Psychosocial correlates of symptoms in functional dyspepsia.

BACKGROUND & AIMS: Psychosocial factors may influence both symptom generation and reporting in functional dyspepsia. We determined the presence and severity of these factors as well as their relationship to dyspeptic symptoms in patients with functional dyspepsia and healthy subjects. METHODS: A total of 151 consecutive patients with functional dyspepsia referred chiefly from primary care clinics and 90 healthy subjects rated 15 dyspeptic symptoms. Participants completed the Medical Outcomes Study SF-36 and Symptom Checklist-90-revised. RESULTS: Functional dyspepsia patients reported significantly higher symptom scores, poorer quality of life, and greater psychiatric distress than healthy subjects. For both patients and healthy subjects, increasing symptom scores were associated with significant decreases in the Physical but not the Mental Components Summary of the Medical Outcomes Study SF-36. Although functional dyspepsia patients showed significantly greater psychiatric distress than healthy subjects, symptoms were correlated only modestly with scores on the Symptom Checklist-90-revised. A number of symptoms showed significant but modest correlations ( r s < .30) with the somatization scale with chest burning correlating most strongly ( r s = .48). Chest burning also was correlated significantly with depression, anxiety, and phobic anxiety. Functional dyspepsia patients at a secondary level of care have greater symptom severity, poorer quality of life, and greater psychiatric distress than healthy subjects. Increasing symptom severity is associated with poorer quality of life primarily in the areas of physical and social functioning. With the exception of chest burning, symptoms are not correlated highly with psychiatric distress. CONCLUSIONS: These data suggest that although functional dyspepsia patients experience increased psychiatric distress, symptom severity and psychiatric distress are not associated strongly.     

Predominant symptoms identify different subgroups in functional dyspepsia

OBJECTIVE: Dyspepsia is a common syndrome that often defies diagnosis. Whether the unexplained (or "functional") dyspepsia represents a homogeneous syndrome or includes different subgroups with specific clinical features has not been clarified. The aim of this study was to investigate the relationship between symptom severity, demographic features, and gastric dysmotility in a large series of patients with functional dyspepsia. METHODS: Severity of individual digestive symptoms, demographic features, and scintigraphic gastric emptying of solids were evaluated in 483 patients with chronic unexplained dyspepsia. RESULTS: Two main subgroups were identified. The first was characterized by predominant epigastric pain, male gender (61%), and normal gastric emptying. The second subgroup was characterized by predominant nonpainful symptoms, female gender (60%), a high frequency of associated irritable bowel syndrome (30%), and delayed gastric emptying (42%). A third group included approximately one-third of patients who did not present with any predominant symptom, and was characterized by a high frequency of delayed gastric emptying (30%), overlapping irritable bowel syndrome (28%), and gastroesophageal reflux disease (41%). CONCLUSIONS: Different subgroups exist among patients with functional dyspepsia seen in a referral center. They can be identified by the predominant symptom and are characterized by different demographic, clinical, and pathophysiological features.     

Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia

To establish the pathogenic role of duodenogastric reflux in dyspeptic symptoms we have compared the clinical features, gastrointestinal motility, and rates of duodenogastric bile reflux in 12 cholecistectomized dyspeptic patients, 12 dyspeptic patients with intact gallbladder, and 12 healthy controls. Specific symptoms were scored for severity and frequency. Gastrointestinal manometry was performed during 3 hr of fasting and 2 hr postprandially. Simultaneously, samples of duodenal and gastric contents were obtained sequentially for quantification of bile acids. Results show that symptom global severity (9.6±0.4 vs 8.8±0.7) and frequency (9.9±0.8 vs 9.0±0.5) were similar in both dyspeptic groups; only abdominal pain was milder in cholecystectomized patients (1.9±0.1 vs 2.6±0.2;P<0.05). Fasting gastric bile acid concentrations were higher in cholecystectomized patients (P<0.05) and antral postcibal motility lower (P<0.05) than in the other groups. No relation among gastric hypomotility, duodenogastric bile reflux, and symptom scores was detected. We concluded that patients with functional dyspepsia and a prior cholecystectomy have clinical features similar to those with gallbladders, but some physiological features are dissimilar: antral motility is decreased and duodenogastric bile reflux is increased. Thus, a uniform clinical expression of various pathophysiological disturbances constitutes the basis of functional dyspepsia.     

胃排空障碍与功能性消化不良相关性的研究

目的：探讨胃排空障碍与功能性消化不良（FD）之间的关系。方法：以双核素标记试餐SPECT技术检测了22例FD患者的液、固体食物胃排空和食物胃内分布，并以实时超声检测了72例FD患者在西沙必利治疗前后的液体胃排空变化，分析这些变化与症状积分变化的相关性．结果：68．2％的FD患者存在胃排空障碍，以固体胃排空延迟为主，单纯液体排空障碍较少；摄食后比对照组有更多的食物滞留于远端胃内，然而，延迟的胃排空和改变了的固体食物胃内分布与FD的主要症状无显著相关性。西沙必利明显缩短FD患者的液体胃排空时间，改善其中部分患者的临床症状，而另一部分患者的症状无明显缓解．结论：西沙必利改善FD症状并非完全依赖于其促排空效应，胃排空障碍与FD之间缺乏必然的联系，它们可能是同一病生基础的两种不同表现．     

Relationship between antral distension and postprandial symptoms in functional dyspepsia

INTRODUCTION Patients with functional dyspepsia (FD)[1] complain of several gastrointestinal (GI) and extra-gastrointestinal (extra-GI) symptoms[2-5] that are usually associated with food ingestion[6]. Several pathophysiological abnormalities have been im…     

The effect of Helicobacter pylori eradication on dyspeptic symptoms,acid reflux and quality of life in patients with functional dyspepsia

BackgroundThe aims of this study were to investigate the effect of Helicobacter pylori eradication on gastroesophageal reflux, gastrointestinal symptoms and quality of life in patients with functional dyspepsia.Methods20 H. pylori positive patients diagnosed as having functional dyspepsia according to Roma-II criteria completed the study period. Esophageal motility testing and pH recordings were obtained from each patient before and at the end of the study period. Each patient's gastrointestinal symptoms were evaluated according to Glasgow dyspepsia score. 36-Item short-form health survey (SF-36) and EDQ5 health survey were obtained form each patient.ResultsH. pylori eradication was accomplished in 13 patients (65%). Glasgow dyspepsia symptom score improved in H. pylori eradicated patients (10.3 vs 7.5, p < 0.05) compared to baseline. Fasting lower esophageal sphincter pressures increased (21.6 vs 25.4 mmHg, p < 0.05) after H. pylori eradication Neither the amplitude of peristaltic contractions in the esophageal body (59.4 vs 57.7 mmHg, p = ns) nor the velocity of peristaltic contractions changed before and after eradication. The percent time of esophageal pH < 4 (0.7 vs 2.6, p < 0.001), reflux events longer than 5 min (0 vs 0.7, p < 0.005) and total reflux number (10.3 vs 19.3, p < 0.005) significantly increased after eradication therapy. In the SF-36 health-related quality of life survey, general health score was 3.5 vs. 3.4, physical activity 25.2 vs. 26.4, physical role 5.9 vs. 6.3, emotional pain 4.6 vs. 4.5, social activity 2.0 vs. 1.9, physical pain 3.4 vs. 3.0, vitality 32.3 vs. 34.6, and mental health 11.9 vs. 11.5, before and at the end of treatment (p = ns), respectively.ConclusionsH. pylori eradication did not influence quality of life in patients with functional dyspepsia. Majority of the patients experienced a significant change in esophageal acid exposure after H. pylori eradication. H. pylori eradication significantly decreases gastrointestinal symptoms, however has no effect on quality of life in patients with functional dyspepsia.     

Patients with functional dyspepsia responding to omeprazole have a characteristic gastro-oesophageal reflux pattern.

BACKGROUND: The effect of acid secretion inhibitors in patients with functional dyspepsia (FD) is equivocal. One previous trial showed an effect in patients with a characteristic gastro-oesophageal reflux pattern. This double-blind trial compares the number of reflux episodes in responders and non-responders to omeprazole. METHODS: Twenty-four patients (men/women, 11:13; mean age, 49 years) with FD were included; those with reflux as the main symptom were excluded. An upper endoscopy and a 24-h oesophageal pH measurement were performed before randomization to treatment with 10-20 mg omeprazole or placebo for 4 weeks. Patients who at questioning considered themselves to have achieved sufficient relief of dyspeptic symptoms after 4 weeks were characterized as responders. RESULTS: The number of responders in the omeprazole and placebo groups was 8 of 14 (57%) and 2 of 10 (20%), respectively (P = 0.07). The mean number of reflux episodes at the 24-h oesophageal pH measurement in responders and non-responders to omeprazole was 57 and 25, respectively (P < 0.003). In the omeprazole group the number of responders was 0 of 5 (0%) in those with < 32 reflux episodes and 8 of 9 (89%) in those with > 32 reflux episodes (P < 0.003). CONCLUSION: Patients with FD responding to omeprazole were characterized by many reflux episodes.     

The origin of symptoms on the brain-gut axis in functional dyspepsia

It was hypothesized that symptoms in functional dyspepsia are originated by an altered mechanism at the brain-gut axis (one or several) in the process of gastric accommodation to a meal. To test the key mechanisms potentially involved in symptomatic gastric accommodation, the sensorial responses (on a 0-10 perception score) and the gastric tone responses (by electronic barostat) to either gastric accommodation (n = 10) or to cold stress (n = 10) were measured in 20 patients with functional dyspepsia and 20 healthy controls. The mechanical accommodation of the stomach to gastric distention (compliance) was similar in patients (52 +/- 8 mL/mm Hg) and controls (57 +/- 6 mL/mm Hg). However, isobaric gastric distention elicited more upper abdominal discomfort in dyspeptics than in controls (perception scores, 4.7 +/- 0.9 vs. 1.1 +/- 0.5, respectively; mean +/- SE; P less than 0.005). Cold stress induced a similar gastric relaxatory response in dyspeptics and controls (delta vol, 145 mL +/- 40 mL vs. 141 mL +/- 42 mL, respectively); hand perception (scores, 8.3 +/- 0.4 vs. 7.9 +/- 0.4, respectively) and autonomic responses were also similar. It is concluded that an abnormal afferent sensorial pathway (altered gastric perception) may be a major mechanism of symptom production in functional dyspepsia.     

Prevalence of acid reflux in functional dyspepsia and its association with symptom profile

AIM: A subset of functional dyspepsia patients respond to acid suppressive therapy, but the prevalence of non-erosive reflux disease in functional dyspepsia and its relevance to symptoms have never been established. The aim of the present study was to study 24 hour pH monitoring in consecutive functional dyspepsia patients. METHODS: A total of 247 patients with dyspeptic symptoms (166 women, mean age 44 (SEM 1) year), with a negative upper gastrointestinal endoscopy and without dominant symptoms of heartburn participated in the study. In all patients, the severity of dyspeptic symptoms and the presence of heartburn was assessed by a questionnaire and a 24 hour oesophageal pH monitoring study was performed. All patients underwent a gastric emptying breath test and in 113 a gastric barostat study was performed. RESULTS: Abnormal pH monitoring (acid exposure >5% of time) was found in 58 patients (23%). Of 21 patients with a positive heartburn questionnaire, 76% had pathological pH monitoring, while this was the case in only 18.5% of patients with a negative heartburn questionnaire. Demographic characteristics and the prevalence of other pathophysiological mechanisms did not differ between heartburn negative patients with normal or abnormal acid exposure. Pathological acid exposure in heartburn negative patients was associated with the presence of epigastric pain (65 v 84%, p<0.005) and of moderate or severe pain (48 v 69%, p = 0.005). CONCLUSION: Pathological oesophageal acid exposure is only present in a subset of heartburn negative functional dyspepsia patients, which are characterised by a higher prevalence of epigastric pain.     

Gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia

AIM:To study the evolution of gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia(FD).METHODS:From June 2008 to November 2009,a total of 1049 patients with FD(65.3%female,mean age42.80±11.64 years)who visited the departments of gastroenterology in Wuhan,Beijing,Shanghai,Guangzhou,and Xi’an,China were referred for this study.All of the patients fulfilled the RomeⅢcriteria for FD.Baseline demographic data,dyspepsia symptoms,anxiety,depression,sleep disorder,and drug treatment were assessed using self-report questionnaires.Patients completed questionnaires at baseline and after1,3,6 and 12 mo follow-up.Comparison of dyspepsia symptoms between baseline and after follow-up was explored using multivariate analysis of variance of repeated measuring.Multiple linear regression was done to examine factors associated with outcome,both longitudinally and horizontally.RESULTS:Nine hundred and forty-three patients(89.9%of the original population)completed all four follow-ups.The average duration of follow-up was12.24±0.59 mo.During 1-year follow-up,the mean dyspeptic symptom score(DSS)in FD patients showed a significant gradually reduced trend(P<0.001),and similar differences were found for all individual symptoms(P<0.001).Multiple linear regression analysis showed that sex(P<0.001),anxiety(P=0.018),sleep disorder at 1-year follow-up(P=0.019),weight loss(P<0.001),consulting a physician(P<0.001),and prokinetic use during 1-year follow-up(P=0.035)were horizontally associated with DSS at 1-year followup.No relationship was found longitudinally between DSS at 1-year follow-up and patient characteristics at baseline.CONCLUSION:Female sex,anxiety,and sleep disorder,weight loss,consulting a physician and prokinetic use during 1-year follow-up were associated with outcome of FD.     

替加色罗治疗慢性便秘、消化不良和反流症状重叠群的临床研究

目的观察替加色罗治疗慢性便秘、消化不良和反流症状重叠群的疗效。方法慢性便秘与消化不良和（或）反流症状重叠患者88例，随机分为三组，替加色罗（TEG）组服用替加色罗6mg，每天2次，餐前30min服用；质子泵抑制剂（PPI）组服用埃索美拉唑40mg，每天1次，早餐前30rain服用；联合治疗组服用替加色罗及埃索美拉唑。疗程均为4周。疗效评价指标为：主要症状的完全缓解率及胃肠道症状总积分、胃肠动力和胃感觉改变。结果治疗4周后，三组胃肠道症状总积分均较治疗前明显下降（P〈0．01），其中TEG组（7．23±3．13）和联合治疗组（5．13±2．26）的总积分下降较PPI组（13．58±2．26明显，P〈0．01）。4周治疗结束时，TEG组上腹痛／不适和烧心症状的完全缓解率分别为59．3％、40．0％，PPI组分别为32．1％、57．1％，联合治疗组分别为74．1％、84．6％，其中TEG组上腹痛／不适的完全缓解率明显高于PPI组（59．3％比32．1％，P=0．043），而烧心症状的完全缓解率明显低于联合治疗组（40．0％比84．6％，P=0．016）。结论替加色罗治疗慢性便秘与消化不良和（或）反流症状重叠群具有良好的疗效和安全性。     

Effect of ginger on gastric motility and symptoms of functional dyspepsia

AIM:To evaluate the effects of ginger on gastric motility and emptying,abdominal symptoms,and hormones that influence motility in dyspepsia.METHODS:Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner.After an 8-h fast,the patients ingested three capsules that contained ginger(total 1.2 g) or placebo,followed after 1 h by 500 mL low-nutrient soup.Antral area,fundus area and diameter,and the frequency of antral contractions were measured using ultrasound at frequen...     

胃食管反流病与功能性消化不良、肠易激综合征症状重叠的研究

目的探讨胃食管反流病（GERD）重叠功能性消化不良（FD）、肠易激综合征（IBS）症状的发生率，分析糜烂性食管炎（EE）和非糜烂性反流病（NERD）亚型患者重叠FD、IBS症状发生率的异同。方法通过胃镜及24h食管pH监测，将147例GERD患者区分为EE47例、病理性酸反流[NERDpH（＋）]42例和生理性酸反流[NERDpH（-）]58例。根据罗马Ⅱ诊断标准对患者重叠FD、IBS症状的情况进行问卷调查。采用《检验比较不同组间重叠症状发生率。结果147例GERD患者中重叠FD症状54例（36．7％），重叠IBS症状19例（12．9％），其中同时重叠FD、IBS症状10例（6．8％）。EE及NERD组重叠FD症状者分别为11例（23．4％）及43例（43．0％），差异有统计学意义（P〈0．05）。EE及NERDpH（＋）组重叠FD症状者分别为n例（23．4％）及13例（31．O％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠FD症状者分别为13例（31．0％）及30例（51．7％），差异有统计学意义（P〈0．05）。EE及NERD组重叠IBS症状者分别为6例（12．8％）及13例（占13．0％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠IBS症状者分别为4例（9．5％）及9例（15．5％），差异无统计学意义（P〉0．05）。结论部分GERD患者重叠FD、IBS症状。无异常食管酸暴露的烧心患者易合并FD症状。     

Perfectionism underlying psychological background correlated with the symptoms of functional dyspepsia

BACKGROUNDS: Early satiety, bloating, and postprandial distress are common symptoms in patients with functional dyspepsia (FD) and anorexia nervosa (AN). Perfectionism is known to be associated with AN, accompanied by abnormal eating behavior. We analyzed perfectionism in FD as compared with that in AN, and investigated the correlation of perfectionism with abdominal symptoms. METHODS: The study group comprised 168 patients with FD according to the Rome II criteria (65% females, mean age 47.7 years) and 101 with AN according to the DSM-IV criteria (100% females, mean age 23 years). As control, 130 healthy subjects (81% females, mean age 26.2 years) were studied. Frost's Multidimensional Perfectionism Scale (FMPS) was used to evaluate perfectionism. Abdominal symptoms were evaluated on the Gastrointestinal Symptoms Rating Scale (GSRS). RESULTS: All subscale scores except for organization were significantly higher in patients with AN than in controls. The parental criticism (PC) score in patients with FD was also significantly higher than that in controls, but lower than that in patients with AN. PC was significantly correlated with the total GSRS, particularly indigestion scores of FD patients (P = 0.0476 and P = 0.0294). CONCLUSIONS: Perfectionism such as PC underlying the psychological background of FD patients may be correlated with their abdominal symptoms.