Functional Dyspepsia

77 Pages·2007·1.43 MB·English

Future Perspectives in Gastroenterology
Functional Dyspepsia
Hubert Mönnikes
Department of Medicine
Division Hepatology, Gastroenterology, and Endocrinology
Charité
Medical Faculty of Freie Universität & Humboldt-Universität, Berlin
Dyspepsia
Prevalence in industrialized countries
• worldwide 25% (7 - 41%)
• with heartburn: 40%
• without heartburn & IBS:10%
32%
14%
16%
27%
41%
26%
13%
7%
2255%%
Adapted from:
Locke, Bailliere‘s Clinical Gastroenterology 1998;12:435-41.
Defining Clinical Pathways for Dyspepsia …
…. discriminate Dyspepsia from GERD and IBS
Upper GI complaints Lower GI complaints
GERD Dyspepsia Irritable Bowel Syndrome
(Functional) Dyspepsia, GERD, IBS
Discrimination by Symptoms limited by Overlap
Early Sateity
Meteorims
Vomiting
Functional
Abdominal Pain
Nausea Dyspepsia
Constipation
Bloating
IBS
Diarrhoe
Epigastric Pain
GERD
Dysphagia Distension
Belching
Heartburn
Regurgitation
Talley N. In: Modlin IM (ed.) From Gastrin to GERD: A Century of Acid Suppression.
Tylney Hall Lectures, Felsenstein CCCP; 8–9 April 2005
Defining Clinical Pathways for Dyspepsia …
Investigated versus Non-investigated Dyspepsia
Upper GI complaints Lower GI complaints
GERD Dyspepsia Irritable Bowel Syndrome
Non-investigated Investigated Dyspepsia
Dyspepsia … had upper GI Endoscopy …
Defining Clinical Pathways for Dyspepsia …
Organic versus Functional Dyspepsia
Upper GI complaints Lower GI complaints
GERD Dyspepsia Irritable Bowel Syndrome
Non-investigated Investigated Dyspepsia
Dyspepsia … normal upper GI Endoscopy
Organic Dyspepsia Functional Dyspepsia
Dyspepsia
Main causes
Williams 1988 Stanghellini 1996 Heikkinen 1996 Thomson 2003
(n = 1386) (n = 1057) (n = 766) (n = 1040)
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Gastric Peptic GERD Functional
neoplasia ulcers Dyspepsia
Functional Dyspepsia
Rome-III Criteria
Rome III:
(cid:131) No evidence for structural disease
longer than 3
(cid:131) One or more of: - Bothersome postprandial fullness
months,
- Early satiation
at least 6 months
- Epigastric pain before diagnosis
- Epigastric burning
Tack, Gastroenterology 2006;
(cid:131) 2 Subgroups: - Postprandial distress syndrome 130:1466-79.
- Epigastric pain syndrome
Functional Dyspepsia
Rome-III Criteria versus Rome-II Criteria
Rome III:
(cid:131) No evidence for structural disease
longer than 3
(cid:131) One or more of: - Bothersome postprandial fullness
months,
- Early satiation
at least 6 months
- Epigastric pain before diagnosis
- Epigastric burning
Tack, Gastroenterology 2006;
(cid:131) 2 Subgroups: - Postprandial distress syndrome 130:1466-79.
- Epigastric pain syndrome
Rome II:
(cid:131) No evidence of organic disease
At least 12 weeks
(cid:131) Persistent or recurrent upper GI symptoms
within the
(cid:131) No relief by defecation or associated preceeding
with the onset of a change in stool behaviour 12 months.
(cid:131) 2 Subgroups: - Dysmotility-like dyspepsia
Talley, Gut 1999; 45 Suppl
- Ulcer-like dyspepisa 2:II37-II42.
Functional Dyspepsia – Rome-III Criteria
Subgroups – PDS and EPS
Postprandial Distress Syndrome (PDS) Epigastric Pain Syndrome (EPS)
Must include one or both of the following: Must include all of the following:
• Bothersome postprandial fullness, • Epigastric pain or burning (at least
occurring after ordinary sized meals, at moderate severity, at least once per
least several times per week* week)*
• Early satiation that prevents finishing a • Pain is intermittent*
regular meal, at least several times per • Not generalized or localized to other
week* abdominal or chest regions*
• Not relieved by defecation or
passage of flatus*
• Not fulfilling criteria for gallbladder
and sphincter of Oddi disorders*
Supportive criteria:
• Pain may be of a burning quality but
without a retrosternal component*
*longer than 3 months, at least 6
• Pain is commonly induced or
months before diagnosis relieved by ingestion of a meal but
may occur while fasting*
Tack, Gastroenterology 2006; 130:1466-79. • PDS syndrome may coexist