Pain versus discomfort—is differentiation clinically useful?

Abstract

Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub‐groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub‐groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro‐oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history‐taking will be of pivotal importance in management strategies for functional dyspepsia.

Dyspeptic symptoms in the general population: a factor and cluster analysis of symptom groupings

“…This hypothesis was not supported by the analysis of the data. It is conceivable that Helicobacter pylori infection, whose prevalence also increases with age, contributes to the age‐dependent increase in dyspeptic symptoms, 15,20 but H. pylori status was not addressed in this study.…”

Functional dyspepsia: past, present, and future

“…It has remained unsettled whether discomfort is a mild variant of pain or a separate symptom complex. 7 Moreover, discomfort comprises a number of different nonpainful symptoms, including upper abdominal fullness, early satiety, bloating, nausea, epigastric burning, belching, and vomiting. While Rome I included some refl ux symptoms with FD, and recognized a subgroup of refl ux-like dyspepsia (see below), the Rome II defi nition of FD excluded patients with predominant heartburn.…”

Systematic review: symptom assessment using patient-reported outcomes in gastroesophageal reflux disease and dyspepsia

“…This was supplemented by a search of the citation lists of related reviews [13][14][15][16][17][18][19], and recent major congress abstracts (Digestive Disease Week and United European Gastroenterology Week 2009-2010) for studies reporting factors affecting symptom scales for GERD and dyspepsia.…”