FUNCTIONAL DYSPEPSIA ASSESSMENT-CURRENT DIAGNOSTIC METHODS AND NEW PROMISING TECHNIQUES
Abstract
Functional Dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by chronic symptoms without an organic cause. Diagnosis follows the Rome IV criteria, requiring symptoms for at least six months. FD affects up to 20% of the population, significantly impacting the quality of life and healthcare systems. Upper gastrointestinal endoscopy is often performed to rule out organic disorders but has limited utility in typical FD cases. FD’s etiology involves gastric motility alterations, dysbiosis, and immune and central nervous system dysfunction. This review summarizes FD diagnostic methods. A PubMed search was conducted using keywords: Functional Dyspepsia, Gastric Motility Assessment, ROME IV, and Gastric Emptying (GE). Relevant studies were manually reviewed, excluding those unrelated to FD or gastric motility assessment. Despite extensive research on organic gastrointestinal diseases, FD's pathophysiology remains unclear, necessitating further studies. Diagnostic methods include the rapid water and nutrient drink tests for assessing impaired gastric accommodation, hypersensitivity, and delayed gastric emptying. Drinking-ultrasonography and three-dimensional ultrasound evaluate gastric motor and sensory functions. MRI-based assessments provide detailed stomach volume and geometry insights. Gastric emptying scintigraphy and the 13C-gastric emptying breath test measure gastric emptying rates. High-resolution electrogastrography (HR-EGG) assesses gastric myoelectrical activity, while EndoFLIP measures sphincter function. Functional MRI and PET scans analyze brain activity related to FD symptoms. These methodologies enhance FD understanding and management. Further research and standardized guidelines are essential to mitigate FD’s impact on patients and healthcare systems
##plugins.themes.bootstrap3.article.details##
functional dyspepsia, gastric emptying, gastroparesis, gut-brain interaction
2. Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ. 1989 Jan 7;298(6665):30-2. doi: 10.1136/bmj.298.6665.30. PMID: 2492849; PMCID: PMC1835369.
3. Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020 Nov 21;396(10263):1689-1702. doi: 10.1016/S0140-6736(20)30469-4. PMID: 33049222.
4. Medić B, Babić Ž, Banić M, Ljubičić L. Modern approach to dyspepsia. Acta Clin Croat. 2021 Dec;60(4):731-738. doi: 10.20471/acc.2021.60.04.21. PMID: 35734496; PMCID: PMC9196234.
5. Enck P, Azpiroz F, Boeckxstaens G, et al. Functional dyspepsia. Nat Rev Dis Primers. 2017 Nov 3;3:17081. doi: 10.1038/nrdp.2017.81. PMID: 29099093.
6. Scarpellini E, Van den Houte K, Schol J, et al. Nutrient Drinking Test as Biomarker in Functional Dyspepsia. Am J Gastroenterol. 2021 Jul 1;116(7):1387-1395. doi: 10.14309/ajg.0000000000001242. PMID: 33941747.
7. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L; American College of Gastroenterology. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013 Jan;108(1):18-37; quiz 38. doi: 10.1038/ajg.2012.373. PMID: 23147521; PMCID: PMC3722580.
8. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008 Mar;103(3):753-63. doi: 10.1111/j.1572-0241.2007.01636.x. PMID: 18028513.
9. Camilleri M, Zheng T, Vosoughi K, et al. Optimal measurement of gastric emptying of solids in gastroparesis or functional dyspepsia: evidence to establish standard test. Gut. 2023 Nov 24;72(12):2241-2249. doi: 10.1136/gutjnl-2023-330733. PMID: 37726164; PMCID: PMC10872889.
10. Koch KL, Hong SP, Xu L. Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects. J Clin Gastroenterol. 2000 Sep;31(2):125-9. doi: 10.1097/00004836-200009000-00007. PMID: 10993427.
11. Boeckxstaens GE, Hirsch DP, van den Elzen BD, Heisterkamp SH, Tytgat GN. Impaired drinking capacity in patients with functional dyspepsia: relationship with proximal stomach function. Gastroenterology. 2001 Nov;121(5):1054-63. doi: 10.1053/gast.2001.28656. PMID: 11677196.
12. Hjelland IE, Ofstad AP, Narvestad JK, Berstad A, Hausken T. Drink tests in functional dyspepsia: which drink is best? Scand J Gastroenterol. 2004 Oct;39(10):933-7. doi: 10.1080/00365520410003344. PMID: 15513330.
13. Abid S, Anis MK, Azam Z, Jafri W, Lindberg G. Satiety drinking tests: effects of caloric content, drinking rate, gender, age, and body mass index. Scand J Gastroenterol. 2009;44(5):551-6. doi: 10.1080/00365520902767546. PMID: 19267286.
14. Tack J, Piessevaux H, Coulie B, Caenepeel P, Janssens J. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology. 1998 Dec;115(6):1346-52. doi: 10.1016/s0016-5085(98)70012-5. PMID: 9834261.
15. Tack J, Caenepeel P, Piessevaux H, Cuomo R, Janssens J. Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia. Gut. 2003 Sep;52(9):1271-7. doi: 10.1136/gut.52.9.1271. PMID: 12912857; PMCID: PMC1773806.
16. Montaño-Loza A, Schmulson M, Zepeda-Gómez S, Remes-Troche JM, Valdovinos-Diaz MA. Maximum tolerated volume in drinking tests with water and a nutritional beverage for the diagnosis of functional dyspepsia. World J Gastroenterol. 2005 May 28;11(20):3122-6. doi: 10.3748/wjg.v11.i20.3122. PMID: 15918201; PMCID: PMC4305851.
17. Hata T, Kato M, Kudo T, et al. Comparison of gastric relaxation and sensory functions between functional dyspepsia and healthy subjects using novel drinking-ultrasonography test. Digestion. 2013;87(1):34-9. doi: 10.1159/000343935. PMID: 23343967.
18. Skrobisz K, Piotrowicz G, Drozdowska A, et al. Use of functional magnetic resonance imaging in patients with irritable bowel syndrome and functional dyspepsia. Prz Gastroenterol. 2019;14(3):163-167. doi: 10.5114/pg.2019.88163. PMID: 31649785; PMCID: PMC6807669.
19. Vandenberghe J, Dupont P, Van Oudenhove L, et al. Regional cerebral blood flow during gastric balloon distention in functional dyspepsia. Gastroenterology. 2007 May;132(5):1684-93. doi: 10.1053/j.gastro.2007.03.037. PMID: 17484866.
20. Van Oudenhove L, Vandenberghe J, Dupont P, et al. Abnormal regional brain activity during rest and (anticipated) gastric distension in functional dyspepsia and the role of anxiety: a H(2)(15)O-PET study. Am J Gastroenterol. 2010 Apr;105(4):913-24. doi: 10.1038/ajg.2010.39. PMID: 20160711.
21. Van Oudenhove L, Vandenberghe J, Dupont P, et al. Regional brain activity in functional dyspepsia: a H(2)(15)O-PET study on the role of gastric sensitivity and abuse history. Gastroenterology. 2010 Jul;139(1):36-47. doi: 10.1053/j.gastro.2010.04.015. PMID: 20406641.
22. Bertoli D, Mark EB, Liao D, et al. A novel MRI-based three-dimensional model of stomach volume, surface area, and geometry in response to gastric filling and emptying. Neurogastroenterol Motil. 2023 Feb;35(2):e14497. doi: 10.1111/nmo.14497. PMID: 36416084; PMCID: PMC10078211.
23. Lee JS, Camilleri M, Zinsmeister AR, et al. Toward office-based measurement of gastric emptying in symptomatic diabetics using [13C]octanoic acid breath test. Am J Gastroenterol. 2000 Oct;95(10):2751-61. doi: 10.1111/j.1572-0241.2000.03183.x. PMID: 11051344.
24. Kovacic K, Zhang L, Nugent Liegl M, et al. Gastric emptying in healthy children using the Spirulina breath test: The impact of gender, body size, and pubertal development. Neurogastroenterol Motil. 2021 Jun;33(6):e14063. doi: 10.1111/nmo.14063. PMID: 33300658.
25. Braden B, Adams S, Duan LP, et al. The [13C]acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals. Gastroenterology. 1995 Apr;108(4):1048-55. doi: 10.1016/0016-5085(95)90202-3. PMID: 7698571.
26. Mandarino FV, Testoni SGG, Barchi A, et al. Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment. Life (Basel). 2023 Aug 14;13(8):1743. doi: 10.3390/life13081743. PMID: 37629600; PMCID: PMC10455809.
27. Camilleri M, Kuo B, Nguyen L, et al. ACG Clinical Guideline: Gastroparesis. Am J Gastroenterol. 2022 Aug 1;117(8):1197-1220. doi: 10.14309/ajg.0000000000001874. PMID: 35926490; PMCID: PMC9373497.
28. Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol. 2008 Jun;6(6):635-643.e1. doi: 10.1016/j.cgh.2008.01.009. PMID: 18406670; PMCID: PMC3739971.
29. Shi J, Shen H, Gao Q, et al. Evaluation of gastric emptying in patients with gastroparesis by three-dimensional ultrasound. Ann Transl Med. 2021 Aug;9(16):1343. doi: 10.21037/atm-21-3972. PMID: 34532480; PMCID: PMC8422084.
30. Gharibans AA, Kim S, Kunkel D, Coleman TP. High-Resolution Electrogastrogram: A Novel, Noninvasive Method for Determining Gastric Slow-Wave Direction and Speed. IEEE Trans Biomed Eng. 2017 Apr;64(4):807-815. doi: 10.1109/TBME.2016.2579310. PMID: 27305668; PMCID: PMC5474202.
31. Brzana RJ, Koch KL, Bingaman S. Gastric myoelectrical activity in patients with gastric outlet obstruction and idiopathic gastroparesis. Am J Gastroenterol. 1998 Oct;93(10):1803-9. doi: 10.1111/j.1572-0241.1998.00524.x. PMID: 9772035.
32. Chen JD, Lin Z, Pan J, McCallum RW. Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci. 1996 Aug;41(8):1538-45. doi: 10.1007/BF02087897. PMID: 8769276.
33. Angeli TR, Cheng LK, Du P, et al. Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting. Gastroenterology. 2015 Jul;149(1):56-66.e5. doi: 10.1053/j.gastro.2015.04.003. PMID: 25863217; PMCID: PMC4617790.
34. Carson DA, O'Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Motil. 2021 Mar;33(3):e14048. doi: 10.1111/nmo.14048. PMID: 33274564.
35. Carlson DA, Kou W, Lin Z, et al. Normal Values of Esophageal Distensibility and Distension-Induced Contractility Measured by Functional Luminal Imaging Probe Panometry. Clin Gastroenterol Hepatol. 2019 Mar;17(4):674-681.e1. doi: 10.1016/j.cgh.2018.07.042. PMID: 30081222; PMCID: PMC6360138.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.