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Title: Association of postprandial distress syndrome and epigastric pain syndrome with putative pathophysiological abnormalities in functional dyspepsia
Authors: Kindt, S├ębastien
Caenepeel, Philip
Bisschops, Raf
Vos, Rita
Tack, Jan #
Issue Date: Apr-2007
Publisher: W b saunders co-elsevier inc
Host Document: Gastroenterology vol:132 issue:4 pages:A73-A73
Conference: Digestive Disease Week location:Washington date:19-24 May 2007
Abstract: The Rome III committee proposed to distinguish postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) as new sub-entities of functional dyspepsia (FD). The purpose of this distinction is to identify subgroups which have a more homogeneous underlying pathophysiology, and which are more likely to respond to specific therapy. The aim of this study was to assess the association of EPS and PDS with pathophysiological mechanisms in FD. Material and methods: A data set of 116 tertiary care FD patients (76 women, mean age 39±1 year) who had filled out a questionnaire evaluating the presence of weight loss and the severity (0=absent, 1=mild, 2=relevant, 3=severe) for each of eight dyspeptic symptoms (epigastric pain, postprandial fullness, bloating, early satiety, nausea, vomiting, belching, heartburn) was retrospectively analyzed to identify EPS, PDS or both, based on symptom responses. For all patients, results of a 14C octanoic and 13C glycin breath test to assess solid and liquid emptying respectively, and a gastric barostat to assess gastric sensitivity and accommodation were available. H pylori status was known for 85 subjects. Data (mean±SEM) were analyzed by t-tests and non-parametric tests. Results: EPS was present in 53% of subjects and PDS in 84%, with overlap in 47%. Demographic features did not differ according to subgroups. Meal-induced accommodation was significantly smaller in PDS (121±15 vs. 184±21 ml, p=0.039) with a higher prevalence of dysaccommodation (39 vs. 5%, p=0.004). Discomfort thresholds were not significantly different in EPS compared to non-PDS (8.8±0.5 vs. 10.7±0.8 mmHg above MDP, NS) nor was the prevalence of gastric hypersensitivity to distention (35 vs. 22%, NS). However, more subjects with both EPS and PDS had gastric hypersensitivity as compared to patients with EPS or PDS alone or none (38 vs. 21%, p=0.046). Weight loss was more pronounced in PDS (7.2±0.7 vs. 2.1±0.9 kg, p<0.001) and EPS (7.3±0.9 vs. 5.2±0.9 kg, p=0.047) as compared to non-PDS and non-EPS respectively. Gastric half-emptying time for solids or liquids didn’t differ as compared to non-EPS or non-PDS. H pylori showed a similar low prevalence in all subgroups. Conclusion: In this retrospective analysis, PDS is associated with impaired gastric accommodation and weight loss. Gastric hypersensitivity was more prevalent when subjects suffered from both EPS and PDS. No specific pathophysiological anomaly was linked to EPS alone. The newly defined entity PDS shows promise to identify a subgroup of FD patients with a higher prevalence of impaired accommodation to a meal.
ISSN: 0016-5085
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Translational Research in GastroIntestinal Disorders
# (joint) last author

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