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

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).

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 effectiveness as a complementary therapy in functional dyspepsia patients.

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 symptom: 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 ± 11.3 vs 55 ± 12; P = 0.001). CONCLUSION: In patients with functional dyspepsia the complementary acupuncture treatment is superior to conventional treatment. Further studies with more patients are needed to confirm these findings.

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 ...

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.

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

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%), when compared to organic dyspepsia patients (11,2%). Women showed greater risk to present functional dyspepsia (OR: 1,74, IC 95%, 1,05-2,89) and in terms of age, the group with ages between 31 to 50 years (OR: 0,28 IC 95%, 0,13-0,54) and 51 to 60 years (OR: 0,41, IC 95%, 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%; 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.

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.

Gastric emptying and intragastric distribution of a solid meal in functional dyspepsia: influence of gender and anxiety.

BACKGROUND: Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. GOALS: To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. METHODS: A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. RESULTS: Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men ( 19 +/- 41 min vs. 78 +/- 22 min) and to female controls (96 +/- 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. CONCLUSION: Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.

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.

Orocecal transit time in patients with functional dyspepsia.

BACKGROUND: The importance of intestinal dysmotility in functional dyspepsia is a controversial issue. GOALS: To investigate the orocecal transit time in patients with functional dyspepsia, as well as a possible association between intestinal transit and the presence of anxiety or Helicobacter pylori infection in these patients. STUDY: The participants in this study were 23 patients with dysmotility-like functional dyspepsia and 24 control subjects. Orocecal transit time was measured by the lactulose hydrogen breath test. The presence of anxiety was assessed by the Hospital Anxiety and Depression (HAD) scale. RESULTS: No significant difference in orocecal transit times was found between patients (median, 55 minutes; 95% confidence interval [CI], 40-60 minutes) and control subjects (median, 50 minutes; 95% CI, 40-60 minutes; p = 1). In the assessment, 15 patients (73%) scored for anxiety on the HAD scale, and 15 patients (65%) had positive test results for H. pylori. There was no significant difference in orocecal transit times between the patients with (median, 55 minutes; 95% CI, 40-63 minutes) and those without H. pylori infection (50 minutes; 95% CI, 40-68 minutes; p = 0.85), or between the patients with (median, 45 minutes; 95% CI, 40-68 minutes) and those without (60 minutes; 95% CI, 40-63 minutes; p = 0.77) anxiety. CONCLUSIONS: Orocecal transit time is within the normal range in patients with functional dyspepsia. Anxiety and H. pylori infection do not seem to influence orocecal transit time in these patients.

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 differences between ulcer and non-ulcer dyspeptic patients]. / Diferencias psicológicas entre pacientes ulcerosos y dispépticos no ulcerosos.

The existence of differences in the psychological profile of 39 endoscopically evaluated patients with ulcer (U) and non ulcer (NU) dyspepsia were examined. There were 21 U and 18 NU subjects. Cigarette smoking, intake of alcohol, coffee, mate, aspirin and NSAID were recorded, but there were no significant differences between the two groups. Personality traits were determined by the Rorschach Test, considering psychological profile (introversive, extroversive, self-restrained), impulse and emotion control (do not allow their expression, impulsive, adequately conveyed) and level of social adaptation (low, normal, high). U and NU subjects experienced a similar number of potentially stressful life events. However, U patients perceived their events more negatively. Although no one type of "ulcer personality" was found consistently, ulcer patients tended to be more introversive and they had a better social adaptation than NU.

Functional disorders of the stomach.

Gastroenterologists frequently encounter patients who report vague epigastric discomforts or sensations of fullness, bloating, and distention in the upper abdomen. The discomfort is neither burning in character nor severe in intensity; there is no nocturnal pain. The epigastric location of discomfort and lack of radiation may help to exclude biliary tract and pancreatic diseases. Nausea may be present, but there is little or no vomiting. After these patients ingest liquids or solid foods, the symptoms of easy filling or early satiety and increasing discomfort and nausea are almost always present. The patient may only report "indigestion," but a specific chief complaint, such as pain, discomfort, nausea, or bloating may be elicited with further inquiries. Solid foods usually provoke more symptoms than do liquids. Symptoms of early satiety, nausea, bloating, and abdominal discomfort may culminate in the vomiting of undigested food. These vague upper gastrointestinal (GI) symptoms have been termed "dyspepsia." When peptic diseases of the stomach are excluded, the symptom complex has been called "nonulcer" dyspepsia, a vague syndrome with symptoms attributed to stomach dysfunction. Nonulcer dyspepsia has been reviewed recently. Such symptoms, commonly attributed to a "functional" disorder, are very common in clinical practice, with an incidence of 30% of patients. In this review, we will discuss an approach to the evaluation and treatment of patients with symptoms of nausea, early satiety, bloating, and vague epigastric discomfort--dyspeptic symptoms associated with functional stomach disorders. We will review the anatomy and motility of the stomach and suggest potential neuromuscular malfunctions of the stomach that may result in epigastric symptoms. The potential role of stress and other brain-gut interactions, which may underlie these symptoms, will also be reviewed.