Dyspepsia is strongly associated with major depression and generalised anxiety disorder - a community study

Prevalence of uninvestigated dyspepsia and gastroesophageal reflux disease in Korea: a population-based study using the Rome III criteria

BACKGROUND/AIMS

There have been few population-based studies on the prevalences of gastroesophageal reflux disease (GERD) and dyspepsia using Rome III criteria in Asian countries.

METHODS

A population-based, cross-sectional study was conducted by telephone interviews of 5,000 Koreans between the ages of 20-69 years. Gastrointestinal symptoms were assessed by a translated Korean version of Rome III criteria. Uninvestigated dyspepsia (UID) was defined by symptom criteria of Rome III. GERD was defined by troublesome heartburn and/or acid regurgitation occurring at least once a week. The EQ5D assessment tool was used for the evaluation of quality of life.

RESULTS

The prevalences of UID, postprandial distress syndrome (PDS), and epigastric pain syndrome (EPS) were 7.7, 5.6, and 4.2 %, respectively. Overlap between PDS and EPS was found in 27.1 % (104/384) of subjects with UID. There were no significant differences in demographic variables between patients with PDS and EPS. The prevalence of GERD was 7.1 %. Overlap between GERD and UID was found in 50.0 % of GERD patients. The EQ5D index of patients without either UID or GERD was 0.92 ± 0.07, and those of patients with only UID, with only GERD, and with both UID and GERD were 0.88 ± 0.09, 0.88 ± 0.11, and 0.84 ± 0.15, respectively.

CONCLUSIONS

GERD and UID based on Rome III criteria were prevalent and significantly affected the quality of life in Korea. In Korean patients with UID, there was considerable overlap and there were no significant differences in demographic variables between PDS and EPS.

[Psychological alterations in patients with adult celiac disease]

Patients with recently-diagnosed adult celiac disease were evaluated with the Gastrointestinal Symptom rating Scale (GSRS) and Psychological General Well-Being Index (PGWBI) to evaluate their psychological alterations, the association between any alterations and gastrointestinal symptoms, and their outcome after starting a gluten-free diet. The patients underwent nutritional assessment and then started a gluten-free diet; they were reassessed 6 months later. Quantitative variables are expressed as the median and 25th-75th percentiles.

RESULTS

We included 21 patients, 17 women and 4 mena, with a mean age of 43 years (31-47). The results of histological analysis were compatible with Marsh I lesions in 6 patients, Marsh IIIa in 6 and Marsh IIIb in 9. At baseline, 8 patients showed severe psychological distress, 4 showed moderate distress and 9 showed no distress. The GSRS score was 34 (17-43) and the PGWBI was 64 (48-87), with a significant correlation between the 2 indexes (rho=-.58, P=.006). At 6 months, 3 patients had severe psychological distress, 5 had moderate distress, 9 showed no distress and 4 showed psychological well-being. The GSRS score at 6 months was 13 (8-17) and the PGWBI was 83 (68-95) (P<.05 compared with baseline data for the 3 indicators). The 6 axes of the PGWBI showed significant improvement. At 6 months, no correlation was found between the GSRS and PGWBI.

CONCLUSIONS

Patients with celiac disease have psychological alterations whose intensity is related to gastrointestinal symptoms. These symptoms improve after the start of a gluten-free diet.

Antidepressants and gastrointestinal symptoms in the general Dutch adult population

BACKGROUND

Gastrointestinal symptoms are frequently reported adverse effects of antidepressants, but antidepressants are also a treatment modality in functional gastrointestinal disorders. We aimed to assess the association between antidepressant use and gastrointestinal symptoms in the general adult population.

METHODS

We assessed gastrointestinal symptoms, medication use, and comorbidity through structured questionnaires in randomly selected individuals. We compared presence of gastrointestinal symptoms in respondents who reported antidepressant use with those who did not. We used multivariable regression analysis to verify the association between antidepressant use and gastrointestinal symptoms.

RESULTS

In total, 16,758 questionnaires were returned and eligible for analysis. Antidepressant use was reported by 701 respondents (4.2%). Gastrointestinal symptoms were more frequently reported by antidepressant users compared with nonusers (40% vs 25%, P < 0.01). This apparent association between antidepressant use and gastrointestinal symptoms did not remain after adjusting for demographic factors, comorbidity, and use of other medications (adjusted odds ratio, 0.94; 95% confidence interval, 0.74-1.18).

CONCLUSIONS

In our cross-sectional population-based study, we did not find an association between antidepressant use and gastrointestinal symptoms.

Social support and depressive symptoms among 'money' boys and general men who have sex with men in Shanghai, China

The primary objective was to examine prevalence and correlates of social support and depressive symptoms among male sex workers (known as 'money boys' (MBs)) and general men who have sex with men (MSM) in Shanghai. The Social Provision Scale (SPS), which consists of 24 items, scored out of 4 for social provision, was used to evaluate the functions of social relationships. The score for each item ranges from 1 to 4, with a higher score indicating more social provision. The overall mean SPS score was 68.1 (s.d.=6.53) for MBs and 69.3 (s.d.=6.99) for general MSM. Depression was measured with a 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D), where a score of 9 has been recommended as the cutoff score to indicate possible depressive symptoms. The prevalence of depressive symptoms was 57.9%, with MBs having a higher level of depressive symptoms than general MSM (70.0% v. 46.1%) (odds ratio=1.86, 95% confidence interval=1.07-3.24). Social support was a protective factor for depressive symptoms (odds ratio=0.92, 95% confidence interval=0.89-0.96). MSM in China, particularly MBs, are vulnerable to low social support and high depressive symptoms, highlighting the need for tailored psychological programs targeting this population.

Dyspepsia

PURPOSE OF REVIEW

Dyspepsia affects up to 40% of the general population and significantly reduces quality of life. A small proportion of patients have peptic ulcer disease as cause and this can be treated empirically with Helicobacter pylori eradication therapy in those that are infected. Approximately 20% have gastro-oesophageal reflux disease and this can be effectively treated with proton pump inhibitor therapy. Patients who remain symptomatic may warrant an endoscopy, but most will have functional dyspepsia. Treatment of functional dyspepsia remains a challenge.

RECENT FINDINGS

Recent large randomized trials suggest tricyclic antidepressant therapy may be effective in functional dyspepsia. A phase III randomized controlled trial reports that a new prokinetic, acotiamide, reduces dyspepsia symptoms in functional dyspepsia patients. There are also preliminary data that suggest buspirone, a drug that promotes gastric accommodation, is also effective in functional dyspepsia. There are also data to suggest that functional dyspepsia is caused by subtle manifestations of inflammation in the upper gastrointestinal tract, possibly caused by food sensitivity or a change in gut flora.

SUMMARY

The initial management of dyspepsia is well established, but managing those with continued symptoms is a challenge. Antidepressants and newer gastric motility agents show promise. Targeting the diet and gut microbiome is another area for future research in functional dyspepsia.

Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis

Background. Multiple sclerosis (MS) patients often suffer from gastrointestinal (GI) symptoms. However, the full extent and prevalence of such symptoms are not clearly established. Thus, we sought to define the prevalence of GI symptoms and syndromes in those with MS. Methods. 218 MS patients completed self-reported demographic and clinical data questionnaires as well as several standardized surveys probing MS severity and GI health. Results. Nearly two thirds (65.6%) of patients endorsed at least one persistent GI symptom. Constipation (36.6%), dysphagia (21.1%), and fecal incontinence (15.1%) were common. Surprisingly, nearly 30% (28.4%) of the patients reported dyspeptic symptoms. Using validated diagnostic algorithms, patients met criteria for functional dysphagia (14.7%), functional dyspepsia (16.5%), functional constipation (31.7%), and IBS (19.3%), among others. Functional dysphagia, functional dyspepsia, and IBS were significantly more common in those with self-identified mood disorders. Conclusions. Constipation, fecal incontinence, and dysphagia are indeed frequent symptoms seen in MS patients. We also noted a ~30% prevalence of dyspepsia in this population. The mechanisms driving this association are not clear and require further study. However, due to this high prevalence, dyspeptic symptoms should be incorporated into the routine assessment of MS patients and, if found, may warrant collaborative referral with a GI specialist.

Decreased Basal and postprandial plasma serotonin levels in patients with functional dyspepsia

BACKGROUND & AIMS

Patients with diarrhea-predominant irritable bowel syndrome (IBS) have been found to have increased postprandial levels of serotonin (5-HT). Functional dyspepsia (FD) and IBS have been proposed to have common methods of pathogenesis, but little is known about the role of 5-HT in FD.

METHODS

We measured postprandial levels of 5-HT in 54 patients with FD (based on Rome III criteria) and 28 asymptomatic healthy individuals (controls). Patients with gastroesophageal reflux disease and IBS as their predominant symptom were excluded. After an overnight fast, the subjects drank a liquid meal (Ensure; 1.06 kcal/mL at 30 mL/min) and underwent a (13)C-octanoic acid breath test to measure gastric emptying times. Blood samples were collected at 0, 30, 60, 90, and 120 minutes after the liquid meal for the 5-HT assay.

RESULTS

Thirty-five patients with FD (65%) had postprandial distress syndrome, and 6 (11%) had a combination of postprandial distress syndrome and epigastric pain syndrome. There were no differences in rates of gastric emptying between patients with FD (103.6 ± 19.4 minutes) and controls (83.1 ± 4.0 minutes; P = .30). However, patients with FD had lower caloric intake (823.40 ± 44.1 kcal) than controls (1021 ± 68.2 kcal; P = .026). Patients with FD also had lower basal (P = .03) and postprandial plasma levels of serotonin at 30 minutes (P = .04), 60 minutes (P = .01), 90 minutes (P = .02), and 120 minutes (P = .002) than controls, as well as area under the curve values over the 120-minute time period (P = .005). Repeated-measures analysis of variance correlated 5-HT level with FD (P < .001).

CONCLUSIONS

In contrast to patients with diarrhea-predominant IBS, those with FD have decreased basal and postprandial plasma levels of 5-HT. These findings indicate that the pathogenic mechanism of FD differs from that of diarrhea-predominant IBS, and that strategies to alter 5-HT levels or activity might be developed to treat patients with FD.

Gastrointestinal symptoms are still prevalent and negatively impact health-related quality of life: a large cross-sectional population based study in The Netherlands

Background

Over the last decades important risk factors for gastrointestinal symptoms have shifted, which may have changed its population prevalence. The aim of this study was to assess the current prevalence of gastrointestinal symptoms, appraise associated factors and assess health-related quality of life in the general population.

Methods

A total of 51,869 questionnaires were sent to a representative sample of the Dutch adult general population in December 2008. Demographic characteristics, gastrointestinal symptoms, health-related quality of life, medication use and co-morbidity were reported. We used multivariable logistic regression analysis to determine factors associated with gastrointestinal symptoms.

Results

A total of 18,317 questionnaires were returned, and 16,758 were eligible for analysis. Prevalence of gastrointestinal symptoms was 26%. Most frequent symptoms were bloating (63%), borborygmi (60%) and flatulence (71%). Female gender (adjusted OR (aOR) 1.59, 95% CI 1.43–1.77), asthma/COPD (aOR 1.47, 95% CI 1.21–1.79), use of paracetamol (aOR 1.33, 95% CI 1.20–1.47), antidepressants (aOR 1.56, 95% CI 1.22–2.00) and acid-suppressive medication were independently associated with presence of gastrointestinal symptoms. Age over 65 years (aOR 0.75, 95% CI 0.65–0.87), and use of statins (aOR 0.75, 95% CI 0.61–0.93) were associated with a lower prevalence of gastrointestinal symptoms. Respondents with gastrointestinal symptoms had a lower mean health-related quality of life of 0.81 (SD = 0.21) compared to 0.92 (SD = 0.14) for persons without gastrointestinal symptoms (P<0.01).

Conclusions

Prevalence of gastrointestinal symptoms in the Dutch community is high and associated with decreased health-related quality of life.