Long-lasting functional abdominal pain and duodenal ulcer are associated with stress, vulnerability and symptoms of psychological stress. A controlled study including healthy and patient controls

OBJECTIVE: To assess psychological differences between patients with functional abdominal pain (FUNC) and three separate control groups comprising patients with duodenal ulcer (DU), patients with gallstone or urinary tract stone (STONE), and healthy non-patient controls (HEALTH).

METHODS: All participants completed a self-administered questionnaire including questions about the relationship between symptoms and certain life events and psychometric tests for psychological distress (SCL-90) and vulnerability.

PARTICIPANTS: The FUNC group consisted of 27 hospital outpatients with long-lasting abdominal pain without demonstrable abnormalities (ten men and 17 women; mean age 38 years). The DU group consisted of 13 untreated outpatients with endoscopically proven duodenal ulcer (nine men and four women; mean age 42 years) while the STONE group comprised 13 untreated patients with gallstone (n = 7) or urinary calculi (n = 6) (six men and seven women; mean age 43 years). The HEALTH group consisted of five men and nine women (mean age 36 years).

RESULTS: Significantly more FUNC and DU patients compared with STONE patients experienced an association with at least one of 14 life events (74%, 77%, and 31%, respectively; p = 0.02). The FUNC and DU groups showed significantly higher scores on the depression subscale of the SCL-90 than the HEALTH group (p < 0.05), and on the anxiety subscale compared with the STONE and HEALTH groups (p < 0.05). The FUNC group scored significantly higher on the somatization subscale compared with all the other groups (p < 0.05). As an overall measure of psychological distress the Global Severity Index (GSI) was calculated. GSI was significantly higher in the FUNC group compared with the HEALTH group (p < 0.01) and tended to be higher in the DU group (p = 0.06). The FUNC and DU groups had significantly higher scores for vulnerability than the STONE and HEALTH groups (p < 0.05).

CONCLUSION: FUNC as well as DU outpatients seem to be more psychologically distressed and vulnerable than healthy controls or outpatients suffering from pain caused by stones in the gallbladder or urinary tract. As opposed to the STONE group, a high proportion of the FUNC and DU patients experienced that the onset or aggravation of abdominal pain was associated with certain life events. The similarities between the FUNC and DU group demonstrate that it is important to separate DU patients from other "organic" patients in such investigations.