Predictors of Abnormal Testing and Symptom Subtypes in Functional Dyspepsia (FD)

Abstract

Purpose: FD is a common, chronic condition that can be divided into symptom subtypes. Although the pathogenesis is unclear, abnormalities of gastric motor and sensory function have been identified, and psychological factors are felt to be important in patient presentation. Aims: (1) To identify predictors of delayed gastric emptying (GE) and abnormal satiety test (ST) results in patients with FD, and (2) To identify symptoms, physiological test results and psychological scores that could discriminate patients with dysmotility-like (DLD) vs. ulcer-like dyspepsia (ULD). Methods: Patients aged 18-75 who met Rome II criteria for FD were enrolled in a multi-center trial assessing baseline symptoms, physiological measures and psychological characteristics as part of an ongoing FD treatment trial. In addition to age, sex and BMI, the following information was collected: (a) symptoms (fullness, inability to finish a meal, nausea, vomiting, pain/burning) using a validated bowel disease questionnaire, (b) scores for anxiety and depression using the Hospital Anxiety and Depression Scale, (c) 4-hour GE as measured by scintigraphy, and (d) volume at and time to maximum satiation using an Ensure drink ST. Separate logistic regression models for each potential predictor adjusting for age, sex and BMI were used to estimate the odds ratios (OR[95%CIs]) for delayed GE, abnormal ST, and dyspepsia subtypes. Results: 97 patients (77% females), mean (±SD) age 45±16 yrs and BMI 26.3±5.0 were assessed. Overall, (1) delayed GE was seen in 25%, but no assessed variables were predictive, (2) 57% had an abnormal ST, and the inability to finish a meal was a significant predictor; (3) 63% had DLD, and neither GE or ST were predictive of subtype (DLD vs. ULD); (4) the symptoms of fullness and nausea were significant predictors of DLD; (5) anxiety and depression scores were not predictive of abnormal physiology or symptom subtypes. Representative data are shown (percentages are row percentages). Conclusion: In this group of patients with FD, symptoms were not predictive of delayed GE, but the inability to finish a meal was predictive of an abnormal ST. GE and ST results were not predictive of dyspepsia subtype. The data suggest that measurement of GE in FD is unlikely to impact management. Funded by NIH grant #U01 DK 065713.Table