Is “How Are You Doing” Enough? Need for Tailored Questions to the Patients With Functional Dyspepsia

Article: Impact of eating attitude and impairment of physical quality of life between tertiary clinic and primary clinic functional dyspepsia outpatients in Japan CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. For some time, we have known that functional dyspepsia (FD) or other functional gastrointestinal (GI) disorders are associated with non-organic causes such as sleep disorders, eating habits and levels of anxiety, whether they maybe the cause or the end result. 1-3 However, we tend to think that FD patients visiting tertiary clinic may present with severe degree of symptoms, psychological problems and impaired quality of life than those going to primary clinic. In this month's edition of JNM, Shimpuku et al 4 have shown that this is not so at least in Japan. There was no significant difference in mean GI Symptom Rating Scale (GSRS) which represents various FD symptoms, or Pittsburg Sleep Quality Index (PSQI) scores which indicates sleep disorders between ter-tiary clinic and primary clinic FD outpatients. Interestingly, state of anxiety and trait of anxiety, which have been known as main determinants for health care seeking behavior, 5-7 were also not different between tertiary and primary clinics, although they were higher than healthy volunteers. In this study, the presence of psychological stress does implicate on the pathophysiology of FD, however, the gravity of psychological comorbidities seem to have less effect on the decision to go to primary or tertiary clinics. 4 Rather, they reported that impairment of physical quality of life measured by Social Function-8 (SF-8) test was more important factor for healthcare-seeking behavior than impairment of mental quality of life in FD patients visiting tertiary clinic compared to those visiting primary clinic. 4 It is worthy to point out that above results about determinant factors for health care seeking behavior should be interpreted under consideration of different referral systems, ease of accessibility to healthcare facilities and diverse cultural factors in each country. In Domestic/International Gastroenterology Surveillance Study performed in 1999, Japanese subjects with relevant