Modifiable and Non-modifiable Risk Factors Association with Functional Dyspepsia

Objective: To determine the frequency of modifiable and non-modifiable risk factors of functional dyspepsia in our population. Materials and Methods: This cross-sectional study has been conducted department of gastroenterology of Isra University Hospital from February 2019 to January 2020. All the patients of all age groups presented with functional dyspepsia and either of gender were included in the study. Patients were interviewed regarding modifiable and nonmodifiable risk factors like age, gender, smoking, body mass index, alcohol consumption and stress. All the data was gathered via study proforma. Results: Total 200 cases of functional dyspepsia were studied for modifiable and non-modifiable risk factors. Mean age of the cases was 49.45+6.33 years. Most of the cases were more than 40 years of the age. Males were 64.5% and females were 40.5%. According to the ethnicity Sindhi and Punjabi were commonest as 40.5% and 35.0% respectively. Inadequate physical activity and smoking habits were highly prevalent as 57.5% and 36.0% respectively. Conclusion: As per study conclusion age more than thirty years, male gender, ethnicity of Sindhi and Punjabi, smoking and inadequate physical activity were observed to be highly prevalent modifiable and non-modifiable risk factor of the functional dyspepsia. Original Research Article Maheshwari et al.; JPRI, 33(47A): 489-493, 2021; Article no.JPRI.73250 490


INTRODUCTION
Functional dyspepsia is the model useful gastrointestinal problem. It is a clinical condition including persistent indications emerging from the gastroduodenal tract [1,2]. As per the Rome criteria, in view of expert agreement, the prototypical indications are inconvenient repetitive postprandial fullness, incapability to complete a typical sized food (early satiety), pain of epigastrium or epigastrium burning in the setting of an ordinary upper endoscopy [2]. Though, several patients having functional dyspepsia additionally experience other inconvenient symptoms like bloating, nausea, belching and heartburn. 20 to 30% of the cases having found with to have sicknesses that record for their symptoms [3,4]. Functional dyspepsia symptoms happen after acid infusion into the duodenum and likely outcome from sensitized pH sensors or inadequate evacuation of the acid because of weakened motor function of proximal duodenum [4,5].
The causative factors of the functional dyspepsia are the multifactorial and the heterogeneous dyspepsia has been not properly defined; though, several mechanisms of the pathophysiology are proposed, most of which are directed at pathways of the gastroduodenal, were proposed to clarify the disorder [6]. Numerous components are as of now being researched as possible reasons for the symptoms of the functional dyspepsia. Given the quantity of possibly unidentified causes of the symptoms of dyspepsia and the relationship of the word function with an absence of a natural reason for manifestations, it is carefully utilizing the term of the functional dyspepsia to define symptoms of dyspepsia without a recognized natural etiology [6].
Many studies investigated the risk factors of the functional dyspepsia and proposed that the female's gender, old age, infection of H. pylori, lower BMI, uses of the nonsteroidal antiinflammatory drugs (NSAIDs) or aspirin, lower educational level are the risk factors of functional dyspepsia [7-9]. FD is prevalent form of dyspepsia throughout the world. The revealed incidence of dyspepsia varies broadly between various populations, perhaps in light of the fact that most investigations have focused on undiagnosed dyspepsia instead of functional dyspepsia [10]. In Pakistan, there have not been widely studied the evaluation of modifiable risk factors of dyspeptic patients even nowadays it is a big issue effecting quality of life. However, this study has been conducted to assess the knowledge reading frequency modifiable risk factors of dyspepsia.

MATERIALS AND METHODS
This cross-sectional study has been conducted in the department of gastroenterology of Isra University Hospital from February 2019 to January 2020. All the patients of all age groups presented with functional dyspepsia and either of gender were included in the study. All the cases having diagnosis of peptic ulcer disease, H. pylori, gastric carcinoma, chronic liver disease and those who were not agreeing to participate in the study were excluded from the study. Patients were interviewed regarding their life style including modifiable and non-modifiable risk factors like age, gender, ethnicity and family history, diabetes, hypertension, smoking, body mass index, alcohol consumption, physical activity and stress. All the data was gathered via study proforma. Data was analyzed by using SPSS version 20. Frequency and percentage were computed for categorical variables. Mean and standard deviation were computed for numerical variables. Chi-square test was applied and a p-value <0.05 was taken as significance level.

RESULTS
Total 200 cases of functional dyspepsia were studied for modifiable and non-modifiable risk factors. Mean age of the cases was 49.45+6.33 years. Most of the cases were more than 40 years of the age and only 23.5% cases were under 40 years. Males were 64.5% and females were 35.5%. family history of functional dyspepsia was 11.0% and remaining had no family history and mostly were unknown regarding it. According to the ethnicity Sindhi and Punjabi were commonest as 40.5% and 35.0% respectively, followed by Urdu speaking were 15.0% and Pathan were 9.0% Table.1.
Out of all 36.0% cases were smokers and 16.0% had diabetes, dyslipidemia was among 5.0% cases, obesity was 16.5%, history of alcoholic consumption was among 7.5% cases, while inadequate physical activity was highly prevalent among 57.5% of the cases Table 1. In this study age, gender, smoking and inadequate physical activities found to be commonest risk factors of functional dyspepsia. On other hand in a south Iranian study of Masoumi SJ et al. [14] observed that there was a significant association occurred between the symptoms of dyspepsia and dairy products consumptions, tea before and after food, smoking, uses of non-steroid anti-inflammatory drugs and drinking water, reflux, dysphagia, heartburn, and uses of acetaminophen. Recently Koloski NA et al. [15] reported that the correlation keeps on significant for the moderate exercise, gender, independent of age, BMI and the smoking, though role of the exercise in pathophysiology of the symptoms of functional dyspepsia is generally not known [15]. In another study it is demonstrated that there was a valuable correlation of dyspepsia with smoking (p<0.05), along with a significant link between dyspepsia and inadequate sleep [16]. Smoking might affect all gastrointestinal functions including those of the esophagus, stomach, and colon, resulting in susceptibility to several kinds of Functional gastrointestinal disorders including gastrointestinal reflex disease, functional dyspepsia and irritable bowel syndrome [17].
In this study according to the ethnicity Sindhi and Punjabi were commonest as 40.5% and 35.0% respectively, followed by Urdu speaking were 15.0% and Pathan were 9.0%. On other hand it is stated that there was no single country or ethnic group observed to have greater incidence of functional dyspepsia [18]. Although future studies are expected to discover the distinctions in functional dyspepsia between different populations will improve the worldwide comprehension of the condition and better surmising will be drawn. [18,19]. There is a wide range has been reported of different risk factors in different studies. However, there is a quate need of large-scale complete lifestyle dependent studies for this unsolved health event.

CONCLUSION
As per study conclusion age more than thirty years, male gender, ethnicity of Sindhi and Punjabi, smoking and inadequate physical activity were observed to be highly prevalent modifiable and non-modifiable risk factor of the functional dyspepsia. Further large scale studies are recommended on this subject.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline Patient's consent and ethical approval has been collected and preserved by the authors.