Functional dyspepsia is considered to be the result of a complex interaction between biological, psychological and social factors. In this issue of the journal, Van Oudenhove and colleagues1 (see page 1666) are the first to (1) present a study reporting these three aspects simultaneously in a large sample of patients attending a tertiary clinic and (2) identify whether the symptoms of functional dyspepsia are more closely associated with measures of gastric function or psychological state. The study suggests strongly it is the latter.

In a sound, cross-sectional study of 201 patients the authors correlated responses to gastric distension with measures of past and recent stress, anxiety, depression and a measure of somatisation with the gastrointestinal items removed. In multivariate analysis, including all these independent measures, somatisation was the only significant correlate of number and severity of dyspeptic symptoms. Somatisation and reported childhood abuse were the only significant correlates of weight loss. These relationships were similar in people who were, or were not, hypersensitive to gastric distension.

Has this study really advanced our knowledge of the aetiology of functional dyspepsia? There are several difficulties with the design of this study which limit its usefulness in this respect, even though it was executed well. These include the choice of endpoints, the cross-sectional design and the dualistic approach.

CHOICE OF ENDPOINTS

No specific theoretical basis is provided for choosing the outcomes …