Non-ulcer dyspepsia

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.

Cognitive and motivational processes underlying coping flexibility: a dual-process model

Discriminative facility was proposed as a cognitive process and need for closure was proposed as a motivational process underlying coping flexibility. The dual-process model posits that need for closure influences discriminative facility, which in turn modifies coping flexibility and psychological adjustment. In Study 1, results of structural equation modeling provided support for the dual-process model. This model was further examined using experimental methods (Study 2) and a prospective design (Study 3). Consistent with the dual-process model, results from all 3 studies showed that participants who were more motivated to seek alternative coping strategies tended to encode stressful situations in a more differentiated way. These individuals used a greater variety of strategies to fit different situational demands and were better adjusted.

Perceptual style and behavioral pattern of individuals with functional gastrointestinal disorders

The present research examined the perceptual style and coping pattern characterizing individuals with functional gastrointestinal disorders. A matched case-control design was adopted to compare differences among the target group of individuals with functional gastrointestinal disorders (n = 40), a pain control group of individuals with rheumatism (n = 40), and the community control group of healthy individuals (n = 40). Perceptual style was measured by both monitoring and blunting responses to hypothetical stressful situations, and coping pattern was measured by the use of coping strategies in real-life stressful events. Results revealed that participants with functional gastrointestinal disorders differed from their healthy and rheumatic counterparts in having higher monitoring and lower blunting scores and using action-oriented coping strategies regardless of the controllability of stressful situations.

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE

This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study.

METHODS

A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors).

RESULTS

Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness.

CONCLUSIONS

The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.

Psychosocial Adjustment to Illness Scale (PAIS-SR) in a Norwegian material of patients with functional dyspepsia, duodenal ulcer, and urinary bladder dysfunction. Clinical validation of the instrument

BACKGROUND

There is an increasing interest in the psychosocial impact of a disease, but few instruments available to measure it.

METHODS

The internal consistency and construct validity of the Norwegian translation of the Psychosocial Adjustment to Illness Scale (PAIS-SR) was examined in a total of 557 patients.

RESULTS

The seven dimensions of the psychosocial adjustment to medical illness from the original test were represented in the Norwegian translation. Psychologic distress, social environment, and vocational environment explained most of the variance. The instrument had high internal consistency with Cronbach's alpha coefficients of > 0.75 on six of seven subscales. The PAIS-SR differentiated between groups of patients with urologic and upper gastrointestinal disease and seemed to give meaningful and useful clinical data. Patients with functional dyspepsia (n = 97) had higher score on psychologic distress than the other groups, whereas patients with duodenal ulcer (n = 97) were significantly less affected in their social life than the other patients.

CONCLUSIONS

The Norwegian translation of the PAIS-SR had high internal consistency, acceptable construct validity, and good discriminating validity.

Helicobacter pylori in functional dyspepsia and normal controls

BACKGROUND

The aim of this study was to examine whether Helicobacter pylori status can identify a specific subset of patients with functional dyspepsia (FD) and erosive prepyloric changes (EPC).

METHODS

Anamnestic, somatic, and psychologic data were collected from 87 patients with functional dyspepsia and 77 normal control persons. Presence of H. pylori infection was assessed by the 14C-urea breath test.

RESULTS

H. pylori infection increased with age. Thirty-four per cent of the patients were H. pylori-positive, compared with 36% of the control persons. The patients had higher scores than the normal control persons on psychologic measures regardless of H. pylori status. Of 27 variables analyzed, age was the only factor that discriminated between H. pylori-positive and -negative patients.

CONCLUSIONS

For most patients with FD and EPC the presence of H. pylori infection is probably a consequence of age, and it does not seem to help us in the search for factors that can identify a subset of patients within our group of FD patients.

Suppression of anger and gastric emptying in patients with functional dyspepsia

Psychologic distress and gastric motor dysfunction have both been implicated in the pathogenesis of functional (non-ulcer) dyspepsia (FD). This study assesses the association between psychologic factors and gastric emptying in 28 FD patients. Subjects completed an extensive range of psychologic questionnaires and underwent dual-isotope scintigraphic assessment of solid and liquid gastric emptying. Attempts to resist, control, suppress, and hold in anger, to adopt a fighting spirit whilst dealing with chronic stressors, and manifest unhappiness were predictors of prolonged gastric emptying. These findings suggest that psychologic factors may be important in the aetiology of gastric stasis and subsequent upper gastrointestinal symptoms in patients with functional dyspepsia.