Abnormal Empathic Abilities And Alexithymia Among Patients With Functional Dyspepsia

Purpose: Brain imaging studies in functional dyspepsia(FD)have found that Anterior Insula(AI)and Anterior Cingulate Cortex(ACC)are abnormal,and they are significantly related to the severity of symptoms.AI and ACC are also important parts for regulating affective empathy(AE).Empathy refers to the ability to feel,understand and predict the motivations,feelings,and behaviors of others.It is not clear whether the empathic ability of FD patients is abnormal.In addition,alexithymia is difficult in identifying and describing emotions and is commonly expressed among with FD patients.Therefore,this study used the Chinese version of Interpersonal Reactivity Index(IRI-C)and the pain empathy paradigm to assess the empathy ability of FD patients,and adopted the Toronto Alexithymia Scale-20(TAS-20)evaluate alexithymia of FD patients.To explore the relationship between empathy and the symptoms and quality of life of FD patients,and whether there is a correlation between empathy and alexithymia in FD patients.In order to gain a deeper understanding of the brain-gut axis regulation mechanism of FD.Methods: Study 1:59 FD patients met Rome III diagnostic criteria were recruited.Healthy people without digestive system diseases matched with the FD group in age,gender and education level were recruited as the control group.Subjects with severe anxiety or severe depression were excluded.The empathy ability of the two groups was evaluated by IRI-C and pain empathy paradigm.IRI-C is to evaluate the subjects’ affective empathy(AE)and cognitive empathy(CE)in the form of questionnaire,including perspective taking(PT),Fantasy(FS),empathy concern(EC)and personal distress(PD).The higher the score is,the stronger the empathy ability is.Pain empathy paradigm is used to evaluate the pain empathy ability of the subjects by pictures.The pain pictures and neutral pictures in daily life are randomly presented by the computer,and the subjects are required to quickly judge whether the characters in the picture feel pain,and make key response,record the accuracy and reaction time.At the end of the judgment task,the pictures were randomly presented again,and the Five-point scale method was used to grade the pain of the characters in the pictures.Dyspepsia symptoms questionnaire and NDLQI were used to evaluate the dyspepsia symptoms and quality of life in FD patients.Study 2:35 FD patients who met Rome III diagnostic criteria were selected.Healthy people without digestive system diseases matched with the FD group in age,gender and education level were recruited as the control group.Dyspepsia symptom questionnaire was used to evaluate the clinical symptoms of FD patients,and the symptom score was expressed by the total score of frequency and severity.The empathy ability was evaluated by IRI-C,and the alexithymia ability was evaluated by TAS-20.Results: Study 1:1.Demographic information: FD patients exhibited a body mass index(BMI)that was significantly lower than that of HCs(p=0.025).No other demographic differences were detected when comparing these two populations,with educational history,alcohol intake,and smoking histories being comparable.2.Empathy ability:(1)Total IRI-C scores for FD patients were significantly higher than those for HCs(p=0.002).Specifically,PD and EC scores were significantly higher for FD patients relative to HCs(PD: p=0.001,EC: p=0.000),whereas FS and PT scores did not differ significantly between these groups(p>0.05).(2)FD patients also scored higher than HCs when rating painful pictures(p=0.000),but their accuracy in judging painful pictures was significantly lower than that of HCs(p=0.017).(3)FD patients exhibited higher anxiety and depression scores than did HCs(SAS: p=0.000;SDS: p=0.000).When SAS and SDS were treated as covariates to evaluate the impact of empathy,we found that there were significant differences in IRI-C scores(p=0.039),PD scores(p=0.006),EC scores(p=0.011)and pain rating scores(p=0.000)between FD patients and HCs.(4)Patients in postprandial distress syndrome(PDS)subgroup showed significantly higher accuracy in judging painful pictures than epigastric pain syndrome(EPS)subgroup(p=0.038).Patients in EPS subgroup showed significantly lower accuracy in judging painful pictures than overlap subgroup(p=0.003).Patients in overlap subgroup showed significantly higher pain rating scores than PDS subgroup(p=0.034).3.The correlation between empathy,dyspepsia symptoms,and FD patient quality of life:(1)FD patients suffering from epigastric pain exhibited higher scores than did those without such pain,including IRI-C scores(p=0.019),EC scores(p=0.046)as well as PT scores(p=0.016).(2)IRI-C scores(p=0.039)and FS scores(p=0.03)were higher for patients experiencing epigastric burning than for patients without the symptom.(3)Patients experiencing postprandial fullness also exhibited higher EC scores than did patients not experiencing this symptom(p=0.033).(4)NDLQI scores for FD patients were negatively correlated with both PD scores(r=-0.280,p=0.032)and with pain rating scores(r=-0.351,p=0.006).Study 2:1.The TAS-20 scores of FD patients were significantly higher than that of HCs(p=0.003).There was no correlation between TAS-20 and symptoms(p>0.05)and NDLQI(p>0.05)in FD patients.There was no correlation between TAS-20 and IRIC,PT,PD,FS,EC.Conclusions: Study 1:Empathetic ability was found to be significantly enhanced in FD patients,especially in patients with epigastric pain,postprandial fullness and epigastric burning.The affective empathy ability was negatively correlated with the quality of life in FD patients.Study 2:There was alexithymia in FD patients,but there was no correlation between empathy and alexithymia,and there was no significant correlation between TAS-20 and FD symptoms and quality of life.