Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features

National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium

doi:10.1053/j.gastro.2021.01.230

Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features

National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods: Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results: Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206⁺ macrophages in both groups compared with obese controls. Conclusions: A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly “organic” gastric neuromuscular disorders. ClinicalTrials.gov

Original language	English (US)
Pages (from-to)	2006-2017
Number of pages	12
Journal	Gastroenterology
Volume	160
Issue number	6
DOIs	https://doi.org/10.1053/j.gastro.2021.01.230
State	Published - May 1 2021

Keywords

Chronic Nausea
Enteric Nervous System
Functional Dyspepsia
Gastric Emptying
Gastroparesis

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1053/j.gastro.2021.01.230

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Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features. / National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium.
In: Gastroenterology, Vol. 160, No. 6, 01.05.2021, p. 2006-2017.

Research output: Contribution to journal › Article › peer-review

National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium 2021, 'Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features', Gastroenterology, vol. 160, no. 6, pp. 2006-2017. https://doi.org/10.1053/j.gastro.2021.01.230

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title = "Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features",

abstract = "Background: The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods: Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results: Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. Conclusions: A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly “organic” gastric neuromuscular disorders. ClinicalTrials.gov",

keywords = "Chronic Nausea, Enteric Nervous System, Functional Dyspepsia, Gastric Emptying, Gastroparesis",

author = "{National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium} and Pasricha, {Pankaj J.} and Madhusudan Grover and Yates, {Katherine P.} and Abell, {Thomas L.} and Bernard, {Cheryl E.} and Koch, {Kenneth L.} and McCallum, {Richard W.} and Irene Sarosiek and Braden Kuo and Robert Bulat and Jiande Chen and Shulman, {Robert J.} and Linda Lee and James Tonascia and Miriel, {Laura A.} and Frank Hamilton and Gianrico Farrugia and Parkman, {Henry P.} and Pasricha, {Pankaj Jay} and Robert Burns and Hernandez, {Guillermo Barahona} and Megan McKnight and April Mendez and Kyle Staller and Andrea Thurler and Christopher Velez and Casey Silvernale and Zubair Malik and Alan Maurer and Amiya Palit and Natalia Vega and Denise Vasquez and Sean Connery and Karina Espino and Marvin Friedman and Thomas Abell and Abigail Stocker and Bridget Cannon and Lindsay McElmurray and Kelly Cooper and Catherine McBride and Kenneth Koch and Lynn Baxter and Anya Brown and Paula Stuart and Emily Sharkey and Alice Sternberg and {Van Natta}, Mark and Laura Wilson and Goro Yamada",

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T1 - Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features

AU - National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health Gastroparesis Clinical Research Consortium

AU - Pasricha, Pankaj J.

AU - Grover, Madhusudan

AU - Yates, Katherine P.

AU - Abell, Thomas L.

AU - Bernard, Cheryl E.

AU - Koch, Kenneth L.

AU - McCallum, Richard W.

AU - Sarosiek, Irene

AU - Kuo, Braden

AU - Bulat, Robert

AU - Chen, Jiande

AU - Shulman, Robert J.

AU - Lee, Linda

AU - Tonascia, James

AU - Miriel, Laura A.

AU - Hamilton, Frank

AU - Farrugia, Gianrico

AU - Parkman, Henry P.

AU - Pasricha, Pankaj Jay

AU - Burns, Robert

AU - Hernandez, Guillermo Barahona

AU - McKnight, Megan

AU - Mendez, April

AU - Staller, Kyle

AU - Thurler, Andrea

AU - Velez, Christopher

AU - Silvernale, Casey

AU - Malik, Zubair

AU - Maurer, Alan

AU - Palit, Amiya

AU - Vega, Natalia

AU - Vasquez, Denise

AU - Connery, Sean

AU - Espino, Karina

AU - Friedman, Marvin

AU - Abell, Thomas

AU - Stocker, Abigail

AU - Cannon, Bridget

AU - McElmurray, Lindsay

AU - Cooper, Kelly

AU - McBride, Catherine

AU - Koch, Kenneth

AU - Baxter, Lynn

AU - Brown, Anya

AU - Stuart, Paula

AU - Sharkey, Emily

AU - Sternberg, Alice

AU - Van Natta, Mark

AU - Wilson, Laura

AU - Yamada, Goro

PY - 2021/5/1

Y1 - 2021/5/1

N2 - Background: The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods: Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results: Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. Conclusions: A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly “organic” gastric neuromuscular disorders. ClinicalTrials.gov

AB - Background: The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods: Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results: Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. Conclusions: A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly “organic” gastric neuromuscular disorders. ClinicalTrials.gov

KW - Chronic Nausea

KW - Enteric Nervous System

KW - Functional Dyspepsia

KW - Gastric Emptying

KW - Gastroparesis

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ER -

Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features

Abstract

Keywords

ASJC Scopus subject areas

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