Abstract
BackgroundThe pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use.MethodsPopulation based case control study based on the second Dutch National Survey of general practice (conducted in 2001). Cases (adults visiting their primary care physician (PCP) with upper GI symptoms) and controls (individuals not having any of these complaints), matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psycho)pharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis.ResultsData from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year). Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs) ranging from 1.37 to 3.45). Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90), including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or social co-morbidity was strongest associated with patients suffering from upper GI symptoms.ConclusionPatients with upper GI symptoms visit their PCP more frequently for problems of any organ system, including psychosocial problems. The relationship between upper GI symptoms and psychological problems is equivocal and may reflect increased health care demands in general.
Highlights
The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood
Matter of debate whether psychological factors are causal to functional dyspepsia or whether they are linked to increased health care demands in general
For 13,288 patients a control counterpart meeting all matching criteria could be selected, but 101 patients could not be matched on ethnicity
Summary
The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Organic disorders such as peptic ulcers and gastro-esophageal reflux disease only account for a minority of cases, and in most patients no cause is found These functional upper gastrointestinal symptoms, comprising dyspepsia, heartburn, epigastric discomfort and other abdominal complaints, are classified by ROME III criteria http://www.romecriteria.org. They are never life threatening, but represent major burdens on health care services [2,3] and quality of life [4,5]. Symptoms of neurosis, anxiety, hypochondria and depression were found to be more common in patients with unexplained gastrointestinal complaints when compared to controls It remains, matter of debate whether psychological factors are causal to functional dyspepsia or whether they are linked to increased health care demands in general (reviewed in [10])
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