Functional Dyspepsia and Gastroparesis

Abstract

Background: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. Key Messages: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT_1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a ‘meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. Conclusion: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.

Sourdough Fermented Breads are More Digestible than Those Started with Baker’s Yeast Alone: An In Vivo Challenge Dissecting Distinct Gastrointestinal Responses

“…The most pronounced sour taste primarily attained to the old tradition. Together with the sensory attributes, the perception of appetite, satiety and gastrointestinal symptoms is essential to assess food digestibility because tightly correlated with gastric emptying and intestinal fermentation [13,14]. It must be highlighted that the present study aimed at investigating bread digestibility in healthy subjects, acting as reference group for further studies on subjects with upper GI symptoms such as bloating, reflux, epigastric pain or irritable bowel syndrome.…”

“…Nevertheless, to define univocally the concept of bread digestibility from a nutritional perspective seems controversial. Indeed, bread digestibility relies on factors of different nature: the perception of appetite, satiety and gastrointestinal symptoms after ingestion [13][14][15], and the bioavailability of proteins and starch. A few in vivo clinical studies have already demonstrated the effect of sourdough fermentation on starch digestibility.…”

Nausea exacerbates symptom burden, quality of life, and functioning in adolescents with functional abdominal pain disorders

“…Further, functional dyspepsia was noted in one‐third of nausea sufferers in our study. Functional dyspepsia frequently presents with nausea and upper abdominal discomfort and symptoms which overlap with those of gastroparesis . These entities are difficult to distinguish clinically.…”

Machine learning prediction of emesis and gastrointestinal state in ferrets

“…Furthermore, animal studies are beginning to demonstrate the utility of implantable devices to record GI function, leading to proof-of-concept studies using miniaturized, wireless, and closedloop device configurations [3]. Significant questions remain before these novel methods can be translated to the clinic, including (1) how many signals are needed to assess specific functions of the GI tract, (2) how to compensate for the intrinsic variability of GI anatomy and electrode placement between individuals, and (3) what features within the GI myoelectric signal are associated with functional changes in the GI system, such as nausea or digestion.…”