GASTROENTEROLOGY ARTICLE OF THE WEEK
February 17, 2005
Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology 2004;127:1239-1255
1. Possible causes of functional dyspepsia include
a. delayed gastric emptying
b. peptic ulcer disease
c. impaired gastric accommodation to a meal
d. hypersensitivity to gastric distention, commonly associated with epigastric
pain
e. H. pylori infection
f. electrogastrography abnormalities, which have been correlated with dyspeptic
symptom patterns
2. Medications that may enhance gastric accommodation include
a. Proton pump inhibitors
b. sildenafil
c. nitrates
d. paroxetine
e. tegaserod
f. clonidine
g. busprione
True or False
3. The typical dyspeptic patient will have worsening of symptoms 45-90 minutes after a meal.
4. Weight loss, while potentially an alarm symptom, has been found to be present in a subset of patients with functional dyspepsia.
5. Worsening of symptoms with fatty meals suggest gallbladder disease rather than functional dyspepsia
6. Anxious rats are more likely to go to see the rat doctors for treatment of pain
7. Patients with functional GI disorders typically present with dyspepsia or IBS type symptoms and rarely switch from one to the other
8. Reassurance, tender loving care and referral to Dr. Clark’s clinic for further evaluation should be the initial management of patients with functional dyspepsia.
9. Acid suppression is of no benefit compared to placebo in patients with dysmotility-like dyspepsia.
10. Erythromycin therapy may impair gastric accommodation to a meal resulting in worsening of dyspeptic symptoms
11. Trials have shown benefit in the empiric use of prokinetics for the treatment of dyspepsia