Introduction

Different pathophysiological mechanisms are thought to play a role in functional dyspepsia (FD) subgroups defined by Rome IV criteria. However, many more studies are needed to determine whether a better separation of pathophysiological mechanisms, so a better therapy choice, can be obtained with the Rome IV subgrouping. This study aims to investigate the difference in psychopathological comorbidities between the FD subgroups defined by the Rome IV criteria. We hypothesized that anxiety and depression would be risk factors differently for each functional dyspepsia subgroup according to Roma IV criteria.

Aims & Methods

This is a cross-sectional observational study conducted at a tertiary gastroenterology center in Turkey between December 2022 and April 2023. Dyspeptic patients, aged over 18 years old referred for an upper gastrointestinal endoscopy were recruited. Participants were asked to fill out the Rome IV gastroduodenal questionnaire along with the Hospital Anxiety and Depression Scale. FD subgroups were defined using the Rome IV criteria. Hospital Anxiety and Depression Scale was used to assess the anxiety and depression of participants. All statistical analyses were conducted using SPSS version 23.0.The p-value of <0.05 was accepted as statistically significant.

Results

Of 424 dyspeptic participants, FD was identified in 117 (27.5%) patients. There were 66 (56.4%) PDS (postprandial distress syndrome), 21 (18%) EPS (epigastric pain syndrome), and 30 (25.6%) overlapping cases. Depression was detected in 35% of FD patients; in 37.9% of the PDS subgroup, 30% of the overlapping subgroup, and 33.3% of the EPS subgroup; There was no difference between the groups (p:0.622). Anxiety was detected in 29.9% of FD patients; in 39.4% of the PDS subgroup, 23.3% of the overlapping subgroup, and 9.5% of the EPS subgroup; detected more frequently in PDS subgroup than in EPS and overlapping subgroups (p:0.022) (Table 1). The frequency of anxiety was significantly higher in patients with postprandial fullness and early satiation symptoms according to those without symptoms (35.8% vs. 15.6%, p:0.035; 44.7% vs. 23.9% p:0.027, respectively).

Conclusion

PDS subgroup, postprandial fullness, and early satiety symptoms were more associated with anxiety, according to the EPS subgroup undd epigastric pain symptom. Evaluating this patient groups in this respect and providing the necessary support can accelerate the recovery process of the patient. It seems reasonable to assume that anxiolytic drugs are of benefit in especially the PDS subgroup. Further studies assessing psychological factors and treatment strategies for FD Rome IV subgroups are required to confirm the relationship of subgroups with depression and anxiety.

References

1. Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J. 2021 Apr;9(3):307-331. doi: 10.1002/ueg2.12061.
2. Esterita T, Dewi S, Suryatenggara FG, Glenardi G. Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review. J Gastrointestin Liver Dis, June 2021 Vol. 30 No 2: 259-266. doi: 10.15403/jgld-3325.
3. Van den Houte K, Carbone F, Goelen N, Schol J, Masuy I, Arts J, et al. Effects of Rome IV Definitions of Functional Dyspepsia Subgroups in Secondary Care. Clinical Gastroenterology and Hepatology 2021;19:1620–1626. doi: 10.1016/j.cgh.2020.06.043.
4. Carbone F, Vanuytsel T, and Tack J. Analysis of Postprandial Symptom Patterns in Subgroups of Patients With Rome III or Rome IV Functional Dyspepsia. Clinical Gastroenterology and Hepatology 2020;18:838–846. doi:10.1016/j.cgh.2019.07.053.
5. Aro P, Talley NJ, Johansson SE, Agréus L, Ronkainen J. Anxiety is linked to new‐onset dyspepsia in the Swedish population: a 10-year follow‐up study. Gastroenterology 2015;148(5):928‐37. doi: 10.1053/j.gastro.2015.01.039.
6. Adibi P, Keshteli AH, Daghaghzadeh H, Roohafza H, Pournaghshband N, Afshar H. Association of anxiety, depression, and psychological distress in people with and without functional dyspepsia. Adv Biomed Res 2016;5:195. doi:10.4103/2277-9175.190936

Disclosure

None to declare

Introduction

There is conflicting data on the risk factors linked to Gastroesophageal Reflux Disease (GERD) and Functional Dyspepsia (FD). Studies that explore the association between anxiety/depression and GERD phenotypes (Esophagitis/EE and Non-Erosive Reflux Disease/NERD), FD, and Rome-IV syndromes are scarce.

Aims & Methods

The aim was to evaluate the association between epidemiological factors and comorbidities with GERD phenotypes, FD, and Rome-IV syndromes, as well as the relationship of these processes with anxiety/depression.
338 participants were selected from 357 patients referred to three tertiary centers in Granada (Spain) for endoscopic assessment. A gastroenterologist individually interviewed each participant prior to the procedure and administered three validated questionnaires (GERD-Q, Rome-IV, and HADS) to detect the presence of GERD, FD, and anxiety/depression, respectively.

Results

45/338 patients were controls, 198/58.6% were classified as GERD, 81/24.0% EE (49/14.5% symptomatic, and 32/9.5% asymptomatic), 117/34.6% NERD, 176/52.1% FD (43/12.7% epigastric pain syndrome, 36/10.7% postprandial distress syndrome, and 97/28.7% overlapping syndrome). 81 patients were mixed GERD-FD. Multivariate analysis found significant independent associations: age in NERD and FD; sex in EE, asymptomatic EE and FD; body mass index in NERD and FD; alcohol in EE; anxiety/depression in FD; use of calcium channel antagonists in EE; and inhalers in FD. We compared controls vs different groups/subgroups finding significantly more anxiety in NERD, FD, all Rome-IV syndromes, and mixed GERD-FD; more depression in FD, overlapping syndrome, and mixed GERD-FD; and higher levels of anxiety+depression in NERD, FD, overlapping syndrome, and mixed GERD-FD.

Table: Multivariate analysis (logistic regression) of factors associated with different groups and subgroups of GERD and FD

Conclusion

The existence of shared demographic and psychopathological risk factors in Non-Erosive Reflux Disease (NERD) and Functional Dyspepsia (FD) implies that they could be part of the same pathophysiological spectrum. The prevalence of anxiety was higher in NERD, while anxiety and depression were more frequent in FD. These results suggest that psychological therapy could be a supportive strategy for both conditions.

Introduction

Disorders of gut brain interaction (DGBIs) is a group of diseases with relatively high prevalence. One of the most common is functional dyspepsia. It has been repeatedly reported that university students tend to have higher prevalence of this disease than general population. Study at medical school is associated with high degree of stress and this could be accumulated during the passing years. As many other factors could affect the symptomatology, the best way to test this hypothesis is to perform a prospective cohort study following one particular group of students over the years.

Aims & Methods

The aim of this study is to evaluate the prevalence of symptoms of functional dyspepsia in selected cohort overtime. This is a prospective, observational study. The observed group were students of medicine from their 1^stto 3^rd year of study. Acquisition of the data was performed by questionnaires. The diagnosis was made by using ROME IV criteria for DGBI. Additional information was obtained from STAX1 and STAX2 validated questionnaires (STAI-X1 shows how the patient feel while answering the questionnaire (anxiety as a state) and STAI-X2 is based on how the patient feel overall (anxiety as a personality trait)) and Beck depression inventory. The measurement was performed in the middle of the school year, every October (2021 to 2023).

Results

Initially 121 students from first year agreed to participate in the study and filled out the questionary. Subsequently the response rate for 2^nd year was 67.8 % and for 3^rd 73%. The symptoms of Functional Dyspepsia were present in 14.9% of participants from 1^st year, 13.4% from 2^nd year and 14.6% from 3^rd year. The cumulative cohort average of STAX 1 was 45.5 points for 1^st year, 46.5 points for 2^nd year and 46.2 points for 3^rd year. The cumulative cohort average of STAX 2 was 47.7 points for 1^st year, 46.2 points for 2^nd year and 46.8 points for 3^rd year. The cumulative cohort average of Beck depression inventory was 8.7 points for 1^st year, 8.8 points for 2^nd year and 8.4 points for 3^rd year. The rate of smoking was 7.4 % of participants from 1^st year, 13.4% participants from 2^nd year and 14.6% from 3^rd year.

Conclusion

The results of this prospective cohort observational study shows that the symptoms of Functional Dyspepsia are highly prevalent among medical students and this varies only insignificantly over time. The probands in average showed no signs of depression however the average levels of anxiety and stress were high during all 3 years. This could be associated with significant rise of smokers within the cohort during the observation period.

Introduction

Different pathophysiological mechanisms are thought to play a role in functional dyspepsia (FD) subgroups defined by Rome IV criteria. Studies are needed to determine whether Rome IV subgroups are linked to distinct pathophysiologies and treatment responses. This study aims to investigate the impact of Helicobacter pylori (H. pylori) infection in the pathogenesis of each FD subgroups, subdivided according to the Rome IV consensus, within a high H. pylori prevalence country, Turkey. The investigation centered on assessing the frequency of H. pylori and examining the impact of eradication therapy on alleviating symptoms, in each Rome IV subgroup.

Aims & Methods

Eradication treatment was applied to cases who were initially diagnosed with FD using the Rome IV criteria and subsequently found to have H. pylori gastritis through endoscopic biopsy. 8-12 weeks after treatment, H. pylori state was evaluated with fecal antigen test. Symptom responses were evaluated in each subgroup at 2, 6, and 12 months post-therapy using a Likert scale and statistically with SPSS version 23.0.

Results

The H. Pylori frequency was statistically more common in individuals with symptoms consistent with epigastric pain syndrome (EPS) (73.1% in EPS, 41% in postprandial distress syndrome (PDS), and 43.9% in overlapping subgroups (p< .001)). With eradication treatment of H. pylori-positive cases, all subgroups demonstrated a significant response and the response rates didn’t exhibit significant difference between subgroups (73.7% in total cases; 70.5% in EPS; 71.4% in PDS; 82.6% in overlapping, in the 12th month (p>0.05)). Eradicated patients showed significant symptomatic improvement with 70.2% in the 12th month. None of the non-eradicated patients experienced symptomatic improvement.

Conclusion

Using Rome IV consensus confirmed the data that H. pylori plays a notable role as a pathogenic factor in FD, particularly in EPS, and it is recommended to screen all FD subgroups, particularly EPS, for H. pylori and eradicate, if detected. Additionally, this study suggests that regions with a high H. pylori prevalence tend to have a higher H. pylori-associated dyspepsia prevalence.

References

1. Wauters L, Dickman R, Drug V, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J. 2021 Apr;9(3):307-331.
2. Houte KVD, Carbone F, Goelen N, et al. Effects of Rome IV Definitions of Functional Dyspepsia Subgroups in Secondary Care. Clinical Gastroenterology and Hepatology 2021;19:1620–1626.
3. Carbone F, Vanuytsel T, and Tack J. Analysis of Postprandial Symptom Patterns in Subgroups of Patients With Rome III or Rome IV Functional Dyspepsia. Clinical Gastroenterology and Hepatology 2020;18:838–846.
4. Vanheel H, Vanuytsel T, Van Oudenhove L, Farre R, Verbeke K, Tack J. Postprandial symptoms originating from the stomach in functional dyspepsia. Neurogastroenterol Motil 2013;25:911-e703
5. Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut. 2022 Jan 12:gutjnl-2021-326583. doi: 10.1136/gutjnl-2021-326583.
6. Kang SJ, Park B, Shin CM. Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence. J Clin Med. 2019 Aug 28;8(9):1324. doi: 10.3390/jcm8091324.
7. Malfertheiner P, Megraud F, Rokkas T, et al. European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022 Aug 8:gutjnl-2022-327745. doi: 10.1136/gutjnl-2022-327745.

Disclosure

The authors declare that they have no conflict of interest.

Introduction

Functional Dyspepsia (FD), a common disorder of gut-brain interaction [1], is associated with alterations in gastric accommodation, gastric emptying, gastric sensitivity, gastroduodenal permeability, and the gut microbiome. Resilience, the ability to maintain function under personal or physical stress, may play a role in the development of FD, although no studies have evaluated this theory. We hypothesize that FD patients have lower resilience than the general population, which may lead to a new therapeutic target.

Aims & Methods

This prospective questionnaire study compared patients with FD (Rome IV criteria) with internal medicine clinic patients without dyspepsia at a tertiary referral center. Participants completed the FD symptom severity score [2], Brief Resilience Scale (BRS) [3], Connor-Davidson Resilience Scale (CDRS) [4], hospital anxiety and depression scale (HADS) [5], early childhood adverse life event questionnaire [6], and perceived stress score [7]. Questionnaires were distributed to clinic patients meeting inclusion/exclusion criteria.

Results

38 FD (mean age 43 years old, 87% female) and 31 control (mean age 57 years old, 39% female) patients completed the survey. FD patients exhibited lower resilience on the CDRS (96.83 vs. 90.26, P<0.04, CI -12.93 to -0.21) but not on the BRS (3.018 vs. 3.022, P<0.96, CI -0.15 to 0.13). FD patients and controls scored no different on the HADS anxiety index (17.05 vs. 18.38, P<0.064, CI -2.74 to 0.08) and depression scores (P<0.14, CI -0.21 to 1.5). The FD group reported "high" perceived psychological stress while the control group reported a “moderate” level (P<0.004, CI 2.002 to 9.827). In childhood, FD patients had significantly more adverse childhood events (29.3% vs. 15%, P<0.004, CI 0.05 to 0.25). FD patients were more likely to have been exposed to a household member suffering from a psychiatric illness compared to control patients (47% vs. 20%, P<0.049, CI 0.001 to 0.5). FD patients were also more likely to report psychological abuse in childhood (53% vs. 17%, P<0.03, CI 0.034 to 0.67). No other significant differences were found in types of early childhood trauma including physical abuse, familial substance abuse, witnessed maternal violence, or criminal behavior by a household member.

Conclusion

This novel, prospective questionnaire pilot study shows that FD patients have lower resilience compared to the general outpatient population on the CDRS. The long-term symptoms of FD may further decrease resilience. While anxiety and psychological stress are not strongly associated with FD, the significant exposure to childhood household members with a psychiatric diagnosis and significantly higher prevalence of self reported psychological abuse may explain the higher prevalence of antidepressant use in this population, especially considering the significantly higher level of self perceived psychological stress [8]. Otherwise, early childhood trauma appears similar between FD patients and patients without FD and is thus not likely to influence resilience markers. Understanding the contribution of resilience to development of FD may lead to therapies enhancing resilience, improving symptoms, and patient well-being.

References

1. El-Serag HB, Talley NJ. Systemic review: The prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004;19:643-654.
2. Taylor F, Higgins S, Carson RT, et al. Development of a symptom-focused patient-reported outcome measure for functional dyspepsia: the functional dyspepsia symptom diary (FDSD). Am J Gastroenterol. 2018 Jan,113(1):39-48.
3. Smith BW, Dalen J, Wiggins K, et al. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194-200
4. Connor KM & Davidson JR. 2003. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress. Anxiety, 18; 76-82
5. Zigmond AS & Snaith RP. 1983. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67: 361-370
6. Felitti VJ, Andra RF, Nordenburg D, et al. Relationship of childhood abuse and household dysfunction to many of the causes of death in adults. The adverse childhood experiences (ACE) study. Am J Prev Med. 1998 May;14(4):245-58
7. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96.
8. Esterita T, Dewi S, Suryatenggara FG, Glenardi G, et al. Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review. J Gastrointestin Liver Dis. 2021 Jun 18;30(2):259-266.

Introduction

Dyspeptic patients frequently report nausea and vomiting. However, Rome IV criteria distinguish functional dyspepsia (FD) and chronic nausea and vomiting syndrome (CNVS) as separate disorders.

Aims & Methods

We aimed to assess and compare the characteristics and symptoms of patients with FD alone, with CNVS alone and those fulfilling both FD+CNVS criteria in a population of investigated dyspepsia. The retrospective study included 3,471 consecutive patients with investigated dyspepsia. Functional dyspepsia and CNVS were diagnosed according to Rome IV criteria. The severity of eight digestive symptoms during the 15 days preceding their appointment was assessed prospectively using a 5-point Likert scale. Quality of life (QoL) was quantified by the GastroIntestinal Quality of Life Index (GIQLI). Anxiety and depression were evaluated using the Hospital Anxiety and Depression scale (HADS). Sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI).

Results

Among the 2,317 patients kept for analysis, 651 had FD alone, 144 CNVS alone and 393 FD+CNVS overlap. 73.2% of patients with CNVS fulfilled the criteria for FD, whereas 37.6% of FD patients met the criteria for CNVS. Patients with FD+CNVS overlap had worse quality of life, higher depression levels, and worse sleep quality than both diagnoses alone (p < 0.05). All symptoms were at least as prevalent in patients with FD+CNVS overlap as in patients with FD alone, except early satiation.

Conclusion

Nausea and vomiting are frequently reported by patients investigated for dyspepsia. Nearly three-quarters of patients with CNVS fulfil the criteria for FD, whereas more than one-third of FD patients meet the criteria for CNVS. Patients exhibiting FD+CNVS overlap have more severe disease than those with FD or CNVS alone.