| Part I Demographic data of Chinese patients with functional dyspepsiaObjective:To analysis the demographic data of Chinese patients with functional dyspepsia (FD), to study the differences between the three subtypes of FD, and to compare anxiety, depression and sleep disorder of FD patients from different cities and different levels of hospitals.Methods:This was a stratified multi-center study.5tertiary hospitals in Wuhan, Beijing, Shanghai, Guangzhou and Xi’an city were selected as center, then2secondary hospitals and2primary hospitals were selected randomly from each city(half of urban and half of rural). From June2008to November2009, patients with FD (Rome III criteria) who visited the general gastroenterology outpatient clinic of the total25hospitals were requested to finish a self-report questionnaire. Baseline demographic data, dyspepsia symptom data, anxiety, depression, sleep disorder, HP status were assessed using self-report questionnaires. Patients completed questionnaires at baseline and1,3,6,12-month follow-up, respectively.Results:1.943patients completed all of the four follow-ups, with a89.9%respond rate. The mean age was42.99±11.74years. There were340males and603females (male to female ratio1:1.77). The average duration of follow-up was12.24±0.59months.2. Compared to non-responders, males (P=0.006), alcohol users (P=0.001), those of higher degree of education (P=0.011), those of better economic situation (P=0.030) and those who had consulted a physician (P<0.001) were significantly more likely to be successfully followed up.3. Among943FD patients,404(43%) were defined as PDS,134(14%) were defined as EPS, and405(43%) were classed as PDS and EPS overlap. The mean dyspepsia symptom scores (DSS) in PDS and EPS overlap group was significantly higher than PDS group (P<0.001), and EPS group (P<0.001). There were no significant differents between PDS group and EPS group (P=0.054).4. Of the943FD patients,85(9.0%) suffered from anxiety,61(6.5%) suffered from depression, and469(49.7%) suffered from sleep disorder. The incidence of anxiety, depression and sleep disorders in FD patients were different between different cities and different levels of hospitals. The highest were in Beijing city with17.9%for anxiety,12.2%for depression and59.2%for sleep disorder. FD patients from tertiary hospitals were subjected to more anxiety than patients from secondary hospitals (P<0.001). FD patients from tertiary hospitals were subjected to more depression than patients from primary hospitals (P=0.005).Conclusions:PDS and EPS overlap group had a higher DSS than PDS group and EPS group. The incidence of anxiety, depression and sleep disorders in FD patients differed from different cities and different levels of hospitals. Part Ⅱ Fluctuation of gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsiaObjective:To study the evolution of gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia.Methods:From June2008to November2009, a total of1049patients with FD (65.3% females, mean age42.80±11.64y) who visited the general gastroenterology outpatient clinic in Wuhan, Beijing, Shanghai, Guangzhou, and xi’an city of China were referred for this study. All of the patients fulfilled the Rome III criteria of FD. Baseline demographic data, dyspepsia symptom data, anxiety, depression, sleep disorder and drug treatments were assessed using self-report questionnaires. Patients completed questionnaires at baseline and1.3,6,12-month follow-up, respectively. Comparison of dyspepsia symptoms between at baseline and at four follow-ups was explored using MANOVA of repeated measuring. Multiple linear regression was done to examine factors associated with outcome, both longitudinally and horizontally.Results:1.943patients (89.9%of the original population) completed all of the four follow-ups. The average duration of follow-up was12.24±0.59months.2. Postprandial fullness was the most common symptom in FD patients, followed by abdominal pain, belching, epigastric burning, while vomit had lowest incidence.3. During1-y follow-up period, the mean dyspepsia symptom score (DSS) in FD patients showed a significant gradually reduced trend (15.04±6.47vs10.46±6.68vs9.00±6.67vs7.59±6.48vs6.91±6.39, P<0.001), and similar differences were found for all individual symptoms (P<0.001).4. For longitudinal associations:Univariate correlates analysis revealed that history of abuse was associated with DSS at1-y follow-up (P=0.025), while no association were found for other variable such as gender, age, BMI, anxiety, depression, sleep disorder, H.pylori status, DSS at baseline, and drug treatments before baseline. For horizontal associations:Univariate correlates analysis found that age (P<0.001), alcohol consumption (P=0.024), anxiety (P<0.001), depression (P<0.001), sleep disorder (P<0.001), bowel symptom at1-y follow-up (P<0.001), weight loss (P<0.001), consulting a physician (P<0.001), prokinetics (P<0.001), gastric mucosa protectant (P<0.001), antacids (P<0.001) and traditional Chinese medicine use during1-y follow-up period (P<0.001) were significantly associated with DSS at1-y follow-up.5. Multiple linear regression analysis showed that gender (P<0.001), anxiety (P=0.018), sleep disorder at1-y follow-up (P=0.019), weight loss (P<0.001), consulting a physician (P<0.001) and prokinetics use during1-y follow-up period (P=0.035) were horizontally associated with DSS at1-y follow-up. No relationship was found longitudinally between DSS at1-y follow-up and patients’characteristic at baseline.Conclusions:During1-y follow-up period, the mean DSS in FD patients showed a significant gradually reduced trend and similar differences were found for all individual symptoms. Female, anxiety, and sleep disorder at1-y follow-up, weight loss, consulting a physician and prokinetics use during1-y follow-up period are associated with outcome. Part III Clinical overlap and natural history of functional dyspepsia and other functional gastrointestinal disordersObjectives:Rare studies have been performed to discuss the overlap of functional dyspepsia (FD) and other functional gastrointestinal disorders (FGIDs) and the natural history of gastrointestinal symptom based on FD patients according to Rome III criteria. We aimed to determine not only the clinical overlap between FD and other FGIDs, but also the instability and variability of symptom subgroups in Chinese patients with FD.Methods:A cohort of1049consecutive FD patients (age≥18years) seen at the general gastroenterology outpatient clinic in Wuhan, Beijing, Shanghai, Guangzhou, and xi’an city of China were requested to fill out a self-report questionnaire at initial visit and1-month,3-month,6-month,1-year later, respectively. Baseline demographic data, gastrointestinal symptoms data (including upper and lower gastrointestinal), H.pylori status, psychosocial factors, sleep disorder, history of abuse were assessed. According to Rome III diagnostic criteria, symptom subgroups were assigned at baseline and1-y follow-up.Results:1.943FD patients completed all of the four follow-ups (89.9%response rate).324(34.4%) had other FGIDs overlap at baseline, including225(69.4%) overlap with gastro-oesophageal reflux disease(GERD),30(9.3%) overlap with irritable bowel syndrome (IBS),23(7.1%) overlap with functional constipation,7(2.2%) overlap with functional diarrhea(D) and39(12%) overlap with more FGIDs at the same time.2. Comparing with FD alone group, FD-other FGIDs overlap group had higher dyspepsia scores (26.72±10.46vs19.57±8.64, P<0.001). Older age (44.27±11.94vs.42.21±11.67, P=0.011), higher physical labor (P=0.001), worse economic condition (P=0.011), H.pylori infection (P=0.002), anxiety (P=0.002), depression (P=0.012) and sleep disorder (P<0.001) were associated with FD-other FGIDs overlap group.3. Following1-y follow-up,495(52.5%) remained the same symptom subgroup,230(24.4%) had transition from one symptom subgroup to another, and218(23.1%) reported no symptom.4. Univariate analysis revealed that older (unadjusted OR:1.014,95%confidence interval (95%CI):1.0-1.027; P=0.043), medium physical labor (unadjusted OR:1.593,95%CI:1.121-2.264; P=0.009), anxiety (unadjusted OR:2.020,95%CI:1.194-3.417; P=0.009), depression (unadjusted OR:1.869,95%CI:1.010-3.458; P=0.046) and sleep disorder (unadjusted OR:1.645,95%CI:1.2-2.257; P=0.002) significantly increased the likelihood of transition between symptom subgroups.5. After multivariate logistic regression analysis, medium physical labor (adjusted OR:1.592,95%CI:1.085-2.336;P=0.018) and sleep disorder (adjusted OR:1.644,95%CI:1.159-2.332; P=0.005) remained independent risk factor for transition between symptom groups. H. pylori-positive (adjusted OR:0.628,95%CI:0.405-0.975; P=0.038) was also independently associated with it.Conclusion:Clinical overlap between FD and other FGIDs are very common. The gastrointestinal symptoms are unstable and about a quarter of patients have transition from one symptom subgroup to another. Medium physical labor, sleep disorder and H. pylori infection were independent risk factors for transition between symptom groups. |
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