No Predominant Symptom Reliably Identifies Dyspepsia Pathology
Subdividing functional dyspepsia
patient groups according to the predominant symptom does not reliably identify subgroups
with a homogeneous underlying pathophysiological
mechanism, finds a report in this month's Gastroenterology.
Functional dyspepsia is considered a
heterogeneous disorder with different pathophysiological
mechanisms contributing to the symptom pattern. The Rome II committee proposed
subdividing patients with functional dyspepsia into groups with predominant
pain versus discomfort with the aim of identifying subgroups with homogeneous pathophysiological and clinical properties. Investigators
analyzed the relationship of predominant pain or discomfort with pathophysiological mechanisms to evaluate whether
considering individual predominant symptoms yields better results. The team
included 720 consecutive functional dyspepsia patients, of which 489 were women
with a mean age of 41 years. The patients filled out a dyspepsia questionnaire
and identified a single-most bothersome symptom. The investigators analyzed the
association of this predominant symptom with demographic, clinical and pathophysiological features. The team noted that 592
patients had Helicobacter pylori
status and gastric emptying. Gastric sensitivity and accommodation testing was
identified in 332 patients.
According to Rome II criteria, 22
percent were pain predominant and 78 percent discomfort predominant. Patients
with predominant pain had a higher prevalence of hypersensitivity. The team
also observed delayed gastric emptying less frequently in these patients, but
there was major overlap. Detailed analysis showed that any of eight dyspeptic
symptoms could be predominant. Predominant early satiety or vomiting was
associated with significantly higher prevalences of
weight loss, occurring in 89 percent and 75 percent of patients, respectively.
Acute onset occurred in about 60 percent of those with predominant early
satiety or vomiting. The investigators found impaired accommodation in 79
percent of patients with predominant early satiety. The highest prevalence of
delayed emptying was found in predominant fullness and of hypersensitivity in
predominant pain. – Newsfeed from GastroHep.com
Gastroenterology; 2006: 130(2): 296-303