1. Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features
- Author
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Pankaj J. Pasricha, Madhusudan Grover, Katherine P. Yates, Thomas L. Abell, Cheryl E. Bernard, Kenneth L. Koch, Richard W. McCallum, Irene Sarosiek, Braden Kuo, Robert Bulat, Jiande Chen, Robert J. Shulman, Linda Lee, James Tonascia, Laura A. Miriel, Frank Hamilton, Gianrico Farrugia, Henry P. Parkman, Pankaj Jay Pasricha, Robert Burns, Guillermo Barahona Hernandez, Megan McKnight, April Mendez, Kyle Staller, Andrea Thurler, Christopher Velez, Casey Silvernale, Zubair Malik, Alan Maurer, Amiya Palit, Natalia Vega, Denise Vasquez, Sean Connery, Karina Espino, Marvin Friedman, Thomas Abell, Abigail Stocker, Bridget Cannon, Lindsay McElmurray, Kelly Cooper, Catherine McBride, Kenneth Koch, Lynn Baxter, Anya Brown, Paula Stuart, Amirah Abdullah, William Snape, Nata DeVole, Karen Earle, Kjersti Kirkeby, Candice Lee, Mimi Lin, Doug Troyer, Anna von Bakonyi, Robert Shulman, Bruno Chumpitazi, Liz Febo-Rodriguez, John Hollier, Cynthia Bouette, Heather Charron, Samuel Nurko, Stephanie Wall, Madeline Kane, Kent Williams, Lina Yossef-Salameh, Frederick Woodley, Cheryl Bernard, Jose Serrano, Sherry Hall, Stephen James, Rebecca Torrance, Margaret Adamo, Patricia Belt, John Dodge, Michele Donithan, Milana Isaacson, Jill Meinert, Laura Miriel, Emily Sharkey, Jacqueline Smith, Michael Smith, Alice Sternberg, Mark Van Natta, Annette Wagoner, Laura Wilson, Goro Yamada, and Katherine Yates
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Gastroparesis ,Vomiting ,Gastroenterology ,Tertiary care ,Severity of Illness Index ,Tertiary Care Centers ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Internal medicine ,medicine ,Upper gastrointestinal ,Humans ,Registries ,Dyspepsia ,Hepatology ,Gastric emptying ,Adult patients ,business.industry ,Stomach ,Nausea ,Middle Aged ,medicine.disease ,Interstitial Cells of Cajal ,Pathophysiology ,Interstitial cell of Cajal ,Abdominal Pain ,030104 developmental biology ,medicine.anatomical_structure ,Gastric Emptying ,Case-Control Studies ,symbols ,030211 gastroenterology & hepatology ,Female ,Symptom Assessment ,business - Abstract
Background The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. Conclusions A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. ClinicalTrials.gov Identifier NCT00398801, NCT01696747
- Published
- 2020