Gastroenterology

Gastroenterology

Volume 130, Issue 2, February 2006, Pages 296-303
Gastroenterology

Clinical–alimentary tract
Association of the Predominant Symptom With Clinical Characteristics and Pathophysiological Mechanisms in Functional Dyspepsia

https://doi.org/10.1053/j.gastro.2005.10.019Get rights and content

Background & Aims: Functional dyspepsia (FD) is considered a heterogeneous disorder with different pathophysiological mechanisms contributing to the symptom pattern. The Rome II committee proposed that subdividing patients with FD into groups with predominant pain versus discomfort might identify subgroups with homogeneous pathophysiological and clinical properties. The aim of this study was to analyze the relationship of predominant pain or discomfort with pathophysiological mechanisms and to evaluate whether considering individual predominant symptoms yields better results. Methods: Consecutive FD patients (n = 720; 489 women; mean age, 41.3 ± 0.6 years) filled out a dyspepsia questionnaire and identified a single most bothersome symptom. We analyzed the association of this predominant symptom with demographic, clinical, and pathophysiological features (Helicobacter pylori status, gastric emptying in 592 patients, and gastric sensitivity and accommodation testing in 332 patients). Results: According to Rome II criteria, 22% were pain predominant and 78% discomfort predominant. Patients with predominant pain had a higher prevalence of hypersensitivity (44% vs 25%) and delayed gastric emptying was observed less frequently in these patients (16% vs 26%), 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 (89% and 75%, respectively) and of acute onset (61% and 60%, respectively). Impaired accommodation was found in 79% of patients with predominant early satiety. The highest prevalence of delayed emptying was found in predominant fullness (38%) and of hypersensitivity in predominant pain (44%). Conclusions: Subdividing FD patient groups according to the predominant symptom does not reliably identify subgroups with a homogeneous underlying pathophysiological mechanism.

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Study Subjects

Consecutive new patients with a diagnosis of FD were recruited for the study. All patients presented to the general gastroenterology outpatient clinic or to the motility outpatient clinic because of unexplained dyspeptic symptoms and underwent careful history taking and clinical examination, upper gastrointestinal endoscopy, routine biochemistry studies, and upper abdominal ultrasonography. Inclusion criteria were the presence of dyspeptic symptoms for at least 12 weeks in the past 12 months in

Characteristics of the Patient Population

A total of 720 consecutive patients with FD (489 women; mean age, 41.3 ± 0.6 years) were prospectively enrolled into this study. Their symptom pattern is summarized in Table 1. The average weight loss was 4 ± 0.5 kg, and 286 patients (40%) reported weight loss of more than 5% of their body weight. Twenty-nine percent of the patients reported an acute onset of their dyspeptic symptoms. Only 13% of the patients were H pylori positive. Fifteen H pylori–negative patients had a history of previous

Discussion

FD is considered a heterogeneous disorder, and factor analysis of dyspeptic symptoms in tertiary care patients did not support the existence of FD as a homogeneous (unidimensional) condition.21 The Rome II committee has proposed to subdivide patients with FD into subgroups based on the predominant single symptom as identified by the patient.1 Patients who report pain centered in the upper abdomen as the most bothersome symptom are considered to have ulcer-like dyspepsia, whereas patients who

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    Copyright © 2006 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.