Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation?
- L Van Oudenhove1,2,
- J Vandenberghe2,
- B Geeraerts1,
- R Vos1,
- P Persoons2,
- B Fischler2,
- K Demyttenaere2,
- J Tack1
- 1Department of Pathophysiology, Gastroenterology Section, University of Leuven & University Hospital Gasthuisberg, Leuven, Belgium
- 2Department of Neurosciences, Division of Psychiatry, University of Leuven & University Hospital Gasthuisberg, Leuven, Belgium
- ProfessorDr J Tack, Center for Gastroenterological Research, University Hospital Gasthuisberg, O&N 1, 7th Floor, Herestraat 49, B-3000 Leuven, Belgium;
- Revised 15 June 2008
- Accepted 24 June 2008
- Published Online First 14 July 2008
Background: Gastric sensorimotor dysfunction, psychosocial factors and somatisation are all implicated in symptom generation in functional dyspepsia (FD).
Aim: To determine the relative contribution of each of these factors to overall dyspeptic symptom severity and weight loss in FD.
Methods: In 201 consecutive tertiary care patients with FD (mean age 40.1 (SD 12.6) years), gastric sensorimotor function was studied using barostat (sensitivity, compliance and accommodation). Psychosocial factors (depression and anxiety disorders, positive and negative affect, perceived stress, alexithymia and history of abuse), somatisation and co-morbid irritable bowel syndrome (IBS) and chronic fatigue symptoms were assessed using self-report questionnaires. Variables were correlated with dyspepsia symptom severity (DSS) and weight loss. Hierarchical multiple linear regression was used to identify determinants of DSS and weight loss.
Results: Multiple linear regression identified the following determinants of DSS: gastric sensitivity (β = 0.77, p = 0.25), depression (β = 0.12, p = 0.06) and somatisation (β = 0.48, p<0.0001) (controlling for age and occupation, R2 = 0.29, p<0.0001). The effect of depression on DSS is partially mediated by somatisation. Gastric sensitivity (β = 2.87, p = 0.08), history of childhood sexual abuse (β = 9.37, p = 0.0006), depression (β = 0.19, p = 0.24) and somatisation (β = 0.67, p = 0.01) are independent determinants of weight loss (controlling for gender and occupation, R2 = 0.42, p<0.0001). The effect of depression on weight loss is fully mediated by somatisation.
Conclusion: Symptom severity and weight loss in FD are determined by psychosocial factors (depression, abuse history) and somatisation, and only to a lesser extent by gastric sensorimotor function. The importance of psychosocial factors and somatisation compared to gastric sensorimotor function is most pronounced in hypersensitive patients.
See Commentary, p 1642
Funding: LVO is a research fellow and JT is a clinical researcher of the Research Foundation–Flanders (FWO–Vlaanderen). This study was funded by a grant from the Research Foundation–Flanders to JT.
Competing interests: None.
Ethics approval: Approval for this study was given by the Medical Ethics Committee of the University Hospital Leuven, in 2001.