Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention
Journal Title: Journal of Clinical and Diagnostic Research - Year 2017, Vol 11, Issue 8
Abstract
Introduction: The association between psychological factors and non-ulcer dyspepsia remains controversial. Aim: To determine the prevalence of Helicobacter pylori (HP) and Stress/Anxiety/Depression (SAD) in patients with Functional Dyspepsia (FD) and assess the outcome at three months after appropriate intervention. Materials and Methods: This prospective non-randomized interventional study was conducted on 120 patients with FD. Initial workup included upper gastrointestinal endoscopy to confirm HP infection with either of two tests, the urease test or histopathology. Patient Health Questionnaire-9 scale (PHQ-9) was used to assess depression, General Anxiety Disorder-7 scale (GAD-7) for anxiety and Perceived Stress Scale (PSS) for stress. Patients were considered positive when they had significant scores on one or more of the questionnaires (SAD+). The subjects were then classified into four groups: Group A (positive for HP and SAD, n=35), Group B (positive for HP and negative for SAD, n=31), Group C (negative for HP and positive for SAD, n=33) and Group D (negative for HP and SAD, n=21). The groups were then treated as follows: Group A: HP eradication plus psychiatric intervention, Group B: HP eradication alone, Group C: psychiatric intervention alone and Group D: proton pump inhibitors. Modified Glasgow Dyspepsia Symptom Score (Mod. GDSS) was used to assess the severity of dyspepsia at baseline and to monitor the change in score over three months. Statistical analysis was done using the Statistical Package for the Social Sciences version 16.0. Non-parametric data like proportions of response in different groups to treatment was analysed using the Chi square test and quantitative data using ANOVA. Gender wise distribution and response to treatment was calculated using the z-test and unpaired t-test. Results: Overall 120 patients were recruited across four groups. A 55% of the subjects were positive for HP and 56.7% for SAD and 29.2% for both. In all three groups with psychiatric comorbidity, females exceeded males in a proportion of 3:1. Mod. GDSS was not significantly different at baseline between HP+ and HP- patients (p=0.1278) except when HP positivity was also associated with SAD (p<0.001), whereas SAD positivity alone significantly increased the baseline Mod. GDSS (p=0.006). Mod. GDSS declined in all four groups at three months. When a fall of four or more was considered as an indicator of significant response to intervention, it was seen that overall 74.2% responded to intervention with the best response in Group B and the poorest was in Group C. Conclusion: There is a significant prevalence of HP and SAD in FD. Appropriate intervention is beneficial except in those who are HP negative and SAD positive. This latter group requires further investigation and or drug intervention for SAD.
Authors and Affiliations
Kirti Katherine Kabeer, Nilakanthan Ananthakrishnan, Chetan Anand, Sivaprakash Balasundaram
Keywords
Related Articles
- EP ID EP361492
- DOI 10.7860/JCDR/2017/26745.10486
- Views 53
- Downloads 0
Successful Completion of Pregnancy on Maintenance Haemodialysis: Experience from a Resource-Short Model
Data pertaining to pregnancy completion on haemodialysis in Chronic Kidney Disease (CKD) patients from the developing world are scarce. We report three successfully completed pregnancies on Maintenance Haemodialysis (MHD...
Impact of a Structured Tuberculosis Awareness Strategy on the Knowledge and Behaviour of the Families in a Slum Area in Chhattisgarh, India
Introduction: Of different methods of disease prevention, health education and awareness programmes can empower people regarding several aspects of disease management and thereby enabling them in accessing the right trea...
Anatomical Configuration of Roots and Canal Morphology of Primary Mandibular First Molars: A CBCT Study
Introduction: Root and canal morphology plays a vital role in improving the success rate of the endodontic treatment in primary teeth. The morphology of root canals in primary teeth leads to complications during pulp the...
Factors that Predict the Response to Treatment in Carpal Tunnel Syndrome
ABSTRACT Introduction: Carpal tunnel release is a very common surgery and most people do very well after the surgery but some pre-existing conditions can have a negative impact on the outcome of the surgery. Our current...
Head Rotation Manoeuvre during Flexible Bronchoscopy
Letter to Editor