Somatisation in functional dyspepsia: integrating gastric physiology with psychological state

Abstract

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 colleagues 1 (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.

Nature and specificity of altered cognitive functioning in IBS

“…These findings are interesting because firstly, while impaired sustained attention, as reflected by increased SDRT on CPT, has not been reported in patients with IBS, this has been reported in patients with somatic symptom and related disorders, a group of conditions characterized by medically unexplained symptoms with high anxious and depressive comorbidity, and nosologically strongly overlapping with functional gastrointestinal disorders . This finding of impaired sustained attention is compatible with previous studies suggesting deficits in the “top‐down” cortical control of attention in IBS contributing to descending pain facilitation.…”

Letter: irritable bowel syndrome is significantly associated with somatisation

“…Some studies show that gastric sensorimotor function may be more important in normosensitive patients, whereas the effect of somatisation is stronger in hypersensitive patients. 2,3 The concept of somatisation is problematic and ambiguous, although clinically very important. It is important to note that, given the nature of the somatisation measure used in this study, the PHQ-12 somatisation scores can only be seen as indicative of functional somatisation.…”