Functional dyspepsia: Are psychosocial factors of relevance

Abstract

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.

Somatic Complaints Are Significantly Associated with Chronic Uninvestigated Dyspepsia and Its Symptoms: A Large Cross-sectional Population Based Study

“…Review studies such as that of Barry and Dinan also confirmed the co-morbidities of anxi-ety, depressive, somatoform disorders, and neuroticism in patients with functional dyspepsia. 19 These psychological problems are commonly seen in most digestive disorders so that in the study of Van Oudenhove et al, 46 anxiety, depression, and somatization were used as the most important variables on separating functional gastroduodenal disorders (FGD). The results of Faramarzi et al 20 in Iran revealed that psychological problems (depression and anxiety) were more prevalent in FD patients.…”

“…These findings are consistent with other previous studies. [19][20][21][22]44 For example, Norton et al 45 showed that participants suffering from functional dyspepsia showed significant differences in terms of anxiety and depression when compared with controls. The results of Filipović et al 21 also approved these facts.…”

“…17,18 Reported factors include gastric sensorimotor dysfunction, Helicobacter pylori infection, dysmotility, psychosocial factors (anxiety, anger-hostility, depression, and general psychological distress), and personality traits (among them, neuroticism). [17][18][19][20][21][22][23] In addition, somatization, which is characterized as physical bodily complaints not fully explained by organic reasons, plays an important role in functional GI disorders in general and in FD in particular. [23][24][25][26] Some studies indicated that there is a considerable overlap of somatic complaints like fatigue, headaches, sleep disorders, and abdominal discomfort in patients with FD, and that these are associated with epigastric pain, epigastric and retrosternal burning, and total dyspeptic symptom scores.…”

Reaching proficiency in laparoscopic splenectomy

“…In a Danish study poor socio-economic status emerged as an important risk factor for peptic ulcer disease which exerts its effect independently of H pylori infection [20] . In functional dyspepsia the role of psychosocial factors continues to be the subject of debate [21] . In this respect our findings support those previous studies.…”

The psyche and the gut

“…1%) addressed different psychological aspects of gastrointestinal diseases, such as quality of life [1] and psychological impact of chronic g astrointestinal diseases [2] , mental problems with hepatitis [3] , family occurrence [4] and other psychological aspects [5] of functional bowel disorders. Only 1 paper reported experimental data on brain imaging [6] and only one review paper addressed the psycho-physiological aspects of visceral pain [7] .…”