Esophageal motility and psychiatric factors in functional dyspepsia patients with or without pain

Subtypes of functional dyspepsia (FD), including refluxlike dyspepsia, ulce rlike dyspepsia, dysmotility-like dyspepsia, and nonspecific dyspepsia, hav e been described and are widely used clinically. However, these symptom pat terns often overlap, and the terms are insufficient for indicating all FD s ymptoms. In this study, we divided 71 FD patients into two groups: patients with or without pain. Group I, the pain dyspepsia group, included patients in whom the main symptoms were epigastralgia and/or chest pain. Group II, the painless dyspepsia group, included patients without pain, in whom the s ymptoms were nausea, vomiting, and heartburn. We examined the relationship between esophageal function and psychiatric factors in the test groups and compared them with a control group. Of the FD patients, 19.7% [8 (25%) of 3 2 group I patients, 6 (15.4%) of 39 group II patients] had esophageal motil ity disorders, such as nutcracker esophagus and diffuse esophageal spasm. T he LES pressure of group I was higher than that of group II by esophageal m anometry (P < 0.05), In 17 (53.1%) of 32 group I patients and 31 (79.5%) of 39 group II patients, psychiatric disorders (38.0% had depressive disorder and 21.1% had an anxiety disorder) were diagnosed following DSM III-R crit eria. Group II tended to be more depressive than group I (P = 0.0508). Psyc hological assessment scores, STAI-I and STAI-II, were higher in groups I an d II than in the control group (P < 0.001). Long-term distress, anxiety, an d depression seem to influence the symptoms of FD patients. Esophageal dysm otility may be an important functional abnormality of FD.