Gastroenterology

Gastroenterology

Volume 150, Issue 6, May 2016, Pages 1380-1392
Gastroenterology

Section II: FGIDs: Diagnostic Groups
Gastroduodenal
Gastroduodenal Disorders

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Symptoms that can be attributed to the gastroduodenal region represent one of the main subgroups among functional gastrointestinal disorders. A slightly modified classification into the following 4 categories is proposed: (1) functional dyspepsia, characterized by 1 or more of the following: postprandial fullness, early satiation, epigastric pain, and epigastric burning, which are unexplained after a routine clinical evaluation; and includes 2 subcategories: postprandial distress syndrome that is characterized by meal-induced dyspeptic symptoms and epigastric pain syndrome that does not occur exclusively postprandially; the 2 subgroups can overlap; (2) belching disorders, defined as audible escapes of air from the esophagus or the stomach, are classified into 2 subcategories, depending on the origin of the refluxed gas as detected by intraluminal impedance measurement belching: gastric and supragastric belch; (3) nausea and vomiting disorders, which include 3 subcategories: chronic nausea and vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; and (4) rumination syndrome.

Section snippets

Definition

FD is a medical condition that significantly impacts on the usual activities of a patient and is characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain, and epigastric burning that are unexplained after a routine clinical evaluation.1

Symptom definitions remain somewhat vague, and potentially difficult to interpret by patients, practicing physicians and investigators alike, as documented by the major misunderstandings that characterize

Gastroduodenal Disorders

B1. Functional Dyspepsia

Diagnostic criteria

  • 1.

    One or more of the following:

    • a.

      Bothersome postprandial fullness

    • b.

      Bothersome early satiation

    • c.

      Bothersome epigastric pain

    • d.

      Bothersome epigastric burning

AND

  • 2.

    No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms

aMust fulfill criteria for B1a. PDS and/or B1b. EPS.

bCriteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

B1a. Postprandial Distress Syndrome

Diagnostic criteria

Must

Definition

Belching is defined as an audible escape of air from the esophagus or the stomach into the pharynx. It occurs commonly and can only be considered a disorder when it is excessive and becomes troublesome. Depending on the origin of the refluxed gas, belching is classified into 2 types: the gastric belch and the supragastric belch.

Epidemiology

The epidemiology of excessive belching in the general population remains to be carefully defined; however, it is not encountered uncommonly in the clinical setting.

Diagnostic Criteria

The

Definitions

Nausea is a subjective symptom and can be defined as an unpleasant sensation of the imminent need to vomit typically experienced in the epigastrium or throat. Vomiting refers to the forceful oral expulsion of gastrointestinal contents associated with contraction of the abdominal and chest wall muscles.

Epidemiology

Nausea is less prevalent than epigastric pain or meal-related symptoms in the community.36 Unexplained chronic nausea is often associated with other gastroduodenal symptoms. Unexplained vomiting

Definition

In human patients, rumination syndrome is characterized by the repetitive, effortless regurgitation of recently ingested food into the mouth followed by rechewing and reswallowing or expulsion of the food bolus.

Epidemiology

Although initially described in infants and the developmentally disabled, it is now known that rumination syndrome occurs in males and females of all ages and cognitive function. The epidemiology of adult rumination syndrome is not well characterized. In a large database of patients with

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    Conflicts of interest The authors disclose no conflicts.

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