Relationship Between Anxiety and Gastric Sensorimotor Function in Functional Dyspepsia

Abstract

Objective: 

To investigate the relationship between anxiety and gastric sensorimotor function in patients with (hypersensitive) functional dyspepsia (FD). Comorbidity between FD and anxiety disorders is high. In FD, epigastric pain is associated with gastric hypersensitivity and neuroticism, a personality trait related to anxiety. Experimentally induced anxiety in healthy volunteers is associated with changes in sensorimotor function of the proximal stomach.

Methods: 

A total of 139 patients with FD (n = 102 women) underwent a barostat investigation to determine gastric compliance, meal accommodation, and thresholds for discomfort and pain. Anxiety was measured by the State-Trait Anxiety Inventory (STAI) scale (anxiety as a stable personality trait) and the STAI-State scale (momentary anxiety). The anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) was filled out to detect comorbid anxiety disorders.

Results: 

Hyper- and normosensitive patients had similar anxiety scores, but gastric compliance was significantly lower in hypersensitive patients (11.4 versus 32.8 ml/mm Hg; p < .001). In the whole patient group, no significant correlations between STAI scores and gastric sensorimotor function were found. In hypersensitive patients (n = 53, 43 women), state anxiety was negatively correlated with discomfort threshold (ρ = −.49; p = .001), pain threshold (ρ = −.48; p = .02), and gastric compliance (ρ = −.46; p = .002). These results were confirmed by multiple linear and logistic regression analyses.

Conclusion: 

In hypersensitive patients with FD, state anxiety is significantly and negatively correlated with discomfort threshold, pain threshold, and compliance. These results strengthen the hypothesis that anxiety is important in FD, especially in hypersensitive patients.

FD = functional dyspepsia; STAI = State-Trait Anxiety Inventory; HADS-A = Hospital Anxiety and Depression Scale-Anxiety subscale; FGID = functional gastrointestinal disorders; IBS = irritable bowel syndrome; CNS = central nervous system; MDP = minimal distending pressure; WMW test = Wilcoxon Mann-Whitney test; OR = odds ratio; ANS = autonomic nervous system; EMS = emotional motor system; PAG = periaqueductal grey; LC = locus coeruleus; HPA-axis = hypothalamo-pituitary-adrenal axis; ASI = anxiety sensitivity index; VSI = visceral sensitivity index.