[PD Test]Diagnosing functional dyspepsia difficult, but simple tests can help

Functional dyspepsia’s general symptom profile can make identification difficult but a number of simple tests can help to distinguish it from other, often concurrent, gastrointestinal diseases.

Functional dyspepsia (FD) involves one or more of bothersome feelings of fullness after eating, early fullness, or epigastric pain or burning, without the presence of overt disease that might explain symptoms.

Gastroesophageal reflux (GERD) disease or irritable bowel syndrome can occur at the same time as FD but diagnosis of either of these does not exclude FD diagnosis. And even when FD diagnosis is made, treatment procedures can be trial-and-error. Refractive FD patients tend to be put on antidepressant therapy.

“If you don’t have response with your first choice of therapy, it has been suggested to add on or switch to another therapy, and then go to antidepressants in the refractory patients,” said Dr. Jan Tack of the University of Leuven in Leuven, Belgium. “And there is not a lot of solid evidence to justify this.”

Understanding the pathophysiological abnormalities of FD can help determine treatment choice and predict how patients will fare 2-3 years down the line, Tack said, but it can also help obtain a more patient-acceptable diagnostic label, which can reduce patient stress.

Additional testing can also help exclude with better certainty any other diagnoses for refractory FD.

Among the myriad tests that can be administered, examining the cause of reflux and potential overlapping diseases is most useful as it is often a symptom of GERD as well. [Gastroenterology 1997;112:1448-1456]

“The heartburn picture is useful in clinical practice,” Tack said. “But therapeutic implications are limited when meta-analyses show no dose-response effects from proton pump inhibitor therapy [for acidity] in dyspeptics. So perhaps giving a higher dose of proton pump inhibitors to a pre-identified group might help. Going further to anti-reflux surgery is a risky scenario.”

Upcoming, Tack said, is the gastroparesis breath test, which involves eating a meal that contains a small amount of radioactive material after which breath samples are taken over time to see how efficiently the stomach is emptying its contents. Delayed emptying is associated with FD.

More invasive tests such as endoscopies or biopsies might reveal malignancies, ulcers, celiac disease, and other issues less than 10 percent of the time, but because they are serious, Tack said they are worthwhile. Still, less invasive CT scans are preferred.

“There is clearly an area of uncertainty where we’re willing to switch therapy or add antidepressants,” Tack said. “This is probably the grayest place for initial testing… and perhaps the pathophysiological tests to look at are intragastric pressure as a surrogate in terms of organic testing, repeat endoscopy, biopsies and ultrasounds.”