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Relationship Between Symptoms And Ingestion Of A Meal In Functional Dyspepsia
  1. Raf Bisschops (raf.bisschops{at}med.kuleuven.be)
  1. Center for Gastroenterological Research, K.U.Leuven, Belgium
    1. George Karamanolis
    1. Center for Gastroenterological Research, K.U.Leuven, Belgium
      1. Joris Arts
      1. Center for Gastroenterological Research, K.U.Leuven, Belgium
        1. Philip Caenepeel
        1. Center for Gastroenterological Research, K.U.Leuven, Belgium
          1. Kristin Verbeke
          1. Center for Gastroenterological Research, K.U.Leuven, Belgium
            1. Jozef Janssens
            1. Center for Gastroenterological Research, K.U.Leuven, Belgium
              1. Jan Tack (jan.tack{at}med.kuleuven.be)
              1. Center for Gastroenterological Research, K.U.Leuven, Belgium

                Abstract

                A subset of functional dyspepsia (FD) patients report meal-related symptoms, possibly representing a pathophysiologically homogeneous subgroup. Our aim 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 age 39±1) filled out a symptom questionnaire, including meal-induced aggravation. All patients underwent a gastric emptying breath test with severity (0-4) scoring of 6 symptoms (pain, fullness, bloating, nausea, burning and belching) at each sampling (15 min interval for 4 hrs). In 129 patients, gastric sensitivity and accommodation were assessed by barostat. Results: The intensity of each FD symptom was significantly increased 15 minutes after the meal, compared to the pre-meal score, and remained elevated until the end of the measurement period (all p<0.05). 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 meal aggravation, while it is pain in those not reporting meal-related symptoms.

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