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Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features
- Source :
- Gastroenterology. 160(6)
- Publication Year :
- 2020
-
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
- 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
Subjects
Details
- ISSN :
- 15280012
- Volume :
- 160
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Gastroenterology
- Accession number :
- edsair.doi.dedup.....deda79c9aaf7c38d9b9981242e2bc90c