T1323 Do Different Types of Patients with Functional Dyspepsia in ROME III Criteria Vary in Related Pathophysiological Mechanisms?

Abstract

BACKGROUND: In Rome III criteria, patients with functional dyspepsia (FD) are divided into: epigastric pain syndrome (EPS), postprandial discomfort syndrome (PDS) and EPS+PDS. Now, it remains unknown whether differences in the FD related pathophysiological mechanisms exit among them. If the differences are detected, it will be very helpful to treat different types of FD patients according to their special pathophysiologies. AIMS: To investigate the differences in FD related pathophysiologies including gastric solid emptying (GE), gastric muscular electrical activity (GME), autonomic nerve system function (ANS), gastric accommodation/sensitivity and abnormal psychological factors among EPS, PDS and EPS+PDS types of FD patients. METHODS: 77 FD patients according to Rome III criteria (57F, mean age 44.8yrs, EPS 17, PDS 34, EPS+PDS 26) were enrolled in this study. GE, GME, ANS, gastric accommodation/sensitivity and abnormal psychological factors were measured by GE test (radionuclide and radiopaque maker methods), multi-channel electrogastrography, heart rate variability analyzer, liquid nutrient load test (LNLT) and Zung Anxiety/Depression Scale, respectively. The study was approved by the ethics committee of PUMC Hospital. RESULTS: 1. No significant differences exited in age, sex and course of FD among the three types (P>0.05). 2. Delayed GE%: EPS vs. PDS vs. EPS+PDS 33.3% vs. 36.7% vs. 40.0% (P= 0.912). 3. GME: Normal percentage of 2-4cpm gastric slow waves: fasting 78.9±10.6% vs. 75.2±15.0% vs. 69.9±19.0% (P=0.209) and postprandial 71.0±14.0% vs. 71.6±15.2% vs. 62.6±17.3% (P=0.097). Percentage of slow wave coupling%: fasting 67.5±17.0% vs. 64.9±21.2% vs. 61.5±23.3% (P=0.684) and postprandial 62.0±15.7% vs. 59.2±19.6% vs. 50.9±18.1% (P=0.138). 4. LNLT: Maximal Intake Volume: 511±140 vs. 451±129 vs. 480±148ml (P=0.431). 5. ANS: Sympathetic Activity: fasting 0.46±0.28 vs. 0.36±0.19 vs. 0.45±0.14 (P=0.174) and postprandial 0.51±0.17 vs. 0.51±0.19 vs. 0.54±0.13 (P=0.821). Vagal Activity: fasting 0.62±0.17 vs. 0.64±0.19 vs. 0.55±0.14 (P=0.156) and postprandial 0.49±0.17 vs. 0.49±0.19 vs. 0.46±0.13 (P=0.821). 6. Zung Anxiety Scale: 45.6±9.4 vs. 48.4±10.1 vs. 49.7±9.5 (P=0.430) and Zung Depression Scale: 49.5±10.4 vs. 55.1±10.4 vs. 55.8±8.6 (P=0.112). CONCLUSIONS: No differences in the FD related pathophysiologies including GE, GME, ANS, gastric accommodation/sensitivity and abnormal psychological factors were detected among EPS, PDS and EPS+PDS types of FD patients, which suggests that the sub-grouping method of EPS, PDS and EPS+PDS is helpless to the treatment strategy“to treat different types of FD patients according to their special pathophysiologies”.