Genetic and psychological determinants of dyspepsia and implications for treatment

Dyspepsia is a very common condition in the population with a prevalence ranging from 25 to 40%. It refers to a complex of symptoms believed arising in the upper gastrointestinal tract and includes heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Dyspepsia is an important and costly health problem due to high medical costs for diagnostic investigations and for drug treatment and its impact on absenteeism from work. The aetiology of dyspepsia is very complex and still poorly understood. Several causal factors are suggested: Helicobacter pylori infection, excessive gastric acid, delayed gastric emptying, visceral hypersensitivity, psychosocial morbidity, use of NSAID's and post-infective mucosal damage. Recently also genetic predisposition has been suggested as a relevant factor in the genesis of dyspeptic complaints. In this thesis we report our studies on the influence of psychological state, major life events, coping style and genetic factors on dyspeptic symptom severity and the extend to which these factors affect the outcome of acid inhibiting treatment in primary care patients with dyspepsia