Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathologic features

Authors: PASRICHA, PANKAJ - Johns Hopkins University School Of Medicine; GROVER, MADHUSUDAN - Mayo Clinic; YATES, KATHERINE - Johns Hopkins University School Of Medicine; ABELL, THOMAS - University Of Louisville; BERNARD, CHERYL - Mayo Clinic; KOCH, KENNETH - Wake Forest University; MCCALLUM, RICHARD - Texas Tech University; SAROSIEK, IRENE - Texas Tech University; KUO, BRADEN - Massachusetts General Hospital; BULAT, ROBERT - Johns Hopkins University School Of Medicine; CHEN, JIANDE - University Of Michigan; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); LEE, LINDA - Johns Hopkins University; TONASCIA, JAMES - Johns Hopkins University; MIRIEL, LAURA - Johns Hopkins University; HAMILTON, FRANK - National Institute Of Diabetes And Digestive And Kidney Diseases; FARRUGIA, GIANRICO - Mayo Clinic; PARKMAN, HENRY - Temple University

Submitted to: Gastroenterology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/28/2021
Publication Date: 5/1/2021
Citation: Pasricha, P.J., Grover, M., Yates, K.P., Abell, T.L., Bernard, C.E., Koch, K.L., McCallum, R.W., Sarosiek, I., Kuo, B., Bulat, R., Chen, J., Shulman, R.J., Lee, L., Tonascia, J., Miriel, L.A., Hamilton, F., Farrugia, G., Parkman, H.P. 2021. Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathologic features Gastroenterology. 160(6):2006-2017. https://doi.org/10.1053/j.gastro.2021.01.230
DOI: https://doi.org/10.1053/j.gastro.2021.01.230

Interpretive Summary: Very slow stomach emptying (gastroparesis) and functional dyspepsia are two conditions that affect children and adults. It has been believed that they can be told apart by their symptoms or how they manifest over time. This study in adults showed that the symptoms of the two disorders overlap so much as to make it not possible to tell them apart. Based on the test usually used to differentiate the two disorders it was found that individuals could move between the two disorders over time. These findings are important as researchers look to potential nutritional and other therapies to address these concerns.

Technical Abstract: 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. 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. 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. 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.