Background Gastric sensorimotor dysfunction, psychosocial factors and somatization 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 FD patients (mean age 40.1±12.6 years), gastric sensorimotor function was studied using barostat (sensitivity, compliance & accommodation). Psychosocial factors (depression and anxiety disorders, positive & negative affect, perceived stress, alexithymia and abuse history), somatization and co-morbid irritable bowel syndrome (IBS) & (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=.77,p=0.25), depression (β=.12,p=.06) and somatization (β=.48,p<.0001) (controlling for age & occupation, R2=.29, p<.0001). The effect of depression on DSS is (partially) mediated by somatization. Gastric sensitivity (β=2.87,p=0.08), childhood sexual abuse history (β=9.37,p=0.0006), depression (β=.19,p=.24) and somatization (β=.67,p=.01) are independent determinants of weight loss (controlling for gender & occupation, R2=.42, p<.0001). The effect of depression on weight loss is (fully) mediated by somatization.
Conclusion Symptom severity and weight loss in FD are determined by psychosocial factors (depression, abuse history) and somatization, and only to a lesser extent by gastric sensorimotor function. The importance of psychosocial factors and somatization compared to gastric sensorimotor function is most pronounced in hypersensitive patients.
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