Fasting and Postprandial Gastric Sensorimotor Activity in Functional Dyspepsia: Postprandial Distress Vs. Epigastric Pain Syndrome

M, Di Stefano; Miceli, Emanuela; Tana, P.; Mengoli, Caterina; Bergonzi, M.; Pagani, Elisabetta

doi:10.1038/ajg.2014.231

Cited by 30 publications

(25 citation statements)

References 37 publications

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“…A carefully conducted study from Italy showed that there was a significantly higher prevalence of fasting hypersensitivity to gastric distension (measured by a barostat) in FD patients with PDS (37 % vs 9 % in patients with EPS), with no difference in gastric accommodation between FD subtypes and healthy volunteers, although EPS was characterized by an alteration of gastric compliance [99]. Sensitivity to acid in the stomach and in the duodenum in FD patients has been studied.…”

Section: Fd and Gastric Dysfunctionmentioning

confidence: 99%

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

2015

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Functional gastrointestinal disorders (FGIDs) are common and distressing. They are so named because a defined pathophysiology in terms of structural or biochemical pathways is lacking. Traditionally FGIDs have been conceptualized as brain-gut disorders, with subgroups of patients demonstrating visceral hypersensitivity and motility abnormalities as well as psychological distress. However, it is becoming apparent that there are certain structural or biochemical gut alterations among subsets with the common FGIDs, most notably functional dyspepsia (FD) and irritable bowel syndrome (IBS). For example, a sodium channel mutation has been identified in IBS that may account for 2 % of cases, and subtle intestinal inflammation has been observed in both IBS and FD. Other research has implicated early life events and stress, autoimmune disorders and atopy and infections, the gut microbiome and disordered mucosal immune activation in patients with IBS or FD. Understanding the origin of symptoms in FGIDs will allow therapy to be targeted at the pathophysiological changes, not at merely alleviating symptoms, and holds hope for eventual cure in some cases.For example, there are promising developments in manipulating the microbiome through diet, prebiotics and antibiotics in IBS, and testing and treating patients for Helicobacter pylori infection remains a mainstay of therapy in patients with dyspepsia and this infection. Locally acting drugs such as linaclotide have been an advance in treating the symptoms of constipation-predominant IBS, but do not alter the natural history of the disease. A role for a holistic approach to patients with FGIDs is warranted, as brain-togut and gut-to-brain pathways appear to be activated.

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Section: Fd and Gastric Dysfunctionmentioning

confidence: 99%

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

2015

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“…Current evidence for the presence of distinct etiopathogenesis is limited and inconclusive. Previous studies found no difference in gastric accommodation between the 2 FD subtypes, and contradictory results were obtained with regard to gastric hypersensitivity and gastric emptying . Division of FD patients into subtypes does currently not reliably distinguish subgroups with a different underlying pathophysiology.…”

Section: Discussionmentioning

confidence: 88%

“…Previous studies found no difference in gastric accommodation between the 2 FD subtypes, and contradictory results were obtained with regard to gastric hypersensitivity and gastric emptying. 50,51 Division of FD patients into subtypes does currently not reliably distinguish subgroups with a different underlying pathophysiology. The use of this classification to guide therapy is, therefore, limited and favors the use of a single universal PROM for assessment of all FD core symptoms.…”

Section: Recommendation For the Use Of Current Available Instrumentsmentioning

confidence: 99%

Systematic review: Disease‐specific instruments to assess gastrointestinal symptoms in functional dyspepsia

Smeets

Masclee

Conchillo

et al. 2018

Neurogastroenterology Motil

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“…[33][34][35][36][37] In Rome IV, the syndrome of functional nausea and vomiting is now identified as a distinct entity and differentiated from FD 32 ; the implications of this change to diagnostic evaluation and management of nonorganic dyspepsia are yet to be realized. The subclassification of FD into PDS and EPS is preserved on the basis of some (although by no means conclusive) evidence from epidemiologic and pathophysiologic studies supporting their separation 28,[38][39][40][41] and while acknowledging some degree of overlap, especially, in referral populations. 42 The definition of PDS is slightly altered to include epigastric pain or burning that worsens with meals along with postprandial fullness and satiety.…”

mentioning

confidence: 99%

Definition, Pathogenesis, and Management of That Cursed Dyspepsia

Koduru

Irani

Quigley

2018

Clinical Gastroenterology and Hepatology

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Dyspepsia is an umbrella term used to encompass a number of symptoms thought to originate from the upper gastrointestinal tract. These symptoms are relatively nonspecific; not surprisingly, therefore, a myriad of conditions may present with any one or a combination of these symptoms. Therein lays the clinician's first challenge: detecting the minority who may have a potentially life-threatening disorder, such as gastric cancer, from a population whose symptoms are, for the most part, considered functional in origin. The second challenge lies in the definition and management of those individuals with functional dyspepsia (FD); the major focus of this review. The Rome process has addressed the issue of FD definition and a look back at the evolution of Rome criteria for this disorder illustrates the complexities that have so frustrated us. There has been no shortage of hypotheses to explain symptom pathogenesis in FD; initially focused on gastric sensorimotor dysfunction, these have now strayed well into the duodenum and have come to entertain such factors as immune responses and the microbiome. FD has proven to be an equally challenging area for therapeutics; while the staple approaches of acid suppression and eradication of Helicobacter pylori have some limited efficacy in select populations, strategies to ameliorate symptoms in the majority of sufferers based on presumed pathophysiology have largely foundered. Lacking a validated biomarker(s) FD continues to be an elusive target and is likely to remain so until we can better define the various phenotypes that it must surely contain.

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Fasting and Postprandial Gastric Sensorimotor Activity in Functional Dyspepsia: Postprandial Distress Vs. Epigastric Pain Syndrome

Cited by 30 publications

References 37 publications

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

Systematic review: Disease‐specific instruments to assess gastrointestinal symptoms in functional dyspepsia

Definition, Pathogenesis, and Management of That Cursed Dyspepsia

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