Stomach

Relationship between symptoms and ingestion of a meal in functional dyspepsia

R Bisschops, G Karamanolis, J Arts, P Caenepeel, K Verbeke, J Janssens, J Tack

Center for Gastroenterological Research, KU Leuven, Belgium

Dr J Tack, Department of Internal Medicine, Division of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium; Jan.Tack{at}med.kuleuven.ac.be

Backgound and aims: A subset of functional dyspepsia (FD) patients report meal-related symptoms, possibly representing a pathophysiologically homogeneous subgroup. The aim of the present study was to establish the time-course of symptoms in relation to meal ingestion, and to assess the relationship between self-reported meal-related symptoms and pathophysiological mechanisms in FD.

Methods: 218 FD patients (149 women, mean (SEM) age 39 (1) years) filled out a symptom questionnaire, including meal-induced aggravation. All patients underwent a gastric emptying breath test with severity (0–4) scoring of six symptoms (pain, fullness, bloating, nausea, burning and belching) at each sampling (15 min interval for 4 h). In 129 patients, gastric sensitivity and accommodation were assessed by barostat.

Results: The intensity of each FD symptom was significantly increased 15 min after the meal, compared with the premeal score, and remained elevated until the end of the measurement period (all p<0.05). The time-course of individual symptoms varied, with early peaks for fullness and bloating, intermediate peaks for nausea and belching, and late peaks for pain and burning. Meal-induced aggravation was reported by 79% of patients, and in these patients postprandial fullness, which peaked early, was the most intense symptom. In patients without self-reported meal-induced aggravation, epigastric pain, which had a delayed peak, was the most intense symptom and they had a lower prevalence of gastric hypersensitivity (27.5% vs 7.7%).

Conclusion: Meal ingestion aggravates FD symptoms in the vast majority of patients, with symptom-specific time-courses. Postprandial fullness is the most severe symptom in patients reporting aggravation by a meal, while it is pain in those not reporting meal-related symptoms.

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Subdividing functional dyspepsia: a paradigm shift?

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This article has been cited by other articles:

• (2009). Postprandial Symptoms in Functional Dyspepsia. JWatch Gastroenterology 2009: 4-4 [Full Text]  
• Talley, N. J (2008). Subdividing functional dyspepsia: a paradigm shift?. Gut 57: 1487-1489 [Full Text]