Predominant Symptoms Identify Different Subgroups in Functional Dyspepsia

Stanghellini, Vincenzo; Tosetti, Cesare; Paternico, A.; Giorgio, Roberto De; Barbara, Giovanni; Salvioli, Beatrice; Corinaldesi, Roberto

doi:10.1111/j.1572-0241.1999.01281.x

Cited by 98 publications

(63 citation statements)

References 26 publications

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“…These observations have potential implications for the investigation and management of disordered gastric emptying in patients with diabetes. The observed relationship between abdominal bloating/fullness and gastric emptying in patients with diabetes is consistent with recent studies of patients with functional dyspepsia (11)(12)(13). The total score for gastric symptoms correlated weakly with solid emptying but not with liquid emptying.…”

Section: Determinants Of Gastric Emptyingsupporting

confidence: 78%

“…In most of these studies, symptoms have been evaluated using either a global symptom score and/or individual upper gastrointestinal symptoms classified as either "present" or "absent," without considering their severity (2-7). This approach may be relevant to the interpretation of these observations, particularly because recent studies of patients with dyspepsia of unknown origin have demonstrated a close association among specific symptoms, such as postprandial fullness with delayed gastric emptying, particularly when these symptoms are severe enough to influence usual activities (11)(12)(13). There is also evidence that gastric emptying in patients with functional dyspepsia may be influenced by demographic factors, such as sex and body weight (11).…”

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confidence: 99%

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Predictors of Delayed Gastric Emptying in Diabetes

et al. 2001

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OBJECTIVE -To define the predictors of the rate of gastric emptying in patients with diabetes.RESEARCH DESIGN AND METHODS -A total of 101 outpatients with diabetes (79 type 1 and 22 type 2) underwent measurements of gastric emptying of a solid/liquid meal (scintigraphy), upper gastrointestinal symptoms (questionnaire), glycemic control (blood glucose concentrations during gastric emptying measurement), and autonomic nerve function (cardiovascular reflexes).RESULTS -The gastric emptying of solid and/or liquid was delayed in 66 (65%) patients. Solid (retention at 100 min 64 Ϯ 3.2 vs. 50.2 Ϯ 3.6%, P Ͻ 0.005) and liquid (retention at 100 min 22.7 Ϯ 1.7 vs. 16.0 Ϯ 1.8%, P Ͻ 0.001) gastric emptying was slower in women than in men. Of all upper gastrointestinal symptoms (including nausea and vomiting), only abdominal bloating/fullness was associated with slower gastric emptying (P Ͻ 0.005). A multiple regression analysis demonstrated that both abdominal bloating/fullness and female sex were predictors of slower gastric emptying of both solids and liquids.CONCLUSIONS -We conclude that the presence of abdominal bloating/fullness but not any other upper gastrointestinal symptom is associated with diabetic gastroparesis and that gastric emptying is slower in diabetic women than in diabetic men. Diabetes Care 24:1264 -1269, 2001T he application of radioisotopic techniques to quantify gastric emptying has established that delayed gastric emptying (gastroparesis) occurs in 30 -50% of patients with longstanding diabetes (1-9), and diabetes and functional dyspepsia represent the two most common disorders associated with chronic gastroparesis (10). Diabetic gastroparesis is also recognized to represent a clinically important problem because of its potential sequelae of upper gastrointestinal symptoms, impaired oral drug absorption, and poor control of blood glucose concentrations (1). However, determinants of the rate of gastric emptying in patients with diabetes are controversial and poorly defined (1-9). Particularly, it is uncertain whether diabetic gastroparesis can be predicted based on clinical, demographic, or biochemical variables. In patients with diabetes, there is also a relatively poor relationship between gastric emptying of solids and gastric emptying of nutrient-containing liquid-meal components (2-4,7); delayed liquid gastric emptying frequently occurs and may be associated with normal solid emptying (7). Hence, the predictors of delay in liquid emptying may potentially differ from those associated with the delayed gastric emptying of solids.Previous studies have reported a relatively weak relationship between upper gastrointestinal symptoms and the rate of gastric emptying in patients with diabetes (2-7). Accordingly, it has been suggested that gastroparesis cannot be predicted based on symptoms and that objective measurement of gastric emptying is required for diagnosis (1,8). In most of these studies, symptoms have been evaluated using either a global symptom score and/or individual upper gastrointestinal symp...

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Section: Determinants Of Gastric Emptyingsupporting

confidence: 78%

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confidence: 99%

Predictors of Delayed Gastric Emptying in Diabetes

et al. 2001

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“…4 Studies have shown correlations between this subdivision and the presence of Helicobacter pylori infection or delayed gastric emptying, 16 and between this subdivision and response to acid-suppressive therapy. 17 However, the subdivision has also been criticized because of the significant overlap between the symptom subgroupings, the considerable number of patients who do not fit into one of the subgroups, and the lack of adequate value in predicting underlying organic disease.…”

Section: Subgroups Of Functional Dyspepsia Patientsmentioning

confidence: 99%

Pathophysiology and Treatment of Functional Dyspepsia

Tack

Lee

2005

Journal of Clinical Gastroenterology

208

247

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Functional dyspepsia is a highly prevalent symptom complex and a heterogenous disorder. Recent studies showed potential associations between specific pathophysiologic disturbances and dyspeptic symptoms. Delayed gastric emptying reported in about 30% of patients with functional dyspepsia is associated with the symptoms of postprandial fullness, nausea, and vomiting. Impaired gastric accommodation present in 40% of functional dyspepsia patients is found to be associated with early satiety. Hypersensitivity to gastric distension is observed in 37% of functional dyspepsia patients and associated with the symptoms of postprandial pain, belching, and weight loss. Psychosocial factors and altered response to duodenal lipids or acid have also been identified as pathophysiologic mechanisms. Therapeutic options are still limited but targeted therapy directed at the underlying pathophysiology seems desirable. Thus, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using some type of pathophysiologic testing will be required.

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“…A delayed GE in patients suffering from FD was found with an incidence that varies from 15% to 50% of cases [13]; therefore it is a non-specific disease marker [14]. Inversely, according to observations of Stanghellini et al certain dysmotility symptoms and their severity were strong risk indicators fora delayed GE [15].…”

Section: Discussionmentioning

confidence: 99%

Effect of Helicobacter pylori eradication on gastric emptying and symptoms in patients with dyspepsia

Waluga¹,

Jonderko²,

Krusiec-Świdergoł³

et al. 2011

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Aim: To study whether eradication of Helicobacter pylori (H. pylori) in patients with functional dyspepsia affects gastric emptying (GE) and concomitantly relieves their clinical symptoms. Material and methods: Eighteen H. pylori-positive patients suffering from functional dyspepsia were recruited. At entrance and two weeks after successful H. pylori eradication they filled in a questionnaire examining the intensity of dyspeptic symptoms and underwent measurement of GE of a 378 kcal solid test meal labelled with 75 μl of 13 C-octanoic acid. Normative values of GE were obtained in 12 healthy controls. Results: Helicobacter pylori eradication was attained in 17 patients. The duration of the lag phase (T_Lag) of the GE did not change after the eradication (mean ± SD 144.5 ±23.2 min) vs. before the eradication (152.1 ±27.6 min). On the other hand, the gastric half emptying time (T 1/2 ) increased statistically significantly from 207.1 ±33.5 min before eradication to 229.5 ±49.4 min (p = 0.0217). Considering the whole patient group, the H. pylori eradication did not significantly affect the dyspeptic symptoms. It was established, however, that the deterioration of the score for fullness or satiety was dependent on the increase in the T_Lag. Also the aggravation of pain, burning or satiety was related to the prolongation of the T 1/2 . Conclusions: 1) Eradication of H. pylori in patients with functional dyspepsia prolongs the gastric half emptying time of a solid meal without eliciting a significant symptomatic improvement.2) The worsening of dyspeptic symptoms may be related to sluggish gastric emptying. StreszczenieCel: Ustalenie, czy eradykacja Helicobacter pylori (H. pylori) u chorych z dyspepsją czynnościową wpływa na szybkość opróżniania żołądka (gastric emptying -GE) i złagodzenie towarzyszących objawów klinicznych. Materiał i metody: W badaniu wzięło udział 18 chorych z infekcją H. pylori cierpiących na dyspepsję czynnościową. W czasie włączania do badania oraz 2 tyg. po skutecznej eradykacji wypełniali oni kwestionariusz mający na celu określe-nie nasilenia objawów dyspeptycznych oraz zostali poddani pomiarowi GE z posiłku stałego o wartości energetycznej 378 kcal z dodatkiem 75 μl 13 C-kwasu oktanowego. Wartości normatywne kinetyki GE wyznaczono u 12 zdrowych osób. Wyniki: Eradykację H. pylori uzyskano u 17 chorych. Czas trwania fazy opóźnienia GE (T_Lag) nie zmienił się po eradykacji (średnia ± SD 144,5 ±23,2 min) w porównaniu z czasem przed eradykacją (152,1 ±27,6 min). Półokres GE (T 1/2 ) natomiast zwię kszył się statystycznie znamiennie z 207,1 ±33,5 min przed eradykacją do 229,5 ±49,4 min po eradykacji (p = 0,0217). Biorąc pod uwagę całą grupę chorych, eradykacja H. pylori nie wpłynęła znamiennie na objawy dyspeptyczne. Wykazano jednak, że pogorszenie punktacji w skali oceny uczucia pełności lub wczesnej sytości zależało od wzrostu długości T_Lag, podczas gdy zwiększenie odczucia bólu, pieczenia i pełności od wydłużenia T 1/2 . Wnioski: 1) Eradykacja H. pylori u chorych z dyspepsją czynnościową...

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Predominant Symptoms Identify Different Subgroups in Functional Dyspepsia

Abstract: Different subgroups exist among patients with functional dyspepsia seen in a referral center. They can be identified by the predominant symptom and are characterized by different demographic, clinical, and pathophysiological features.

Cited by 98 publications

References 26 publications

Predictors of Delayed Gastric Emptying in Diabetes

Predictors of Delayed Gastric Emptying in Diabetes

Pathophysiology and Treatment of Functional Dyspepsia

Effect of Helicobacter pylori eradication on gastric emptying and symptoms in patients with dyspepsia

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