| Functional Dyspepsia (FD) means that it is the clinical disease groups of epigastric discomfort continuous or repeated , including bellyful and complaint after the meal, quick satiety, epigastric pain, epigastric burning sensation and all functional disease that can not explain above-mentioned symptoms . The symptom appeared in at least 6 months before diagnosing, and met the above standard in nearly 3 months.The pathogenesis of FD is not identify now, and people research indicates in recent years that FD is a psychosomatic disease with special pathology and physiological foundation. Functional Dyspepsia with psychic reaction and somnipathy especially depression and anxiety symptom, is paid attention by the clinic day by day. This subject is based on Rome II and CCMD3 standard, to observe the changes in depression and anxiety symptom, clinical symptom, gastric emptying and some relevant change of hormone of pre-cure antidepressant treatment and post-cure anti-depressant treatment, and to investigate the relationship between psychological factors, gastric receptive relaxation, hydrocortisone and the pathogenesis of FD ,the curative effect.MethodWe take FD with depression and anxiety symptom as the observation target, according to Rome II and CCDM3 standards, and divide the patients into two groups, including treat group 20 cases and contrast group 20 cases. Treat group cases received antidepressant drugs and mental adjustment treatment, and contrast group cases were given routine treatment such as repressing gastric acid secretion, motivation and digestant and so on. All the cases received symptom score, severity evaluation, HAMD scale score evaluating, water load test, cortisol detection pre-cure antidepressant treatment and post-cure antidepressant treatment, and then we evaluate the effect of two kinds of treatment.We used the Statistical Package for the Social sciences 10.0(SPSS 10.0 for Windows) for data analysis. All statistics analysis were performed with chi-square test. P values were computered, with statistical significance indicated by a value of P<0.05.Result1. Result of symptom score: Treat group cases received antidepressant treatment, and alimentary symptom improved expressly, and the symptom score obviously reduced. The symptom is improved to some extent too, but the total symptom score can not be changed obviously for contrast group after treatment, t=2.692. Two groups of symptom total score compared before and after treatment, t =10.833, (P<0.05), the difference has significance.2. Result of HAMD scale score: According to the depression severity standard, the HAMD scale score of treat group cases obviously dropped after treatment compared with contract group, t =10.833 ,(P<0.05), the difference has significance.3. Result of water load test: There is no obvious difference ( P > 0.05 ) to treat the two groups before antidepressant cure . Contrast group utility 5 of group after treating (25%), excellence 4 results (20%), inefficacy 11 (55%), always efficient 9 examples (45% ); Treat group utility 4 cases after treating (20%), excellence 13 results to account for (65%), inefficacy 3 (15%), always 17 efficient examples (account for 85%). Compared with contrast group t =-2.154, obvious difference (P < 0.01 ). 4. Result of the cortisol measures: In treat group 14 cortisol inspection result in normal range (60-160ng/ml), 6 in severe degrees of patient more in above one year case history, the cortisol examined rises. After antidepressant cure 4 in severe degree of patients drop to normally, 2 are still on the high level ; and contrast group 15 in normal range, 5 in severe degree of patients is unusual, after antidepressant treat only one case return to normal, 4 are still higher than normal level . Statistical analysis t =5.668, P <0.05 two groups have obvious differences.Conclusion1. It is higher that the symptom score and HAMD scale score in these paitents of FD with depression and anxiety symptom. After treating, their symptom improved and scale score reduced together. So psychological factor and FD with anxiety-depression have important relation of invasion.2. HAMD scale score dropped step by step and the capacity of water load rised too, it implied that psychologism is very important to influence water load capacity, and water load test can be regarded as FD stomach sensitiveness inspection method because it is safe fast and easy.3. FD with the heavy depression and anxious patient whose HPA axles are hyperfunction, the level of blood cortisol rised, which proved that the paitent had the disorder of neural endocrine. Antidepressant treatment is that make cortisol content become more and more normal through balanced Hypercalcemia hyperfunction HPA axle function, and then the capacity of water load rised, and reduced viscera sensitivity and the receptive relaxation function of proximal chylostomach. Result show that Antidepressant treatment is an effective treatment method and worth popularizing and applying. |
