The Effect Of Neurotransmitters On The Quality Of Life And The Curative Effect Of Patients With Functional Dyspepsia

Objective:To detect neurotransmitter levelsin functional dyspepsia(FD)patients without obvious effects by the treatment of proton pump inhibitors(PPI)and/or prokinetic drugs,and to explore the impactsof neurotransmitters on anxiety,depression,somatization,severity of symptoms,the quality of life and therapeutic effect of FD patients.Methods:363 FD patients without obvious effects by the treatment of PPI and/or prokinetic drugs were collectedacorrding to the Rome ?diagnostic criteria by a cross-sectional study method,of which six neurotransmitters:5-HT,NE,DA,Ach,GABA and Glu levels were evaluated by encephalofuctuograph(EFG)technology.All FD patients completed DSS,GAD-7,PHQ-9,PHQ-15,PHQ-12 and NDIscales.The relationships between six neurotransmitters and DSS,anxiety,depression,somatization,NDI,therapeutic effect were analyzed in FD patients.Statistical analysis was carried out by quartile spacing,Chi square test,Spearman correlation analysis,nonparametric test(Mann Whitney U test)and binary logistic regression.Results:17.1%(62/363)patients with EPS,14.6%(53/363)patients with PDS,68.3%(248/363)patients with EPS and PDS overlap were diagnosed acorrding to the Rome ? diagnostic criteria.Their six neurotransmitters:5-HT,NE,DA,Ach,GABA,and Glu were no significant differences(P>0.05).Assessed by the overall treatment effect(OTE)less than 25%,52.1%(189/363)FD patients were in the effective groupand 47.9%(174/363)were in the ineffective group,in which six neurotransmitterswere not significantly different(P>0.05).When assessed by the OTE less than 50%,70.8%(257/363)patients were classifiedin the effective group,and 29.2%(106/363)patients in the ineffective group;5-HT(Z=-5.834,P=0.000),NE(Z=-5.553,P=0.000),DA(Z=-6.012,P=0.000),Ach(Z=-5.633,P=0.000),GABA(Z=-5.759,P=0.000),and Glu(Z=-5.774,P=0.000)showed significant differences.According to classification by the OTE less than 50%,and 5-HT,NE and DA were lower than the normal reference range concurrently,the rates of three neurotransmitters were compared between the ineffective group and the effective group,the differences of 5-HT+NE+DA(?2=38.886,P=0.000),NE+5-HT+DA(?2=23.210,P=0.000),DA+5-HT+NE(?2=19.372,P=0.000)were statistically significantdifferent.When 5-HT,NE and DA increased concurrently,there were not statistically significant differences between the ineffective group and in the effective group(P>0.05).Compared the rates of six neurotransmittersnormal,decreased and increasedaccording to the OTE less than 25%,5-HT(?2=9.229,P=0.010)?NE(?2=12.986,P=0.002),DA(?2=12.050,P=0.002),Ach(?2=12.274,P=0.002),GABA(?2=9.945,P=0.007),Glu(?2=11.146,P=0.004)had statistical differences.5-HT(?2=30.862,P=0.000),NE(?2=37.204,P=0.000),DA(?2=43.308,P=0.000),Ach(?2=36.311,P=0.000),GABA(?2=38.675,P=0.000),Glu(?2=39.854,P=0.000)had also statistical differences compared by the OTE less than 50%.In allpatients 5-HT(r=0.125,P=0.017),NE(r=0.130,P=0.013),DA(r=0.126,P=0.016)and Ach(r=0.119,P=0.024)were correlated with anxiety,respectively.NE(r=0.255,P=0.045),DA(r=0.262,P=0.039)were also correlated with anxiety in EPS group.There were no correlations between six neurotransmitters and depression,DSS,PHQ15 and NDI(P>0.05).Analyzed by the OTE less than 50%,the binary logistic regression analysis showed that decreased 5-HT level(OR=0.433,95%confidence interval:0.215?0.817,P=0.019),and increased 5-HT level(OR=2.098,95%confidence interval:1.168?3.768,P=0.013)were determinants for FD patients'therapeutic effect.Compared with the " overlapping group",the curative effect of PDS patients was more better(OR=2.755,95%confidence interval:1.448?5.244,P=0.002).Conclusion:Six neurotransmitters levels were detected by the EFG technology,most of which decreased or increased concurrently.There were no correlations between six neurotransmitters and depression,somatization,DSS and the quality of life,and there was relatively a low correlation with anxiety.However,neurotransmitter levels might be related to the curative effect of FD patients.The lower the level of neurotransmitters decreased,the worse the therapeutic effect might be;the higher the level of neurotransmitters increased,the better the therapeutic effect might be.But the results of univariate and multivariate analysis were not consistent,whichneeded further research in the future.Our results suggest that FD patient neurotransmitter levels might be related to theircurative effect.These results may be helpful to study whether neurotransmitter levels in plasma and gastrointestinal tissue are related to the curative effectof FD patients,and to explore whether measuring those neurotransmitters mayhelp to select antidepressants in FD patients in the future.