Functional dyspepsia and the Rome criteria: a success story

Abstract

The Rome III criteria for functional dyspepsia (FD), published in 2006, immediately generated controversy but have arguably helped to jump start the field in terms of mechanistic and therapeutic research. One controversy has surrounded the veracity of FD symptom subgroups and their overlap. In clinical practice the overlap of postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) is striking. In this issue, results from Belgium suggest overlap can be reduced by reclassifying those who have postprandial pain or nausea as PDS, and meal-related symptoms predominate in FD. This is consistent with other objective experimental observations. The realization most FD occurs postmeal ingestion is driving a new conceptualization of the syndrome. For example, the observation there is an excess of duodenal eosinophils in PDS has been confirmed, with recent observations implicating increased duodenal permeability and immune activation. The link between PDS and anxiety, not identified in EPS, provides yet further evidence for distinct pathophysiological entities. While symptom-based criteria likely need refinement, the recognition of PDS and EPS has promoted exciting progress.

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

“…In population‐based symptom analyses, dyspeptic symptoms were shown to group around clusters, representing EPS and PDS 3,156 . The literature is divided on the usefulness of distinguishing PDS and EPS for patient management.…”

“…When the Rome III subdivision is used, a major overlap is found between both, which is largely corrected with the Rome IV subdivision as a good separation between both subtypes is now found both in epidemiological studies and in clinical practice. 3,11,40,[156][157][158] While some studies report different treatment responses, 159,160 others do not. 161,162 To date, no fully published study has evaluated differential pathophysiological mechanisms or treatment outcomes according to the Rome IV subdivision.…”

Prevalence of overlap syndromes and symptoms in pediatric functional dyspepsia

“…Adult data suggests that meal-related symptoms, including pain and nausea, may be the norm in FD [ 25 ]. The PDS subtype did have some associations with other GI symptoms in our pediatric cohort, including increased pain with eating (79 %) and weight loss (36 %), as well as a trend toward increased nausea with eating (70 %).…”

Validation of the Leuven Postprandial Distress Scale, a questionnaire for symptom assessment in the functional dyspepsia/postprandial distress syndrome

“…However, in clinical practice, overlap between postprandial distress syndrome and epigastric pain syndrome occurs in a large subset of patients . In functional dyspepsia as a group, ingestion of a meal is the most important trigger for symptom occurrence, and we recently showed that adapting the Rome III subdivision by taking into account the meal relationship of functional dyspepsia symptoms reduces the overlap between postprandial distress syndrome and epigastric pain syndrome through an increase in those that can be classified as postprandial distress syndrome …”