Mo2064 ROME III Functional Dyspepsia Subdivision in PDS and Eps: Recognizing Postprandial Symptoms Reduces Overlap

Abstract

patients satisfied ROME criteria for CVS, while 27 (3.2%) had a gastroenterologist confirmed diagnosis of CVS. Overall, the ROME CVS criteria detected 100% of the clinically confirmed CVS cases, yielding sensitivity and NPVs of 100%; however, a substantial number of false positive cases were detected (n=135, 16.2%), resulting in specificity and PPV values of 83.2% and 16.6%, respectively. Of the false positive cases, 100 (74.1%) met ROME criteria for: functional dyspepsia in 86 (63.7%), functional vomiting in 49(36%), chronic idiopathic nausea in 24 (17.8%), functional heartburn in 68 (50.4%), and functional chest pain in 23 (17.0%). There were no significant differences in age, gender, reported symptom severity/ frequency, HRQOL, or somatization scores between expert clinician diagnosis and ROMEIII diagnosis of CVS (p.0.20 for each). Self-report of vomiting frequency and symptomfree intervals (Rome III RDQ Questions 28 and 31) also did not distinguish between the two CVS groups (P.0.16 for each). Tricyclic antidepressants were predominantly used for prophylaxis (76.9%); zonisamide (42.3%), topiramate (11.5%) and levatiracetam (7.7%) were used less often. Conclusions: Questionnaires overestimate CVS diagnosis, and cannot be substituted for expert clinician evaluation of patients. Functional foregut syndromes often confound diagnosis, but prophylactic management recommendations (i.e. neuromodulator use) may be similar for confounding diagnoses.