| Functional dyspepsia (Functional Dyspepsia, FD) refers to a group of clinical syndrome which has the symptoms caused by the dysfunction of stomach and duodenum and by examination to exclude organic diseases caused by these symptoms. The main symptoms include one or more of abdominal pain, epigastric burning sensation, fullness after the meal, and early satiety, which can co-exist abdominal distention, belching, loss of appetite, nausea, vomiting and so on. Those symptoms behave chronic course with Sustained or recurrent. The course of FD is more than six months and the symptoms are continued existence nearly three months. The pathogenesis of FD has not yet been clear, the spirit and psychological factors has been considered closely related to the pathogenesis of FD. Some patients of FD with psychological barriers, especially depression and anxiety symptoms, which have caused an increasing clinical concern. This subject is based on the Rome III diagnostic criteria for FD and " the Classification and diagnostic criteria of mental disorders in China ( edition three)" (CCMD3) diagnostic criteria for depression ,to observe the changes of the patients of FD with depression before and after antidepressant treatment, in clinical symptoms, HAMD score, proximal gastric accommodation in diastolic function and thyroid hormone. The aim is to further explore the pathogenesis of FD and evaluation of the efficacy of antidepressant treatment. MethodsWe take the patients of FD with depression as the observation target, according to Rome III and CCMD3 standards, and randomly divide the patients into two groups, including study group 30 cases and contrast group 22 cases. The cases of study group received antidepressant drugs, psychological adjustment treatment, and routine treatment .the cases of control group were given to conventional treatment such as inhibiting gastric acid secretion, motivation and digestant and so on. Both groups were treated for 8 weeks. Both groups received the evaluation of each gastrointestinal symptom scores, whole symptoms scores, the measurement of HAMD score and the water load, and the detection of thyroid hormone before and after treatment. These results of the two different treatment methods received statistical analysis.All data was processed by SPSS13.0 statistical package. All statistics analysis were performed with Independent-Sample T Test. P values were computered, with statistical significance indicated by a value of P<0.05.Results1. Result of each gastrointestinal symptom score: The study group was significant improvement after treatment and each symptom scores decreased significantly. Both P<0.05. The control group also improved after treatment, but the symptoms scores did not change significantly with P>0.05. After treatment, the study group compared with the control group in gastrointestinal symptom improvement was significantly different with P all <0.05.2. Result of whole symptom score: The study group which recieved antidepressant treatment was significant improvement in symptom, and was significant reduction in symptom score with t=7.257, (P <0.05). The symptom of control group also improved but the symptom score did not change obviously, t = 1.987, (P> 0.05) .3. Result of HAMD Scale score: After the treatment of 8 weeks , the study group compared with the control group, HAMD Scale score decreased significantly than that before treatment, t = -10.975, (P<0.05), there was a significant difference.4. Result of water load test: two groups were no significant difference before treatment in water load (P> 0.05). After treatment, the study group compared with the control group, the difference in water load was significant, t = 3.769, (P <0.05).5. Results of thyroid hormone measurement: Before treatment, there were 22 cases of Study group whose Detection value of thyroid hormone were within the normal range, and 8 cases was abnormal. After antidepressant treatment, six cases were back to normal. Before treatment, 16 cases of control group were within the normal range with six cases abnormal. By conventional treatment, no one case returned to normal. Both statistical analysis: FT3: t = 3.945, FH4: t = 3.073, TSH: t =-5.380, P all <0.05. The difference of the efficacy of two groups was significant.Conclusions1. Depression was likely prevalent in patients of FD. The conventional treatment is poor to patients of FD associated with depression. But the effect of antidepressant treatment is significant. What is more, the improvement of gastrointestinal symptom is relevance to the decline of HAMD scores. These results tell us psychological factors play an important role in the pathogenesis of FD .2.The HAMD score gradually increased with the decline in the volume of Water load, which suggest that psychological barriers is an important factor that affect the volume of water load. Water load test with a fast, safe and simple features, can be used as examination to detection the gastric sensitivity and receptivity diastolic function of FD patients.3.Part of the FD patients with depression have the dysfunction of hypothalamus -pituitary - thyroid (HPT) axis, which can be manifested as clinical symptoms of depression, subclinical hypothyroidism, levels of FT3, FT4 lower and level of TSH higher. Even more, the higher the value of HAMD score the greater of the likelihood existence of subclinical hypothyroidism .In other word, the hypothyroidism are related to the severity of depression.4. The FD patients whose HAMD score value are higher that severe depression, are abnormal in blood levels of thyroid hormones. That suggest these patients exist neuroendocrine disorders. By improving mood disorder and regulating endocrine disorders, antidepressants promote thyroid hormone levels to back normal and increase water load volume, further improve the gastric diastolic receptivity function and alleviate dyspepsia symptoms. The results showed that the treatment of antidepressant treatment is an effective way to FD. It is worth further promotion in clinical use. |
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