When Patients With Functional GI Issues Felt Better, They Got Better

Improvements in psychological factors, such as anxiety and sleep disturbance, were associated with improvements in functional dyspepsia symptom severity, a retrospective single-center study found.

Multivariable regression analysis showed a positive association between changes in symptom severity scores with mean sleep severity at baseline (β=0.02, P=0.003) and changes in anxiety scores (β=0.01, P=0.048), reported Judy Nee, MD, from Beth Israel Deaconess Medical Center in Boston, and colleagues.

Absence of inflammatory bowel syndrome (IBS) and fewer medications for gastrointestinal symptoms were also factors in symptom severity, the authors wrote in Clinical Gastroenterology and Hepatology.

In fact, patients without IBS showed greater reductions in symptom severity score versus those with IBS (reductions of 0.32 from baseline vs 0.21, respectively), they noted.

“Based on our mediation analysis, it appears that sleep disturbance has a direct impact on dyspepsia symptoms as the effect of sleep disturbance on dyspepsia symptom severity change does not appear to be mediated via a change in anxiety scores,” Nee told MedPage Today. “Functional dyspepsia affects so many people, yet factors associated with change are unknown.”

Functional dyspepsia — which causes epigastric pain or burning, early satiety, or postprandial fullness — affects up to 11% of the world. The chronic gastrointestinal disorder often leads to greater patient medical expenses and a lower quality of life, the authors said.

Prior research found that underweight adults are at higher risk for functional dyspepsia. In another study, anxiety was suggested as a possible risk factor as well, but Nee’s group noted that data were lacking with respect to other possible risk factors.

They aimed to evaluate the severity of functional dyspepsia symptoms over time in association with psychological, clinical, and demographic factors.

From October 2017 to April 2020, questionnaires were given to 128 functional dyspepsia patients from a tertiary care center (at initial visit and follow-up at 3 and 6 months) to report their psychological and clinical symptoms. Rome IV criteria was used to diagnose functional dyspepsia as well as IBS.

The patient assessment of gastrointestinal disorders-symptom severity index (PAGI-SYM) was used to measure functional dyspepsia severity. A change in the PAGI-SYM score from baseline to follow-up was the primary outcome. Psychological issues related to sleep disturbances, anxiety, or depression were assessed by a set of tools from the NIH, the patient reported outcome measures information system (PROMIS) scales.

Patients were included if they met the criteria for Rome IV, with functional dyspepsia being the sole cause of their symptoms. Recent symptoms of epigastric pain or burning had to occur in patients at least once weekly and early satiety or postprandial fullness had to be present at a minimum of 3 days a week with an onset of at least 6 months.

Overall, there were 128 included in the study. Patients were a mean age of about 44, and over three-quarters were women. Half met the Rome IV criteria for IBS. There were 54 patients with epigastric pain syndrome (EPS)/post-prandial distress syndrome (PDS) overlap, 53 patients with PDS, and 21 patients with EPS. Subtypes of functional dyspepsia showed no relationship to changes in dyspepsia severity.

“Our study showed that FD [functional dyspepsia] patients who had a significant improvement in their anxiety also reported significant improvement in their dyspepsia,” the authors wrote. “This was observed in patients with EPS/PDS overlap” and in multivariable analysis, the PDS subtype specifically was the only factor independently linked with improvement.

There were 34.4% of functional dyspepsia participants with anxiety, 23.3% with sleep disturbances, and 17.8% with depression. Most patients were on at least one medication at follow-up.

More severe dyspepsia (at baseline) was associated with greater improvement in dyspepsia severity during follow-up. At 3 to 6 months of follow-up, a greater reduction in PAGI-SYM scores was correlated with higher PAGI-SYM scores at baseline (β=0.40, P<0.001), which accounted for 40% of the variance in change in these score changes, the authors said.

Authors described the relationship between dyspepsia and anxiety disturbances as potentially “bidirectional,” in which “worsening of gastrointestinal symptoms worsens psychosomatic symptoms which in turn make gastrointestinal symptoms even worse by affecting gastrointestinal sensorimotor function.”

Nee and colleagues acknowledged several limitations of their study, which included the small sample size of participants. In addition, the majority of participants were previously seen by a specialist, seeking a second opinion, which limited the study’s generalizability.

“Early assessment of sleep and anxiety in a gastroenterology setting may identify functional dyspepsia patients whose GI outcomes would be improved with sleep and/or anxiety treatments,” they wrote.