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Symptom patterns in functional dyspepsia and irritable bowel syndrome: relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters
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  1. S Haag1,
  2. N J Talley2,
  3. G Holtmann1
  1. 1Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstr 55, D-45122 Essen, Germany
  2. 2Mayo Clinic, College of Medicine, Rochester, MN, USA
  1. Correspondence to:
    Dr G Holtmann
    Department of Gastroenterology, Hepatology, and General Internal Medicine, Royal Adelaide Hospital, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia; gerald.holtmannweb.de

Abstract

Background: Our aim was to assess the relationship between gastric motor and sensory function and symptom patterns in community subjects and patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS).

Methods: We recruited 291 asymptomatic blood donors, 151 symptomatic blood donors (recurrent abdominal pain or discomfort), and 40 patients with FD or IBS. Abdominal symptoms were assessed using the bowel disease questionnaire (BDQ) and, in addition, the most bothersome symptom complex identified (dysmotility-type, ulcer-type dyspepsia, or IBS). Gastric emptying time (GET (t1/2, min)) was measured by 13C-octanoic breath test and a nutrient challenge performed. Twenty randomly selected asymptomatic blood donors, 48 symptomatic blood donors (30 FD, 18 IBS), and 40 patients (23 FD, 17 IBS) had additional function testing.

Results: GET (t1/2) was significantly (p<0.05) longer in blood donors with FD symptoms (99 (6) min) and FD patients (110 (12) min) compared with asymptomatic controls (76.7 (7) min), but was not significant in IBS blood donors or patients. Overall, 25 of 48 blood donors with symptoms and 18 of 40 patients had slow gastric emptying. GET was most delayed in subjects with predominantly dysmotility-type symptoms (167 (36) min v controls; p<0.01). Symptom intensities after a nutrient challenge were significantly higher in FD patients and symptomatic blood donors compared with asymptomatic controls; 14 of 48 blood donors with symptoms and 16 of 40 patients had a symptom response to the nutrient challenge exceeding the response (mean (2SD)) of healthy asymptomatic controls.

Conclusion: Gastric emptying and the global symptom response to a standardised nutrient challenge are abnormal in population based (non-health care seeking) subjects with dyspepsia.

  • BDQ, bowel disease questionnaire
  • FD, functional dyspepsia
  • FGID, functional gastrointestinal disorder
  • GET, gastric emptying time
  • IBS, irritable bowel syndrome
  • GORD, gastro-oesophageal reflux disease
  • functional dyspepsia
  • irritable bowel syndrome
  • gastric emptying
  • consulters
  • non-consulters

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