy, breath test, ultrasonography, or magnetic resonance imaging), and gastric accommodation evaluation (magnetic resonance imaging, ultrasound, single-photon emission computed tomography, and barostat). Antroduodenal manometry can be used for the assessment of the myoelectrical activity of the stomach, whereas sensory function can be evaluated with the barostat, tensostat, and satiety test. Management of FD includes general measures, acid-suppressive drugs, eradication of H. pylori, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. This review presents an update on the diagnosis of patients presenting with dyspepsia, with an emphasis on the pathophysiological and pathogenetic mechanisms of FD and the differential diagnosis with organic causes of dyspepsia. The management of uninvestigated and FD, as well as the established and new pharmaceutical agents, is also discussed.

Inhibitory effects of desvenlafaxine on gastric slow waves, antral contractions, and gastric accommodation mediated via the sympathetic mechanism in dogs

Desvenlafaxine succinate (DVS; Pristiq) is a new antidepressant, serotonin-norepinephrine reuptake inhibitor. Antidepressants have been widely used for the treatment of functional gastrointestinal disorders. Possible roles of DVS on gastrointestinal motility have not been studied. The aim of this study was to investigate the effects of DVS on gastric slow waves (GSW), antral contractions, and gastric accommodation in dogs. Fifteen healthy dogs implanted with gastric serosal electrodes and a gastric cannula were studied in four separate sessions: control, DVS (50 mg), propranolol (1 mg·kg(-1)·h(-1)), and propranolol + DVS. GSW were measured via the gastric serosal electrodes. Antral contractions were assessed via an intraluminal manometric catheter inserted via the gastric cannula. The sympathovagal activity was assessed from the spectral analysis of the heart rate variability signal. Gastric tone was measured by barostat via an intragastric balloon inserted into the fundus via the gastric cannula. In the postprandial period, in comparison with the control, DVS reduced the percentage of normal GSW (P=0.001) and increased the percentage of tachygastria (P=0.005) and bradygastria (P=0.002). Simultaneously, DVS increased the sympathetic activity (P=0.006) and the sympathovagal ratio (low frequency/high frequency; P=0.044). These effects were blocked by propranolol. DVS attenuated postprandial antral contractions and gastric accommodation. The postprandial antral contractile index (area under the curve) was decreased by 26% with DVS (P=0.013), and gastric accommodation was decreased by about 50% with DVS (P < 0.001). The inhibitory effect of DVS on gastric accommodation was blocked by propranolol. DVS inhibits gastric contractions, slow waves, and accommodation in the fed state. These inhibitory effects are associated with an increased sympathetic modulation in the gastrointestinal system. Cautions should be made when DVS is used for treating patients with depression and gastric motility disorders.

Psychopathological features of irritable bowel syndrome patients with and without functional dyspepsia: a cross sectional study

Background

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) show considerable overlap and are both associated with psychiatric comorbidity. The present study aimed to investigate whether IBS patients with FD show higher levels of psychopathology than those without FD. As a preliminary analysis, it also evaluated the psychopathological differences, if any, between IBS patients featuring the two Rome III-defined FD subtypes, i.e. postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS).

Methods

Consecutive outpatients (n = 82, F = 67, mean age 41.6 ± 12.7 years) referred to our third level gastroenterological centre, matching the Rome III criteria for IBS and, if present, for concurrent FD, were recruited. They were asked to complete a 90-item self-rating questionnaire, the Symptom Checklist 90 Revised (SCL-90-R), in order to assess the psychological status. Comparisons between groups were carried out using the non-parametric Mann-Whitney U test.

Results

Patients with IBS only were 56 (68.3%, F = 43, mean age 41.6 ± 13.3 years) and patients with both IBS and FD were 26 (31.7%, F = 24, mean age 41.8 ± 11.5 years), 17 of whom had PDS and 9 EPS. Patients with both IBS and FD scored significantly higher on the SCL-90-R GSI and on eight out of the nine subscales than patients with IBS only (P ranging from 0.000 to 0.03). No difference was found between IBS patients with PDS and IBS patients with EPS (P ranging from 0.07 to 0.97), but this result has to be considered provisional, given the small sample size of the two subgroups.

Conclusions

IBS-FD overlap is associated with an increased severity of psychopathological features. This finding suggests that a substantial subset of patients of a third level gastroenterological centre with both IBS and FD may benefit from psychological assessment and treatment.

Psychopathological features of irritable bowel syndrome patients with and without functional dyspepsia: a cross sectional study

BACKGROUND

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) show considerable overlap and are both associated with psychiatric comorbidity. The present study aimed to investigate whether IBS patients with FD show higher levels of psychopathology than those without FD. As a preliminary analysis, it also evaluated the psychopathological differences, if any, between IBS patients featuring the two Rome III-defined FD subtypes, i.e. postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS).

METHODS

Consecutive outpatients (n = 82, F = 67, mean age 41.6 ± 12.7 years) referred to our third level gastroenterological centre, matching the Rome III criteria for IBS and, if present, for concurrent FD, were recruited. They were asked to complete a 90-item self-rating questionnaire, the Symptom Checklist 90 Revised (SCL-90-R), in order to assess the psychological status. Comparisons between groups were carried out using the non-parametric Mann-Whitney U test.

RESULTS

Patients with IBS only were 56 (68.3%, F = 43, mean age 41.6 ± 13.3 years) and patients with both IBS and FD were 26 (31.7%, F = 24, mean age 41.8 ± 11.5 years), 17 of whom had PDS and 9 EPS. Patients with both IBS and FD scored significantly higher on the SCL-90-R GSI and on eight out of the nine subscales than patients with IBS only (P ranging from 0.000 to 0.03). No difference was found between IBS patients with PDS and IBS patients with EPS (P ranging from 0.07 to 0.97), but this result has to be considered provisional, given the small sample size of the two subgroups.

CONCLUSIONS

IBS-FD overlap is associated with an increased severity of psychopathological features. This finding suggests that a substantial subset of patients of a third level gastroenterological centre with both IBS and FD may benefit from psychological assessment and treatment.

[Guidelines for the treatment of functional dyspepsia]

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.

Duodenal implications in the pathophysiology of functional dyspepsia

Functional dyspepsia (FD) is a heterogeneous disorder associated with diverse pathophysiologic mechanisms. Studies have shown duodenal implications in the pathophysiology of FD. Duodenal hypersensitivity to acid, increased duodenal acid exposure, and abnormal responses to duodenal lipids or released cholecystokinin have been observed in patients with FD. Moreover, there is evidence indicating duodenal immune activation in FD. Alterations in the number of duodenal eosinophils or intraepithelial lymphocytes have been reported in a subset of FD patients, particularly in patients with post-infectious FD. Whether these abnormalities in the duodenum play a crucial role in the generation of dyspeptic symptoms needs to be elucidated. Further investigations on the relationship between duodenal abnormalities and well-known pathophysiologic mechanisms of FD are required. Furthermore, the causative factors related to the development of duodenal abnormalities in FD warrant further study.

[Body image and psychiatric comorbidity in patients with somatoform gastrointestinal disorders]

OBJECTIVES

The significance of body perception and satisfaction with one's own body in patients with somatoform disorders of the upper and lower gastrointestinal tract is presently unknown, as is the relationship thereof to depression and other psychiatric comorbidities.

METHODS

Consecutive patients from the outpatient clinic of a university centre presenting with symptoms suggestive of somatoform gastrointestinal disorders were examined by gastroenterological and psychosomatic experts. In addition, psychological tests (The Body Image Questionnaire, FKB-20, the Hospital Anxiety and Depression Scale, HADS-D) were carried out.

RESULTS

Complete data from n = 44 patients were evaluated. In 64 % of patients we found high scores of anxiety, and in 45 % high scores of depression. In the FKB-20, 32 % of patients scored high on the "Negative Evaluation of the Body" subscale (AKB), and 96 % had low scores on the subscale "Perception of Body Dynamics" (VKD). Patients with functional bowel disorders perceived their own body significantly more negative than did healthy controls and patients after acute myocardial infarction. The AKB subscale of the FKB-20 correlated significantly and positively with anxiety in the HADS. HADS depression in turn correlated negatively with the VKD subscale of the FKB-20: Patients with low scores in depression report higher vitality.

CONCLUSIONS

Nearly half of the patients with somatoform gastrointestinal disorders seen at a university centre exhibited high scores in anxiety and depression. A substantial fraction reported disturbed body perception and satisfaction with their own body image. These patients have not yet found their place between somatic medicine and psychotherapy: Although somatic und psychological symptoms coexist to a similar degree, patients tend to focus predominantly on their somatic complaints.

Validation of Self-administrated Questionnaire for Psychiatric Disorders in Patients with Functional Dyspepsia

Introduction

Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking.

Aims

1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities.

Methods

Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard.

Results

55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at ≥3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027).

Conclusions

Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.

Psychosocial-spiritual factors in patients with functional dyspepsia: a comparative study with normal individuals having the same endoscopic features

OBJECTIVES

The aim of the study is to identify factors that are associated with dyspeptic symptoms in patients with functional dyspepsia (FD) in a multivariate context.

METHODS

Demographic data, personal habits, stressful life events, and psychological distress were compared between functional dyspeptic patients with gastric reddish streaks and asymptomatic counterparts who underwent upper gastrointestinal endoscopy as part of a self-paid physical check-up.

RESULTS

There were 93 patients in the symptomatic group and 67 patients in the asymptomatic group. FD patients had a lower proportion of tea consumption (38 vs. 61%, P = 0.004), more were single (20 vs. 6%, P<0.05), less belief in religion (46 vs. 66%, P<0.05), a greater number (median+/-interquartile range, 3.0+/-2.0 vs. 2.0+/-2.0, P<0.001) and more severity (1.5+/-0.9 vs. 1.0+/-1.0, P<0.001) with regard to stressful life events, greater scores of symptom dimensions of somatization, depression, anxiety, and psychotism and general severity index of psychopathology as compared with asymptomatic counterparts. Only tea consumption [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.15-0.72, P<0.01)], religion (OR = 0.42, 95% CI = 0.19-0.91, P<0.05), number of stressful life events (OR = 2.74, 95% CI = 1.28-5.88, P<0.01), and somatization (OR = 6.80, 95% CI = 1.21-38.08, P<0.05) remained statistically significant in multivariate analysis.

CONCLUSION

FD with gastric reddish streaks exhibited increased somatization, more stressful life events, less belief in religion, and less tea consumption as compared with asymptomatic counterparts. The findings of the study suggest the importance of adopting a more comprehensive holistic bio-psycho-socio-spiritual model when dealing with FD patients.

Whither dyspepsia? A historical perspective of functional dyspepsia, and concepts of pathogenesis and therapy in 2009

Functional dyspepsia is a highly prevalent but heterogeneous disorder; multiple pathogenetic mechanisms are likely involved but the underlying causal pathways in functional dyspepsia remain obscure. The term functional dyspepsia was popularized by the famed Walter Alvarez at the Mayo Clinic early last century. Prominent Australian gastroenterologists who have contributed to our understanding of functional dyspepsia include Peter Baume, Barry Marshall, Douglas Piper, Nick Talley, John Kellow, and Gerald Holtmann. Specific dyspeptic symptoms have not generally correlated very well with any particular physiologic disturbance, although gastric disaccommodation and duodenal eosinophilia have been linked to early satiety in this condition. Genetic markers have been tentatively identified, and functional dyspepsia can follow bacterial gastroenteritis. No objective diagnostic tools for functional dyspepsia are currently agreed upon, although meal induction of symptoms appears reproducible and may have diagnostic utility. The symptomatic criteria for functional dyspepsia (Rome III criteria) are based on expert consensus and the exclusion of organic causes. Various therapeutic modalities for functional dyspepsia have been explored; however, empirical approaches are still employed for the treatment of functional dyspepsia. Better approaches for functional dyspepsia are likely to follow an improved understanding of the underlying pathophysiological abnormalities.

Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study

BACKGROUND

The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use.

METHODS

Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001). Cases (adults visiting their primary care physician (PCP) with upper GI symptoms) and controls (individuals not having any of these complaints), matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psycho)pharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis.

RESULTS

Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year). Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs) ranging from 1.37 to 3.45). Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90), including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or social co-morbidity was strongest associated with patients suffering from upper GI symptoms.

CONCLUSION

Patients with upper GI symptoms visit their PCP more frequently for problems of any organ system, including psychosocial problems. The relationship between upper GI symptoms and psychological problems is equivocal and may reflect increased health care demands in general.

A qualitative study of complementary and alternative medicine use in persons with uninvestigated dyspepsia

Dyspepsia is a common disorder. A lack of effective therapies for managing dyspepsia may invite use of complementary and alternative medicine (CAM). The aim of this study was to elucidate CAM methods and their perceived effects in a middle-sized community in Sweden. Group interviews were used. Persons with uninvestigated dyspepsia, according to the Rome II criteria, were included. Data were studied systematically using manifest content analysis. A total of 25 persons (13 women and 12 men) were assigned to five different groups. The CAM methods used by participants were categorized as follows: (1) nutritional, (2) drug/biological, (3) spiritual/psychological, and (4) physical activity. In this study, 26 CAM methods associated with various effects were identified and all persons had used at least one method.

Psychopathology is associated with dyspeptic symptom severity in primary care patients with a new episode of dyspepsia

BACKGROUND

Personality and psychiatric disorders are reported to be more common in dyspeptic patients with severe complaints, but it remains unclear whether this association exists for patients with mild and moderate dyspepsia.

AIM

To study the association between dyspeptic symptom severity and psychopathology, major life events and coping ability in patients with a new episode of dyspepsia. METHODS; Dyspeptic symptom severity was measured using the validated eight symptom Veldhuyzen van Zanten questionnaire. Psychopathology was measured using the Symptom Check List-90 (SCL 90). Major life events were measured with a modified version of the Social Readjustment Rating Scale (SRRS). Coping styles were measured by a short version of the Utrecht Coping Questionnaire, distinguishing six coping styles. Linear regression was used to assess the relationship between dyspepsia symptom severity and psychological factors.

RESULTS

In all, 664 patients with a new episode of uninvestigated dyspepsia, aged >18 years were included. Dyspeptic symptom severity was positively correlated with the presence of depression (P < 0.01), somatization symptoms (P < 0.01), use of an active coping style (P < 0.01) and negatively correlated with age (P < 0.01).

CONCLUSIONS

Primary care patients consulting with dyspepsia have higher levels of depression and somatization especially at younger age. An active coping style is associated with dyspepsia symptom severity.

A taxometric analysis of health anxiety

BACKGROUND

A long-standing issue in the health anxiety literature is the extent to which health anxiety is a dimensional or a categorical construct. This study explores this question directly using taxometric procedures.

METHOD

Seven hundred and eleven working adults completed an index of health anxiety [the Whiteley Index (WI)] and indicated their current health status. Data from those who were currently healthy (n=501) and receiving no medical treatment were examined using three taxometric procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIGEN) and L-mode factor analysis (L-MODE).

RESULTS

Graphical representations (comparing actual to simulated data) and fit indices indicate that health anxiety is more accurately represented as a dimensional rather than a categorical construct.

CONCLUSIONS

Health anxiety is better represented as a dimensional construct. Implications for theory development and clinical practice are examined.

Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress

BACKGROUND

The burden of functional GI disorders and their associations with psychological distress in women veterans is unclear.

AIM

To examine 1-year prevalence of irritable bowel syndrome (IBS) and dyspepsia symptoms and their associations with anxiety, depression and post-traumatic stress disorder (PTSD) among women veterans receiving primary care at a Veteran Affairs Medical Center Women's Clinic.

METHODS

Irritable bowel syndrome, dyspepsia and psychological distress were assessed using the validated self-administered Bowel Disorder Questionnaire, the Beck Depression and Anxiety Inventories, as well as the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder Questionnaire.

RESULTS

We enrolled 248 women (84% participation rate). Ninety-three (38%) reported IBS and 51 (21%) dyspepsia symptoms. Women with IBS and dyspepsia reported higher mean scores of anxiety (IBS: 24 vs. 12, P < 0.0005 and dyspepsia: 26 vs. 12, P < 0.0005), depression (IBS: 22 vs. 11, P = 0.0005 and dyspepsia: 23 vs. 11, P < 0.0005) and PTSD (IBS: 87 vs. 69, P < 0.001 and dyspepsia: 86 vs. 69, P < 0.0005). Age- and ethnicity-adjusted logistic regression analyses showed a 3- to 46-fold increase in odds of IBS and dyspepsia among women with anxiety, depression or PTSD.

CONCLUSION

Women veterans have high prevalence of IBS and dyspepsia symptoms, both of which are highly associated with presence of depression, anxiety and PTSD.

Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients

BACKGROUND AND AIM

The prevalence of psychological disorders is high in patients with irritable bowel syndrome (IBS) but their role in symptom reporting is uncertain. It is thus interesting whether the number of functional gastrointestinal disorders (FGID) determines the load of psychological comorbidity. The Rome III criteria have not been used to evaluate such a relationship as yet. Moreover, not many studies have examined the sensitivity of the Rome III criteria in detecting IBS. Our aims were therefore: (i) to determine whether those IBS participants with more FGID had a tendency to greater psychological comorbidity than those with fewer FGID; and (ii) to assess the performance of the Rome III criteria in detecting IBS versus the diagnosis of the gastroenterologist.

METHODS

A cross-sectional survey of 32 consecutive outpatients with clinically diagnosed IBS was performed. The Hospital Anxiety and Depression Scale (HADS), the Short Form 12 Health Survey (SF-12), and the Rome III criteria questionnaire (BDQ-6) were administered. Multiple linear regression was conducted to detect associations among FGID, anxiety, depression and quality of life.

RESULTS

Overall, 50% of participants were anxious and 12% were depressed. Forty-four percent of participants had >two FGID; however, the number of FGID did not correlate with scores for anxiety, depression or quality of life. Amazingly, only 50% (CI: 33-67) of participants clinically diagnosed with IBS met Rome III criteria for IBS.

CONCLUSION

Contrary to our expectations, a greater load of FGID did not correlate with a greater load of psychological comorbidity. Surprisingly, the Rome III criteria detected only 50% of clinical cases of IBS.

The frequency of the psychiatric symptoms in the patients with dyspepsia at a university hospital

OBJECTIVE

According to the psychiatric hypothesis, the symptoms of dyspepsia may be due to depression, anxiety or a somatization disorder. We investigated the frequency of psychiatric symptoms in patients undergoing endoscopic procedures with dyspepsia, either with or without pathological findings, and compared this with control subjects without dyspeptic symptoms.

METHODS

Ninety patients with dyspeptic symptoms and 90 control subjects participated in the study. Both the patients and the controls were asked to complete a questionnaire about socio-demographic characteristics, the Turkish version of the Spielberger State-Trait Anxiety Inventory (STAI) and the Symptom Check List-90 (SCL-90). In order for us to determine whether the criteria for any of the conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were met, the patients were asked to take part in the Structured Clinical Interview for DSM-IV disorders.

RESULTS

Of the participants, 47.8% had a psychiatric disorder according to DSM-IV criteria, somatoform disorder (44.2%) being the most common. While 42.2% patients were determined to have a pathological finding using endoscopic evaluation, 57.8% had no findings. Together with the somatization and obsessive-compulsive disorder subscale scores, the total SCL-90 score and the mean trait anxiety score were statistically significantly higher in participants with no pathological findings. There were trends for anxiety (13.2% vs. 7.7%) and mood (2.6% vs. 0.0%) disorders to be more frequent in patients with pathological findings, while somatoform disorder+depressive disorder (17.3% vs. 5.2%) was more frequent in patients with no findings, although the differences were not statistically significant (Z=0.7, P>.05). The scores of state-trait anxiety, somatization, obsession-compulsion, depression, anxiety, phobic anxiety and psychotism subscales, and the total SCL-90 score were statistically significantly higher in those participants without a pathological finding than in the controls.

CONCLUSIONS

Regarding the high frequency of psychiatric disorders in patients with dyspeptic symptoms, we think that such patients should be evaluated by two separate departments, gastroenterology and psychiatry.