10 Are psychosocial factors of aetiological importance in functional dyspepsia?

The causes of functional dyspepsia remain unclear. Research has linked other functional gastrointestinal disorders, particularly irritable bowel syndrome, to a history of physical or sexual abuse, psychosocial distress and certain psychiatric disorders. In functional dyspepsia, there is a possibility of certain psychiatric disorders, particularly alcohol abuse and eating disorders, indirectly influencing the development of functional dyspepsia-like symptoms. However, the literature on possible psychosocial correlates in functional dyspepsia is not as mature as the literature on irritable bowel syndrome. This paper critically reviews the psychosocial dimensions and implications for the psychotherapeutic treatment of functional dyspepsia.     

Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?

OBJECTIVE: Different subgroups can be identified in functional dyspepsia based on symptom type or severity, and may correlate with pathophysiological disturbances. In particular, female sex and severe fullness and vomiting have been reported to be strong independent predictors of slow solid gastric emptying. We aimed to determine if symptom patterns or severity could identify those with abnormal gastric emptying among patients with dysmotility-like functional dyspepsia and, for comparison, type I diabetes mellitus. METHODS: Patients with postprandial symptoms and documented functional dyspepsia by endoscopy (n = 551) and patients with type I diabetes who had postprandial dyspepsia (n = 247) enrolling in two separate randomized controlled trials were evaluated at baseline. Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated C13 octanoic acid breath test with sampling over 4 h. A self-report questionnaire measured the presence and severity of eight symptoms on visual analog scales. The validated Nepean Dyspepsia Index measured the frequency, severity, and bothersomeness of 15 upper GI symptoms on Likert scales. RESULTS: Gastric emptying was definitely delayed (t1/2 > 192 min) in 24% of patients with functional dyspepsia and 28% with diabetes. Delayed gastric emptying was associated with female gender but not age or Helicobacter pylori status. The age- and sex-adjusted risk (odds ratio) of delayed gastric emptying for the upper GI symptoms ranged from 0.99 to 1.0 (all p values > or =0.2). The results were very similar in functional dyspepsia and diabetes. There was also no correlation between t1/2 and number of symptoms or symptom severity scores. CONCLUSIONS: Symptom prevalence and severity were similar in dyspeptic patients with and without delayed gastric emptying. Specific symptoms do not seem to be of predictive value in dysmotility-like dyspepsia for identifying alterations of gastric emptying.     

Functional dyspepsia： Are psychosocial factors of relevance？

The pathogenesis of Functional Dyspepsia (FD) remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intrinsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to variation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.     

Determinants of symptom pattern in idiopathic severely delayed gastric emptying: gastric emptying rate or proximal stomach dysfunction?

BACKGROUND: Idiopathic gastroparesis is a syndrome characterised by severely delayed gastric emptying of solids without an obvious underlying organic cause. Although delayed gastric emptying is traditionally considered the mechanism underlying the symptoms in these patients, poor correlations with symptom severity have been reported. AIMS: To investigate proximal stomach function and to study the correlation of delayed gastric emptying and proximal stomach dysfunction with symptom pattern and severity in idiopathic gastroparesis. METHODS: 58 consecutive patients (19 men, mean (standard deviation) age 41 (2) years) with severely delayed solid gastric emptying (gastric half-emptying time (t(1/2))>109 min) without an organic cause were recruited. They filled out a symptom-severity questionnaire and underwent a gastric barostat study for assessment of gastric sensitivity and accommodation. Correlation of these mechanisms with symptom pattern and overall symptom severity (sum of individual symptoms) was analysed. RESULTS: At two different cut-off levels for gastric emptying (upper limit of normal t(1/2) up to 1.5 and 2 times), no significant change in symptom pattern occurred. 25 (43%) patients had impaired accommodation, and this was associated with higher prevalence of early satiety (p<0.005) and weight loss (p = 0.009). 17 (29%) patients had hypersensitivity to gastric distension, and this was associated with higher prevalences of epigastric pain (p = 0.005), early satiety (p = 0.04) and weight loss (p<0.005). Overall symptom severity was not correlated with gastric emptying or accommodation, but only with sensitivity to gastric distension (R = -0.3898, p = 0.003) and body weight (R = -0.4233, p = 0.001). CONCLUSIONS: In patients with idiopathic gastroparesis, the symptom pattern is determined by proximal stomach dysfunction rather than by the severity of delayed emptying.     

Drink tests in functional dyspepsia: which drink is best?

BACKGROUND: Drinking capacity is often reduced in functional dyspepsia. Drink tests may therefore have diagnostic potential. A simple drink test in combination with ultrasonography was applied in this study, the aim being to find the best drink for this test. METHODS: On separate days, 10 patients with functional dyspepsia (FD) and 10 healthy controls (C) drank three different test meals (Nutridrink 150 kcal/100 mL, meat soup 4 kcal/100 mL and water) at a rate of 100 mL/min until maximal drinking capacity. Intragastric volume at maximal drinking capacity was determined using 3-dimensional ultrasonography. RESULTS: Drinking capacity (P < 0.05) and intragastric volume (P < 0.01) were significantly lower in patients than in the controls with the meat soup meal, but not with Nutridrink or water. Gastric emptying distinguished significantly (P < 0.05) between patients and controls only with Nutridrink. Gastric emptying of Nutridrink was significantly correlated to the rate by which nausea was induced (P = 0.02), while gastric emptying of meat soup was significantly negatively correlated to the rate by which fullness was induced (P < 0.05). Receiver operating characteristic (ROC) analysis indicated that optimal discrimination between patients and controls was obtained by the combined test results of symptoms per intragastric volume using meat soup as the test meal. CONCLUSION: For the non-invasive diagnosis of functional dyspepsia by a rapid drink test in combination with ultrasonography, a meat soup meal is preferable compared to Nutridrink or water.     

Drink tests in functional dyspepsia: which drink is best?

Background: Drinking capacity is often reduced in functional dyspepsia. Drink tests may therefore have diagnostic potential. A simple drink test in combination with ultrasonography was applied in this study, the aim being to find the best drink for this test. Methods: On separate days, 10 patients with functional dyspepsia (FD) and 10 healthy controls (C) drank three different test meals (Nutridrink® 150?kcal/100?mL, meat soup 4?kcal/100?mL and water) at a rate of 100?mL/min until maximal drinking capacity. Intragastric volume at maximal drinking capacity was determined using 3‐dimensional ultrasonography. Results: Drinking capacity (P?P?P?P?=?0.02), while gastric emptying of meat soup was significantly negatively correlated to the rate by which fullness was induced (P?Conclusion: For the non‐invasive diagnosis of functional dyspepsia by a rapid drink test in combination with ultrasonography, a meat soup meal is preferable compared to Nutridrink or water.     

Combined analysis of the ORCHID and OCAY studies: does eradication of Helicobacter pylori lead to sustained improvement in functional dyspepsia symptoms?

Currently, one of the most important unresolved questions concerning Helicobacter pylori is whether eradication of the organism leads to a sustained improvement in symptoms in patients diagnosed with functional (non-ulcer) dyspepsia. Recently, two very similar studies, the ORCHID and OCAY studies, have been completed and the combined results of these two multicentre, multinational, randomised, double blind, controlled clinical trials are reviewed.     

Hypertension and psychosocial factors: which came first,the egg or the chicken?

In this issue of the Journal of Geriatric Cardiology, the article of Yu, et al1 presents an intriguing issue in the field of hypertension treatment and pathophysiology. On     

Hypertension and psychosocial factors: which came first,the egg or the chicken?

In this issue of the Journal of Geriatric Cardiology,the article of Yu, et al1 presents an intriguing issue in the field of hypertension treatment and pathophysiology.……     

Does the application of tape influence quadriceps sensorimotor function in knee osteoarthritis?

OBJECTIVES: Using additional data from two previously reported studies, the aim was to determine the effects of immediate and short-term continuous (3 weeks) application of knee tape on quadriceps sensorimotor function in individuals with symptomatic knee osteoarthritis (OA). METHODS: A within-subjects study (n = 18) and a randomized controlled trial (n = 87) were performed using community volunteers. Therapeutic tape (patellar realignment and soft-tissue unloading) was compared with control (placebo) tape and no tape. Outcome measures included knee joint position sense, isometric quadriceps strength and electromyographic quadriceps onset during stair descent. RESULTS: Application of therapeutic tape worsened joint position sense (variable error) at a knee angle of 40 degrees (P < 0.01), but did not immediately alter any other sensorimotor parameter. Even after 3 weeks of wearing tape continuously, sensorimotor function was not altered. Furthermore, no differential effect of tape was noted when participants were dichotomized into those with poor and good sensorimotor scores at baseline. CONCLUSIONS: Neither immediate application nor continuous use of tape (for 3 weeks) appears to influence sensorimotor function in people with knee OA. Alterations in sensorimotor function cannot explain the pain-relieving effects of therapeutic tape observed in this population.     

Belching: dyspepsia or gastroesophageal reflux disease?

OBJECTIVES: Eructation (belching) is a common symptom seen in clinical practice. Because either belching or heartburn may result from transient lower esophageal sphincter relaxations, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). In this retrospective study we evaluated the prevalence of belching in dyspepsia and GERD and the relation of belching to acid reflux events documented by pH monitoring. METHODS: We examined the prevalence, frequency, and severity of belching and other GERD symptoms by use of standardized questionnaires in 180 GERD patients (group A) and 78 dyspeptic controls (group B) referred for evaluation at our institution. GERD was defined as either endoscopic esophagitis (or Barrett's esophagus) or positive DeMeester score (>14.2) on pH monitoring or both. Dyspeptic patients had normal endoscopy and pH studies. We also analyzed the relationship of belching to acid reflux events during the 24-h period of pH studies. RESULTS: Of 180 GERD patients, 132 (70%) reported belching during pH monitoring, versus 63 of 78 dyspeptic patients (80%) (p = ns). Similarly, 163 of 180 GERD patients (90%) reported heartburn versus 64 of 78 of dyspeptic patients (82%) (p = ns). Review of symptom questionnaires revealed no significant difference in belching severity between groups. However, heartburn and acid regurgitation were significantly more severe among GERD patients. There was a significantly higher correlation of both heartburn and belching with acid events in patients with GERD compared with patients with dyspepsia. In addition, although both belching and heartburn were significantly improved in patients with GERD, belching scores remained unchanged after proton pump inhibitor (PPI) therapy in patients with dyspepsia. CONCLUSIONS: Belching is as common and as severe in patients with dyspepsia as it is in patients with GERD. Belching and heartburn in GERD patients are more likely correlated with episodes of pathological acid reflux. Because belching cannot be clinically used as a discriminatory symptom, ambulatory pH monitoring should be considered to elucidate the relationship of belching to acid reflux in patients with dyspepsia or GERD.