|Title:||Distinct aetiopathogenesis in subgroups of functional dyspepsia according to the Rome III criteria||Authors:||YU-JEN FANG
|Issue Date:||2015||Publisher:||BMJ Publishing Group||Journal Volume:||64||Journal Issue:||10||Start page/Pages:||1517-1528||Source:||Gut||Abstract:||
Background and objective Whether there is distinct pathogenesis in subgroups of functional dyspepsia (FD), the postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) remains controversial. We aimed to identify the risk factors of FD and its subgroups in the Chinese population. Methods Patients with dyspepsia and healthy subjects who underwent gastric cancer screening were enrolled in this multicentre study from 2010 to 2012. All patients were evaluated by questionnaire, oesophagoduodenoscopy, histological examination and Helicobacter pylori tests. Subgroups of FD were classified according to the Rome III criteria. Psychiatric stress was assessed by the short form Brief Symptom Rating Scale. CagA and VacA genotypes were determined by PCR. Results Of 2378 patients screened for eligibility, 771 and 491 fulfilled the diagnostic criteria of uninvestigated dyspepsia and FD, respectively. 298 (60.7%) and 353 (71.9%) individuals were diagnosed with EPS and PDS, respectively, whereas 169 (34.4%) had the overlap syndrome. As compared with 1031 healthy controls, PDS and EPS shared some common risk factors, including younger age (OR 0.95; 99.5% CI 0.93 to 0.98), nonsteroidal anti-inflammatory drugs (OR 6.60; 99.5% CI 3.13 to 13.90), anxiety (OR 3.41; 99.5% CI 2.01 to 5.77) and concomitant IBS (OR 6.89; 99.5% CI 3.41 to 13.94). By contrast, H. pylori (OR 1.86; 99.5% CI 1.01 to 3.45), unmarried status (OR 4.22; 99.5% CI 2.02 to 8.81), sleep disturbance (OR 2.56; 99.5% CI 1.29 to 5.07) and depression (OR 2.34; 99.5% CI 1.04 to 5.36) were associated with PDS. Moderate to severe antral atrophy and CagA positive strains were also more prevalent in PDS. Conclusions Different risk factors exist among FD subgroups based on the Rome III criteria, indicating distinct aetiopathogenesis of the subdivisions that may necessitate different therapeutic strategies.
|ISSN:||0017-5749||DOI:||10.1136/gutjnl-2014-308114||SDG/Keyword:||acetylsalicylic acid; bacterial antigen; bacterial protein; cagA protein, Helicobacter pylori; VacA protein, Helicobacter pylori; adult; age; anxiety; Article; bacterial strain; cancer screening; Chinese; coffee; controlled study; cross-sectional study; depression; disease association; disease classification; disease severity; distress syndrome; dyspepsia; epigastric pain syndrome; esophagogastroduodenoscopy; female; genotype; Helicobacter pylori; histopathology; human; inflammatory bowel disease; major clinical study; male; pathogenesis; polymerase chain reaction; postprandial distress syndrome; priority journal; prospective study; rating scale; risk factor; sleep disorder; stomach cancer; aged; clinical trial; complication; differential diagnosis; dyspepsia; follow up; gastric mucosa; gastrointestinal endoscopy; genetics; Helicobacter Infections; isolation and purification; lifestyle; mental stress; microbiology; middle aged; multicenter study; pathology; postprandial state; predictive value; questionnaire; Aged; Antigens, Bacterial; Bacterial Proteins; Diagnosis, Differential; Dyspepsia; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastric Mucosa; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Life Style; Male; Middle Aged; Postprandial Period; Predictive Value of Tests; Prospective Studies; Risk Factors; Stress, Psychological; Surveys and Questionnaires
|Appears in Collections:||醫學系|
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