Functional dyspepsia is considered a heterogeneous disorder with different pathophysiological mechanisms contributing to the symptom pattern.
The Rome II committee proposed subdividing patients with functional dyspepsia into groups with predominant pain versus discomfort.
The proposal aimed to facilitate identifying subgroups with homogeneous pathophysiological and clinical properties.
Dr Jan Tack and colleagues analyzed the relationship of predominant pain or discomfort with pathophysiological mechanisms.
The investigative team evaluated whether considering individual predominant symptoms yields better results.
The team included 720 consecutive functional dyspepsia patients, of which 489 were women with a mean age of 41 years.
| Any of 8 dyspeptic symptoms could be predominant|
The patients filled out a dyspepsia questionnaire and identified a single most bothersome symptom.
The investigators analyzed the association of this predominant symptom with demographic, clinical, and pathophysiological features.
The team noted that 592 patients had Helicobacter pylori status, and gastric emptying.
Gastric sensitivity and accommodation testing was identified in 332 patients.
According to Rome II criteria, 22% were pain predominant and 78% discomfort predominant.
Patients with predominant pain had a higher prevalence of hypersensitivity.
The team also observed delayed gastric emptying less frequently in these patients, but there was major overlap.
Detailed analysis showed that any of 8 dyspeptic symptoms could be predominant.
Predominant early satiety or vomiting was associated with significantly higher prevalences of weight loss, occurring in 89% and 75% of patients, respectively.
Acute onset occurred in about 60% of those with predominant early satiety or vomiting.
The investigators found impaired accommodation in 79% of patients with predominant early satiety.
The highest prevalence of delayed emptying was found in predominant fullness, and of hypersensitivity in predominant pain.
Dr Tack's team concludes, “Subdividing functional dyspepsia patient groups according to the predominant symptom does not reliably identify subgroups with a homogeneous underlying pathophysiological mechanism.”