Longitudinal and cross-sectional factors associated with long-term clinical course in functional dyspepsia: a 5-year follow-up study.
OBJECTIVE
Functional dyspepsia (FD) is a heterogeneous disorder with different pathophysiological mechanisms underlying the symptom pattern, but little is known about its clinical course. The aims of this study were to study the long-term evolution of symptoms in a clinical FD population and to identify factors associated with outcome.


METHODS
FD patients who previously underwent gastric function testing and filled out a dyspepsia symptom score (DSS) were contacted. At follow-up, patients indicated whether symptoms had worsened, remained unchanged, improved, or disappeared. Anxiety and depression, DSS, chronic fatigue symptoms, irritable bowel syndrome (IBS) comorbidity, and FD-specific quality of life (QoL) were assessed using mailed questionnaires. Bivariate associations between different patient characteristics and DSS and QoL at follow-up were tested; multiple linear regression was used to identify factors associated with the outcomes, both longitudinally and cross-sectionally.


RESULTS
Data were obtained from 253 patients (84.9% of the eligible and consenting population (n=298) and 53.2% of the original population (n=476)). The mean duration of follow-up was 68±2 months. Disappeared, improved, unchanged, and worsened symptoms were reported by 17.4, 38.3, 30.8, and 13.4% of the patients, respectively. Correlations between dyspepsia symptoms at initial visit and follow-up were small to moderate in magnitude. DSS at initial visit and trait anxiety were longitudinally associated with DSS at follow-up, with a trend found for weight loss; depression, chronic fatigue, and IBS at follow-up were cross-sectionally associated with DSS. Trait anxiety, weight loss, and DSS at initial visit were independently associated with QoL at follow-up; depression as well as DSS and chronic fatigue at follow-up were cross-sectionally associated.


CONCLUSIONS
About half of FD patients reported disappeared or improved symptoms after a mean follow-up of 5 years. Although stability of symptom levels is low to moderate, DSS at initial visit, trait anxiety, and initial weight loss are more strongly associated with outcome than gastric sensorimotor function.
Center for Gastroenterological Research, Department of Pathophysiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Sébastien
S
Kindt
Lukas
L
Van Oudenhove
Leen
L
Mispelon
Philip
P
Caenepeel
Joris
J
Arts
Jan
J
Tack
D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D018450:Disease Progression; D004415:Dyspepsia / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires