Abstract
Subtypes of functional dyspepsia (FD), includingrefluxlike dyspepsia, ulcerlike dyspepsia,dysmotility-like dyspepsia, and nonspecific dyspepsia,have been described and are widely used clinically.However, these symptom patterns often overlap, and theterms are insufficient for indicating all FD symptoms.In this study, we divided 71 FD patients into twogroups: patients with or without pain. Group I, the pain dyspepsia group, included patients in whomthe main symptoms were epigastralgia and/or chest pain.Group II, the painless dyspepsia group, includedpatients without pain, in whom the symptoms were nausea, vomiting, and heartburn. We examinedthe relationship between esophageal function andpsychiatric factors in the test groups and compared themwith a control group. Of the FD patients, 19.7% [8 (25%) of 32 group I patients, 6 (15.4%) of 39group II patients] had esophageal motility disorders,such as nutcracker esophagus and diffuse esophagealspasm. The LES pressure of group I was higher than that of group II by esophageal manometry (P< 0.05). In 17 (53.1%) of 32 group I patients and 31(79.5%) of 39 group II patients, psychiatric disorders(38.0% had depressive disorder and 21.1% had an anxiety disorder) were diagnosed followingDSM III-R criteria. Group II tended to be moredepressive than group I (P = 0.0508). Psychologicalassessment scores, STAI-I and STAI-II, were higher ingroups I and II than in the control group (P <0.001). Long-term distress, anxiety, and depression seemto influence the symptoms of FD patients. Esophagealdysmotility may be an important functional abnormality of FD.
Similar content being viewed by others
REFERENCES
Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985
Kerlin P: Postprandial antral hypomotility in patients with idiopathic nausea and vomiting. Gut 30:54–59, 1989
Gilvarry J, Buckley MJM, Bettie S, Hamilton H, O'Morain CA: Eradiation of Helicobacter pylori affects symptoms in non-ulcer dyspepsia. Scand J Gastroenterol 32:535–540, 1997
Pieramico O, Ditschuneit H, Malfertheiner P: Gastrointestinal motility in patients with non-ulcer dyspepsia: A role for Helicobacter pylori infection? Am J Gastroenterol 88:364–368, 1993
Talley NJ: A critique of therapeutic trials in Helicobacter pylo ri-positive functional dyspepsia. Gastroenterology 6:1174–1183, 1994
Heading RC: Definitions of dyspepsia. Scand J Gastroenterol 6( suppl 182):1–6, 1991
Talley NJ, Zinsmeister AR, Scleck CD, Melton LJ: Dyspepsia and dyspepsia subgroups: A population-based study. Gastroenterology 102:1259–1268, 1992
Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR: Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy. Gastroenterology 105:1378–1386, 1993
Collin-Jones DG: Management of dyspepsia; report of a working party. Lancet 1:576–579, 1988
Castell DO: The nutcracke r esophagus. The hypertensive lower esophageal sphincter, and nonspecific esophageal mortility disorders. In DO Castell, JA Castell (eds). Esophageal Motility Testing, 2nd ed. Norwalk, Connecticut; Appleton & Lange 1994, pp 135–147
Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242, 1984
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers: Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 35:583–592, 1987
Richter JE, Bradley LA, Castell DO: Esophageal chest pain: Current controversies in pathogenesis, diagnosis, and therapy. Ann Intern Med 110:66–78, 1989
Speilberger C, Gorsuch R, Lushene R: Manual for the State-Trate Anxiety Inventry. Palo Alto, California, Consulting Psychologists Press, 1970
Kane FJ, Strohlein J, Harper RG: Nonulcer dyspepsia associated with psychiatric disorder. South Med J 86:641–646, 1993
Hsu JJ, O'Connor MK, Kang YW, Kim CH: Nonspecific motor disorder of the esophagus: A real disorder or a manometric curiosity? Gastroenterology 104:1281–1284, 1993
Talley NJ, Piper DW: The association between non-ulcer dyspepsia and other gastrointestinal disorders. Scand J Gastroenterol 20:896–900, 1985
Richter JE, Hakshaw BT, Wu WC, Castell DO: Edorophonium: A useful provocative test for esophageal chest pain. Ann Intern Med 103:14–21, 1985
Lee CA, Reynolds JC, Ouyang A, Baker L, Cohen S: Esophageal chest pain value of high-dose provocative testing with edrophonium chloride in patients with normal esophageal manome tries. Dig Dis Sci 32:682–688, 1987
Haug TT, Svebak S, Hausken T, Wilhelmsen I, Berstad A, Ursin H: Low vagal activity as mediating mechanism for the relationship between personality factors and gastric symptoms in functional dyspepsia. Psychosom Med 56:181–186, 1994
Lemann M, Dederding JP, Flourie B, Franchisseur C, Rambaud JC, Jian R: Abnormal Perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. Dig Dis Sci 36:1249–1254, 1991
Bradette M, Pare P, Douville P, Morin A: Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52–58, 1991
Klatt S, Pieramico O, Guethner C, Glasbrenner B, Beckh K, Adler G: Gastric hypersensitivity in nonulcer dyspepsia. An inconsistent finding. Dig Dis Sci 42:720–723, 1997
Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986
Bradley LA, McDonald JE, Richter JE: Psychophysiological interactions in the esophageal disease: Implications for assessment and treatment. Semin Gastrointest Dis 1:5–22, 1990
Bennett E, Beaurepaire J, Langeluddecke P, Kellow J, Tennant C: Life stress and non-ulcer dyspepsia: A case-control study. J Psychosom Res 35:579–590, 1991
Emeran A, Raybould H: Role of visceral afferent mechanism in functional bowel disorders. Gastroenterology 99:1698–1704, 1990
Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing in patients with non-cardiac chest pain or dysphagia: Results of three years’ experience with 1161 patients. Ann Intern Med 106:593–597, 1987
Talley NJ, Phillips SF, Bruce B, Twomey CK, Zinsmeister AR, Melton LJ III: Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome. Gastroenterology 99:327–333, 1990
Talley NJ, Fung LH, Gilligan IJ, McNeil D, Piper DW: Association of anxiety, neuroticism and depression with dyspepsia of unknown cause. Gastroenterology 90:886–892, 1986
Langeluddecke P, Goulston K, Tennant C: Psychologic factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease. J Psychosom Res 34:215–222, 1990
Magni G, Mario F, Bernasconi G: DSM-III diagnoses associated with dyspepsia of unknown cause. Am J Psychiatry 144:1222–1223, 1987
Clouse RE, Lustman PJ: Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med 309:1337–1342, 1983
Mine K, Kanazawa F, Hosoi M, Kinukawa N, Kubo C: Treating nonulcer dyspepsia considering both functional disorders of the digestive system and psychiatric conditions. Dig Dis Sci 43:1241–1247, 1998
Handa M, Mine K, Yamamoto H, Hayashi H, Tsuchida O, Kanazawa F, Kubo C: Antidepressant treatment of patients with diffuse esophageal spasm: A psychosomatic approach. J Clin Gastroenterol 28:228–232, 1999
Rights and permissions
About this article
Cite this article
Handa, M., Mine, K., Yamamoto, H. et al. Esophageal Motility and Psychiatric Factors in Functional Dyspepsia Patients with or Without Pain. Dig Dis Sci 44, 2094–2098 (1999). https://doi.org/10.1023/A:1026690806330
Issue Date:
DOI: https://doi.org/10.1023/A:1026690806330