Impaired Quality of Life in Patients with Autoimmune Atrophic Gastritis.

BACKGROUND: Autoimmune atrophic gastritis (AAG) leads to vitamin B12 deficiency that may manifest with neuropsychiatric disorders, such as emotional instability, cognitive deficits, depression, and personality changes. AIMS: To evaluate the quality of life (QoL) in patients with AAG and the interplay between QoL, psychopathological symptoms, and demographic factors. METHODS: This is an observational, cross-sectional study including 102 patients with AAG (mean age 62 ± 13 years), 100 with functional gastrointestinal disorders (mean age 38.3 ± 17 years), 100 with other chronic organic gastrointestinal diseases (mean age 50.9 ± 21.4 years), and 100 healthy controls (mean age 37.5 ± 18.9 years). The 36-Item Short Form Health Survey questionnaire (SF-36) and the General Health Questionnaire-12 were administered. The results of the scales were compared among the study groups. Linear regression analyses were fitted to identify independent predictors of QoL in AAG patients. RESULTS: QoL was significantly different among the four groups in all subdomains. In particular, the AAG group was significantly (P < 0.01) more impaired than the functional gastrointestinal disorder group in the physical functioning and it was significantly more impaired than the control group in all the quality of life subdomains with exception of vitality. Vitamin B12 serum level was a significant (P < 0.04) independent predictor of physical functioning. CONCLUSIONS: Patients with AAG have a decreased QoL compared to healthy controls, but in line with that of patients with organic gastrointestinal disorders. Physical component is responsible for worsening QoL. Vitamin B12 supplementation may positively affect patient's perception of body functioning.

Psychological distress in patients with chronic atrophic gastritis: the risk factors, protection factors, and cumulative effect.

This study aimed to examine the psychological status among Chronic Atrophic Gastritis (CAG) patients and to find the cumulative effects of risk and protective factors. A sample of 101 CAG patients completed the investigation. Hierarchical linear regression was used to find risk and protective factors, and examine the cumulative effects in risk factor index (RFI) and protective factor index (PFI). Results showed that nine symptoms from SCL-90-R were severer among CAG patients than those in adult norm. Risk factors including positive family history of cancer and higher negative life events could predict higher GSI (ß = 0.206, p = 0.023; ß = 0.398, p < 0.001; R² = 0.203); more household resistant, positive coping and stronger resilience were protective factors and could predict GSI negatively (ß = -0.188, p = 0.020; ß = -0.350, p = 0.012; ß = -0.066, p = 0.621; R² = 0.190). The GSI was positively correlated with RFI (ß = 0.338, p < 0.001; R² = 0.113) and negatively related to PFI (ß = -0.378, p < 0.001; R² = 0.133). In conclusion, CAG patients suffered from various psychological distress, and the protective factors should be enhanced cumulatively to protect against psychological distress.

The relationship of interpersonal sensitivity and depression among patients with chronic atrophic gastritis: The mediating role of coping styles.

AIMS AND OBJECTIVES: To investigate the prevalence of depression and the relationship among interpersonal sensitivity, coping styles and depression in patients with chronic atrophic gastritis and explore the mediating role of coping styles between interpersonal sensitivity and depression. METHODS: A cross-sectional survey of 101 patients diagnosed with chronic atrophic gastritis aged 33-83 years. All the participants were surveyed face to face and given the informed consent. Sociodemographic and clinical characteristics, the interpersonal sensitivity dimension of the Symptoms Checklist-90-Revised, the Trait Coping Style Questionnaire and Hospital Depression Scale were measured. A descriptive analysis and a correlation matrix were used to illuminate the characteristics of subjects and bivariate correlations, respectively. Hierarchical regression analysis and bootstrapping method were used to test the mediating effect of coping styles between interpersonal sensitivity and depression. RESULTS: The prevalence of depression among patients with chronic atrophic gastritis was 54.50%. The regression analysis revealed that interpersonal sensitivity was positively related to depression. The effect of interpersonal sensitivity on depression was partially mediated by coping styles, including positive coping and negative coping. CONCLUSIONS: Depression was highly prevalent in patients with chronic atrophic gastritis. Coping styles played a mediating role between interpersonal sensitivity and depression, which had important clinical implications for physicians and nurses. RELEVANCE TO CLINICAL PRACTICE: Patients who are at high risk of depression should be identified and applicable targets should be made for prevention and intervention, in consideration of mental health of patients with chronic atrophic gastritis.

Psychological effects of Helicobacter pylori-associated atrophic gastritis in patients under 50 years: A cross-sectional study.

BACKGROUND: While gastrointestinal function is known to be closely related to psychological status, the influence of Helicobacter pylori-associated atrophic gastritis is currently unknown. We aimed to determine whether atrophic gastritis status or H. pylori infection is associated with psychological distress or depressed mood. MATERIALS AND METHODS: We performed a cross-sectional, observational study involving 975 Japanese individuals (503 females; mean age, 44 ± 8 years) who underwent a health checkup. Psychological distress was defined as a Kessler-6 Scale score ≥13 and depressive mood as a Center for Epidemiological Studies Depression Scale score ≥ 16. The odds ratios with 95% confidence intervals assessing the risk of psychological distress or depressive mood associated with H. pylori infection (H. pylori-specific immunoglobulin G levels >10 U/mL) and atrophic gastritis status (pepsinogen I levels < 70 µg/L and pepsinogen I/II ratio < 3) were calculated using multiple logistic analysis adjusting for several covariates. RESULTS: Individuals with atrophic gastritis had a significantly higher risk of experiencing psychological distress, with younger females (<50 years) displaying the highest risk for psychological distress and depressive mood regardless of H. pylori infection status. Among females aged <50 years, H. pylori-seropositive participants with atrophic gastritis (HP+AG+) showed the highest risk of psychological distress (OR, 16.4; 95% CI, 3.45-94.9) and depression (OR, 2.86; 95% CI, 1.31-6.05), using HP-AG- status as the reference. CONCLUSIONS: Our findings support the results of previous animal studies regarding the psychological response to gastritis in humans. Further studies are needed to elucidate whether H. pylori eradication provides psychological benefits.

Helicobacter pylori eradication improves the quality of life regardless of the treatment outcome: A multicenter prospective cohort study.

Helicobacter pylori (Hp) eradication is recommended for improving the quality of life (QOL) of patients with epigastric symptoms, especially reflux and dyspepsia. However, no reports have investigated the improvement of QOL after the eradication of Hp irrespective of epigastric symptoms. The aim of this study was to investigate the improvement in the QOL after the eradication of Hp irrespective of epigastric symptoms, and evaluate the factors associated with an improved QOL after the eradication of Hp.This prospective cohort study was performed at 15 referral institutions from September 2013 to December 2014. The patients' QOL and epigastric symptoms were evaluated before and after the eradication of Hp using the 8-item Short-Form Health Survey (SF-8) and the modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease, respectively.One hundred sixty-five of 184 Hp-infected patients underwent Hp eradication treatment. The treatment was successful in 82.4% (136/165) of the cases. One hundred sixty of the 165 Hp-infected patients were eligible for inclusion in the QOL analysis. In the indices of QOL on the SF-8, the scores on both the mental component summary (MCS) and the physical component summary (PCS) were found to have significantly improved after the eradication of Hp. However, the epigastric symptoms before the eradication of Hp were not correlated with either the MCS or PCS. A low QOL value before the eradication of Hp was the factor what was most strongly associated with the improvement in the QOL.The eradication of Hp improved the QOL, regardless of the outcome of the treatment, especially in patients who had an impaired QOL before the eradication.

Health-related quality of life and utilities in gastric premalignant conditions and malignant lesions: a multicentre study in a high prevalence country.

BACKGROUND AND AIMS: A recent review of economic studies relating to gastric cancer revealed that authors use different tests to estimate utilities in patients with and without gastric cancer. Our aim was to determine the utilities of gastric premalignant conditions and adenocarcinoma with a single standardized health measure instrument. METHODS: Cross-sectional nationwide study of patients undergoing upper endoscopy (n=1,434) using the EQ-5D-5L quality of life (QoL) questionnaire. RESULTS: According to EQ-5D-5L, utilities in individuals without gastric lesions were 0.78 (95% confidence interval: 0.76-0.80), with gastric premalignant conditions 0.79 (0.77-0.81), previously treated for gastric cancer 0.77 (0.73-0.81) and with present cancer 0.68 (0.55-0.81). Self-reported QoL according to the visual analogue scale (VAS) for the same groups were 0.67 (0.66-0.69), 0.67 (0.66-0.69), 0.62 (0.59-0.65) and 0.62 (0.54-0.70) respectively. Utilities were consistently lower in women versus men (no lesions 0.71 vs. 0.78; premalignant conditions 0.70 vs. 0.82; treated for cancer 0.72 vs. 0.78 and present cancer 0.66 vs. 0.70). CONCLUSION: The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis.

Non-fearful panic disorder in gastroenterology.

BACKGROUND: Nonfearful panic disorder (NFPD) is a panic condition masked under the appearance of somatic symptoms only, without the component of fear, and it represents a challenging diagnostic task. METHOD: This is the first case report of NFPD in a male patient with acute gastric pain and gastrointestinal disease (atrophic gastritis and H. pylori infection). RESULTS: The patient showed atypical panic symptoms and demoralization on the Diagnostic Criteria for Psychosomatic Research screening. He was successfully treated with anti-panic medication and cognitive-behavioral therapy. DISCUSSION: The case report shows that accurate psychosomatic assessment may help clinicians avoid diagnostic delay, prevent the administration of unnecessary medications, and give patients more appropriate treatment.

[Neuropsychiatric symptoms in vitamin B12 deficiency and microcarcinoidosis. The complications of chronic atrophic gastritis]. / Neuro-psychiatrische Symptome bei Vitamin-B12-Mangel und Mikrokarzinoidose. Komplikationen einer chronischen atrophischen Gastritis.

HISTORY AND FINDINGS: A 69-year-old woman reported marked restriction of voluntary movements of the hands in the preceding 6 months. She had also experienced loss of motivation, memory and concentration. Her skin was pale yellow, and scratches on her skin indicated marked pruritus. INVESTIGATIONS: Neurological examination revealed decreased vibratory sense in both legs. Haemoglobin concentration was 8.3 g/dl, mean corpuscular volume 114 fl, vitamin B12 level < 100 ng/l, folic acid level normal. Antibody titre against parietal cells was increased, vitamin B12 resorption diminished. Gastroscopy revealed small raised lesions, made up of hyperplastic cells which stained with chromogranin, indicating a diagnosis of microcarcinoid of the gastric mucosa. TREATMENT AND COURSE: On administration of cobalamine (1,000 micrograms i.m. daily for 2 weeks, twice weekly for 6 weeks, then once per week for the last 7 months) the blood picture returned to normal, but the microcarcinoids, the psychological symptoms and the apraxia of the hands were unchanged.

Precursor lesions of the GI tract and psychosocial risk factors for prediction and prevention of gastric cancer.

In two prospective studies, including a total of 1,353 and 1,914 male and female participants, a variety of medical and psychosocial risk factors were assessed by means of personal interviews and observational categories. The incidence of gastric cancer was determined for the following study groups: 1) all persons with chronic atrophic gastritis and pernicious anemia who had one to three relatives with a history of gastric cancer, 2) persons with a previous operation for gastric ulcer (partial resection) and one to three relatives with gastric cancer, and 3) a comparable group without any of these characteristics, serving as a reference. The hypothesis was that significantly more gastric cancer was to be expected in groups 1 and 2. A second hypothesis was that interaction between the specific precursors and psychosocial risk factors (chronic hopelessness due to withdrawing objects) was useful for the prediction of gastric cancer. The results may open new avenues for the prevention of gastric cancer via preventive psychotherapy in identified risk groups.