Rome III functional dyspepsia subdivision in <scp>PDS</scp> and <scp>EPS</scp>: recognizing postprandial symptoms reduces overlap

Carbone, Florencia; Holvoet, Lieselot; Tack, Jan

doi:10.1111/nmo.12585

Cited by 54 publications

(57 citation statements)

References 31 publications

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“…Although replication of our results is needed, revisions of the existing classification system (currently Rome III) should to take into account that, at least in tertiary care, FD may represent one single rather than two distinct syndromes, as also suggested by earlier data demonstrating frequent overlap between EPS and PDS in tertiary care . However, recent findings indicate that defining PDS based on postprandial nature of symptoms rather than based on distinct symptom profiles per se significantly reduces this overlap . Further, our current factor analytical results do identify distinct symptom‐based factors corresponding to Rome III subgroups, which may be driven by distinct underlying pathophysiological mechanisms.…”

Section: Discussionsupporting

confidence: 70%

The latent structure of the functional dyspepsia symptom complex: a taxometric analysis

Oudenhove

Jasper

Walentynowicz

et al. 2016

Neurogastroenterology Motil

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Section: Discussionsupporting

confidence: 70%

The latent structure of the functional dyspepsia symptom complex: a taxometric analysis

Oudenhove

Jasper

Walentynowicz

et al. 2016

Neurogastroenterology Motil

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“…12 Investigation on the effect of meal ingestion on symptom generation has indicated that in patients with dyspepsia, not only postprandial fullness and early satiation, but also epigastric pain or epigastric burning sensation and nausea (not vomiting) may increase after the meals. Carbone et al 13 in Belgium reported that by accounting the relationship between epigastric pain and nausea in relation to meal ingestion, symptoms of PDS and EPS frequently coexist in patients with FD, and then postprandial symptoms substantially contributes to the overlap in the previous Rome III definition. Then they demonstrated that a more rigorous link of symptoms after meals to PDS might improve the separation efficiency of PDS from EPS.…”

Section: Epigastric Pain Syndrome May Coexistmentioning

confidence: 99%

“…Then they demonstrated that a more rigorous link of symptoms after meals to PDS might improve the separation efficiency of PDS from EPS. 13 Accordingly, the definition of PDS was slightly revised by including that, in addition to postprandial fullness and early satiety that is known to occur postprandially, other symptoms such as epigastric pain and burning can be occurred or modified also by ingesting a meal (Table). 4 In addition, epigastric bloating, belching, and nausea can be present in both PDS and EPS as possible adjunctive features of both, while vomiting is unusual, and should prompt a search for other diagnoses such as nausea and vomiting disorder.…”

Section: Epigastric Pain Syndrome May Coexistmentioning

confidence: 99%

The Application of the Rome IV Criteria to Functional Esophagogastroduodenal Disorders in Asia

Suzuki

2017

J Neurogastroenterol Motil

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The Rome criteria were amended as Rome IV. For functional esophageal disorders, the exclusion criteria have been more specifically revised based on further understanding of other esophageal disorders, including eosinophilic esophagitis and spastic and hypercontractile motor disorders. Another revised point is the more restrictive definition of gastroesophageal reflux disease, indicating that sensitivity to a physiological reflux burden may be placed more firmly within the functional group. For functional dyspepsia (FD), only minor changes were introduced, mainly to improve specificity. Among the major symptoms of FD, not only postprandial fullness, but also epigastric pain, epigastric burning, and early satiation should be "bothersome." Investigation on the effect of meal ingestion on symptom generation has indicated that not only postprandial fullness and early satiety, but also epigastric pain, epigastric burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered a possible cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such status can be termed as "H. pylori-associated dyspepsia." Prompt esophagogastroduodenoscopy and H. pylori testing and treatment would be more beneficial, especially in Asia, which has a high prevalence of gastric cancer. Acotiamide, tandospirone, and rikkunshito are the newly listed as treatment options for FD. For further therapeutic development, clinical studies based on the strict Rome IV criteria should be performed.

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“…In this issue of Neurogastroenterology and Motility, the research group of Tack evaluated 199 patients with FD selected from 1029 patients presenting for endoscopy . Consistent with previous outpatient studies, PDS was more frequent than EPS but the overlap group with both PDS and EPS was the most prevalent.…”

mentioning

confidence: 76%

Functional dyspepsia and the Rome criteria: a success story

Talley

2015

Neurogastroenterology Motil

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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.

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Rome III functional dyspepsia subdivision in PDS and EPS: recognizing postprandial symptoms reduces overlap

Abstract: EPS and PDS symptoms frequently coexist in FD patients, with postprandial symptoms substantially contributing to the overlap. A more rigorous linking of postprandially occurring symptoms to PDS, regardless of their qualitative nature, may improve the separation between PDS and EPS.

Cited by 54 publications

References 31 publications

The latent structure of the functional dyspepsia symptom complex: a taxometric analysis

The latent structure of the functional dyspepsia symptom complex: a taxometric analysis

The Application of the Rome IV Criteria to Functional Esophagogastroduodenal Disorders in Asia

Functional dyspepsia and the Rome criteria: a success story

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