Is It Time to Abandon Gastric Emptying in Patients With Symptoms of Gastroparesis and Functional Dyspepsia?

Abstract

Conflicts of interestLin Chang has obtained grant support from Vanda Pharmaceuticals; has served as a consultant for Shire-Takeda; and is a member of the Rome Foundation Board of Directors. The other author discloses no conflicts.

British Society of Gastroenterology guidelines on the management of functional dyspepsia

“…This questions the distinction between FD and gastroparesis based on gastric emptying rates alone, 18 although it is possible that patients presenting with severe nausea, which is not a cardinal symptom of FD, and those with coexistent chronic constipation may represent a subgroup of patients in whom symptoms do correlate with delayed gastric emptying and/or whole gut transit. 17 However, this remains a subject for future research. There is the potential for iatrogenic harm, due to invasive interventions, from attaching a label of gastroparesis, based on the results of gastric emptying studies, to a patient who otherwise meets criteria for FD and has no risk factors for gastroparesis.…”

“…Of particular importance, FD and gastroparesis are symptom-based constructs with significant overlapping features, which cannot be fully distinguished on the basis of either symptoms or gastric emptying studies 16 17. The gastroparesis construct may over-emphasise motor deficits to the detriment of a more holistic approach,18 and so the terms FD with or without delayed gastric emptying may be preferable 19…”

“…In addition, the two groups of patients were not stable; during 1 year of follow-up 40% in each group moved to the other group, based on repeat gastric emptying testing. This questions the distinction between FD and gastroparesis based on gastric emptying rates alone,18 although it is possible that patients presenting with severe nausea, which is not a cardinal symptom of FD, and those with coexistent chronic constipation may represent a subgroup of patients in whom symptoms do correlate with delayed gastric emptying and/or whole gut transit 17. However, this remains a subject for future research.…”

Gastroparesia o dispepsia funcional: ¿espectro de una misma enfermedad o entidades diferentes?

“…El VG es un proceso dinámico que puede cambiar con el tiempo, por lo tanto, puede que un paciente fluctúe entre los diagnósticos de Gp y DF. Tal como sucede en el contexto de pacientes con estreñimiento crónico y síndrome de intestino irritable subtipo estreñimiento, donde solo la presencia o ausencia del dolor abdominal los distingue 23 . Este concepto fue recientemente demostrado por el Gastroparesis Clinical Research Consortium (GCRC), en un estudio en el cual incluyeron un total de 944 pacientes en un periodo de 12 años, el 76% cumplían criterios para Gp con gammagrafía, mientras que el 24% tenían VG normal y cumplían criterios para DF; todos tenían características clínicas y severidad de síntomas gastrointestinales similares.…”