Abstract
It is important for physicians to consider psychological factors whenever evaluating patients with functional dyspepsia (FD). Psychosocial factors associated with either the onset or aggravation of FD include negative emotion such as anxiety or depression, stress, personality, coping strategies, and lifestyles. Explanation for symptoms, reassurance, modification of lifestyles, consultation on risk factors, hypnosis, and cognitive behavioral therapy may help treat these patients. A combination of psychotherapy and muscular relaxation helps reduce the onset of pain and relieve symptoms. In FD patients with mild symptoms, reassurance and lifestyle adjustments are often sufficient. For those with more severe or persistent symptoms, it is desirable to use proton pump inhibitors (PPIs), prokinetics, and psychotropic agents. Tricyclic antidepressants can be used for refractory symptoms of FD, especially in epigastric pain syndrome. In addition, mirtazapine is recommended for FD patents with weight loss. Drug-drug interaction needs to be evaluated when considering the combined use of cimetidine and nefazodone/tricyclic antidepressants in FD patients, because of a risk for cumulative drug toxicity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Jones RH, Lydeard SE, Hobbs FOR, Kenure JE, et al. Dyspepsia in England and Scotland. Gut. 1990;31:401–5.
Thompson WG, Heaton KW. Functional bowel disorders in apparently health people. Gastroenterology. 1980;79:283–8.
Camilleri M, Thompson DG, Malagelada JR. Functional dyspepsia. J Clin Gastroenterol. 1986;8:424–9.
Colgan S, Creed F, Klass H. Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain. Psychol Med. 1988;18:887–92.
Harvey RF, Shah SY, Read AE. Organic and functional disorders in 200 gastroenterology outpatients. Lancet. 1983;1:632–4.
Kane FJ Jr, Strohlein J, Harper RG. Nonulcer dyspepsia associated with psychiatric disorder. South Med J. 1993;86:641–6.
Morris C. Invited review: non-ulcer dyspepsia. J Psychosom Res. 1991;35:129–40.
Yamawaki H, Futagami S, Wakabayashi M, et al. Management of functional dyspepsia: state of the art and emerging therapies. Ther Adv Chronic Dis. 2018;9:23–32.
Thompson WG. Nonulcer dyspepsia. Can Med Assoc J. 1984;130:565–9.
Haug TT, Svebak S, Wilhelmsen I, et al. Psychological factors and somatic symptoms in functional dyspepsia: a comparison with duodenal ulcer and healthy controls. J Psychosom Res. 1994;38:281–91.
Kellner R. Psychosomatic syndromes and somatic symptoms. Washington, DC: Am Psychiatric Press; 1991. p. 97–110.
Piacentino D, Cantarini R, Alfonsi M, et al. Psychopathological features of irritable bowel syndrome patients with and without functional dyspepsia: a cross sectional study. BMC Gastroenterol. 2011;11:94.
Talley NJ. Functional dyspepsia: new insights into pathogenesis and therapy. Korean J Intern Med. 2016;31:444–56.
Colin-Jones DG. Management of dyspepsia: report of a working party. Lancet. 1988;1:576–9.
Cheng C, Hui W, Lam S. Coping style of individuals with functional dyspepsia. Psychosom Med. 1999;61:789–95.
Langeluddecke P, Goulston K, Tennant C. Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease. J Psychosom Res. 1990;34:215–22.
Magni G, Di Mario F, Bernasconi G, et al. DSM-III diagnoses associated with dyspepsia of unknown cause. Am J Psychiatry. 1987;144:1222–3.
Magni G, Dimario F, Borgherini G. Personality and duodenal ulcer response to antisecretory treatment. Digestion. 1987;38:152–5.
Wilson KCM, Whiteoak R, Dewey M, et al. Aspects of personality of soldiers presenting to an endoscopy clinic. J Psychosom Res. 1989;33:85–91.
Roberts DM. The psychiatric basis of dyspepsia in the absence of organic disease. J R Army Med Corps. 1978;124:13–8.
Talley NJ, Fung LH, Gilligan IJ, et al. Association of anxiety, neuroticism and depression with dyspepsia of unknown cause. Gastroenterology. 1986;90:886–92.
Bennett E, Baeurepaire J, Langeluddecke P, et al. Life stress and non-ulcer dyspepsia: a case-control study. J Psychosom Res. 1991;35:579–90.
Hill O, Blendis L. Physical and psychological evaluation of non-organic abdominal pain. Gut. 1967;8:221–9.
Gomez J, Dally P. Psychologically mediated abdominal pain in surgical and medical outpatient clinics. Br Med J. 1977;1:1451–3.
Creed F, Guthrie E. Psychological factors in the irritable bowel syndrome. Gut. 1987;28:1307–18.
McIntosh JH, Nasiry RW, Frydmann M, et al. The personality pattern of patients with chronic peptic ulcer. Scand J Gastroenterol. 1983;18:945–50.
Creed F, Craig T, Farmer R. Functional abdominal pain, psychiatric illness, and life events. Gut. 1988;29:235–42.
Craig TKJ, Brown GW. Goal frustration and life events in the etiology of painful gastrointestinal disorder. J Psychom Res. 1984;28:411–21.
Jorgensen LS, Bonlokke L, Christensen NJ. Life strain, life events and autonomic response to a psychological stressor in patients with chronic upper abdominal pain. Scand J Gastroenterol. 1986;21:605–13.
Hui WM, Shiu LP, Lan SK. The perception of life events and daily stress in nonulcer dyspepsia. Am J Gastroenterol. 1991;86:292–6.
Koh KB, Lee SI, Lee JM. A comparison of stress perception and depression between gastric cancer and gastritis patients. Korean J Psychosom Med. 1994;2:88–97.
Oh S, Koh KB. The comparison of perceived stress and coping strategies in patients with gastric ulcer and those with chronic gastritis. Korean J Psychosom Med. 2000;8:11–9.
Jonsson BH, Theorell T, Gotthard R. Symptoms and personality in patients with chronic functional dyspepsia. J Psychosom Res. 1995;39:93–102.
Talley NJ, Piper DW. A prospective study of social factors and major life event stress in patients with dyspepsia of unknown cause. Scand J Gastroenterol. 1987;22:268–72.
Alexander F. Psychosomatic medicine: its principles and applications. New York: WW Norton; 1950.
Talley NJ, Phillips SF, Bruce B, et al. Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome. Gastroenterology. 1990;99:327–33.
Sifneos PE. The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom. 1973;22:255–62.
Talley NJ, Ellard K, Jones M, et al. Suppression of emotions in essential dyspepsia and chronic ulcer: a case-control study. Scand J Gastroenterol. 1988;23:337–40.
Adami HO, Bergstrom R, Nyren O, et al. Is duodenal ulcer really a psychosomatic disease? Scand J Gastroenterol. 1987;22:889–96.
Yates WR. Gastrointestinal disorders. In: Sadock BJ, Sadock VA, editors. Comprehensive textbook of psychiatry. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Wilhelmsen I, Haug TT, Ursin H, et al. Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer: significance of somatization. Dig Dis Sci. 1995;40:1105–11.
Johnsen R, Jacobsen BK, Forde OH. Associations between symptoms of irritable colon and psychological and social conditions and lifestyle. Br Med J. 1986;292:1633–5.
Mechanic D. The concept of illness behaviour. J Chronic Dis. 1961;15:189–94.
Lydeard S, Jones R. Factors affecting the decision to consult with dyspepsia: comparison of consulters and nonconsulters. J R Coll Gen Pract. 1989;39:495–8.
Christensen MF, Mortensen O. Long-term prognosis in children with recurrent abdominal pain. Arch Dis Child. 1975;50:110–4.
Talley NJ, Jones M, Piper DW. Psychosocial and childhood factors in essential dyspepsia: a case-control study. Scand J Gastroenterol. 1988;23:341–6.
Barsky AJ, Klerman GL. Overviews: hypochondriasis, bodily complaints and somatic styles. Am J Psychiatry. 1983;140:273–83.
Kellner R. Hypochondriasis and somatization. JAMA. 1987;258:2718–22.
MacDonald AJ, Bouchier IAD. Non-organic gastrointestinal illness: a medical and psychiatric study. Br J Psychiatry. 1980;136:276–83.
Vanheel H, Tack J. Therapeutic options for functional dyspepsia. Dig Dis. 2014;32:230–4.
Lacy BE, Talley NJ, Locke GR 3rd, et al. Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther. 2012;36:3–15.
Barbara L, Camilleri M, Corinaldes R, et al. Definition and investigation of dyspepsia. Dig Dis Sci. 1989;34:1272–6.
Lennard-Jones JE. Functional gastrointestinal disorders. N Engl J Med. 1983;308:431–5.
Jones R. What happens to patients with non-ulcer dyspepsia after endoscopy? Practitioner. 1988;232:75–8.
Warwick HMC, Salkovskis PM. Reassurance. Br Med J. 1985;290:1028.
Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut. 1987;28:423–5.
Bennett P, Wilknson S. A comparison of psychological and medical treatment of the irritable bowel syndrome. Br J Clin Psychol. 1985;24:215–6.
Bates S, Sjoden PO, Nyren O. Behavioral treatment of non-ulcer dyspepsia. Scand J Behav Ther. 1988;17:155–65.
Klimes I, Mayou RA, Pearce MJ, et al. Psychological treatment for atypical noncardiac chest pain: a controlled evaluation. Psychol Med. 1990;20:605–11.
Salkovskis PM, Warwick HM. Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behav Res Ther. 1986;24:597–602.
Sanders MR, Rebgetz M, Morrison M, et al. Cognitive-behavioral treatment of recurrent non-specific abdominal pain in children. J Consult Clin Psychol. 1989;57:294–300.
Koh KB. Stress and psychosomatic symptoms. 2nd ed. Seoul: Ilchokak; 2011. p. 426–38.
Baume P, Tracey M, Dawson L. Efficacy of two minor tranquilizers in relieving symptoms of functional gastrointestinal distress. Aust NZ J Med. 1975;5:503–6.
Talley NJ, Phillips SF. Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med. 1988;108:865–79.
Holtman G, Talley NJ. Functional dyspepsia: current treatment recommendations. Drugs. 1993;45:918–30.
Beliles K, Stoudemire A. Psychopharmacologic treatment of depression in the medically ill. Psychosomatics. 1998;39:S2–S19.
Beliles KE, Stoudemire A. Psychopharmacokinetics: clinical applications in medical illnesses. In: Stoudemire A, Fogel BS, editors. Medical psychiatric practice, vol. 3. Washington, DC: American Psychiatric Press, Inc; 1995. p. 1–77.
Gregory DW, Davies GT, Evans KT. Natural history of patients with X-ray- negative dyspepsia in general practice. Br Med J. 1972;4:519–20.
Spiro HM. Moynihan’s disease? the diagnosis of duodenal ulcer. N Engl J Med. 1974;291:567–9.
Bonnevie O. Outcome of non-ulcer disease. Scand J Gastroenterol. 1982;17(Suppl 79):135–8.
Sloth H, Jorgensen LG. Predictors for the course of chronic non-organic upper abdominal pain. Scand J Gastroenterol. 1989;24:440–4.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Koh, K.B. (2018). Approach to Functional Dyspepsia. In: Stress and Somatic Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-030-02783-4_22
Download citation
DOI: https://doi.org/10.1007/978-3-030-02783-4_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-02782-7
Online ISBN: 978-3-030-02783-4
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)