Introduction
Functional dyspepsia (FD) is an enigma in itself but a commonly prevalent problem, around 10-30%, encountered by physicians worldwide [1]. There is evidence of low-grade inflammation in duodenal mucosa including eosinophilic infiltration and T-cell mediated among others [2]. Moreover, since vitamin D has immunomodulatory properties and its role has been well established in various diseases including inflammatory bowel diseases and cancers, evaluation of vitamin D status in patients with FD needs to be actively pursued given its immuno-regulatory attributes [3]. The beneficial roles of vitamin D, particularly in gut and neurological functioning of the body counts in an effective option in treating irritable bowel syndrome [4,5]. In one study, increased VDR (vitamin D receptor) expression is seen in duodenal mucosa and it has been proposed that since Vitamin D acts as a ligand of VDR, assessing vitamin D status in such patients remains an area of active research [6]. Thus the authors here seeks to probe into the key role of Vitamin D in the FD patients, utilizing evidence from previous studies in vitamin abnormalities [4].
Aims & Methods
This case control study was done at a tertiary care hospital with 150 cases and 150 controls. FD was diagnosed by the ROME IV criteria. Demographic and serum vitamin D levels including perceived stress score (PSS) and salivary alpha levels were determined for both cases and controls. Statistical analysis were done with the help of SPSS version 27.
Results
Majority of the FD cases were males (57.3%). Post prandial distress syndrome (PPDS) represented the major type of functional dyspepsia (FD) cases (104 cases; 69.3 %), followed by epigastric distress syndrome (EPS) (48 cases, 32%). Among the cases, 6.6 % had sleep problems, 18.6% had heart burn, 18.6% had bowel disturbances and 13.4% had headache. Cases have higher mean age than the controls (42.24±12.047 vs 38.94±, p=0.028). A higher mean BMI was found among the control group (23.2 vs 21.2, p<0.05) and higher percentage of obese individuals in the control group (42.7% vs 29.3%, p= 0.05). Majority of the cases are from rural background (89.3% vs 74%, p<0.001). Comparison of perceived stress scale (PSS) showed that cases had significantly higher grades of PSS than control (p<0.001). Hypovitaminosis D (<30ng/ml) was found significantly more among cases (73.3% vs 60%; p<0.05) with an odds ratio (OR) of 1.833 (CI95%= 1.126- 2.985). After adjustment of age, place of residence and BMI, Vitamin D levels were significantly associated with functional dyspepsia in the regression analysis. Nagelkerke R Square= 11%, p= 0.023, OR= 1.016
| Cases | Control | P value |
| Vitamin D, Mean SD | 22.9 ± 18.3
| 27.8 ± 17.5
| 0.009
|
| Vitamin D categories, n (%) |
|
| 0.020
|
| Vit D deficiency (VDD) | 110 (73.3)
| 90 (60)
|
|
| Normal Vitamin D | 40 (26.7)
| 60 (40)
|
|
Conclusion
The present work demonstrates a close association of VDD, BMI and PSS score in FD patients for the first time. Findings from the study has been able to shed light into the role of Vitamin D in FD and the possible need for vitamin D supplementation to further improve the management of such cases, thus opening new avenues for further research.
References
1. Talley NJ, Ford AC. Functional dyspepsia. New England Journal of Medicine. 2015 Nov 5;373(19):1853-63.
2. Romano C, Valenti S, Cardile S, Benninga MA. Functional dyspepsia: an enigma in a conundrum. Journal of pediatric gastroenterology and nutrition. 2016 Dec 1;63(6):579-84.
3. Athanassiou L, Mavragani CP, Koutsilieris M. The immunomodulatory properties of vitamin D. Mediterranean Journal of Rheumatology. 2022 Mar;33(1):7.
4. Barbalho SM, Goulart RD, Araújo AC, Guiguer ÉL, Bechara MD. Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D. Expert review of gastroenterology & hepatology. 2019 Apr 3;13(4):345-59.
5. Abbasnezhad A. Effect of vitamin D on gastrointestinal symptoms and health‐related quality of life in irritable bowel syndrome patients: a randomized double‐blind clinical trial. Neurogastroenterology & Motility. 2016 Oct;28(10):1533-44.
6. Stanghellini V. Functional dyspepsia and irritable bowel syndrome: beyond Rome IV. Digestive Diseases. 2017;35(S1):14-7.
Disclosure
The authors have no conflict of Interest