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 14 December 2017

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News

Pathophysiological abnormalities in functional dyspepsia

The most recent issue of the American Journal of Gastroenterology reports pathophysiological abnormalities in functional dyspepsia subgroups according to the Rome III criteria.

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The Rome III criteria proposed to subdivide functional dyspepsia into a postprandial distress syndrome group, characterized by the presence of postprandial fullness and/or early satiety, and an epigastric pain syndrome group, characterized by the presence of epigastric pain and/or epigastric burning. 

It has been suggested that different pathophysiological mechanisms underlie the symptom presentations in these subgroups that might determine treatment choices. 

Dr Tack and colleagues from Belgium investigated the prevalence of gastric sensorimotor dysfunction in the postprandial distress syndrome, epigastric pain syndrome, and overlap groups.

The researchers evaluated potential differential associations with dyspeptic symptom scores.

The prevalence of gastric hypersensitivity was 37%
American Journal of Gastroenterology
The team recruited consecutive functional dyspepsia patients fulfilling Rome III criteria, and they scored frequency of dyspeptic symptoms over the past 3 months. 

The cumulative symptom score was calculated by adding up the score of these dyspeptic symptoms. 

Based on these symptom scores, the patients were subdivided into subgroups according to the Rome III consensus.

Group 1 included postprandial distress syndrome, characterized by postprandial fullness and/or early satiety at least several times a week.

Group 2 included epigastric pain syndrome, characterized by epigastric pain and/or epigastric burning at least once a week.

Group 3 was an overlap group, fulfilling the criteria for both postprandial distress syndrome and epigastric pain syndrome. 

Gastric sensitivity and gastric accommodation were measured using barostat testing, and solid gastric emptying was determined using the [14C]octanoate breath test.

A total of 560 functional dyspepsia patients were classified into postprandial distress syndrome, epigastric pain syndrome, and overlap groups.

The prevalence of gastric hypersensitivity, impaired gastric accommodation, and delayed gastric emptying were 37%, 37%, and 23%, respectively, without any differential distribution in Rome III subgroups. 

Comparing the physiological parameters for these gastric sensorimotor functions, the team found only a significant difference in the gastric half emptying time between subgroups, with the overlap group having a higher half time compared with the epigastric pain syndrome group. 

In the overlap group, the researchers noted that gastric hypersensitivity was associated with the severity of postprandial distress syndrome symptoms, epigastric pain syndrome symptoms, and the cumulative symptom score, whereas delayed gastric emptying was associated with nausea, and the cumulative symptom score.

Dr Tack's team comments, "Except for gastric emptying in the overlap group, functional dyspepsia subgroups as defined by the Rome III criteria are not differentially associated with putative pathophysiological mechanisms."

"These observations question the utility of this classification for guiding therapeutic choices in clinical practice."

Am J Gastroenterol 2017; 112:132–140
20 January 2017

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