Psychological Factors May Play an Important Role in Pediatric Functional Dyspepsia

Background: Dyspepsia is a common clinical condition associated with a complex of upper abdominal symptoms including: upper centered discomfort or pain, feeling of abdominal fullness, early satiety, abdominal distention and bloating, belching , 5.2 and nausea. Stress plays an important role in emergence of FD symptoms and sympathoadrenal imbalance. The most common comorbid psychological disorders seen in FGIDs include: anxiety disorders, mood disorders and somatoform disorders.

The aim: To investigate psychological disorders and sympathoadrenal imbalance (SB) condition in children with FD.

Methods: Target group: 80 schoolchildren aged 6-12 with FD. The study involved psychological testing and of SB assays (ELISA: cortisol, norepinephrine, insulin, adrenocorticotropic hormone (ACTH), glucose levels).

Results: 38.8±1.2% patients (31/80) demonstrated clinical performance of isolated abdominal pain syndrome and 61.1±2.3% children (49/80) had symptoms of post-prandial distress syndrome. Psychological testing revealed high levels of anxiety – 38.8±1.5% (31/80), depression – 41.3±2.3% (33/80), sleep disorders – 85.0±1.1% (68/80) and cognitive dysfunction – 46.3±1.4% (37/80). The functional status of the sympathoadrenal system was as follows: 24-hour urine norepinephrine ME– 111.4mg/day [QR: 108,4; 115,3] (reference values (RV): 20-90mg/day); plasma norepinephrine ME – 14.3pg/mL [QR: 13,1; 17,5] (RV: 3-10pg/mL), plasma cortisol ME – 597.6nmol/L [QR: 578,1; 608,3] (RV: 85-580nmol/L), ACTH ME – 15.8pg/ml [QR: 13,9; 17,8] (RV: 9-52pg/mL), glucose ME – 5.2mmol/ml [QR: 4,9; 5,5] (RV: 3.3-5.5mmol/ml), insulin ME – 8.2μIU/ml [QR: 6,4; 12,5] (RV: 5-20μIU/ml).

Conclusions: FD in children is associated with imbalance in sympathoadrenal system as well as with such psychological disorders as anxiety, depression, sleep disorders, and cognitive dysfunction.

Key words: functional dyspepsia, stress, children, sympathoadrenal balance, psychological disorders.