Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus

OBJECTIVE: Gastrointestinal (CI) symptoms are common in patients with long- standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabet es. METHODS: A consecutive sample of outpatients with diabetes mellitus (n = 20 9) and a random sample of community diabetics (n = 892) completed a validat ed questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. RESULTS: Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroti cism scores were significantly higher for most CI symptoms (11 of 14, all p < 0.05), and a dose-response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depres sion (HAD <greater than or equal to> 11). Anxiety, depression, and neurotic ism were each independently associated with the number of GI symptoms, adju sting for age, gender, duration and type of diabetes, and self-reported gly cemic control. CONCLUSIONS: Increased levels of state anxiety and depression and neurotici sm are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms , or whether GI symptoms per se increase levels of anxiety and depression. (Am J Gastroenterol 2001;96:1033-1038. (C) 2001 by Am. Coll. of Gastroenter ology).