It has been demonstrated that patients with functional dyspepsia have experiences social life stress events, and accompanied by psychological disorders, mainly manifested as depression and anxiety. Mental factors can lead to excessive gastrointestinal consensual reaction, and result in different brain-gut axis disturbance, and then cause the gastrointestinal sensorimotor abnormality and endocrine chan
ges.
Objective
To observe the effect of antidepressant treatment on the changes of water load and serum cortisol in patients with functional dyspepsia, and analyze the therapeutic mechanism.
Design
A comparative observation.
Setting
The First Affiliated Hospital o Zhengzhou University.
Participants
Forty-five patients with functional dyspepsia accompanied by depression were selected from the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University from July 2004 to July 2006, and they were 25–65 years of age, and their disease courses ranged 1–10 years. They were all accorded with the diagnostic standards for Rome II functional dyspepsia functional dyspepsia. As the patients' will, they were divided into treatment group (n =30, 12 males and 18 females) and control group (n =15, 6 males and 9 females), and there were no significant differences in the data between the two groups (P > 0.05). The programs were discussed and agreed by the committee of medical ethics of the First Affiliated Hospital of Zhengzhou University. Informed contents were obtained from all the patients.
Methods
In the treatment group, the patients were treated with venlafaxine sustained release capsule (75 mg per day), and those with sleep disorder were added by benzodiazepines (alprazolam). In the control group, the patients were given routine treatments of antacid, prokinetics, etc. Before and after 8-week treatment, the following examinations were performed: ![]()
geURL/B8JBT-4PCRRJY-D-2/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> The gastrointestinal symptoms were assessed according to the symptoms; ![]()
geURL/B8JBT-4PCRRJY-D-4/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> The severity of depression was evaluated with Hamilton depression scale (HAMD); ![]()
geURL/B8JBT-4PCRRJY-D-6/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=13 width=13> The relaxation of proximal stomach was observed using water load test; ![]()
geURL/B8JBT-4PCRRJY-D-8/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> The serum level of cortisol was detected.
Main outcome measures
![]()
geURL/B8JBT-4PCRRJY-D-2/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> Symptom score; ![]()
geURL/B8JBT-4PCRRJY-D-4/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> HAMD score; ![]()
geURL/B8JBT-4PCRRJY-D-6/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=13 width=13> Water load amount; ![]()
geURL/B8JBT-4PCRRJY-D-8/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> Serum level of cortisol.
Results
All the 45 patients were involved in the analysis of results. ![]()
geURL/B8JBT-4PCRRJY-D-2/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> Symptom score: The scores of gastrointestinal symptoms were decreased as compared with those before treatment in both the treatment group and control group (P < 0.05). ![]()
geURL/B8JBT-4PCRRJY-D-4/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> HAMD scores: The scores of HAMD were decreased as compared with those before treatment in both the treatment group and control group (P < 0.05). ![]()
geURL/B8JBT-4PCRRJY-D-6/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=13 width=13> Water load amount: The total effective rate was significantly higher in the treatment group than the control group (P < 0.05). ![]()
geURL/B8JBT-4PCRRJY-D-8/0?wchp=dGLbVlb-zSkWb"" alt=""Image"" align=""absbottom"" border=""0"" height=12 width=12> The serum levels of cortisol after treatment were significantly lower than those before treatment in the patients with severe gastrointestinal symptoms in the treatment group and control group (P < 0.05).
Conclusion
Antidepressants can normalize the cortisol level of patients with functional dyspepsia, and then decrease gastric sensitivity and ameliorates the receptive relaxation of proximal stomach, also increase the water load amount correspondingly, and finally control the gastrointestinal symptoms of functional dyspepsia.
