Functional Dyspepsia, 2016

Nicholas J. Talley; Marjorie M. Walker; Gerald Holtmann


Curr Opin Gastroenterol. 2016;32(6):467-473. 

In This Article

Symptom Assessment

A key feature of the PDS is that the symptoms occur postprandially rather than before or in-between meals. In contrast, the pain of EPS is not required to be meal related, although in some cases a clear-cut meal relationship is observed. The Rome IV working team report noted in functional dyspepsia that meal-related symptoms, even if not reported clinically or on a retrospective questionnaire, can often be induced by a standardized meal. As PDS and EPS often overlap in outpatients, Carbone et al.[5] evaluated whether focussing on the presence or absence of meal-related symptomatology might identify clearer subgroups that overlapped less. In a specialized center, they recruited 199 functional dyspepsia cases (out of 1029 presenting for upper endoscopy) and classified cases as overlap (both PDS and EPS) or no overlap. Of interest, the overlap group was more likely to report that epigastric pain was postprandial (70%) versus those with EPS alone (31%), suggesting a subset of cases with overlap actually have meal-related pain and the supposed overlap is artificial. Identifying those with symptoms related to a meal rather than solely focussing on early satiety or postprandial fullness is likely to identify the true PDS subset. The data further suggest that the majority with functional dyspepsia have meal-related symptoms, and perhaps those whose symptoms are not induced by a meal have a completely different underlying disorder.

In research and practice, symptom assessment is vital to diagnose and monitor the response to treatment of functional dyspepsia. Taylor et al.[6] have reviewed the utility of available questionnaires to assess symptoms of functional dyspepsia. They identified 16 questionnaires, but only two, the Nepean Dyspepsia Index (NDI; both long and short forms) and the Dyspepsia Symptom Severity Index (DSSI), covered all the key symptoms based on published qualitative research and Rome III criteria. However, the authors point out the need to develop new patient-reported outcome measures that meet the strict Food and Drug Administration requirements for regulatory approval of new drugs in functional dyspepsia.