Clinical Classification of Subgroups According to the Rome III Criteria Cannot be Used to Distinguish the Associated Respective Pathophysiology in Japanese Patients with Functional Dyspepsia

Abstract

Objective Patients who meet the Rome III criteria for functional dyspepsia (FD) are generally classified into the following two subgroups, those with postprandial distress syndrome (PDS) and those with epigastric pain syndrome (EPS), in order to treat the dyspeptic symptoms caused by the respective pathophysiological conditions. However, whether simple classification of FD can accurately distinguish the pathophysiological differences between PDS and EPS remains to be clarified because the pathophysiology of FD is characterized and complicated by various factors. Methods After classifying FD patients who were not receiving medication at the initial visit, we assessed and compared the following pathophysiological factors between the PDS and EPS groups: (1) the gastric reservoir and emptying functions using a radioisotope method (n=75), (2) the autonomic nervous system (ANS) function using electrocardiography (n=45), (3) gastric mucosal atrophy and intestinal metaplasia using histological examinations (n=47), (4) endoscopic findings of the stomach, such as superficial changes, abnormal gastroesophageal flap valves (n=67) and (5) Helicobacter pylori infection (n=48). Results The FD patients exhibited higher rates of an impaired reservoir function (49.3%), gastric emptying disorders (54.7%) and relative hyperactivity of the sympathetic nervous system (31.9%) than the control subjects. However, endoscopic and histological changes of the stomach were similar in both the FD patients and control subjects. In addition, no differences were observed in the above-mentioned factors between the PDS and EPS groups. Conclusion The simple classification of FD patients into two subgroups according to the Rome III criteria following diagnosis does not indicate any differences in the pathophysiology related to the respective dyspeptic symptoms of FD patients.

Disorder of autonomic nervous system and its vulnerability to external stimulation in functional dyspepsia

“…In addition, while GI function during nighttime should be active due to food absorption and other physiological functions, in the present study it was diminished, implying impaired excretory function as a result of diminished food digestion or GI motility. Previous studies have reported that delayed gastric emptying is involved in 30–60% of FD cases, ( 25 – 27 ) and the findings of the present study appear to support this assertion. As an event capable of altering ANS function, meals typically trigger an increase in parasympathetic nervous system activity.…”

Prevalence of Irritable Bowel Syndrome, Functional Dyspepsia and their Overlap in Bulgaria: a Population-Based Study

“…In contrast, disturbed gastric accommodation and gastric emptying might drive PPDS. However, studies evaluating the role of these putative pathophysiological mechanisms among FD subtypes have shown conflicting results [51][52][53].…”

Gastric emptying scintigraphy in postprandial distress syndrome

“…Ochi M et al also did not find any association of delayed gastric emptying in the two groups of functional dyspepsia pointing to different mechanism for PDS. 14 This is supported by a recent study by Vanheel et al 15 where visceral hypersensitivity was closely associated with PDS. Further they did not find any difference between the Rome-III subgroups in the prevalence of gastric hypersensitivity, impaired gastric accommodation and delayed gastric emptying.…”