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Introduction

Functional dyspepsia (FD) is an enigma in itself but a commonly prevalent problem, around 10-30%, encountered by physicians worldwide [1]. There is evidence of low-grade inflammation in duodenal mucosa including eosinophilic infiltration and T-cell mediated among others [2]. Moreover, since vitamin D has immunomodulatory properties and its role has been well established in various diseases including inflammatory bowel diseases and cancers, evaluation of vitamin D status in patients with FD needs to be actively pursued given its immuno-regulatory attributes [3]. The beneficial roles of vitamin D, particularly in gut and neurological functioning of the body counts in an effective option in treating irritable bowel syndrome [4,5]. In one study, increased VDR (vitamin D receptor) expression is seen in duodenal mucosa and it has been proposed that since Vitamin D acts as a ligand of VDR, assessing vitamin D status in such patients remains an area of active research [6]. Thus the authors here seeks to probe into the key role of Vitamin D in the FD patients, utilizing evidence from previous studies in vitamin abnormalities [4].

Aims & Methods

This case control study was done at a tertiary care hospital with 150 cases and 150 controls. FD was diagnosed by the ROME IV criteria. Demographic and serum vitamin D levels including perceived stress score (PSS) and salivary alpha levels were determined for both cases and controls. Statistical analysis were done with the help of SPSS version 27.

Results

Majority of the FD cases were males (57.3%). Post prandial distress syndrome (PPDS) represented the major type of functional dyspepsia (FD) cases (104 cases; 69.3 %), followed by epigastric distress syndrome (EPS) (48 cases, 32%). Among the cases, 6.6 % had sleep problems, 18.6% had heart burn, 18.6% had bowel disturbances and 13.4% had headache. Cases have higher mean age than the controls (42.24±12.047 vs 38.94±, p=0.028). A higher mean BMI was found among the control group (23.2 vs 21.2, p<0.05) and higher percentage of obese individuals in the control group (42.7% vs 29.3%, p= 0.05). Majority of the cases are from rural background (89.3% vs 74%, p<0.001). Comparison of perceived stress scale (PSS) showed that cases had significantly higher grades of PSS than control (p<0.001). Hypovitaminosis D (<30ng/ml) was found significantly more among cases (73.3% vs 60%; p<0.05) with an odds ratio (OR) of 1.833 (CI95%= 1.126- 2.985). After adjustment of age, place of residence and BMI, Vitamin D levels were significantly associated with functional dyspepsia in the regression analysis. Nagelkerke R Square= 11%, p= 0.023, OR= 1.016

	Cases	Control	P value
Vitamin D, Mean SD	22.9 ± 18.3	27.8 ± 17.5	0.009
Vitamin D categories, n (%)			0.020
Vit D deficiency (VDD)	110 (73.3)	90 (60)
Normal Vitamin D	40 (26.7)	60 (40)

Conclusion

The present work demonstrates a close association of VDD, BMI and PSS score in FD patients for the first time. Findings from the study has been able to shed light into the role of Vitamin D in FD and the possible need for vitamin D supplementation to further improve the management of such cases, thus opening new avenues for further research.

References

1. Talley NJ, Ford AC. Functional dyspepsia. New England Journal of Medicine. 2015 Nov 5;373(19):1853-63.
2. Romano C, Valenti S, Cardile S, Benninga MA. Functional dyspepsia: an enigma in a conundrum. Journal of pediatric gastroenterology and nutrition. 2016 Dec 1;63(6):579-84.
3. Athanassiou L, Mavragani CP, Koutsilieris M. The immunomodulatory properties of vitamin D. Mediterranean Journal of Rheumatology. 2022 Mar;33(1):7.
4. Barbalho SM, Goulart RD, Araújo AC, Guiguer ÉL, Bechara MD. Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D. Expert review of gastroenterology & hepatology. 2019 Apr 3;13(4):345-59.
5. Abbasnezhad A. Effect of vitamin D on gastrointestinal symptoms and health‐related quality of life in irritable bowel syndrome patients: a randomized double‐blind clinical trial. Neurogastroenterology & Motility. 2016 Oct;28(10):1533-44.
6. Stanghellini V. Functional dyspepsia and irritable bowel syndrome: beyond Rome IV. Digestive Diseases. 2017;35(S1):14-7.

Disclosure

The authors have no conflict of Interest

ASSOCIATION OF VITAMIN D WITH FUNCTIONAL DYSPEPSIA- A NEW KID IN THE BLOCK?

DR. DHRITI SUNDAR DAS 1, Gautom Kumar Saharia 1, Manas Panigrahi 1, Debananda Sahoo 1

1 All India Institute of Medical Sciences, Bhubaneswar, India

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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According to the Montreal definition, “[gastro-oesophageal reflux disease (GORD)] is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.”1 GORD has a negative effect on quality of life and is frequently encountered in clinical practice, with an estimated prevalence of around 24% in Europe. In the US, GORD-related healthcare costs account for $9 billion per year. A variety of symptoms are associated with GORD—heartburn and regurgitation are typical symptoms, while chest pain, cough and sore throat are considered atypical symptoms—but none is pathognomonic

Mistakes in gastro-oesophageal reflux disease diagnosis and how to avoid them

Francois Mion, Sabine Roman

Topics

Neurogastroenterology & Motility Oesophagus

Citation

Roman S and Mion F. Mistakes in gastro-oesophageal reflux disease and how to avoid them. UEG Education 2017; 17: 24–26.

Published

2024

UEG Mistakes In Articles

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A recent UEG survey indicated that dysphagia, heartburn, bloating, abdominal pain and changes to bowel habit are each reported by 5–15% of the general population.1 For patients with mild symptoms, negative tests provide reassurance and simple, symptomatic management might be all that is required (e.g. acid suppression, stool regulation). However, for those with severe symptoms that persist on therapy, ruling out life-threatening disease is not sufficient, and referral to the neurogastroenterology and motility (NGM) laboratory for physiological measurements is often indicated. Clinical investigations aim to explain the cause of symptoms and establish a diagnosis that can guide rational treatment. Until recently, it could be argued that manometry, scintigraphy, breath tests and related tests rarely provided this information. As a result, only patients with suspected major motility disorders (e.g. achalasia, severe reflux disease or faecal incontinence) were routinely referred to the NGM laboratory for tests. Technological advances, such as high-resolution manometry (HRM), now provide objective measurements not only of motility, but also of function in terms of the movement (and digestion) of ingested material within the gastrointestinal tract. Furthermore, the ability to associate events (such as bolus retention, reflux or gas production) with symptoms provides an indication of visceral sensitivity and can identify what is causing patient complaints. Here, I discuss frequent mistakes in clinical investigation of gastrointestinal motility and function based on a series of consensus documents published by members of the International Working Group for Disorders of Gastrointestinal Motility and Function.

Mistakes in clinical investigation of gastrointestinal motility and function

Mark Fox

Topics

Neurogastroenterology & Motility

Citation

Fox M. Mistakes in clinical investigation of gastrointestinal motility and function. UEG Education 2018; 18: 15–20.

Published

2024

UEG Standards and Guidelines

Consensus

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ABSTRACT

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt “fatty pancreas” as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Society for Primary Care Gastroenterology, European Society of Pathology, European Society of Gastrointestinal Endoscopy, European Society of Gastrointestinal and Abdominal Radiology, European Association for the Study of the Liver, European Pancreatic Club

Guideline

Consensus

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026; 14:e70185

Published

2026

UEG Standards and Guidelines

Consensus

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Abstract

Background

Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.

Methods

A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as >=80% agreement) was reached for 25 statements.

Results

The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause.

Conclusions and Inferences

A multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.

Keywords: consensus, endoscopy, gastric emptying, gastroparesis, guideline, prokinetic

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis

Jolien Schol

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility

Citation

United European Gastroenterol J.2021;9:287–30

Published

2021

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background

There are several options for the surgical management of GERD in adults. Previous guidelines and systematic reviews have compared the effects of total fundoplication versus pooled effects of different techniques of partial fundoplication.

Objective

To develop evidence-informed, trustworthy, pertinent recommendations on the use of total, posterior partial and anterior partial fundoplications for the management of GERD in adults.

Methods

We performed an update systematic review, network meta-analysis, and evidence appraisal using the GRADE and the Confidence in Network Meta-Analysis methodologies. An international, multidisciplinary panel of surgeons, gastroenterologists, and a patient representative reached unanimous consensus through an evidence-to-decision framework to select among multiple interventions, and a Delphi process to formulate the recommendation. The project was developed in an online authoring and publication platform (MAGICapp), and was overseen by an external auditor.

Results

We suggest posterior partial fundoplication over total posterior or anterior 90° fundoplication in adult patients with GERD. We suggest anterior >90° fundoplication as an alternative, although relevant comparative evidence is limited (weak recommendation). The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/j20X4n.

Conclusion

This rapid guideline was developed in line with highest methodological standards and provides evidence-informed recommendations on the surgical management of GERD. It provides user-friendly decision aids to inform healthcare professionals' and patients' decision making.

Key summary

Various surgical options exist for the management of GERD in adults.
We summarized evidence through network meta-analysis of interventions.
We suggest partial posterior fundoplication over total posterior or anterior 90° fundoplication.
We suggest anterior >90 degrees may be an alternative.

Keywords: AGREE‐S, fundoplication, GERD, guideline, Nissen, Toupét

UEG and EAES rapid guideline: Update systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on surgical management of GERD

Sheraz Markar

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Oesophagus Stomach & H. Pylori Surgery

Citation

United European Gastroenterol J. 2022; 10( 9): 983– 98

Published

2022

UEG Mistakes In Articles

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Around 11% of the worldwide population experience irritable bowel syndrome (IBS), making it one of the most frequent gastroenterological diagnoses.1 The symptoms of IBS include abdominal pain associated with unpredictable bowel habits and variable changes in the form and frequency of stool.2 While all patients with IBS suffer from recurrent bouts of abdominal pain, their bowel habits are varied: around one-third suffer predominantly with diarrhoea (IBS-D), one-fifth experience predominantly constipation (IBS-C) and half have an erratic mixed pattern of both diarrhoea and constipation (IBS-M).3 This very heterogeneous condition undoubtedly has multiple causes and an individualized approach to management and treatment is required. Here I discuss the mistakes most frequently made when diagnosing and managing IBS. The mistakes and discussion that follow are based, where possible, on published data and failing that on many years of my own clinical experience.

Mistakes in irritable bowel syndrome and how to avoid them

Robin Spiller

Topics

Neurogastroenterology & Motility Primary Care

Citation

Spiller R. Mistakes in irritable bowel syndrome and how to avoid them. UEG Education 2016: 16; 31–33.

Published

2024

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