The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

Abstract Background: Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p<0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p <0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p <0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p <0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.

Download Full-text

Dispepsia funcional y gastroparesia: ¿dos entidades superpuestas? De la fisiopatología a la terapéutica

Acta gastroenterológica latinoamericana ◽

10.52787/bvbw1724 ◽

2021 ◽

Vol 51 (2) ◽

Author(s):

María Mercedes Manresa ◽

Paula Cecilia Carboné ◽

Guillermina Diez

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Current Knowledge ◽

Medical Condition ◽

Epigastric Pain ◽

Gastrointestinal Microbiota ◽

Gastrointestinal Infections ◽

Presumptive Diagnosis ◽

Postprandial Fullness ◽

Neuromuscular Abnormalities

Functional dyspepsia and gastroparesis represent the most common sensory-motor disorders of the upper gastrointestinal tract. Scientific advances in the last decade have shown that there is significant overlap between them. This review aims to address current knowledge about their pathophysiology, diagnosis and treatment. Functional dyspepsia is a medical condition that is characterized by one or more of the following symptoms: early satiety, postprandial fullness, and epigastric pain or burning. The pathophysiological mechanisms involved are: the gastroduodenal motility and sensory abnormalities, the immune dysfunction, the duodenal inflammation, the gastrointestinal infections, the alterations in the gastrointestinal microbiota and the dysfunction of the gut-brain axis. The Rome IV criteria make possible to establish a presumptive diagnosis of functional dyspepsia in most patients, although it continues to be a diagnosis of exclusion that requires the performance of an upper digestive video endoscopy to confirm it. The recommended therapeutic options are: the eradication of Helicobacter pylori, the proton pump inhibitors, the tricyclic antidepressants and prokinetics. Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of a mechanical obstruction. The pathophysiology is caused by neuromuscular abnormalities of gastric motor function. Gastric emptying scan is the current gold standard for diagnosis. The mainstays of treatment are restoration of hydration and nutrition, and pharmacological treatment with prokinetics and antiemetics.

Download Full-text

Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-09 ◽

2017 ◽

Vol 54 (1) ◽

pp. 46-50 ◽

Cited By ~ 3

Author(s):

Alessandra Maciel ALMEIDA ◽

Luísa Alvarenga Guerra MARTINS ◽

Patrícia Liz Terenzi CUNHA ◽

Viviane Willig BRASIL ◽

Lucas Galuppo Fernandes FÉLIX ◽

...

Keyword(s):

Functional Dyspepsia ◽

Eating Habits ◽

Epigastric Pain ◽

Pain Syndrome ◽

Postprandial Fullness ◽

Epigastric Pain Syndrome ◽

Dyspeptic Symptoms ◽

Rome Iii ◽

Belo Horizonte ◽

Social Demographic

ABSTRACT BACKGROUND Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

Download Full-text

Management of functional dyspepsia: state of the art and emerging therapies

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622317725479 ◽

2017 ◽

Vol 9 (1) ◽

pp. 23-32 ◽

Cited By ~ 15

Author(s):

Hiroshi Yamawaki ◽

Seiji Futagami ◽

Mako Wakabayashi ◽

Noriko Sakasegawa ◽

Shuhei Agawa ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Clinical Symptoms ◽

Epigastric Pain ◽

Pain Syndrome ◽

Multicenter Studies ◽

Gastric Accommodation ◽

Double Blind ◽

Epigastric Pain Syndrome ◽

Rome Iv

Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. Several etiologies have been associated with the disorder. In the Rome IV criteria, the brain–gut axis was acknowledged as an important factor in the etiology of functional gastrointestinal (GI) disorders. The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. A previous study has reported that proton pump inhibitors (PPIs) and H2-blockers were equally effective in functional dyspepsia. A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. The pharmacological mechanisms of acotiamide remain unknown; whether acotiamide alters gastric emptying and gastric accommodation in patients with functional dyspepsia remains an open question. Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs). Different drugs are needed to accommodate the clinical symptoms and etiology in individual patients.

Download Full-text

PREVALENCE OF ACIDIC AND NON-ACIDIC REFLUXES IN PATIENTS WITH FUNCTIONAL DYSPEPSIA AND ITS RISK FACTORS INVESTIGATED BY MEANS OF MULTICHANNEL INTRALUMINAL PH-MONITORING

Wiadomości Lekarskie ◽

10.36740/wlek201904119 ◽

2019 ◽

Vol 72 (4) ◽

pp. 604-612

Author(s):

Sergii Melashchenko ◽

Viacheslav Chernobrovyi ◽

Oleg Ksenchyn

Keyword(s):

Functional Dyspepsia ◽

Reference Group ◽

Epigastric Pain ◽

Ph Monitoring ◽

Significant Proportion ◽

Pain Syndrome ◽

Esophageal Diseases ◽

Weakly Alkaline ◽

Epigastric Pain Syndrome ◽

Significant Difference

Introduction: Previous studies performed by conventional pH-monitors showed that a significant proportion of patients with functional dyspepsia have abnormal acidic gastroesophageal reflux. The investigation, using advantages of multichannel intraluminal pH-monitoring, were not conducted. The aim to reveal the prevalence of all types of refluxes in patients with functional dyspepsia and to estimate risk provoking factors for abnormal reflux. Methods and materials: Patients were divided into 6 groups. The 1st, 2nd and 3rd groups covered 127 adult patients with epigastric pain syndrome, postprandial distress syndrome and mixed variant respectively. The 4th included 69 NERD patients suffered from frequent (more than one episode per week) heartburn. The 5th group also consisted of 22 NERD patients without heartburn or with rare heartburn-regurgitation. The reference group included 30 subjects without dyspeptic complaint and established diagnoses of gastro-esophageal diseases. For all persons the 200-min MII-pH-monitoring was performed with standardized stimulating breakfast (507kcal, 100 mg caffeine, 300ml) recording basal and postprandial phases. Results: It was found that the difference in comparison to the reference group in the number of refluxes is determined by the number of acid refluxes and not by weakly-acidic and weakly-alkaline refluxes. Patients with functional dyspepsia from all subgroups had an excessive amount of acidic refluxes in comparison with the reference group - 3.7±0.7, 4.7±0.8 and 2.8±0.7 vs 1.8±0.3 episodes (p<0.05). Using the previously obtained threshold values for abnormal acidic reflux (> 6 episodes per 200 min.) and total refluxes (>17 episodes per 200 min.) it was revealed that 22.8% patients with FD had abnormal GER. In addition, 16.5% had an isolated excess of non-acidic reflux. All three dyspeptic groups didn’t have a significant difference in the distribution of patients among subtypes of abnormal presence or absence of acidic/non-acidic refluxes. Conclusion: In functional dyspepsia abnormal acidic reflux are common and affect 22.8% of patients. It is independently associated with hiatal hernia (OR=4.17), previously healed a peptic ulcer (OR=3.90), occasional heartburn (OR=1.25), body mass index (OR=1.11), younger age (OR=0.97).

Download Full-text

DA-9701 (Motilitone): A Multi-Targeting Botanical Drug for the Treatment of Functional Dyspepsia

International Journal of Molecular Sciences ◽

10.3390/ijms19124035 ◽

2018 ◽

Vol 19 (12) ◽

pp. 4035 ◽

Cited By ~ 3

Author(s):

Mirim Jin ◽

Miwon Son

Keyword(s):

Functional Dyspepsia ◽

Serotonin Receptors ◽

Epigastric Pain ◽

Herbal Medicines ◽

Gastrointestinal Disorder ◽

Clinical Results ◽

Promising Alternative ◽

Postprandial Fullness ◽

Botanical Drug ◽

Upper Abdomen

Functional dyspepsia (FD) is the most common functional gastrointestinal disorder (FGID). FD is characterized by bothersome symptoms such as postprandial fullness, early satiety, and epigastric pain or burning sensations in the upper abdomen. The complexity and heterogeneity of FD pathophysiology, which involves multiple mechanisms, make both treatment and new drug development for FD difficult. Current medicines for FD targeting a single pathway have failed to show satisfactory efficacy and safety. On the other hand, multicomponent herbal medicines that act on multiple targets may be a promising alternative treatment for FD. DA-9701 (Motilitone), a botanical drug consisting of Corydalis Tuber and Pharbitidis Semen, has been prescribed for FD since it was launched in Korea in 2011. It has multiple mechanisms of action such as prokinetic effects, fundus relaxation, and visceral analgesia, which are mediated by dopamine D2 and several serotonin receptors involved in gastrointestinal (GI) functions. In clinical studies, DA-9701 has been found to be beneficial for improvement of FD symptoms and GI functions in FD patients, while showing better safety compared to that associated with conventional medicines. In this review, we provide updated information on the pharmacological effects, safety, and clinical results of DA-9701 for the treatment of FGIDs.

Download Full-text

A Randomized Controlled Study of Efficacy and Safety Profile of Levosulpiride and Itopride in Functional Dyspepsia

Journal of Mahatma Gandhi University of Medical Sciences and Technology ◽

10.5005/jp-journals-10057-0131 ◽

2020 ◽

Vol 5 (2) ◽

pp. 50-56

Author(s):

Ganesh Narain Saxena ◽

Saumya Mathur

Keyword(s):

Functional Dyspepsia ◽

Safety Profile ◽

Epigastric Pain ◽

Randomized Controlled Study ◽

Controlled Study ◽

Efficacy And Safety ◽

Early Satiety ◽

Postprandial Fullness ◽

Presenting Symptoms ◽

Randomized Controlled

ABSTRACT Introduction Dyspepsia is a clinical problem of considerable magnitude for the healthcare system due to the high prevalence and chronic and recurrent nature of symptoms. Earlier dyspepsia was referred to as a heterogeneous group of symptoms in the upper abdomen and retrosternal which are related to ingestion of meals and include heartburn, regurgitation, epigastric pain, epigastric burning, postprandial fullness/distension, early satiety, bloating, belching, anorexia, nausea, and vomiting. This has prompted the search for newer agents with equal efficacy but lower side effect potential such as levosulpiride and itopride. Aim and objectives To evaluate and compare the efficacy of the newer drugs like levosulpiride and itopride in functional dyspepsia. Observations and results The most common presenting symptoms in the present study were epigastric fullness (81%), upper abdominal pain (55%), early satiety (52%), and epigastric burning (45%). Less common symptoms were bloating (27%), belching (11%), heartburn (10%), and nausea (8%). Conclusion Drugs, itopride and levosulpiride, were equally effective in ameliorating different symptoms of functional dyspepsia at the end of 4 weeks of treatment. There was a significant reduction in mean global symptom score (GSS) and mean duration score and mean score of severity in follow-up visits at the 2nd and 4th week from the day of presentation (p value < 0.05). How to cite this article Saxena GN, Mathur S. A Randomized Controlled Study of Efficacy and Safety Profile of Levosulpiride and Itopride in Functional Dyspepsia. J Mahatma Gandhi Univ Med Sci Tech 2020;5(2):50–56.

Download Full-text

Perfusion Nutrient Load Test Combined With 2dus in Assessment of Proximal and Distal Gastric Emptying in Healthy Subjects and Functional Dyspepsia Patients

Gastroenterology ◽

10.1016/s0016-5085(11)60759-2 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-188

Author(s):

Jing Zhang ◽

Xiaohong Sun ◽

Meiyun Ke ◽

Zhifeng Wang ◽

Xilin Yang ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Healthy Subjects ◽

Load Test ◽

Nutrient Load

Download Full-text

Simultaneous Measurement of Gastric Emptying of a Soup Test Meal Using MRI and Gamma Scintigraphy

Diagnostics ◽

10.3390/diagnostics10030170 ◽

2020 ◽

Vol 10 (3) ◽

pp. 170 ◽

Cited By ~ 2

Author(s):

Asseel Khalaf ◽

Caroline L. Hoad ◽

Elaine Blackshaw ◽

Jaber Alyami ◽

Robin C. Spiller ◽

...

Keyword(s):

Gastric Emptying ◽

Test Meal ◽

Retention Rate ◽

Stomach Contents ◽

Individual Variability ◽

Gamma Scintigraphy ◽

Clinical Value ◽

Significant Difference ◽

Magnetic Resonance Imaging Mri ◽

The Individual

Measurement of gastric emptying is of clinical value for a range of conditions. Gamma scintigraphy (GS) has an established role, but the use of magnetic resonance imaging (MRI) has recently increased. Previous comparison studies between MRI and GS showed good correlation, but were performed on separate study days. In this study, the modalities were alternated rapidly allowing direct comparison with no intra-individual variability confounds. Twelve healthy participants consumed 400 g of Technetium-99m (99mTc)-labelled soup test meal (204 kcal) and were imaged at intervals for 150 min, alternating between MRI and GS. The time to empty half of the stomach contents (T1/2) and retention rate (RR) were calculated and data correlated. The average T1/2 was similar for MRI (44 ± 6 min) and GS (35 ± 4 min) with a moderate but significant difference between the two modalities (p < 0.004). The individual T1/2 values were measured, and MRI and GS showed a good positive correlation (r = 0.95, p < 0.0001), as well as all the RRs at each time point up to 120 min. Gastric emptying was measured for the first time by MRI and GS on the same day. This may help with translating the use of this simple meal, known to elicit reliable, physiological, and pathological gastrointestinal motor, peptide, and appetite responses.

Download Full-text