Introduction
Functional dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by postprandial fullness, early satiation, epigastric pain or burning in the absence of a readily identifiable cause at upper endoscopy. Proton pump inhibitors (PPIs) are often used as a first-line treatment for FD, although their efficacy has not been convincingly established.
Aims & Methods
The aim was to investigate symptom patterns in FD patients with and without acid-suppressive therapy (PPI or H2-antagonist, H2RA) and to evaluate the use of these drugs in different patient groups. Ambulatory tertiary-care patients referred for upper gastrointestinal endoscopy were requested to fill out Rome IV gastro-duodenal questionnaires. Those fulfilling Rome IV FD criteria with a negative endoscopy were identified as FD patients and subdivided into patients on and off acid-suppressive therapy. The pattern of GI symptoms was compared between these two subgroups, using frequency thresholds from the Rome IV criteria. The chi-square or Fisher exact (when applicable) test was used to evaluate statistical significance (p<0.05).
Results
The Rome IV questionnaire was filled out by a total of 1002 patients (58% females, 48.5 ± 0.5 years, BMI 25.4± 0.5). Of these, 229 (23%, 73% females, 45.5 ± 1.1 years, BMI 23.9 ± 0.3) fulfilled the diagnostic criteria for FD. Organic findings at endoscopy included Barrett’s oesophagus (n=40, 4%), peptic ulcers (n=24, 2%), and reflux oesophagitis (n=352, 35%).
PPI/H2RA usage in FD patients was 60%, which was not significantly different from patients diagnosed with Barrett’s oesophagus (75%, p=0.07), peptic ulcer (50%, p=0.33), reflux oesophagitis (57%, p= 0.45) or the combined group with organic abnormality at upper endoscopy (46%, p=0.1). There was no significant difference (p=0.67) in PPI/H2RA usage between the EPS (epigastric pain syndrome, 55% usage) and PDS (postprandial distress syndrome, 50% usage) subgroups of FD.
The most prevalent symptoms in FD patients were postprandial fullness (76%), epigastric pain (67%) and bloating (62%). Patients on acid-suppressive therapy reported more nausea (41% vs 27%, p=0.04) and excessive belching (50% vs 36%, p=0.05) compared to patients without acid suppression. There was no significant difference in postprandial fullness (84% vs 73%, p=0.05), epigastric pain (75% vs 64%, p=0.08), heartburn (17% vs 28%, p=0.06) and bloating (70% vs 58%, p=0.06) between the two subgroups. Looking at the EPS and PDS subgroups of FD, there was a significant difference (p=0.03) in bloating between patients on (73%) and off (46%) acid suppression in the PDS subgroup of FD.
Conclusion
The cardinal symptom pattern in FD patients referred for upper endoscopy is similar for those on and off acid-suppressive therapy, but those on PPI/H2RA report more nausea and belching. No difference in acid-suppressive therapy use was observed between FD patients and those with organic findings at endoscopy.