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Relationship of functional dyspepsia with mental and physical stress

Article in Annals of Psychophysiology · October 2020

DOI: 10.29052/2412-3188.v7.i1.2020.25-30

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 Ann. psychophysiol.
ISSN 2412-3188 (Online) | 2410-1354 (Print)

Original Article
Relationship of functional dyspepsia with
mental and physical stress
Prem Shankar, Nikeeta Mandhan, Syed Muhammad Hussain Zaidi,
Muhammad Saad Choudhry & Akshay Kumar
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi-Pakistan.

Abstract
Background: Functional Dyspepsia is a globally prevalent illness, which although
not life-threatening, displays a strong influence on the quality of life. Functional
Citation: Shankar P, Mandhan N, Zaidi Dyspepsia is essentially chronic indigestion with no obvious physical cause. The
SMH, Choudhry MH & Kumar A. APP. objective of this study was to evaluate the frequency of functional dyspepsia and
2020; 7(1):25-30
its association with mental and physical stress. It could have the same significant
Corresponding Author Email: association as Irritable Bowel Syndrome has with stress.
mohdzaidi06@hotmail.com
Methodology: The data were collected from 221 students from 3 medical colleges
DOI: 10.29052/2412-3188.v7.i1.2020.25-30 of Karachi, Pakistan. Subjects were asked to fill out questionnaires concerning
demographics, lifestyle, and dietary habits. Rome III criteria was employed to
Received 16/02/2020
identify functional dyspepsia and sub-sections of the Sadaf Stress Scale (SSS) was
Accepted 02/09/2020 used to measure mental and physical stress.
Results: Out of the 221 subjects majority were females (67.4%) with a mean age of
Published 01/10/2020
21.47 years. 34.8% of subjects were diagnosed to have functional dyspepsia, out of
Copyright © The Author(s). 2020 This which around three quarters were females (68.5%). A moderate positive
is an open access article distributed under
the terms of the Creative Commons
correlation was observed between functional dyspepsia and mental and physical
Attribution 4.0 International License, stress.
which permits unrestricted use, Conclusion: It is concluded from the study results that there is a high frequency
distribution, and reproduction in any
medium, provided the original author and of functional dyspepsia among individuals with mental and physical stress or
source are credited. functional dyspepsia might cause the stress.

Keywords
Funding: The author(s) received no Functional Dyspepsia, Physical Stress, Mental Stress, Sadaf Stress Scale (SSS),
specific funding for this work.
Rome III Criteria.
Conflicts of Interests: The authors have
declared that no competing interests
exist.

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 ISSN 2412-3188 (Online) | 2410-1354 (Print)

Introduction improved cardiac health and their immune

system performs better against infections. In
Functional Dyspepsia is a common
addition, the progress after surgical
gastrointestinal disorder characterized by
procedures is also faster among individuals
chronic indigestion with no obvious physical
undergoing modest levels of stress9. It is said
cause1. It is usually referred to as a diagnosis
that physical stress is necessary for survival
of exclusion, which is made when all
but within the optimal range. As chronic
required investigations reveal no identifiable
physical stress weakens the immune system
etiology1. The condition is multifactorial and
and causes hypertension, anxiety,
therefore the etiological factors are diverse.
depression, fatigue, gastrointestinal, and
Globally, the prevalence lies in between
cardiac difficulties9. Mental stress affects
11.3% age ≥ 60 years compared to 9.9% with
parts of the brain involved in memories,
patients aged below 60, whereas in Asian
perception, thoughts and decision-making
regions the reported frequency is in between
processes. Moderate stressful events enable
8% to 23%2,3. The prevalence among medical
the brain to perform better. But continuous
students is unknown. Pathophysiological
academic stress and/or work stress involving
abnormalities accompanying the condition
increased cognitive functioning leads to
include accelerated gastric emptying,
psycho-somatic abnormalities which in turn
impaired gastric accommodation, gastric or
affects the gastrointestinal system and
duodenal hypersensitivity to distension, and
function9.
nutrients4.
The Rome III criteria is frequently employed
Literature confirms that stress affects the gut-
to establish the diagnosis of functional
brain communication, and induces pain,
dyspepsia and other gastrointestinal
bloating and other gastrointestinal
disorders which includes postprandial
problems . Stress either be physical or
4,5
fullness, early satiety, pain and burning
mental greatly influences the gut bacteria
sensation in epigastrium providing negative
which in turn alters the mood, emotion and
status on the required investigation
behaviour. Therefore, there is a direct impact
including an upper GI endoscopy, with the
of brain and gut activity over one another5. A
onset of at least six months and the duration
study indicated that personality patterns
of at least three months10. A stress evaluation
including depression, anxiety and stress
concept and specific stress evaluating tool for
altered the individual’s gastrointestinal tract
the local Pakistani population, Sadaf Stress
activity6. Significant exposure to stress
Scale (SSS) has been developed and widely
increases the risk of gastrointestinal tract
used for the evaluation of seven different
diseases7. It is proposed that the mood
types of stresses specifically among the
alterations are associated with Irritable
Pakistani people11. The scale is divided into
Bowel Syndrome (IBS) and functional
seven subcategories comprising of 114 items
dyspepsia6. Moreover, the young population
entitled physical, mental, psychosocial,
is more likely to develop such gastric
traumatic, nutritional, emotional, and
conditions as the current educational model
chemical stress. Preliminary data collected
imposes inadvertently opposing effects on
showed high variability and predictability.
the mental health of the learners and due to
Cronbach reality test obtained a value
high frequency of depression and anxiety,
between 0.945 and 0.916. Revises SSS use 95
they have increased susceptibility for
items, employing Spearmen brown
disorders such as functional dyspepsia8.
coefficient analysis with significant
coefficient levels9.
Although it is believed that a little stress
makes a positive impact and always makes
Although dyspepsia is not a life-threatening
the immune system stronger. Individuals
entity, it certainly has dreadful effects on the
with moderate physical stress usually have
patient’s quality of life12. It is one of the

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diseases having a significant medical, response scores were calculated and

economic, social, and political impact on the categorized into the level of stress i.e.,
society. In Pakistan, information about Normal, Mild, Moderate, and Severe.
epidemiology and risk factors for functional
dyspepsia and related disorders specifically Data analysis was performed using the SPSS
among university or medical students is version 22.0. The frequency was calculated
scarce. The objective of the present study was
for functional dyspepsia. Correlation with
to determine the frequency of functional
stress variables and gender differences were
dyspepsia and its association with mental
and physical stress among medical students determined using Spearman’s rho and Mann
of Pakistan. Whitney U test, respectively. We also
calculated the Mean rank for functional
dyspepsia and physical and mental stress
Methodology
with the Kruskal Wallis H test. The p-values
A survey based study was conducted at 3
≤ 0.05 was considered statistically significant.
medical colleges (Karachi medical & dental
college, Sindh Medical College, and Dow Result
Medical College) of Karachi, Pakistan. We The data from 221 medical students was
approached a total number of 240 medical analyzed, of them, the majority were females
students out of which 221 volunteered to (67.4%). The mean age of the sample
participate in the study. Prior Informed population was 21.47 years. A total of 34.8%
consent was obtained from all subjects. Study of subjects were diagnosed to have functional
participants were asked to fill a structured dyspepsia, out of which around three
questionnaire comprising of demographics, quarters were females (68.5%). A strong
lifestyle, and food intake information. Rome positive correlation was observed among
III criteria were used to identify functional functional dyspepsia and both mental
dyspepsia10 and to measure the physical and (r=0.411; p=0.001) and physical stress
mental stress, sub-section of Sadaf stress scale (r=0.475; p=0.001) (Table 3). The difference
(SSS) was used11, this Likert scale consists of in symptoms of dyspepsia was statistically
5-point scale ranging 1 to 5 i.e., Never, Rarely, insignificant between both genders (p-
Sometimes, very often, always and the value=0.69).

Table 1: Demonstrates the gender-based differences in the relative frequency of

functional dyspepsia in the study population

Variable Gender n(%) p-value

Male (n=72) Female (n=149)
Frequency of dyspepsia 25(32.4) 52(68.5) 0.69
*p-value<0.05 is considered significant

As per the results obtained from Rome III Criteria, functional dyspepsia was more frequent among
the 3rd year (32.4%) and 5th year (22%) medical students. Concerning physical and mental stress,
the results were comparable in all years but it was observed that the 1st year students had relatively
maximum physical and mental stress.

Table 2: Demonstrates the yearly distribution of the sample population with reference to the
frequency of dyspepsia and stress (mental & physical)

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Rome III Criteria (n) SSS

Years Total Heartburn Epigastric Abdominal Early Dyspepsia (Mean Ranks)
n(%) Pain Fullness Satiety n(%) Mental Physical
Stress Stress
1st 31(14) 12 13 13 13 13(16.9) 136 140
2nd 26(11.8) 11 11 11 11 11(14.3) 111.5 130.8
3rd 75(33.9) 25 24 25 25 25(32.4) 106.6 98.8
4th 31(14) 11 11 12 11 11(14.3) 118.5 125.1
5th 58(26.2) 17 17 17 17 17(22) 97.6 93.3

Table 3 shows the correlation of physical and mental stress with functional dyspepsia, it was found
to be significantly correlating with mental and physical stress among the studied population (p-
value=0.001).

Table 3: Correlation of functional dyspepsia with mental and physical stress.

Variables Co-relation coefficient p-value

Dyspepsia Mental Stress 0.411 0.001*
Physical Stress 0.475 0.001*
*p-value < 0.05 is considered significant

Discussion and those involved in cognitive activities,

Stress was determined as a positive risk specifically students20,21.
factor for the development of functional
dyspepsia among the local medical students, Other than stress, several other lifestyle
which is also supported by several previous factors including tobacco smoking, alcohol
studies13-16. The regular diagnostic rate of consumption and junk food consumption,
functional dyspepsia among the Pakistani etc. increase the likelihood of development of
population ranges between 11 to 15%, as functional dyspepsia2,22,23. Although alcohol
reported by local physicians17. In our study consumption is yet not common locally but
population, the frequency of functional smoking and junk food consumption remain
dyspepsia was found to be 34.8%. In at the forefront of doing the damage to the
comparison, an Indian study reported a normal gut activity in addition to stress.
lesser frequency than our estimated figure Increased consumption of junk and fried food
despite having similar demographics and was found among the enrolled study
lifestyle factors2. This inflated rate might be participants with a high frequency of
due to higher (moderate and severe) physical functional dyspepsia.
and mental stress in our study population.
People suffering from functional dyspepsia
In support several studies confirmed the bi- exhibit a greater rate of absence from work,
directionality of the brain-gut pathway i.e. reduction in productivity, and higher
stress has detrimental effects on the quality of dependence on healthcare resources
life of an individual, influencing mood, compared to general population24. For
emotions and gut activity and hence leads to students, the symptoms associated with
functional gastrointestinal disorders18,19. A functional dyspepsia may cause a significant
higher frequency of functional dyspepsia is impact on the study habits, concentration
observed among individuals enduring high span, class attendance, and test performance.
occupational stress, intense physical activity

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To the best of our knowledge, none of the Pathogenesis of functional

Pakistani universities currently have a gastrointestinal disorders – an
students’ health counselling program interdisciplinary Perspective. Praxis (Bern
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and psychological health. Campus-wide 4. Camilleri M, Functional Dyspepsia and
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management of stress-induced psychological Stress Effects on the Body. Available at:
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reduction in the overall prevalence of these 6. Huerta-Franco M-R, Vargas-Luna M,
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limitations of the study was the Ordaz M, Flores-Hernandez C. Effects of
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Endoscopy, which should have been done as 2013; 4:108–118.
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Acknowledgment Spiller RC, Talley NJ, Thompson WG,
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