Abstract and Introduction
Abstract
Background: The European consensus defined gastroparesis as a condition characterised by delayed gastric emptying (GE) in the absence of mechanical obstruction, with a symptom pattern of predominant nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). The distinction between patients with gastroparesis and those with functional dyspepsia (FD), another gastrointestinal condition characterised by predominant PDS or epigastric pain syndrome symptoms, is ongoing.
Aim: To investigate the extent that symptom patterns may differentiate gastroparesis from FD.
Methods: This retrospective study included 637 patients from Leuven University Hospital in 2006–2021 who had upper gastrointestinal symptoms, underwent a GE test, and completed the Dyspepsia Symptom Severity (DSS) questionnaire. Patients were identified as with gastroparesis-like symptoms (GPLS; i.e., moderate to severe nausea with moderate to severe PDS) or FD symptoms (not fitting GPLS). We excluded patients aged <18 years, and those with diabetes, organic gastrointestinal disease or a history of abdominal surgeries. Demographic and clinical variables were compared.
Results: Among 545 patients, 238 reported GPLS and 307 reported FD symptoms. Those with GPLS had a significantly higher prevalence of delayed GE (half emptying time (T1/2) ≥109 min) and lower body mass index than those with FD (33.2% vs 17.6%, p < 0.01; 19.9 vs 21.2, p < 0.01, respectively). Among GPLS patients, those with delayed GE had higher DSS than those without (13.0 vs 12.0, p < 0.01).
Conclusions: In tertiary care patients who reported gastroparesis or FD symptoms, the presence of delayed GE was associated with GPLS. In patients with GPLS, delayed GE was associated with higher symptom severity.
Introduction
Gastroparesis (GP) and functional dyspepsia (FD) are two common sensorimotor disorders in the gastroduodenal region.[1,2] GP is a clinical syndrome characterised by delayed gastric emptying (GE) in the absence of a mechanical obstruction.[3–5] Several symptoms have been reported in GP patients, including nausea and vomiting, post-prandial fullness, early satiety and bloating.[6] On the contrary, FD is defined by symptoms of postprandial fullness, early satiation, epigastric pain and/or epigastric burning and is diagnosed based on the ROME IV diagnostic criteria.[7] Symptom recognition is crucial for the diagnosis and treatment of gastrointestinal functional and motility disorders. Currently, symptom-based management of GP and FD forms the mainstay of therapy.[8] A recent study by the Gastroparesis Clinical Research Consortium showed that patients with GP and FD at tertiary hospitals are not distinguishable based on clinical symptoms and pathologic features and concluded that GP and FD are both on a spectrum of gastric sensorimotor dysfunction.[9] The distinction between patients with GP from those with FD is a matter of ongoing debate over the last decade because of the large symptom overlap and the variable correlation between symptoms and delayed GE.[10–12] The recent United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus identified nausea and vomiting as cardinal symptoms of GP, in the presence of overlapping postprandial distress syndrome (PDS).[13] In addition, the European consensus on FD identifies early satiation, postprandial fullness, and epigastric pain or burning as predominant symptoms in FD.[14] These two recent consensuses seem to provide directions for both the diagnostic process and treatment options in both conditions. However, it remains to be established to what extent the symptom patterns may differentiate GP versus FD.
Therefore, in the current study, the database of the University Hospitals Leuven was used to estimate the prevalence of delayed GE, using the GE breath test in patients with a symptom pattern suggestive of GP, compared to those with a FD symptom pattern.
Aliment Pharmacol Ther. 2023;57(7):773-782. © 2023 Blackwell Publishing
