Dispepsia funcional y gastroparesia: ¿dos entidades superpuestas? De la fisiopatología a la terapéutica

Abstract

Functional dyspepsia and gastroparesis represent the most common sensory-motor disorders of the upper gastrointestinal tract. Scientific advances in the last decade have shown that there is significant overlap between them. This review aims to address current knowledge about their pathophysiology, diagnosis and treatment. Functional dyspepsia is a medical condition that is characterized by one or more of the following symptoms: early satiety, postprandial fullness, and epigastric pain or burning. The pathophysiological mechanisms involved are: the gastroduodenal motility and sensory abnormalities, the immune dysfunction, the duodenal inflammation, the gastrointestinal infections, the alterations in the gastrointestinal microbiota and the dysfunction of the gut-brain axis. The Rome IV criteria make possible to establish a presumptive diagnosis of functional dyspepsia in most patients, although it continues to be a diagnosis of exclusion that requires the performance of an upper digestive video endoscopy to confirm it. The recommended therapeutic options are: the eradication of Helicobacter pylori, the proton pump inhibitors, the tricyclic antidepressants and prokinetics. Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of a mechanical obstruction. The pathophysiology is caused by neuromuscular abnormalities of gastric motor function. Gastric emptying scan is the current gold standard for diagnosis. The mainstays of treatment are restoration of hydration and nutrition, and pharmacological treatment with prokinetics and antiemetics.