Functional dyspepsia—symptoms, definitions and validity of the Rome III criteria

Abstract

Dyspepsia refers to a heterogeneous group of symptoms that are localized in the epigastric region. Typical dyspeptic symptoms include postprandial fullness, early satiation, epigastric pain and epigastric burning, but other upper gastrointestinal symptoms such as nausea, belching or abdominal bloating often occur. Functional dyspepsia is defined as the presence of dyspeptic symptoms in the absence of an organic cause that readily explains them. The Rome III consensus proposed the subdivision of functional dyspepsia into postprandial distress syndrome (PDS), characterized by postprandial fullness and early satiation, and epigastric pain syndrome (EPS), characterized by epigastric pain or burning. Epidemiological studies in the USA and Europe confirmed the presence of both subgroups, with good separation between EPS and PDS. By contrast, other studies have found major overlap between EPS and PDS in patients with functional dyspepsia in specialist care centres in Europe and Asia. Preliminary pathophysiological studies suggest that PDS might be characterized by a higher prevalence of impaired gastric accommodation than EPS and raised duodenal eosinophil counts. Whether different treatment approaches are needed for EPS and PDS is currently unclear; only acotiamide, a new drug for the treatment of functional dyspepsia, has been found to be efficacious in PDS but not in EPS. Further randomized controlled trials testing treatment response by subgroup are urgently needed.

Key Points

  • Functional dyspepsia refers to dyspeptic symptoms that cannot currently be explained by an organic cause

  • The Rome III criteria has divided functional dyspepsia into two subgroups; postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS)

  • Patients with PDS typically report postprandial fullness and early satiation, whereas those with EPS are more likely to experience epigastric pain and burning

  • Currently, it is unknown whether patients with PDS and EPS need to be treated differently; randomized controlled trials are required to test treatment response by subgroup

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Figure 1: Graphical representations of the functional dyspepsia symptom profile that could be used to help patients identify their symptom descriptions.
Figure 2: Prevalence of FD, PDS, EPS and their overlap in three studies in the general population.29,30,31
Figure 3: Prevalence of PDS, EPS and their overlap in three studies in gastroenterology clinic patient samples.34,35,36

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Acknowledgements

J. Tack would like to acknowledge the support of a Methusalem grant from Leuven University.

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Correspondence to Jan Tack.

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Tack, J., Talley, N. Functional dyspepsia—symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 10, 134–141 (2013). https://doi.org/10.1038/nrgastro.2013.14

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