A validated tool for psychiatric comorbidity in the patients with functional dyspepsia.

TO THE EDITOR: We read the article by Tse et al.1 with interest, which showed the usefulness of 12-item General Health Questionnaire (GHQ-12) as a reliable screening tool for psychiatric disorders in the patients with functional dyspepsia. Interesting studies were recently published showed anxiety to be linked to functional dyspepsia and especially postprandial distress syndrome, but not epigastric pain syndrome.2,3 Also the systematic review about the efficacy of antianxiety or antidepressive agents on functional dyspepsia showed significant treatment benefit (pooled relative risk for sustained symptoms, 0.55; 95% confidence interval, 0.36-0.85), although funnel plots were asymmetric.4 Whether psychological factors are causally linked to functional dyspepsia is controversial. In a prospective cohort study, there was no difference in mental distress or fear of serious illness in functional versus organic gastointestinal diseases, and gastrointestinal symptom reduction related to alleviation of mental distress only reached statistical significance in patients with organic disease.5 Psychologic comorbidity might be related to underlying pathophysiology and influence the disease course, treatment modality and the health care utilization. Therefore, the evaluation of psychiatric comorbidity in patients with functional dyspepsia is important. The sensitivity and specificity of GHQ-12 were 63.0% and 92.9%, respectively when the cut-off of GHQ-12 was at ≥ 3 in this study. It suggests GHQ-12 as an acceptable screening tool to detect psychiatric disorders in the patients with functional dyspepsia. In many previous studies, the Symptom Checklist-90-Revised (SCL-90-R) has been selected for assessment of psychological status in the patients with functional dyspepsia.6,7 The SCL-90-R is another self-report questionnaire, a clinical symptom rating scale consisting of 90 questions. GHQ-12 is a simpler screening tool for general practitioner to define the psychological comorbidity in dyspepsia than the SCL-90-R. The proportion of the patients with previously diagnosed psychiatric disorders is slightly high (49.1%, 27 subjects) in this study. It would be related with measurement bias, such as recall bias, and exposure suspicion bias.

In conclusion, the testing of psychiatric comorbidity in functional dyspepsia might be worthy and GHQ-12 is a simple screening tool for evaluating the psychiatric profile in functional dyspepsia.