Postinfectious onset in functional dyspepsia is a risk factor for weight loss

Functional Dyspepsia and Its Subgroups: Prevalence and Impact in the Rome IV Global Epidemiology Study

BACKGROUND

Functional dyspepsia (FD) is one of the most common disorders of gut-brain interaction (DGBI). Varying reported population prevalences probably reflect different definitions and methodological approaches.

AIM

To study the prevalence and impact of FD and its subgroups in an internet survey.

METHODS

A total of 54,127 respondents from 26 countries completed the survey including the Rome IV diagnostic questionnaire, Patient Health Questionnaire-4 (PHQ-4), PHQ-12, PROMIS Global-10, demographics, and medical history. Respondents reporting a history of relevant organic disease, or fulfilling criteria for self-induced or cyclic vomiting, or cannabinoid hyperemesis were excluded.

RESULTS

Rome IV FD prevalence was 7.2% (range 2.2%-12.3%), significantly higher in women and decreased with age. The most prominent subtype was postprandial distress syndrome (PDS) (66.6%). Rome IV IBS was found in 26.1% of those fulfilling FD criteria. Functional heartburn and chronic nausea and vomiting criteria were fulfilled in, respectively, 9.0% and 7.0%. Fulfilling FD symptom criteria was significantly associated with increased prevalence of anxiety and depression and with lower quality of life and higher healthcare seeking behaviour.

CONCLUSIONS

Rome IV FD is one of the most prevalent DGBI globally. Across countries, it is associated with female sex, younger age, psychological distress, reduced quality of life, and higher health care utilisation. PDS is the dominant subgroup. Overlapping other DGBI are present in a minority.

Good clinical practice recommendations for the diagnosis and treatment of functional dyspepsia: An expert review from the Asociación Mexicana de Gastroenterología

INTRODUCTION AND AIMS

Functional dyspepsia (FD) is a highly prevalent condition characterized by upper gastrointestinal symptoms with no apparent organic cause. It is a complex and multifactorial disease that frequently overlaps with other disorders of gut-brain interaction. It is recurrent, has a variable therapeutic response, and affects patient quality of life. Our aim was to formulate good practice recommendations for the management of FD through a consensus review of the disease, updating and complementing the 2017 consensus on dyspepsia from the Asociación Mexicana de Gastroenterología (AMG).

METHODS

Sixteen experts summoned by the AMG carried out a literature review (2017-2024) and formulated good clinical practice recommendations for the diagnosis and treatment of FD. They were discussed until reaching a consensus, and the most recent evidence on the theme was evaluated, utilizing the GRADE system.

RESULTS

Twenty-three good clinical practice recommendations for the management of FD were developed that addressed the following aspects: (1) definition, pathophysiology, and epidemiology; (2) diagnosis; (3) nonpharmacologic treatment; (4) Helicobacter pylori eradication; (5) antisecretory and anti-acid therapy; and (6) prokinetics and neuromodulators.

CONCLUSIONS

FD is one of the most frequent gastrointestinal conditions seen in daily practice. We present good clinical practice recommendations for the specific management of this disorder, taking into account the most recent advances that complement and update the consensus on dyspepsia published by the AMG in 2017.

Epidemiology of Disorders of the Gut-Brain Interaction: An Appraisal of the Rome IV Criteria and Beyond

Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.

Factors Associated with Overlap between Functional Dyspepsia and Nonerosive Reflux Disease in Endoscopy-based Helicobacter pylori-uninfected Japanese Health Checkup Participants: A Prospective, Multicenter Cross-sectional Study

Objective We assessed the factors associated with overlap between functional dyspepsia (FD) and nonerosive reflux disease (NERD) in endoscopy-based Helicobacter pylori-uninfected Japanese health checkup participants. Methods We utilized baseline data from 3,085 individuals who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The participants were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) score. FD, postprandial distress syndrome (PDS), and epigastric pain syndrome (EPS) were defined according to the Rome III criteria. NERD was defined as heartburn or regurgitation ≥1 day/week without erosive esophagitis. Results Of the 3,085 participants, 73 (2.4%), 97 (3.1%), and 84 (2.7%) had FD alone, NERD alone, and FD-NERD overlap, respectively. Factors associated with FD-NERD-overlap participants compared with participants with neither FD nor NERD were women [odds ratio (OR): 2.08, 95% confidence interval (CI): 1.24-3.52], body mass index (BMI) <18.5 (OR: 2.87, 95% CI: 1.56-5.07), alcohol consumption ≥20 g/day (OR: 1.85, 95% CI: 1.06-3.15), and a high STAI score (OR: 2.53, 95% CI: 1.62-4.00). Increasing age (OR: 1.06, 95% CI: 1.01-1.11) and EPS symptoms [pure EPS (OR: 3.67, 95% CI: 1.65-8.51) and PDS-EPS overlap (OR: 11.6, 95% CI: 4.09-37.2)] were associated with FD-NERD overlap vs. FD alone. Women (OR: 3.17, 95% CI: 1.47-7.04), BMI <18.5 (OR: 3.03, 95% CI: 1.04-9.90), and acid reflux symptoms ≥2 days a week (OR: 3.57, 95% CI: 1.83-7.14) were associated with FD-NERD overlap vs. NERD alone. Conclusion Understanding the clinical features of overlap between FD and NERD will lead to better management.