Psychiatric–Medical ComorbidityDepressive mood and quality of life in functional gastrointestinal disorders: differences between functional dyspepsia, irritable bowel syndrome and overlap syndrome
Introduction
Functional gastrointestinal disorders (FGID) are common conditions diagnosed based on symptom-related criteria, pertaining to chronic or recurrent symptoms without organic abnormalities [1]. FGID manifest as combinations of several known physiological determinants, including increased motor reactivity, enhanced visceral hypersensitivity, altered mucosal immune and inflammatory function and altered central/enteric nervous system regulation as influenced by psychosocial and psychological factors [2]. Psychosocial stressors, whether acute or more sustained, frequently precede the onset and exacerbation of FGID symptoms and influence the treatment outcome [3], [4], [5], [6]. Anxiety, depression, panic, posttraumatic stress and somatization disorders frequently precede or occur simultaneously with FGID, indicating that a psychiatric disorder cannot always be regarded as being indicative of FGID [7]. Previous studies performed in Korea have shown that life-style factors such as coping style, depression and anxiety are linked to functional dyspepsia (FD) [8], [9] as well as irritable bowel syndrome (IBS) [10].
Various FGID diagnostic criteria have been developed, and the Rome III criteria published in 2006 are now regarded as being especially relevant. Since the presence of IBS does not exclude a diagnosis of FD based on Rome III criteria, there may be a subgroup of patients exhibiting overlap of FD and IBS. Indeed, a recent study showed that such a clinical overlap is very common and that a risk factor for this is the presence of postprandial fullness [11]. It is possible that the greater number of symptoms experienced by patients with FD-IBS induce greater psychological distress than FD alone or IBS alone.
We hypothesized that the quality of life and depressive mood differ between FD alone, IBS alone and FD-IBS overlap. The aim of this study was to describe differences in quality of life and affective symptoms for patients with FGID diagnoses based on Rome III criteria.
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Subjects
From December 2006 to December 2008, 307 subjects who visited the Health Promotion Center and Digestive Disease Center of Konkuk University Hospital for both upper and lower gastrointestinal (GI) endoscopy were included in the study. Subjects referred from private clinics or other hospitals due to a possibility of GI bleeding, malignancy, or infection were excluded from the study. Medical chart review was done to exclude subjects with malignancy, infection, other GI diseases, and psychiatric
FGID as diagnosed based on Rome III criteria
Of 279 subjects had normal endoscopic examinations, 70 and 124 subjects had FD and IBS based on Rome III criteria, respectively. Of these subjects, 42 subjects had both FD and IBS criteria. Therefore, 279 subjects were classified into four groups, FD alone (n=28), IBS alone (n=82), FD-IBS overlap (n=42), and normal subjects (n=127). IBS comprised 67 subjects of diarrhea-dominant type, 18 of constipation-dominant type, 38 of mixed type, and 1 of unclassified type.
Depressive mood based on the BDI and CDI scores
In one-way ANOVA tests, the mean
Discussion
It has recently been reported that anxiety but not depression is linked to FD in the general population based on Rome III criteria [18] and that diagnoses of IBS and FD based on a self-administered bowel-disorders questionnaire are strongly associated with depression, anxiety, and posttraumatic stress disorders in female veterans [19]. Psychosocial variables are known to be important determinants of the outcomes of global wellbeing, health-related quality of life and health-care seeking, and
Acknowledgment
This study was supported by BK 21 project of Konkuk University.
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