A Systematic Review of the Effectiveness of Antianxiety and Antidepressive Agents for Functional Dyspepsia

The role of psychological factors in functional gastrointestinal disorders: a systematic review and meta-analysis

PURPOSE

To systematically reevaluate the role of psychological factors in functional gastrointestinal disorders (FGIDs) and thus provide a scientific basis for the psychological treatment of FGIDs.

METHODS

A literature search was conducted using the PubMed, Embase, Web of Science, and Cochrane Library databases from January 2018 to August 2022 for researches on psychological factors affecting patients with functional gastrointestinal disorders. Meta-analysis was carried out with Stata17.0 after the screening, extraction, and evaluation of article quality.

RESULTS

The search included 22 articles with 2430 patients in the FGIDs group and 12,397 patients in the healthy controls. Meta-analysis showed anxiety [(pooled SMD = 0.74, 95%CI: 0.62 ~ 0.86, p < 0.000) (pooled OR = 3.14, 95%CI: 2.47 ~ 4.00, p < 0.000)], depression [(pooled SMD = 0.79, 95%CI: 0.63 ~ 0.95, p < 0.000) (pooled OR = 3.09, 95%CI: 2.12 ~ 4.52, p < 0.000)], mental disorders (pooled MD =  -5.53, 95%CI: -7.12 ~  -3.95, p < 0.05), somatization (pooled SMD = 0.92, 95%CI: 0.61 ~ 1.23, p < 0.000), and sleep disorders (pooled SMD = 0.69, 95%CI: 0.04 ~ 1.34, p < 0.05) are risk factors for functional gastrointestinal disorders.

CONCLUSION

There is a significant association between psychological factors and FGIDs. Interventions such as anti-anxiety drugs, antidepressants, and behavioral therapy are of great clinical significance in reducing FGIDs risk and improving prognosis.

Is there a causal link between psychological disorders and functional gastrointestinal disorders?

INTRODUCTION

Psychological distress is associated with functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS) and functional dyspepsia (FD) but only evidence from prospective longitudinal and treatment studies can indicate whether the link between FGIDs and psychological distress is causal. Emerging evidence suggests underlying biological mechanisms may explain the association of psychological distress with FGIDs.

AREAS COVERED

This review critically evaluates whether anxiety and/or depression and FGIDs are causally related including evidence for a temporal sequence, strength and specificity of the association, biological gradient, and biological plausibility.

EXPERT OPINION

Accumulating evidence suggests that psychological factors are causal for symptoms in a subset of FGID patients and not explained by health care seeking behavior (brain-gut disorder). In other cases, psychological factors may arise secondary to intestinal disease (gut-brain disorder). Prospective population-based studies are needed in FGIDs other than IBS and FD to determine if a similar brain-gut and gut-brain syndrome exists. Treatment studies have not phenotyped FGIDs according to brain-gut versus gut-brain origins which may be important in understanding true treatment efficacy. Future research needs to unravel biological mechanisms that may explain the link between psychological factors and FGIDs but promising data in the area of the brain-gut-immune-microbe axis is emerging.

Management of functional dyspepsia in 2020: a clinical point of view

Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.

Correlation of sleep quality with anxiety and depression in elderly patients with functional dyspepsia in a tertiary hospital

BACKGROUND

Functional dyspepsia (FD) is a common disease affecting the sleep quality of elderly patients, and patients with long-term sleep disorders are accompanied by different degrees of anxiety and depression.

AIM

To observe the advantages of sleep quality and anxiety and depression in elderly patients with FD in a tertiary hospital, and to explore the importance of sleep quality factors in predicting anxiety and depression.

METHODS

One hundred and twelve elderly patients with FD who were hospitalized at The Second Hospital of Jinhua, Zhejiang Province from September 2017 to September 2019 were selected as research subjects. Pittsburgh sleep quality index (PSQI) scale and anxiety/depression self-rating scale (SAS/SDS) were used for investigation.

RESULTS

In elderly patients with FD, the scores of sleep quality, sleep time, sleep efficiency, use of hypnotic drugs, and PSQI and SAS scores were all significantly lower in women than in men (P < 0.05), and the score of each dimension in the overall population was significantly higher than the domestic norm (P < 0.05). Through regression analysis, it was found that the prediction performance of daytime function, sleep quality, sleep time, and sleep efficiency for anxiety was higher (P < 0.05), and sleep efficiency and daytime function performed significantly better in predicting depression (P < 0.05). The regression analysis suggested that X₁ and X₂ accounted for 61.54% and 38.46% of the predicted variance, respectively. After stratification and gradual regression of sleep quality and anxiety and depression, four variables (X₁, X₂, X₃, and X₄) were entered into the regression equation. X₁, X₂, X₃, and X₄ accounted for 38.26%, 22.86%, 17.63%, and 20.85% of the predicted variance.

CONCLUSION

Among all factors of sleep quality, daytime function, sleep quality, sleep efficiency, and sleep time can predict anxiety, while sleep efficiency and daytime function can predict depression. Therefore, targeted treatment and nursing intervention should be adopted in clinical work according to each factor of sleep quality.

Gastroparesis and Functional Dyspepsia: A Blurring Distinction of Pathophysiology and Treatment

Gastroparesis and functional dyspepsia are 2 of the most common gastric neuromuscular disorders. These disorders are usually confused, having both similarities and differences. The pathophysiology of these disorders involves abnormal gastric motility, visceral hypersensitivity, mucosal inflammation, and various cellular changes. Both disorders have similar symptoms such as epigastric pain or discomfort, early satiety, and bloating. If patients suspected of having either gastroparesis or functional dyspepsia present with upper gastrointestinal symptoms, they should undergo upper endoscopy to exclude an alternative organic cause. Although the gastric emptying rate is frequently assessed during the clinical workup of patients with gastroparesis or functional dyspepsia, the correlation between gastric emptying and the symptoms is generally poor. Once the diagnosis of gastroparesis or functional dyspepsia is made, treatment should focus on the predominant symptom. Recently, various treatment modalities have been developed and validated. Prokinetic agents are generally used as treatment for both gastroparesis and functional dyspepsia. Acid-suppressive therapy, Helicobacter pylori eradication, and use of drugs that enhance gastric accommodation are employed for functional dyspepsia. Psychoactive drugs are also effective in symptom control. For gastroparesis, antiemetic agents, ghrelin receptor agonists, and serotonergic agents are used aside from prokinetic agents. Acupuncture and gastric electrical stimulation can be attempted. In severe cases, endoscopic and surgical interventions are considered for symptom control.

Association between psycho-psychological factors and functional dyspepsia in elderly patients: Effect on activity of daily living score

AIM

To analyze the association between psycho-psychological factors and functional dyspepsia (FD) in elderly patients and the effect on patients' activity of daily living (ADL) score.

METHODS

Sixty elderly psychiatric patients with FD admitted to Shaoxing Seventh People's Hospital from August 2016 to September 2017 were selected as a study group, and 60 patients with FD with good mental status were selected as a control group. Psycho-psychological status and gastric function indexes were tested in both groups. The self-rating anxiety scale, self-rating depression scale, 24 h heart rate variability and water stress test were also used to assess the patients in the two groups.

RESULTS

The self-rating anxiety scale and self-rating depression scale scores of elderly patients in the study group were significantly higher than those in the control group (P < 0.05), and the number of patients with anxiety and depression in the study group was significantly higher than that in the control group (P < 0.05). The initial sensation and maximum tolerance of the water load test in the study group were significantly lower than those in the control group (P < 0.05), and the time to semi-emptying of gastric solids in the study group was significantly longer than that in the control group (P < 0.05). The incidence of adverse reactions in the study group was significantly lower than that in the control group (P < 0.05). ADL scores of elderly patients in the study group were significantly higher than those in the control group before and after treatment (P < 0.05).

CONCLUSION

Psycho-psychological status of patients is closely related to the development and progression of FD, and may cause damage to the gastric sensory function and motor function of the patients.

Pharmacological treatments for functional nausea and functional dyspepsia in children: a systematic review

INTRODUCTION

Chronic idiopathic nausea (CIN) and functional dyspepsia (FD) cause considerable strain on many children's lives and their families. Areas covered: This study aims to systematically assess the evidence on efficacy and safety of pharmacological treatments for CIN or FD in children. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs) investigating pharmacological treatments of CIN and FD in children (4-18 years). Cochrane risk of bias tool was used to assess methodological quality of the included articles. Expert commentary: Three RCTs (256 children with FD, 2-16 years) were included. No studies were found for CIN. All studies showed considerable risk of bias, therefore results should be interpreted with caution. Compared with baseline, successful relief of dyspeptic symptoms was found for omeprazole (53.8%), famotidine (44.4%), ranitidine (43.2%) and cimetidine (21.6%) (p = 0.024). Compared with placebo, famotidine showed benefit in global symptom improvement (OR 11.0; 95% CI 1.6-75.5; p = 0.02). Compared with baseline, mosapride versus pantoprazole reduced global symptoms (p = 0.011; p = 0.009). One study reported no occurrence of adverse events. This systematic review found no evidence to support the use of pharmacological drugs to treat CIN or FD in children. More high-quality clinical trials are needed.

ABBREVIATIONS

AP-FGID: Abdominal Pain Related Functional Gastrointestinal Disorders; BART: Biofeedback-Assisted Relaxation Training; CIN: Chronic Idiopathic Nausea; COS: Core Outcomes Sets; EPS: Epigastric Pain Syndrome; ESPGHAN: European Society for Pediatric Gastroenterology Hepatology and Nutrition; FAP: Functional Abdominal Pain; FD: Functional Dyspepsia; GERD: Gastroesophageal Reflux Disease; GES: Gastric Electrical Stimulation; H2RAs: H2 Receptor Antagonists; IBS: irritable bowel syndrome; NASPGHAN: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; PDS: Postprandial Distress Syndrome; PPIs: Proton Pump Inhibitor; PROMs: Patient Reported Outcome Measures; RCTs: Randomized Controlled Trials; SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants.