Psychological Distress in Dyspepsia Markku Pajala Psychological Distress in Dyspepsia

Dyspepsia affects a quarter of the population annually. Most of them have a functional gastrointestinal disorder (FGID), eg. functional dyspepsia (FD) or irritable bowel syndrome (IBS). There is a great deal of evidence on the association between psychological factors, eg. anxiety and depression, and FGIDs. It is uncertain if 1) psychological factors cause dyspepsia, 2) dyspepsia causes psychological distress, 3) this distress leads to increased health care seeking, or 4) there is indeed bidirectional interaction between gut and brain. In 400 dyspeptic study patients 195 had an organic dyspepsia (OD) usually gastro-oesophageal reflux or peptic ulcer disease. The remainder, 205 patients had functional dyspepsia (FD). All patients filled out questionnaires regarding abdominal symptoms, mental distress and suspicion of serious illness on admission and at the one-year follow-up. The FD cohort also gave a medical history and their visits for gastrointestinal reasons in health centers, hospitals and private clinics were evaluated. The ageand sex-adjusted risk of having mental distress in dyspeptic patients was almost fourfold higher than in the general population, but there was no difference between dyspepsia groups. Mental distress and suspicion of serious illness were present in almost 40 and 20% of the patients, respectively. The non-relation between mental distress and abdominal symptoms in FD was confirmed in a one-year follow-up study. The correlation between changes in abdominal symptoms and psychological factors was significant only in patients with organic dyspepsia, which would support the idea that somatic symptoms cause mental distress and fear of serious illness. During the seven year follow-up, the majority of the patients re-visited their general practitioner (GP) and were prescribed antisecretory medication. Lower and upper gastrointestinal (GI) endoscopies and radiological re-investigation were both performed in a quarter of the patients. Mental distress and suspicion of serious illness did not increase the risk of health care needs. A single lower gastrointestinal symptom i.e. bowel-symptom, increased the likelihood of an additional outpatient visit or endoscopy by 19%. The non-correlation between changes in gastrointestinal symptoms and mental distress in patients with FD with a similar alleviation in mental distress questions the proposed specific link between gut and brain. It seems, that mental distress and suspicion of serious illness is merely a nonspecific reaction to abdominal symptoms. Our findings do not support the idea of brain-gut axis in FD. National Library of Medical Classification: WI 145, WI 147, WM 172.4, WM 172.5 Medical Subject Headings: Dyspepsia/psychology; Gastrointestinal Diseases/psychology; Stress, Psychological/psychology; Mental Disorders/complications; Health Resources/utilization