Estrés laboral y su correlación con la prevalencia de dispepsia funcional en militares en actividad que acudieron al hospital geriátrico del ejército / Relationship between the frequency of work-related stress and prevalence of functional dyspepsia in Lima Geriatric Army Hospital

Objetivo: Determinar la relación existente entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en una muestra de 218 militares mayores de 50 años durante el año 2010 en el Hospital Militar Geriátrico de Lima. Materiales y métodos: Investigación descriptiva- explicativa; para la obtención de datos acerca del estrés se empleó la Escala de Sucesos Vitales de Holmes-Rahe y fichas clínicas para el registro clínico y de endoscopia alta que cumplan criterios de Roma III para dispepsia funcional. Para el procesamiento y análisis de datos se empleó el paquete de programas estadísticos SPSS (Statistical Packagefor Social Sciences). Resultados: el 100% de militares presentaron algún nivel de estrés laboral durante el año de estudio; así, el 36,7% presentó un alto nivel, el 31,2% nivel medio o moderado, y el 32,1% presentó nivel bajo de estrés; de estos porcentajes los niveles medio y alto de estrés representaron el 67,9%. Estos resultados permiten establecer que el estrés laboral es un malestar frecuente en la población estudiada (Chi2 tabular = 3,841, chi2 observado = 27,908). Con relación a la dispepsia funcional se determinó una prevalencia de 37,2%, porcentaje que indica que es una patología frecuente en dichos militares (Z tabular = 1,96, Zc = 9,163). Conclusiones: Existe una relación significativa entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en militares en actividad mayores de 50 años (Chi2 tabular= 5,991, chi2 observado =28,878, coeficiente de contingencia=0,342).

Objective: To determine the relationship between the frequency of work-related stress and prevalence of functional dyspepsia in a sample of 218 military older 50 years in 2010 in Lima Military Hospital Geriatric. Materials and methods: Descriptive and explanatory study and for the data collection on stress, were used the Vital Events Scale Holmes-Rahe and clinical records for clinical and upper endoscopy registration that comply the criteria of Rome III for functional dyspepsia. For processing and data analysis the statistical software package SPSS (Statistical Package for Social Sciences) was used. Results: 100% of military showed some level of work stress during the study year; thus, 36.7% had a high level, 31.2% medium or moderate level, and 32.1% had low stress level; these percentages medium and high stress levels accounted for 67.9%. These results establish that job stress is a common discomfort in the study population (tabulated Chi2 = 3.841, chi2 observed = 27,908). Regarding functional dyspepsia prevalence of 37.2%, which indicates that it is a common condition in those military (tabular Z = 1.96, Z c = 9.163) it was determined. Conclusions: There is a significant relationship between the frequency of work-related stress and prevalence of functional dyspepsia in military activity in older than 50 years (tabulated Chi2 = 5.991, chi2 observed = 28,878, contingency coefficient = 0.342).

Acupuncture effcctiveness as a complementary therapy in functional dyspepsia patients / Eficacia da acupuntura como terapia complementar em pacientes com dispepsia funcional

Context Functional dyspepsia represents a frequent gastrointestinal disorder in clinical practice. According to the Roma III criteria, functional dyspepsia can be classified into two types as the predominant sympton: epigastric pain and postprandial discomfort. Even though the pathophysiology is still uncertain, the functional dyspepsia seems to be related to multiple mechanisms, among them visceral hypersensitivity, changes in the gastroduodenal motility and gastric accommodation and psychological factors. Objective Evaluate the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients. Methods Randomized clinical trial in which were enrolled patients with functional dyspepsia patients in according with Rome III criteria. One group was submitted to drug therapy and specific acupuncture (GI) and the other to drug therapy and non-specific acupuncture (GII). The gastrointestinal symptoms, presence of psychiatric disorders and quality of life were evaluated, at the end and three months after treatment. Results After 4 weeks of treatment there was improvement of gastrointestinal symptoms in Group I (55 ± 12 vs 29 ± 8.8; P = 0.001) and Group II (50.5 ± 10.2 vs 46 ± 10.5; P = 0.001). Quality of life was significantly better in Group I than group II (93.4 ± 7.3 vs 102.4 ± 5.1; P = 0.001). Anxiety (93.3% vs 0%; P = 0.001) and depression (46.7% vs 0%; P = 0.004) were significantly lower in Group I than group II. When comparing the two groups after 4 weeks of treatment, gastrointestinal symptoms (29 ± 8.8 vs 46 ± 10.5; P<0.001) and quality of life (102.4 ± 5.1 vs 96 ± 6.1; P = 0.021) were significantly better in Group I than group II. Three months after the treatment, gastrointestinal symptoms remained better only in Group I, when compared to the pre-treatment values (38 ± ...

Contexto A dispepsia funcional representa uma frequente desordem gástrica da prática clínica. Segundo os critérios de Roma III, pode ser subdividida em dois tipos: do tipo dor epigástrica e tipo desconforto pós prandial, de acordo com o sintoma predominante. Embora de fisiopatologia incerta, a dispepsia funcional parece estar relacionada a múltiplos mecanismos, entre eles: a hipersensibilidade visceral, alterações da motilidade gastroduodenal e acomodação gástrica e participação de fatores psíquicos. Objetivos Avaliar a eficácia da acupuntura como forma complementar ao tratamento medicamentoso em pacientes com dispepsia funcional. Método Ensaio clínico randomizado, com portadores de dispepsia funcional, segundo os critérios de Roma III. Dois grupos foram formados: Grupo I (terapia medicamentosa e acupuntura específica) e; II (terapia medicamentosa e acupuntura não específica). Foram avaliados o índice de sintomas gastrointestinais, a presença de transtornos psíquicos e a qualidade de vida no início, no fim e 3 meses após o tratamento. Resultados Após 4 semanas de tratamento houve melhora dos sintomas gastrointestinais no Grupo I (55 ± 12 vs 29 ± 8,8; P = 0,001) e no Grupo II (50 ± 10 vs 46 ± 10,5; P = 0,001). Na comparação intergrupos, os sintomas gastrintestinais (29 ± 8,8 vs 46 ± 10,5; P<0,001) e os sintomas de ansiedade (0% vs 41,7%; P = 0,003) foram significativamente menores no Grupo I e a qualidade de vida (102,4 ± 5,1 vs 96,4 ± 6,1; P = 0,021) também foi significativamente melhor neste grupo. Três meses após o tratamento, os sintomas gastrointestinais permaneceram melhores no Grupo I, quando comparados aos valores pré-tratamento (38 ± 11,3 vs 55 ...

Burden of common mental disorders in patients with Functional Dyspepsia

To assess the frequency of common mental disorders among diagnosed functional dyspepsia patients. A case-control study with 150 cases of functional dyspepsia [FD] and 150 healthy controls were recruited from Gastroenterology Clinic at the Aga Khan University Hospital Karachi from 1st March 2009 through 31st August 2009. Urdu version of WHO-developed Self-Reporting Questionnaire [SRQ] was administered to diagnose patients of FD and healthy controls. A cut off score of 8 on SRQ was used to confirm cases of Common mental disorders [CMD]. Data was entered and analyzed by SPSS version 16.0. There was significant difference in CMD i.e. 107 [71.33%] versus 23 [15.33%] in cases and controls respectively [p- <0.001]. Among cases CMD was more common in females i.e. in 57 [80.3%] as compared 50 [63.3%] in males [p- 0.022]. There is high prevalence of Common mental disorders among patients with functional dyspepsia and this needs to be addressed while treating patients

Dispepsia funcional e depressão como fator associado / Functional dyspepsia and depression as an associated factor

OBJETIVO: Avaliar a associação entre depressão e dispepsia funcional. PACIENTES E MÉTODOS: Estudo transversal onde foram avaliados 348 pacientes com diagnóstico de dispepsia no Ambulatório de Gastroenterologia do Hospital Universitário de Pelotas, RS, cidade de médio porte do sul do Brasil, durante o período de 1 ano (de março de 2001 a março de 2002). Após o diagnóstico de dispepsia avaliou-se a presença de depressão, tanto em pacientes com dispepsia funcional, quanto naqueles com dispepsia orgânica. Utilizou-se a análise univariada para descrição das freqüências das variáveis de interesse e da análise bivariada, com o teste qui-quadrado, para comparação entre proporções das variáveis categóricas. A técnica da regressão logística foi utilizada para estabelecer a chance dos pacientes com depressão apresentarem dispepsia funcional e para controlar o efeito das variáveis intervenientes sobre a variável de desfecho RESULTADOS: Evidenciaram maior prevalência de deprimidos entre os pacientes com dispepsia funcional (30,4 por cento) em relação àqueles com dispepsia orgânica (11,2 por cento). As mulheres apresentaram maior chance de dispepsia funcional (OR: 1,74, IC 95 por cento, 1,05-2,89) e, em relação à idade, os intervalos entre 31 e 50 anos (OR: 0,28 IC 95 por cento, 0,13-0,54) e de 51 a 60 anos (OR: 0,41, IC 95 por cento, 0,17-0,96) mostraram efeito protetor, ou seja, indivíduos nessas faixas etárias têm menor risco de apresentar dispepsia funcional. Após a análise multivariada, pacientes deprimidos apresentaram chance três vezes maior de co-morbidade com dispepsia funcional do que pacientes não-deprimidos (OR 3,13; IC 95 por cento; 1,71-5,74).

AIM: To assess the association between depression and functional dyspepsia. PATIENTS AND METHODS: Three hundred and forty eight dyspeptic patients were included in a cross-sectional study in the gastroenterology outpatient clinic of a University Hospital in southern Brazil (Pelotas, RS) within a 1-year period (from March, 2001 to March, 2002). The assessment of depression occurred after the diagnosis of dyspepsia. The presence (or not) of depression was verified in both functional and organic dyspeptic patients. In a second moment, the results were compared, an univariate analysis was used to describe the frequencies of the interest variables and a chi-square for the comparison between proportions of the categorical variables. The logistic regression technique was used to establish the odd of functional dyspeptic patients to present depression and to control the effect of other variables in the outcome variable RESULTS: Showed greater prevalence of depression among functional dyspepsia patients (30,4 percent), when compared to organic dyspepsia patients (11,2 percent). Women showed greater risk to present functional dyspepsia (OR: 1,74, IC 95 percent, 1,05-2,89) and in terms of age, the group with ages between 31 to 50 years (OR: 0,28 IC 95 percent, 0,13-0,54) and 51 to 60 years (OR: 0,41, IC 95 percent, 0,17-0,96) showed protection effect (subjects within this age groups have minor risk to present functional dyspepsia). After the multivariate analysis depressed patients showed three times greater comorbidity with functional dyspepsia when compared to non-depressed patients (OR 3, 13; IC 95 percent; 1, 71-5, 74). DISCUSSION: The adjustment for the gender, age and marital status variables confirmed the association between functional dyspepsia and depression. Results point the need to assess the presence of depression in functional dyspepsia patients and to establish specific treatment strategies for these patients.

Initial ligguistic and psychometric validation of the Arabic version of nepean dyspepsia index

To report the initial evaluation of the linguistic and psychometric validation of the Nepean Dyspepsia Index [NDI], as part of the ongoing research of quality of life among dyspeptic patients. The Arabic version of the NDI was administered to 158 subjects [54 with non-ulcer dyspeptic [NUD]], 50 with gastro-esophageal reflux disease [GERD] and 54 with no history of gastroenteritis disease], with a mean age of 46.6 and SD 10.7. All subjects answered the Arabic versions of the General Health Questionnaire [GHQ], the Self-Report Questionnaire [SRQ], and the Short Form-12 Quality of Life [QOL] scale. We administered the final translation of the NDI by consensus. The study was conducted in King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between December 2002 and January 2004. The NDI has shown adequate internal consistency. Cronbach Alpha coefficient ranged between 0.88 to 0.93, and Split-half correlation reliability ranged between 0.82 and 0.94. Correlations between NDI subscales and total scores were high and significant. Adequate Face and content validity was demonstrated by consultation with gastroenterologists and clinical psychologists. Convergent validity was shown in the moderate and significant correlation of the NDI subscales and global index with the indices of the SF-12. Divergent validity was shown in that subscales of the NDI revealed low correlation with scales which measure other dimensions; thus, both QOL subscales and symptom checklist have discriminated patients from non-patients groups [p>0.01]. The factorial structure of the NDI was also examined, and it revealed 4 factors, which is similarly the same with other studies. The initial validation of the Arabic version of the NDI has shown that this scale has adequate psychometric and linguistic property and can represent a good addition to health outcome measures in dyspepsia research. Further validation studies are recommended

Evaluación y terapia psicológica en la dispepsia funcional / Evaluation and psychological therapy in functional dyspepsia

La dispepsia funcional (DF) se define como dolor o malestar en la parte superior del estómago, sin que haya alteraciones estructurales que expliquen los síntomas. Actualmente, es uno de los problemas gastrointestinales más comunes. Su etiología es biopsicosocial, ya que hay evidencia concluyente de la implicación de factores psicológicos y biológicos. Aunque la terapia psicológica en esta condición médica tiene escaso desarrollo, existe evidencia de que tanto el tratamiento cognitivo-conductual como la hipnosis tienen efectos beneficiosos sobre los síntomas y las recaídas, pero se requieren más estudios para llegar a resultados concluyentes.

Tratamiento psicológico de la dispepsia funcional: un análisis crítico / Psychological treatment of functional dyspepsia: a critical analysis

El objetivo del presente artículo ha consistido en realizar una revisión crítica sobre el tratamiento psicológico de la dispepsia funcional (DF), un síndrome definido por síntomas abdominales superiores sin causa orgánica identificable por medios diagnósticos convencionales. Se han analizado los efectos de diversas terapias psicológicas, tales como la terapia cognitivo-conductual, la hipnosis y la terapia dinámica, entre otras. Se concluye que todas tienen efectos significativos sobre la reducción de los síntomas dispépticos y psicopatológicos en comparación con los grupos de control. Sin embargo, son necesarios nuevos estudios antes de poder establecer resultados concluyentes. Se sugiere la necesidad de estudiar en futuras investigaciones los efectos de la terapia sobre la calidad de vida de las personas con DF, así como también su papel sobre las conductas de riesgo (fumar, consumir alcohol y tener inadecuados hábitos de alimentación), el análisis coste-beneficio, y los efectos diferenciales sobre los diversos tipos de DF.

psychopathology of duodenal ulcer compared with functional dyspepsia: a case control study

This is a prospective study of the psychiatric morbidity in 80 patients with duodenal ulcer, 80 with functional dyspepsia and 80 healthy controls; matchd for age sex and marital status. A semi structured psychiatric interview and clinical mental state examination were used in the psychiatric assessment of the patients and controls. Psychiatric diagnoses were made according to DSM3 R. a modified version of life events scale by tannant and Andrews was used in the assessment of life Events in relation to psychiatric illness. Psychiatric illness was significantly more in the patients than the controls. Anxiety and depressive disorders dominated the clinical picture and the symptoms were usually of mild nature. Other neurotic were rare and psychotic illness was absent. Though more psychiatric patients experienced life events than the controls, differences, however were not statistically significant. Further studies are needed, especially in relation to the casusative association between the functional dyspepsia and psychiatric disturbances

Doenças funcionais do aparelho digestivo / Functional disorder in gastroenterology

Skill in the diagnosis and management of functional disorders is essential for anyone concerned with human disease. The main principie is to distinguish between organic clinical entities and functional disorders. The pathophysiologic mechanisms that generate the symptoms of the functional disorders are imper- fectly understood. The most important etiologic factors are rela- ted to stress such as mental, emotional, or physical tension, strain, or distress. The importance of the functional disorders in gastroenterology is due to their high prevalence in almost all peoples at some time of their lives. The treatment of the func- tional disorders try to be specific but is very difficult because the pathophysiologic mechanisms involved are unclear. On the other hand, nonpharmacologic strategies by the physician can be efficients, mainly establishing a therapeutic relationship with your patient.

Habilidade em diagnosticar e lidar com desordens funcionais é essencial a qualquer um que cuide de doenças humanas. É fundamental distinguir entre entidades clínicas orgânias e distúrbios funcionais. A fisiopatologia dos distúrbios funcionais nâo é bem compreendida. Os fatores etiológicos mais importantes relacionam-se ao estresse, tais como estados de tensâo mental, emocional ou física. O tratamento farmacológico tem limitações como inespecificidade e os altos índices de efeito placebo. Por outro lado, a adoção de estratégias não farmacológicas pelo médico pode ser eficiente, principalmente esta- belecendo um relacionamento terapêutico com seu paciente.

Psychological factors and stressful life events among a group of functional dyspepsia patients in Jordan

The purpose of this study is to identify the role of psychological factors and stressful life events in the pathogenesis of functional dyspepsia patients. Patients and Forty consecutive patients referred to the Psychiatry Department from the Gastroenterology Department at the King Hussein Medical Centre were diagnosed as suffering from functional dyspepsia after negative clinical examinations via the means of ultrasonography, endoscopy and barium meals, compared with a control group, also consisting of forty patients and matched in sex, age and education. Both groups were interviewed and assessed by a psychiatrist and a psychologist using the Jordanian Version of the Cornell Index N2 and the Arabic Version of the Life Events Scale. Functional dyspepsia patients scored significantly higher on anxiety, fear, depression, hypochondriasis, somatization and psychopathic sub-scales as well as suffering from more stresses than the control group. When comparing female and male dyspeptic patients it was revealed that females suffered from more psychological disorders than males. This study concludes that psychological factors and stressful life events play a major role in developing symptoms of dyspepsia in some individuals, and an early psychosocial assessment of such patients would prevent subjecting a fair number of them to chronicity as well as costly time consuming physical investigations

Neuroticism and stressful life events in patients with non-ulcer dyspepsia.

Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), Brief Psychiatric Rating Scale and Presumptive Stressful Life Events Scale were used to measure neuroticism, psychiatric morbidity and stressful life events in 35 patients with non-ulcer dyspepsia (NUD), 22 cass of peptic ulcer disease (PUD), 65 irritable bowel syndrome (IBS) and 45 age and sex matched healthy controls. NUD subjects had significantly higher total MHQ scores (28.8 +/- 11.3; p < 0.001) and scores in subscales of somatization (7.8 +/- 3.4; p < 0.001) and hysterical personality traits (5.5 +/- 2.8; p < 0.01) compared to healthy controls. MHQ scores in IBS subjects was significantly higher than in NUD, but in PUD subjects it was in-between NUD and healthy controls. Psychiatric morbidity, as assessed by Brief Psychiatric Rating Scale, was significantly higher in patients with NUD and IBS than in normal controls. Stressful Life event score was statistically similar in all the groups.

Role of anxiety and personality in non-ulcer dyspepsia: a comparative study with duodenal ulcer.

BACKGROUND: Though emotional factors are known to influence gut functions, studies evaluating the role of anxiety and personality in non-ulcer dyspepsia (NUD) are few and have not yielded consistent results. AIMS: To find out whether anxiety and abnormal personality pattern are specifically associated with NUD. METHODS: 33 patients with NUD and 30 patients with duodenal ulcer, who were randomly selected from among those attending a gastroenterology out-patient clinic, were administered a) the Eyesenck Personality Inventory, to measure neuroticism and extroversion; and b) a short self-rating scale for anxiety, to measure state and trait anxiety. RESULTS: There were no significant differences between the two groups in state anxiety, neuroticism and extroversion. Trait anxiety, however, was significantly higher in the NUD group (p = 0.05). CONCLUSIONS: Though the difference in trait anxiety score between the two groups attained significance, this finding needs further support to indicate a causal role for anxiety in NUD. There is need for further studies about the role of anxiety in various subgroups of NUD.