Stress and psychologic and environmental factors in functional dyspepsia

Patients with functional dyspepsia are a heterogeneous group in whom psychologic and environmental factors and stress may contribute to their reports of symptoms. There is no unique personality profile in patients with functional dyspepsia. Although they have more anxiety, neuroticism, and depression than healthy subjects, their personality scores are no different than other patients with chronic abdominal pain syndromes, be they organic or functional in nature. Social factors including older age, male gender, unmarried status, and social incongruity are associated with increased frequency and severity of symptoms but not health-care-seeking behavior. Childhood role models with abdominal pain and the tendency to perceive negative life events as having great impact on their lives may affect the coping skills of these patients. Although patients with functional dyspepsia react to acute experimental stress with gastric physiologic changes similar to healthy subjects, their visceral pain thresholds are lower, which may contribute to their reports of symptoms. Despite common beliefs, most environmental factors such as smoking, alcohol, coffee, or use of nonsteroidal anti-inflammatory drugs are not important contributors to these patients' symptoms.