Overlap Of Functional Dyspepsia Research Articles

Attributes of multiple concurrent functional gastrointestinal disorders in female university students in South Korea

ABSTRACT Functional gastrointestinal disorders (FGIDs) are common in young adults, particularly women, who tend to develop multiple FGIDs over time. This study aimed to investigate the prevalence of multiple concurrent FGIDs among female university students and identify differences in dietary habits, academic stress, and quality of life (QOL) based on the number of concurrent FGIDs. This secondary analysis included data from 406 female participants, originally collected through an online survey from two universities in one city in Korea. The online survey was accessible only after participants were verified as students through their online community. Concurrent FGID was present in 25.8 percent (n = 16) of the participants with FGIDs (n = 62), with the most common being irritable bowel syndrome + functional dyspepsia overlap (43.8 percent, 7/16). Participants with multiple concurrent FGIDs consumed fewer grains and vegetables, while significantly more of them consumed instant food, fast food, milk, and tea/coffee. They experienced significantly higher academic stress and lower QOL than those without the disease. Female university students with concurrent FGIDs tend to have unhealthy dietary habits, and concurrent FGIDs negatively affect academic stress and QOL. Therefore, female university students should undergo early-stage screening for FGIDs, and a comprehensive program should address their dietary habits and stress-coping skills.

Multimorbidity of Allergic Diseases Is Associated With Functional Gastrointestinal Disorders in a Young Japanese Population.

Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people. A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

Effect of Rebamipide on the Intestinal Barrier, Gut Microbiota Structure and Function, and Symptom Severity Associated with Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Randomized Controlled Trial.

Treatment of functional digestive disorders is not always effective. Therefore, a search for new application points for potential drugs is perspective. Our aim is to evaluate the effect of rebamipide on symptom severity, intestinal barrier status, and intestinal microbiota composition and function in patients with diarrheal variant of irritable bowel syndrome overlapping with functional dyspepsia (D-IBSoFD). Sixty patients were randomized to receive trimebutine (TRI group), trimebutine + rebamipide (T + R group), or rebamipide (REB group) for 2 months. At the beginning and end of the study, patients were assessed for general health (SF-36), severity of digestive symptoms (Gastrointestinal Symptom Rating and 7 × 7 scales), state of the intestinal barrier, and composition (16S rRNA gene sequencing) and function (short-chain fatty acid fecal content) of the gut microbiota. The severity of most digestive symptoms was reduced in the REB and T + R groups to levels similar to that observed in the TRI group. The duodenal and sigmoidal lymphocytic and sigmoidal eosinophilic infiltration was decreased only in the REB and T + R groups, not in the TRI group. Serum zonulin levels were significantly decreased only in the REB group. A decrease in intraepithelial lymphocytic infiltration in the duodenum correlated with a decrease in the severity of rumbling and flatulence, while a decrease in infiltration within the sigmoid colon correlated with improved stool consistency and decreased severity of the sensation of incomplete bowel emptying. In conclusion, rebamipide improves the intestinal barrier condition and symptoms in D-IBSoFD. The rebamipide effects are not inferior to those of trimebutine.

Treatment options for patients with overlap of functional dyspepsia and irritable bowel syndrome

Оbjective — to study the characteristics of changes in intestinal dysbiosis and psychoemotional status in patients with overlap of functional dyspepsia (FD) and irritable dowel syndrome (IBS) and to evaluate the efficacy of peppermint oil application in the treatment of such patients.
 Materials and methods. Examinations involved 92 patients with overlap of FD and IBS, from them 35 (38.0 %) men and 57 (62.0 %) women. Young patients (up to 45 years old) prevailed: 72 subjects (78.3 %). Epigastric pain syndrome was detected in 12 (13.0 %) patients, postprandial distress syndrome in 21 (22.8 %) patients, and 59 (64.1 %) patients had a mixed FD form. IBS with alternating constipation and diarrhea was diagnosed in 51 out of 59 (86.4 %) patients with the mixed FD form. Psychological testing was conducted to assess the psycho‑emotional status. The HADS scale was used to detect anxiety‑depressive disorders. Before and after treatment, all patients completed the SF‑36 quality of life (QoL) questionnaires. To diagnose the condition of the intestinal microbiota, presence of bacterial intestinal overgrowth syndrome (SIBO) was determined with the use of a hydrogen breath test with lactulose loading.
 Results. The use of the drug «Capsumen» in the complex treatment of patients with FD and IBS contributed to a rapid decrease in the intensity of abdominal pain (AP) (p < 0.05). In addition to positive clinical dynamics and AP relief, normalization of the intestinal microbiome was found in the patients. The SIBO frequency in patients who received «Capsumen» significantly decreased compared to the initial indexes and did not significantly differ from the data of healthy individuals. In all patients with FD and IBS, on the background of therapy, quality of life increased and anxiety‑depressive disorders decreased, compared to the data before treatment (p < 0.05).
 Conclusions. The use of peppermint oil in patients with FD and IBS demonstrated to be efficient and safe. The decrease in the abdominal pain frequency and intensity has been registered, in combination with the positive effects on the intestinal microbiome and normalization of quality of life, and minimizing anxiety‑depressive disorders.

Синдром перекреста функциональной диспепсии и синдрома раздраженного кишечника: современные представления о патогенезе и возможностях медикаментозной коррекции

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) overlap is an adverse clinical case, which is associated with clinical manifestation aggravation of each of the diseases and a significant life quality reduction. Comorbidity occurrence in functional gastrointestinal disorders (FGID) is due to the presence of common risk factors and pathogenetic mechanisms. This review is aimed at systematization of the available data on the FGID etiopathogenesis. The role of genetic factors, nervous control, in particular n. vagus, providing afferent and efferent interaction between intestine and brain, as well as infectious agents that cause the low-grade inflammation preservation in the intestinal mucosa, is considered. The article also shows the role of mast cell mediators that alter gastrointestinal motility and secretion. The role of Helicobacter pylori in the formation of FGID is considered separately. The importance of a detailed diagnosis during the examination of patients with FGID was noted to exclude serious organic pathology with similar symptoms. The main methods of correction in the conditions of FD and IBS comorbidity are indicated. KEYWORDS: overlap syndrome, functional dyspepsia, irritable bowel syndrome, inflammation, comorbidity. FOR CITATION: Livzan M.A., Lisovskiy M.А., Gaus O.V. Irritable bowel syndrome and functional dyspepsia overlap: modern ideas concerning the pathogenesis and drug correction opportunities. Russian Medical Inquiry. 2023;7(7):439–444 (in Russ.). DOI: 10.32364/2587-6821-2023-7-7-6.

A Randomized, Double-blinded, Placebo-controlled Study to Evaluate the Efficacy and Safety of DA-9701 (Motilitone) in Patients With Constipation-type Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Pilot Study.

Background/AimsTo assess the effects and safety of DA-9701 (Motilitone) in patients with constipation-type irritable bowel syndrome (IBS-C) which frequently accompany functional dyspepsia (FD).MethodsFD and IBS-C were diagnosed based on the Rome III criteria. Randomized subjects were administered 30 mg of DA-9701 or placebo 3 times a day for 4 weeks. The study endpoints were evaluated the percentage of responders in the overall symptom evaluation of IBS-C and FD.ResultsThirty IBS-C patients and 30 placebos were prospectively enrolled. The proportion of responders with improvement in overall symptoms of IBS-C was 53.33% in the DA-9701 group and 40.00% in the placebo group (P = 0.301). Compared to the placebo group, the decrease of abdominal pain score in the DA-9701 group was significantly higher at week 3 in the DA-9701 group (0.96 ± 0.77 vs 0.55 ± 0.79, P = 0.042) but no significance at week 4. There was no significant difference in total IBS quality of life score at week 4 between the 2 groups (P = 0.897). Among patients with IBS-C accompanied by FD, the proportion of responders in the DA-9701 group was 50.00% (15/30), which was higher than 31.03% (9/29) of the placebo group (P = 0.138).ConclusionsDA-9701 showed trend of treatment efficacy in patients with IBS-C and FD overlap including overall improvement, and safety, compared to placebo but without significance probably due to small numbers. It is suggested the need for a large-scale clinical trial to confirm this preliminary effect of DA-9701.

Overlap of functional dyspepsia and irritable bowel syndrome by revised Rome IV criteria: meta-analysis

Introduction. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) overlap is an adverse clinical situation, as patients with this syndrome have more severe clinical manifestations resulting in significant reductions in quality of life. For now, there are no meta-analytical papers that would summarize the frequency of FD – IBS overlap using the revised Rome IV criteria. Objective. To organize data on the prevalence of FD – IBS overlap using the revised Rome IV criteria.Materials and methods. A search for studies was conducted in MEDLINE / PubMed, EMBASE, Cochrane electronic databases. The search depth was 6 years (from January 2016 to February 2021). The final analysis included original publications from peerreviewed periodicals that used the revised Rome IV criteria as a method for diagnosing FD and IBS in the adult population with detailed descriptive statistics allowing to include resulting data in the meta-analysis.Results and discussion. The final analysis included 6 studies involving 1,180 patients with PD and 600 patients with IBS. The generalized prevalence of IBS in patients with PD was 41.511% (95% CI: 22.203–62.288). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 94.28%). The generalized prevalence of PD in patients with IBS was 38.791% (95% CI: 9.438–73.710). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 99.25%).Сonclusion. The complete meta-analysis showed that the frequency of FD - IBS overlap using the revised Rome IV criteria is quite high and accounts for about 40%. At the same time, further large studies of more homogeneous structure are needed to verify these results and study the potential pathogenetic relationship between PD and IBS.

The overlap of functional dyspepsia and irritable bowel syndrome: a random combination or appropriate relationship?

This review considers the relationship between functional dyspepsia and irritable bowel syndrome. The high overlap rate of two prevalent types of functional gastrointestinal disorders is explained by the commonality of a number of etiological and pathogenetic factors of both diseases, which should be taken in account in the treatment of such patients.

INVESTIGATION OF GASTRIC MOTILITY IN PATIENTS WITH THE OVERLAP SYNDROME OF THE GASTROESOPHAGEAL REFLUX DISEASE AND FUNCTIONAL DYSPEPSIA

Rationale: The phenomenon of overlap of two disorders, non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD) is an important clinical problem, while the symptoms in such patients are more severe and prevalent than in those with non-overlapping NERD or FD. This phenomenon may lead to treatment failure, if therapy does not take into account the specific pathophysiological mechanisms of the NERD and FD overlap. Aim : To study motility of the proximal and distal parts of the stomach in patients with the overlap syndrome of NERD with FD. Materials and methods: The study enrolled 56 patients (34 women and 22 men), aged from 18 to 45 years, who met the diagnostic criteria for NERD and FD (the Rome criteria III, esophageal endoscopy, 24-hour pH measurement or 24-hour impedance pH measurement), and had both NERD and FD symptoms simultaneously (overlap); 46 healthy volunteers. The accommodation of the proximal (fundal) part of the stomach and motility of the distal gastric part was assessed by ultrasonography (Aixplorer, SuperSonic Imagine, France, with convex probe 1–6 MHz) before and after the intake of the liquid test food. The patients filled in questionnaires to assess the symptoms and their severity (scored from 0 to 3). The difference between their mean ± standard deviation (SD) values was assessed by Students t-test and was considered significant at p < 0.05. Results : After intake of the liquid test food, the patients with the FD and NERD overlap syndrome demonstrated an advanced and statistically significant gastric motility abnormality both in its proximal and distal parts, compared to healthy control: accommodation disturbances and its reduction, decreased amplitude (61.4 ± 7.5 vs 90.2 ± 6.9%, p < 0.05), frequency of contractions of the antrum during 3-minute interval (4.3 ± 1.5 vs 9.7 ± 1.4, p < 0.05), antral motility index (4.3 ± 1.4 vs 8.8 ± 1.3%, p < 0.05), and gastric emptying (37.1 ± 14.5 vs 69.1 ± 19.5%, p < 0.05). Gastric accommodation abnormalities were associated with a statistically significant increase in the severity of the following symptoms: abdominal distention, postprandial feeling of fullness, early satiety, eructation, and heartburn (р< 0.05 for all symptoms). Conclusion: Detection of gastric accommodation and evacuation abnormalities that determine the overlap syndrome, indicate some common mechanisms of pathophysiology of FD and NERD, which should be taken into account for therapy optimization.

Su1001 Overlap of Functional Dyspepsia in Patients With Gastroesophageal Reflux Disease: Impact on Clinical, Metabolic, and Psychosocial Characteristics

Su1001 Overlap of Functional Dyspepsia in Patients With Gastroesophageal Reflux Disease: Impact on Clinical, Metabolic, and Psychosocial Characteristics

Determinants of symptoms in gastroesophageal reflux disease

Nonerosive reflux disease (NERD) is detected frequently. Furthermore, as general checkups including endoscopy have become popular, silent erosive esophagitis (EE), which is defined as EE without the typical symptoms of gastroesophageal reflux disease (GERD), is also frequently encountered. We investigated the determinants of symptom presentation in symptomatic EE, NERD, and silent EE, which are representative GERD groups. Participants in a prospective health-screening cohort underwent upper endoscopy from June 2009 to September 2010. GERD was defined as heartburn and/or acid regurgitation at least weekly or EE by endoscopy. All participants were asked to complete a validated questionnaire, which included questions about gastrointestinal symptoms and the somatization symptom checklist (SSC). Among 4565 participants (men, 51.9%; mean age, 46.0±10.2 years), GERD was found in 678 participants (14.9%) and EE in 335 participants (7.3%). Each group of participants was classified into the following three categories: (i) symptomatic EE (n=38, 5.6%); (ii) NERD (n=343, 50.6%); and (iii) silent EE (n=297, 43.8%). Male sex and obesity were common predictors in both the symptomatic and the silent EE groups compared with the control group. Higher scores on the SSC [odds ratio (OR), 3.7; 95% confidence interval (CI), 1.8-7.8] and overlap of functional dyspepsia (OR, 35.4; 95% CI, 14.9-84.3) were predictors of symptomatic EE compared with asymptomatic EE. Symptomatic EE was more strongly associated with male sex (OR, 7.8; 95% CI, 2.9-20.9) than was NERD. Somatization was the most important determinant of GERD symptoms. Silent EE was prevalent among participants with GERD, even though its natural history and clinical significance are unknown.

Overlap of functional dyspepsia and GERD—diagnostic and treatment implications

GERD and functional dyspepsia are the two most prevalent upper gastrointestinal disorders. Gastro-oesophageal reflux is most commonly diagnosed using the cardinal symptoms of heartburn and regurgitation. Patients might also be diagnosed using a questionnaire, after empiric treatment with an acid suppressant, after upper endoscopy or by pH testing. Functional dyspepsia is best diagnosed using symptoms outlined by the Rome committee in conjunction with a normal upper endoscopy. Theoretically, distinguishing these two populations should be easy for all health-care providers. In reality, however, carefully separating out these two populations can be quite difficult, as substantial overlap exists epidemiologically, symptomatically and even diagnostically. This overlap renders precise diagnosis a challenge; given the limited treatment options, the primary goal is to identify those patients who will respond to acid suppressive therapy. Despite the frequency with which functional dyspepsia and GERD overlap, remarkably few studies have investigated this overlap. Most recommendations are based on data derived from separate studies of functional dyspepsia and GERD. A further limitation of existing studies is their failure to differentiate between the various diagnostic categories into which the individual presenting with heartburn might belong.

Is There Enough Evidence for the Association of GNβ3 C825T Polymorphism With Functional Dyspepsia and Irritable Bowel Syndrome?

TO THE EDITOR: I read with great interest the paper from the Kim et al1 on the G-protein beta3 subunit (GNβ3) C825T polymorphism with overlap syndrome of functional dyspepsia (FD) and irritable bowel syndrome (IBS) which demonstrated that no apparent association of the GNβ3 C825T polymorphism with FD, IBS or the overlap of FD and IBS existed. However, a recent study on Korean children showed the CC genotype of GNβ3 C825T may be associated with FD and diarrhea predominant IBS and the TT genotype might be associated with constipation predominant IBS.2 Since the first study3 from Germany which indicated homozygous GNβ3 825CC genotype was associated with unexplained predominantly upper abdominal symptoms, many studies4-13 around the world showed inconsistent results on the association between the GNβ3 C825T polymorphism and functional gastrointestinal disorders (FGIDs). Many factors including heterogeneity of the disease, sample size, sample selection or racial difference may have contributed to these conflicting results. Still, we need to perform further large-scaled well-controlled studies to clarify this unresolved issue. The GNβ3 C825T polymorphism may change gastrointestinal motor and sensory functions through intracellular signal transduction and biological activity. Camilleri et al14 showed that GNβ3 T allele was associated with lower fasting gastric volume, which was one of the factors that predicted a portion of the variance in the symptoms of patients with dyspepsia.15 Further physiologic studies that deal with the effect of the GNβ3 C825T polymorphism on gastrointestinal motor and sensory functions are necessary to clarify the pathophysiologic mechanism in which genetic variations contribute to gastrointestinal symptoms. Can the GNβ3 C825T polymorphism influence response to therapy in FGIDs? Camilleri et al16 recently showed that GNβ3 TC/TT genotype might be associated with lower sensations of gas and urgency in response to rectal distention after clonidine treatment in humans. These findings could lead us to select FGIDs patients potentially treatable with clonidine and other drugs, based on genetic variation. Further pharamcogenetic studies could open a new horizon on treating patients with FGIDs in the future.

Is There Enough Evidence for the Association of GNβ3 C825T Polymorphism With Functional Dyspepsia and Irritable Bowel Syndrome?: Author's Reply

TO THE EDITOR: We appreciate the interest and comments1 on our paper, which was published in the July 2012 issue of this journal.2 We totally agree with the comment that many factors including heterogeneity of the disease, sample size, sample selection or racial difference may contribute to conflicting results of the genetic association studies in functional gastrointestinal disorders. Based on the reports showing the association of G-protein beta3 subunit (GNβ3) C825T polymorphism with functional dyspepsia (FD) and irritable bowel syndrome (IBS), we hypothesized that GNβ3 C825T polymorphism is associated with the overlap of FD and IBS. However, we failed to demonstrate the positive association. Moreover, in our study, GNβ3 C825T polymorphism was not significantly associated with the existence of FD alone or IBS alone. Four Korean studies including ours have been published in the literature.2-5 Among them, 2 studies showed the positive association4,5 and the others presented the negative association of GNβ3 C825T polymorphism with FD or IBS.2,3 The results were not consistent even in the former studies. The 825T allele is associated with enhanced G-protein activation and, thereby, increased cellular or physiologic responses.6 However, the CC genotype is characterized by diminished signal transduction responses. The genotype, associated with FD or IBS, should be different according to the distribution of subtypes. Theoretically, significant differences in the genotype frequency are more likely to exist between the subtypes of FD or IBS and the controls rather than between the entire group of FD or IBS and the control group. Previous Western studies have also shown conflicting results.7-10 The CC genotype is associated with unexplained dyspepsia in Germany.7 Whereas, homozygous T or C alleles of the GNβ3 C825T polymorphism is associated with meal-unrelated dyspepsia in a US community.8 Tertiary referral FD in the Netherlands is reported to be associated with the 825T allele of the GNβ3 gene.9 There is a report showing that GNβ3 C825T polymorphism is not associated with lower functional gastrointestinal disorders.10 Similarly, studies on a genetic polymorphism in the gene encoding for activity of the serotonin transporter protein in IBS patients have produced inconsistent results. FD and IBS are symptom-based disorders without measurable biomarkers. In addition, FD or IBS consists of subtypes with different phenotypes and pathophysiologic mechanisms. Because of those complex features, there are some fundamental problems in evaluating the genetic basis of FD and IBS. The pathophysiological mechanisms underlying symptom-based phenotypes are likely to be heterogeneous. Different biological mechanisms can produce similar symptom patterns. Individuals with delayed gastric emptying and those without such changes both can meet the postprandial distress syndrome diagnostic criteria as well as the FD symptom criteria. FD and IBS are common diseases and present diverse traits. The complex traits result from common variants with a relatively high frequency, but the effect size of each variant is relatively small.11 Moreover, the clinical phenotypes in an individual are not stable over time. Diverse environmental factors as well as genetic factors are required to develop a clinical phenotype. So, many factors may be involved in conflicting results of the genetic association studies in functional gastrointestinal disorders. We concur with the comments that physiologic studies that deal with the effect of the GNβ3 C825T polymorphism on gastrointestinal motor and sensory functions and pharmacogenomic studies on the response to the specific drugs are necessary.

G-Protein Beta3 Subunit C825T Polymorphism in Patients With Overlap Syndrome of Functional Dyspepsia and Irritable Bowel Syndrome

Background/AimsGuanine nucleotide binding protein (G-protein) beta polypeptide 3 (GNB3) C825T polymorphism alters intracellular signal transduction, which may lead to motor or sensory abnormalities of the gastrointestinal tract. The aim of the present study was to evaluate the association of the GNB3 C825T polymorphism with susceptibility to overlap syndrome of functional dyspepsia (FD) and irritable bowel syndrome (IBS) in a Korean population.MethodsOne hundred sixty-seven patients with FD alone, 60 patients with IBS alone, 85 patients with the overlap of FD and IBS, and 434 asymptomatic healthy subjects participated in the study. Genotyping for GNB3 C825T polymorphism was performed using their blood samples.ResultsNo association of GNB3 genotypes in patients with FD alone, IBS alone or overlap phenotype, when compared to genotypes in controls, was detected. The frequency of CT and TT genotypes relative to the CC genotype for the phenotypes of FD alone, IBS alone and the coexistence of FD and IBS did not significantly differ. Comparison of the TT genotype with the CC/CT genotype showed no significant association for each phenotype group.ConclusionsThere is no apparent association of the GNB3 C825T polymorphism with the susceptibility to FD, IBS or the overlap of FD and IBS. Larger-scale studies and further investigation on other candidate genes are required.

Epidemiology of uninvestigated and functional dyspepsia in Asia: facts and fiction.

Dyspepsia is a syndrome consisting of epigastric pain, burning, fullness, discomfort, early satiety, nausea, vomiting and belching. Functional dyspepsia (FD) is diagnosed if upper gastrointestinal endoscopy does not show structural abnormality explaining these symptoms. 8%-30% and 8%-23% of Asian people suffer from of uninvestigated dyspepsia and FD, respectively. Most patients with uninvestigated dyspepsia are found to have FD. Patients with FD are usually young and there is no predilection to any gender. Overlap of FD with other functional bowel diseases such as irritable bowel syndrome and gastroesophageal reflux disease is common in Asia. Cultural difference in reporting of symptoms of dyspepsia is well-known. Moreover, dietary factors, socio-cultural and psychological issues, gastrointestinal infection including that caused by Helicobacter pylori, frequency of organic diseases such as peptic ulcer and gastric cancer responsible for dyspeptic symptoms in the study population may also influence epidemiology of dyspepsia. There is considerable heterogeneity in the above issues among different Asian countries. More studies on epidemiology of FD are needed in Asia.

Functional dyspepsia impairs quality of life in the adult population

Data on the impact of functional dyspepsia on health-related quality of life in the general adult population are scarce. To explore the impact of functional dyspepsia applying the Rome III definition on health-related quality of life in the general population. A random sample of an adult Swedish population (n=1001, The Kalixanda study) was invited to undergo an oesophagogastroduodenoscopy. An extended abdominal symptom questionnaire and Short Form-36 (SF-36) questionnaire, which includes eight domains measuring physical, mental and social aspects of quality of life, were completed at the clinic visit just before oesophagogastroduodenoscopy. Two hundred and two (20%) individuals reported uninvestigated dyspepsia (UID), 157 (16%) functional dyspepsia (FD), 52 (5%) epigastric pain syndrome (EPS) and 122 (12%) postprandial distress syndrome (PDS). UID, FD and PDS had a clinically meaningful (a ≥ 5 point) and statistically significant impact (P<0.05) on health-related quality of life in all SF-36 domains except for Role Emotional. EPS had a significant impact on Bodily Pain and Vitality. Overlap of FD with irritable bowel syndrome (IBS) had a significant impact on Bodily Pain (P=0.002) and General Health (P=0.02) while FD overlap with gastro-oesophageal reflux symptoms (GERS) had a significant impact on Bodily Pain (P=0.02) compared with FD without any overlap with IBS or GERS. Functional dyspepsia impacts all main domains describing physical, mental and social aspects of health-related quality of life in the general population. Overlap of functional dyspepsia with irritable bowel syndrome or gastro-oesophageal reflux symptoms impacts the domain related to bodily pain.

Overlap of functional dyspepsia and irritable bowel syndrome in a community sample

Background. General practitioners base their treatment and investigation on the symptoms presented by the patients. Subgroups of dyspepsia have been defined in order to guide management.Aim. To study prospectively changes over time in the presentation of dyspepsia according to different subtypes in a general practitioner population.Subjects. Patients consulting the general practitioner because of dyspeptic complaints.Methods. A random sample of general practitioner patients consulting with different dyspepsia subtypes (ulcer-like, reflux-like, dysmotility-like, uncharacteristic and relapsing dyspepsia) were studied three years after the initial consultation by postal questionnaires to the general practitioners (obtaining information from the patient records) and to the patients (obtaining self-reported symptoms during twelve months). The subtype of dyspepsia at baseline was compared to the subtype in the patient questionnaire.Results. Between 20 and 34% of the patients reported no dyspepsia after three years, with no significant difference between the subtypes. Changes from one subtype to another were common, ulcer-like and reflux-like often changed into dysmotility-like dyspepsia. Dysmotility-like dyspepsia was significantly more stable over time. Patients with more than one episode of dyspepsia changed subtype significantly less.Conclusions. Most patients who presented with dyspepsia to the general practitioner still reported symptoms three years later. Few patients with dysmotility-like dyspepsia changed subtype over time, whereas changes from one subtype to another were common in other subtypes. This implies that dyspeptic patients could end up having dysmotility-like complaints possibly due to the lack of effective treatment for this condition, compared to the other dyspepsia subtypes.