Functional Dyspepsia, 2016

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

Disclosures

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

In This Article

Gastroduodenal Dysfunction

Slow gastric emptying, impaired fundic relaxation (fundic disaccommodation), and gastroduodenal hypersensitivity to balloon distention have been identified in different subsets with functional dyspepsia.[1,2] Gastric emptying fails to correlate with symptoms, but failure of fundic relaxation after a meal correlates with early satiety. Failure of fundic relaxation is postulated to abnormally distribute gastric contents such that the antrum becomes distended and patients perceive excessive fullness.[1,2] Gastric accommodation can be assessed by a balloon (barostat) or using a nuclear medicine technique [single photon emission computed tomography (SPECT)], but these remain research tools. A useful noninvasive technique that can assess gastric accommodation is abdominal ultrasound; this requires an experienced operator, but as Steinsvik et al.[26] report from Bergen in a large retrospective analysis of 160 functional dyspepsia patients and 154 with IBS, 36% with functional dyspepsia had abnormal gastric accommodation. Further, a 500 ml soup meal (0.9 g fat) significantly worsened all dyspepsia symptoms in patients with functional dyspepsia compared with controls, and supports the concept that applying a bedside meal test may help to objectively diagnose functional dyspepsia.

Dibaise et al.[27] report that psychological distress levels are high in functional dyspepsia cases presenting for assessment of gastric emptying. Of 209 patients assessed, the majority (72%) fulfilled Rome III criteria for functional dyspepsia. Of interest, in those without functional dyspepsia similar levels of psychological distress were documented, and this was not related to gastric emptying findings. This study provides further evidence that gastric emptying is not a primary mechanistic disturbance in functional dyspepsia.

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