Gastric Emptying And Psychological Parameters In Post-prandial Distress Syndrome Patients

Objective: Functional dyspepsia (FD) is a common gastric diseases whose pathogenesis remains uncertain. Gastric motility dysfunction, associated with some upper gastrointestinal tract syndromes such as post-prandial fullness, early satiation, nausea and belching, may have a role on its pathogenesis. Based on Rome III standard, FD can be divided into epigastric pain syndrome(EPS) and post-prandial distress syndrome(PDS). Post-prandial fullness, early satiation, nausea and belching is the main clinical manifestations of PDS patients and response to eating. To identify whether gastric motility dysfunction exist in PDS patients and the relationships between these gastric syndromes and gastric emptying, we compared the gastric emptying in PDS patients and matched healthy control with nuclide method. Demonstration of PDS mechanism contributes to clinical treatment target for PDS .As previous study, psychological factors show association with PDS. We also compared the anxious and depressive state between PDS patients and healthy controls by self-rating anxiety scale(SAS) and self-rating depression scale(SDS) analysis.Methods: 34 PDS patients included 14 males and 20 females with mean age 45.94±13.19 and mean body mass index(BMI) 23.04±3.32 are involved. 21 healthy controls included 9 males and 12 females with mean age 42.47±14.52 and mean BMI 22.50±2.25 are compared in this study.We detected the gastric emptying of PDS patients and healthy controls with PET/SPECT(Siemens, Germany). We detected stomach radioactive counting at the timepoint of 0min, 30min, 60 min, 90 min and 120 min respectively. We treated gastric emptying half-time(GET_1/2) and the gastric emptying rate at 120 minutes(GE₁₂₀) as gastric emptying parameters.We scored the gastric symptoms in PDS patients with the LDQ, and the relationships with gastric emptying were compared with SPSS 10.0 software.We use the self-rating anxiety scale(SAS) and self-rating depression scale(SDS) to evaluate the mental state of PDS patients included 4 males and 16 females with mean age 38.00±10.09 , and 30 healthy controls included 7 males and 22 females with mean age 36.97±11.19 are compared in this study.We scored gastric symptoms of PDS patients also with the LDQ. All data were performed with SPSS 10.0 software for correlation analysis and P<0.05 was considered as statistical difference.Results: 1. Compared with healthy control, gastric emptying delayed significantly in PDS patients, with GET_1/2 (min) of 105.54±25.66 vs 78.19±14.33 in matched controls (t=5.066, P=0.000). As for GE₁₂₀ (%) of 56.32±12.91 in PDS patients vs 70.71±11.18 in matched controls (t=-4.221, P=0.000). Whereas in the PDS patients, no statistical correlations existed between gastric motility parameter refer_s to GET_1/2 or GE₁₂₀ and main PDS clinical manifestation such as post-prandial fullness , early satiation, upper abdominal pain, upper abdominal burning sensation, post-prandial nausea and belching(P>0.05).2. The relationships between psychological factor_s and PDS frequency also studied. Compared with healthy controls, the total crude scores of SAS in PDS patients were high with 39.90±6.45 vs 29.73±8.35(t=4.603, P=0.000). The total standard scores in PDS patients were also higher than that of healthy controls, with 49.80 vs 36.73±10.45(t=4.761, P=0.000), respectively. Compared with healthy control, the total crude scores of SDS in PDS patients were high with 40.50±8.38 vs 30.31±5.79(t=4.717, P=0.000). The total standard scores in PDS patients were also higher than that of healthy controls, with 50.30±10.50 vs 38.03±8.59(t=4.524, P=0.000), respectively.In SDS, the depressive state could be divided into four factor_s including physical symptoms and anxiety(factorâ… ), optimistic sentiments(factorâ…¡), physiological state (factorâ…¢) and dysthymia (factorâ…£). The statistical difference between the PDS patients and healthy controls exist refer_s to these factor_s (t=3.344, P=0.002; t=2.680, P=0.011; t=5.488, P=0.000; t=2.472, P =0.017), respactively.The total scores of clinical symptoms in PDS patients was statistically correlated with anxiety and depression(r_s=0.502, P=0.024; r_s=0.911, P=0.000).Upper abdominal pain and Upper abdominal burning sensation were statistically correlated with anxiety(r_s=0.561, P=0.010; r_s=0.611, P=0.004). Other clinical symptoms, such as post-prandial fullness, early satiation, post-prandial nausea and belching were not statistically correlated with anxiety (r_s=0.019, P=0.936; r_s=-0.064, P=0.790; r_s=0.372, P=0.106; r_s=0.321, P=0.168).Early satiation, upper abdominal pain , upper abdominal burning sensation, post-prandial nausea and belching were statistically correlated with depression(r_s=0.574, P=0.008; r_s=0.539, P=0.014; r_s=0.862, P=0.000; r_s=0.588, P=0.007; r_s=0.475, P=0.034). Only post-prandial fullness were not statistically correlated with depression(r_s=0.170, P=0.472).Conclusion: 1. The GET_1/2 in PDS patients delayed compared with healthy controls, and the GE₁₂₀ in PDS patients was obviously decreasing compared with healthy controls. These outcomes explained that patients with PDS has gastric dyskinesis.2. There is no correlation between the clinical symptoms in PDS patients and delayed gastric emptying. The outcomes explained that we can not evaluate the delayed gastric emptying with clinical symptoms in PDS patients.3. The total standard scores of SAS and SDS in PDS patients were obviously higher than that of healthy controls. It explains that PDS patients are easier to have psychologic obstacle compared with healthy people.4. The clinical symptoms is statistically correlated with anxiety and depression in PDS patients. So we can evaluate the extent of anxiety and depression by the severity of clinical symptoms in PDS patients.