Application and value of anxiety and depression scale in patients with functional dyspepsia

BACKGROUND

Patients with functional dyspepsia (FD) cannot be assessed for their mental health using a suitable and practical measure. The purpose of the study is to investigate the usefulness of several anxiety and depression scales in patients with FD, offering recommendations for clinical identification and therapy.

METHODS

From September 2021 to September 2022, patients were sought and selected. The psychological symptoms were assessed using ten depression or anxiety questionnaires. The receiver operating characteristic (ROC) curve, Spearman analysis, Pearson correlation analysis, and single factor analysis were applied.

RESULTS

Prospective analysis was performed on 142 healthy individuals and 113 patients with FD. In the case group, anxiety and depression symptoms were more common than in the control group, and the 10 scales showed strong validity and reliability. HAMD had the strongest connection with the PHQ-9 score on the depression scale (0.83). The score correlation between SAS and HAMA on the anxiety analysis scale was the greatest at 0.77. The PHQ-9, SAS, HAMD, and HAMA measures performed exceptionally well in detecting FD with anxiety or depression symptoms (AUC = 0.72, 0.70, 0.70, 0.77, and 0.77, respectively).

CONCLUSIONS

PHQ-9, SAS, HAMD, and HAMA scales have good application performance in FD patients. They can assist gastroenterologists in evaluating anxiety and depression symptoms, and provide reference and guidance for subsequent treatment.

Association between craniofacial pain complaints, somatoform symptoms and chronic diseases

OBJECTIVE

This case-control study aimed to investigate associations between craniofacial pain complaints, somatoform symptoms and chronic diseases.

DESIGN

306 subjects were included in this study (174 patients and 132 healthy subjects). The evaluation consisted of demographic data, number of functional and nonfunctional chronic diseases, medications, somatoform symptoms (xerostomia, dry mucosa, numbness, gastrointestinal complaints), and pain complaints with associated characteristics (number of pain areas, sensation of tired face, bruxism, sleep disturbances, masticatory musculoskeletal evaluation). Statistical analysis included descriptive data, tested with chi-square, Fisher's exact, nonparametric Kolmogorov-Smirnoff, Student's t-test, Pearson's coefficient, two-steps cluster classification, multivariate linear and LASSO regressions.

RESULTS

Functional disorders were prevalent in 111 (63.8 %) patients with facial pain. They were taking more medication (p < 0.001) and had more sleep disturbances (p < 0.001), higher xerostomia scores (p < 0.001) and more gastrointestinal complaints (p < 0.001) than controls. There was a positive correlation between the functional score and the number of cranial areas with headache (R² = 0.266, <0.001). The regression models for facial pain (R² = 0.632), craniofacial pain (R² = 0.623) and headache (R² = 0.252) showed significant dependency of functional disorders (p < 0.001).

CONCLUSION

craniofacial pain was associated with functional diseases and somatoform symptoms. This association needs further investigation to understand the role of those disorders in craniofacial pain, considering that pain complaints are common somatoform and functional symptoms.

[Focusing on the functional dry eye]

Dry eye is one of the most common eye diseases characterized by disturbance of tear film homeostasis and a series of ocular discomforts. Discrepancy of ocular subjective symptoms and objective signs, especially unexplained severe symptoms without visible signs has been a long-time confusion for ophthalmologists. Functional disorder is a medical condition that impairs normal functioning of bodily processes due to autonomic nervous dysfunction caused by cerebral cortical dysfunction, but at the exterior, there is no appearance of abnormality. Clinical manifestations are the disease symptoms with a lack of exact physical signs and examination results to confirm the diagnosis. According to the definition and characteristics of functional disorder, we put forward the concept of functional dry eye. We assume that those patients with dry eye symptoms but without detectable signs could be classified into such a functional dry eye subtype. The possible mechanism, clinical manifestations, and treatment strategies are further discussed. (Chin J Ophthalmol, 2019, 55: 885-890).

Insights into the evaluation and management of dyspepsia: recent developments and new guidelines

Dyspepsia is a very common gastrointestinal (GI) condition worldwide. We critically examine the recommendations of recently published guidelines for the management of dyspepsia, including those produced jointly by the American College of Gastroenterology and the Canadian Association of Gastroenterology, and those published by the UK National Institute for Health and Care Excellence. Dyspepsia is a symptom complex, characterized by a range of upper GI symptoms including epigastric pain or burning, early satiety, and post-prandial fullness. Although alarm features are used to help prioritize access to upper GI endoscopy, they are of limited utility in predicting endoscopic findings, and the majority of patients with dyspepsia will have no organic pathology identified at upper GI endoscopy. These patients are labelled as having functional dyspepsia (FD). The Rome IV criteria, which are used to define FD, further subclassify patients with FD as having either epigastric pain syndrome or post-prandial distress syndrome, depending on their predominant symptoms. Unfortunately, the Rome criteria perform poorly at identifying FD without the need for upper GI endoscopy. This has led to the investigation of alternative diagnostic approaches, including whether a capsaicin pill or combined serum biomarkers can accurately identify patients with FD. However, there is insufficient evidence to support either of these approaches at the present time. Patients with FD should be tested for H. pylori infection and be prescribed eradication therapy if they test positive. If they continue to have symptoms following this, then a trial of treatment with a proton pump inhibitor (PPI) should be given for up to 8 weeks. In cases where symptoms fail to adequately respond to PPI treatment, a tricyclic antidepressant may be of benefit, and should be continued for 6 to 12 months in patients who respond. Prokinetics demonstrate limited efficacy for treating FD, but could be considered if other strategies have failed. However, there are practical difficulties due to their limited availability in some countries and the risk of serious side effects. Patients with FD who fail to respond to drug treatments should be offered psychological therapy, where available. Overall, with the exception of recommendations relating to H. pylori testing and the prescription of PPIs, which are made on the basis of high-quality evidence, the evidence underpinning other elements of dyspepsia management is largely of low-quality. Consequently, there are still many aspects of the evaluation and management of dyspepsia that require further research.

Hurt, tired and queasy: Specific variants in the ATPase domain of the TRAP1 mitochondrial chaperone are associated with common, chronic "functional" symptomatology including pain, fatigue and gastrointestinal dysmotility

Functional disorders are common conditions with a substantial impact on a patients' wellbeing, and can be diagnostically elusive. There are bidirectional associations between functional disorders and mitochondrial dysfunction. In this study, provided clinical information and the exon sequence of the TRAP1 mitochondrial chaperone were retrospectively reviewed with a focus on the functional categories of chronic pain, fatigue and gastrointestinal dysmotility. Very-highly conserved TRAP1 variants were identified in 73 of 930 unrelated patients. Functional symptomatology is strongly associated with specific variants in the ATPase binding pocket. In particular, the combined presence of all three functional categories is strongly associated with p.Ile253Val (OR 7.5, P = 0.0001) and with two other interacting variants (OR 18, P = 0.0005). Considering a 1-2% combined variant prevalence and high odds ratios, these variants may be an important factor in the etiology of functional symptomatology.

Progress in treatment of gastrointestinal functional disorders by electroacupuncture at Zusanli

Electroacupuncture at human acupuncture points has an important impact on gastrointestinal motility. Zusanli, the He-sea point of the Stomach Meridian of Foot-Yangming, is one of the most common points for electroacupuncture. Electroacupuncture at Zusanli at a specific frequency can improve gastrointestinal functional diseases, such as gastroesophageal reflux, functional dyspepsia, and irritable bowel syndrome. Although there is still controversy over the efficacy of electroacupuncture at Zusanli for gastrointestinal functional diseases, many studies support the notion that electroacupuncture at Zusanli plays an important role in modulating gastrointestinal functional diseases. In this paper we review the recent progress in the treatment of gastrointestinal functional diseases by electroacupuncture at Zusanli.