Ochi Masahiro, Tominaga Kazunari, Tanaka Fumio, Tanigawa Tetsuya, Yamagami Hirokazu, Watanabe Kenji, Watanabe Toshio, Fujiwara Yasuhiro, Arakawa Tetsuo
Department of Internal Medicine, Meijibashi Hospital, Japan.
Intern Med. 2013;52(12):1289-93. doi: 10.2169/internalmedicine.52.9205.
Patients who meet the Rome III criteria for functional dyspepsia (FD) are generally classified into the following two subgroups, those with postprandial distress syndrome (PDS) and those with epigastric pain syndrome (EPS), in order to treat the dyspeptic symptoms caused by the respective pathophysiological conditions. However, whether simple classification of FD can accurately distinguish the pathophysiological differences between PDS and EPS remains to be clarified because the pathophysiology of FD is characterized and complicated by various factors.
After classifying FD patients who were not receiving medication at the initial visit, we assessed and compared the following pathophysiological factors between the PDS and EPS groups: (1) the gastric reservoir and emptying functions using a radioisotope method (n=75), (2) the autonomic nervous system (ANS) function using electrocardiography (n=45), (3) gastric mucosal atrophy and intestinal metaplasia using histological examinations (n=47), (4) endoscopic findings of the stomach, such as superficial changes, abnormal gastroesophageal flap valves (n=67) and (5) Helicobacter pylori infection (n=48).
The FD patients exhibited higher rates of an impaired reservoir function (49.3%), gastric emptying disorders (54.7%) and relative hyperactivity of the sympathetic nervous system (31.9%) than the control subjects. However, endoscopic and histological changes of the stomach were similar in both the FD patients and control subjects. In addition, no differences were observed in the above-mentioned factors between the PDS and EPS groups.
The simple classification of FD patients into two subgroups according to the Rome III criteria following diagnosis does not indicate any differences in the pathophysiology related to the respective dyspeptic symptoms of FD patients.
符合罗马III功能性消化不良（FD）标准的患者通常分为以下两个亚组，即餐后不适综合征（PDS）患者和上腹痛综合征（EPS）患者，以便针对各自病理生理状况引起的消化不良症状进行治疗。然而，由于FD的病理生理学具有多种因素且情况复杂，FD的简单分类能否准确区分PDS和EPS之间的病理生理差异仍有待阐明。
在对初诊时未接受药物治疗的FD患者进行分类后，我们评估并比较了PDS组和EPS组之间的以下病理生理因素：（1）使用放射性同位素方法评估胃储存和排空功能（n = 75）；（2）使用心电图评估自主神经系统（ANS）功能（n = 45）；（3）通过组织学检查评估胃黏膜萎缩和肠化生（n = 47）；（4）胃部内镜检查结果，如表面变化、异常的胃食管瓣（n = 67）；以及（5）幽门螺杆菌感染情况（n = 48）。
FD患者的胃储存功能受损（49.3%）、胃排空障碍（54.7%）和交感神经系统相对亢进（31.9%）的发生率高于对照组。然而，FD患者和对照组的胃部内镜及组织学变化相似。此外，PDS组和EPS组在上述因素方面未观察到差异。
根据罗马III标准在诊断后将FD患者简单分为两个亚组，并不能表明FD患者各自消化不良症状相关的病理生理学存在任何差异。
