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Sirs,

We read with interest the recent article by Mak et al.,[1] in which the investigators from Hong Kong reported an 8% community prevalence of dyspepsia using the Rome III criteria, which was strongly associated with anxiety and depression. Whilst this study adds to the body of literature from other community[2] and institution-based[3] studies on the association of dyspepsia with psychological distress, we would like to highlight several issues. First, the prevalence of dyspepsia at 8% in this study is significantly lower compared to recent publications from other urban Asian populations.[4] We believe that this may have resulted from the restrictive definition employed by the Rome III dyspepsia criteria, which is thought to be less representative of both Western[5] and Eastern[6] patients with true dyspepsia. Furthermore, this exclusive definition may have resulted in a failure of the study to demonstrate important socioeconomic associations with dyspepsia[4] and dyspepsia-related medical consultation,[7] an issue which is pertinent to the Asian region.

On a separate note, the authors concluded that preceding mental disorders were not a risk factor for dyspepsia, as their data suggested a coincidental onset of anxiety and depression with dyspepsia. Whilst clearly of interest, we believe that additional data on health-related quality of life (HRQOL) may have supplemented this observation. A low HRQOL has been shown to predict the onset of dyspepsia,[8] is strongly associated with the presence of dyspepsia[4] and known to influence dyspepsia-related consultation.[7] In addition, differences in HRQOL are known to exist between functional and organic dyspepsia, but this cannot be explained by variation in psychological disorders alone.[9]

In short, we welcome the findings from Mak et al., but feel that a restrictive definition of dyspepsia and the omission of HRQOL data were some limitations of this interesting study.

Acknowledgement

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  2. Acknowledgement
  3. References

Declaration of personal and funding interests: None.

References

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  2. Acknowledgement
  3. References