Table 3

State of fulfilment of putative criteria for implicating pathophysiological mechanisms in symptom generation in three prototype functional gastrointestinal disorders, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system (see table 2)

NumberCriterionNCCP: acid refluxFD: impaired accommodationFD delayed gastric emptying*IBS: rectal hypersensitivity
1PresenceAAAA
2Temporal associationABBB
3CorrelationAC*C**C***
4InductionDBCC
5A. Therapeutic responseBCC****C
B. Congruent natural history‡DDDD
Plausibility score *****11988
  • The evidence includes the overlapping syndrome of idiopathic gastroparesis given the difficulty differentiating the two on clinical grounds

  • * Only supportive data for early satiation and weight loss.

  • ** Only support for postprandial fullness, nausea and vomiting in selected studies

  • *** A majority of studies found correlations, but they are often in the weak to moderate range and relate to a single symptom or a subset of symptoms. On the other hand, meal-induced symptom aggravation correlates with increased rectal sensitivity.

  • **** Gastroprokinetic agents improve symptoms and enhance emptying rate in placebo-controlled trials, but both aspects are poorly correlate

  • ***** This score is generated by allocating numbers ranging from 3 to 0 for GRADE scores A to D respectively for each of the 4items and for the highest sub-item 5, and adding these up to generate a total between 0 and 15.

  • †† This represents a currently understudied area, but could be used when suitable therapeutic interventions are not available.

  • FD, functional dyspepsia; IBS, irritable bowel syndrome; NCCP, non-cardiac chest pain.