Risk Factors Study of Functional Dyspepsia Based on Rome III Criteria
Date Issued
2012
Date
2012
Author(s)
Fang, Yu-Jen
Abstract
Background:
Functional dyspepsia (FD) is a heterogeneous symptom disease. The diagnosis of FD is based on chronic or recurrent symptoms thought to originate in gastroduodenal region without organic lesions or metabolic disease, on routine diagnostic examinations. FD is a common disorder with significant impact on quality of life and health care burden. Numerous pathophysiological mechanisms, such as gastroduodenal motor dysfunction, visceral hypersensitivity, Helicobacter pylori (H. pylori) infection, psychosocial factors, diet, and life style have been suggested to play a role in the development of FD. Because of its heterogeneity, new Rome III criteria are implemented for diagnosis and further subgroup classification of FD, consisting of epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). Although previous studies have revealed several risk factors such as life style, H. pylori, and psychopathological factors were associated with FD, the results were still controversial. Moreover, studies based on new Rome III criteria and addressing risk factors in different subgroups are few. We also noted that studies from Taiwan are scanty.
Aims:
We aimed to investigate risk factors of FD in Taiwan based on the Rome III criteria and compare different risk factors in two subgroups of FD.
Methods:
From January 2011 to May 2012, consecutive dyspeptic outpatients were assessed with standard Rome III diagnostic questionnaire in National Taiwan University Hospital and its Yuan-Lin Branch. All patients received detailed history taking, including demographic data, lifestyle and 5-item Brief Symptom Rating Scale (BSRS-5). Then they underwent upper gastrointestinal endoscopy and laboratory checkup to exclude organic disease or other metabolic disorder. Radom biopsy was obtained from antrum and body for pathology, Helicobacter pylori (H. pylori) culture, and rapid urea test. To select control, we enrolled all consecutive asymptomatic subjects participating in self-paid health checkup from Health Examination Center. Similar work up was performed for control group except that they received additional 13-UBT. Multiple linear regression models were used for statically analyses.
Results:
There were 1311 health subjects enrolled for screening as control. After exclusion of 46 subjects with cancer history, 86 diabetes mellitus, 2 chronic kidney disease, 3 liver cirrhosis, 58 reflux esophagitis and 85 peptic ulcers, a total of 1031 subjects were selected as control. There were 2378 symptomatic patients from outpatient department. Among them, 80 patients with cancer, 79 with history of abdominal operation, 74 diabetes mellitus, 38 liver cirrhosis, 13 chronic kidney diseases, 14 incomplete questionnaires, 80 refusal, and 116 with history of H. pylori eradication were excluded. Before investigation, 818 patients fulfilled Rome III criteria for FD. After eaxinations, 306 patients with organic lesions (243 peptic ulcers, 60 reflux esophagitis) were excluded. Finally, 512 patients (69.9% female mean age 50 years old) were subjected for analyses. There was an overlap (n=176, 34.4%) between the patients diagnosed with EPS (n=310, 60.5%) and those with PDS (n=368, 71.9%). Seventeen patients did not fit diagnostic criteria of PDS and EPS (3.3%). By multivariable linear regression analysis, the following factors were associated with increasing risk of FD：female gender (odd ratio(OR):1,82, 95% confidence interval（CI）1.19~2.78)、bet nut chewing(OR:5.04, 95% CI1.92~13.20)、NASID (OR:7.52, 95% CI 4.34~13.03)、severe sleep disturbance（OR:2.64, 95% CI1.46~4.76）、anxiety【mild(OR:2.57, 95% CI 1.69~3.94)；moderate(OR:4.09, 95% CI 2.23~7.51)；serve(OR:5.27, 95%CI 1.95~14.30)】、depression【mild(OR:1.93；95% CI 1.24~3.00)；moderate(OR:2.42, 95% CI 1.12~5.22)；serve(OR:5.29, 95%CI1.59~17.66)】、H.pylori (OR:1.60, 95% CI 1.14~2.24)、combined non-erosive esophagitis(OR:12.10,95%CI 7.92~18.49)、irritable bowel syndrome(OR:8.26, 95% CI 4.78~14.30). In contrast, age (OR: 0.95, 95%CI0.93~0.97) and education with college level (OR: 0.42, 95% CI0.24~0.72) were associated with decreased risk. The subdivision of FD revealed the following factors were associated with increased risk of PDS but not for EPS：drinking(OR:1.74, 95%CI1.04~2.89)、sleep disturbance mild(OR:2.24, 95%CI1.37~3.66)；moderate(OR:2.17, 95%CI1.23~3.82)；serve（OR:5.89, 95%CI3.07~11.31）】、depression【mild(OR:1.86, 95%CI1.11~3.13)；moderate(OR:3.15, 95%CI1.29~7.68)；serve(OR:8.25, 95%CI2.13~31.91）】、H.pylori (OR:1.59, 95%CI1.08~2.35)。Comparison of PDS and EPS demonstrated that the diagnosis of PDS was independently associated with higher proportion of sleep disturbance (p<0.001).
Conclusions:
Patients fulfilling Rome III FD criteria had more NASID usage, sleep disturbance, anxiety, depression, overlap syndrome with NERD or IBS, and H.pylori infection. Diagnosis of PDS, but not EPS, is independently associated with sleep disturbance.
Subjects
Functional dyspepsia
epigastric pain syndrome
postprandial distress syndrome
Rome III criteria
Helicobacter pylori
lifestyle
SDGs
Type
thesis
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