Pantelis Oustamanolakis

Dyspepsia: Organic Versus Functional

Dyspepsia is the medical term for difficult digestion. It consists of various symptoms in the upper abdomen, such as fullness, discomfort, early satiation, bloating, heartburn, belching, nausea, vomiting, or pain. The prevalence of dyspepsia in the western world is approximately 20% to 25%. Dyspepsia can be divided into 2 main categories: “organic” and “functional dyspepsia” (FD). Organic causes of dyspepsia are peptic ulcer, gastroesophageal reflux disease, gastric or esophageal cancer, pancreatic or biliary disorders, intolerance to food or drugs, and other infectious or systemic diseases. Pathophysiological mechanisms underlying FD are delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distension, altered duodenal sensitivity to lipids or acids, altered antroduodenojenunal motility and gastric electrical rhythm, unsuppressed postprandial phasic contractility in the proximal stomach, and autonomic nervous system-central nervous system dysregulation. Pathogenetic factors in FD are genetic predisposition, infection from Helicobacter pylori or other organisms, inflammation, and psychosocial factors. Diagnostic evaluation of dyspepsia includes upper gastrointestinal endoscopy, abdominal ultrasonography, gastric emptying testing (scintigraphy, breath test, ultrasonography, or magnetic resonance imaging), and gastric accommodation evaluation (magnetic resonance imaging, ultrasound, single-photon emission computed tomography, and barostat). Antroduodenal manometry can be used for the assessment of the myoelectrical activity of the stomach, whereas sensory function can be evaluated with the barostat, tensostat, and satiety test. Management of FD includes general measures, acid-suppressive drugs, eradication of H. pylori, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. This review presents an update on the diagnosis of patients presenting with dyspepsia, with an emphasis on the pathophysiological and pathogenetic mechanisms of FD and the differential diagnosis with organic causes of dyspepsia. The management of uninvestigated and FD, as well as the established and new pharmaceutical agents, is also discussed.

Prucalopride for chronic intestinal pseudo‐obstruction

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137c Globus Patients are Characterized by Abnormal Sensitization of the Esophageal Body Upon Repeated Balloon Distensions

participating 15 refused, 10 were deceased secondary to unrelated conditions, 5 were medically incapacitated for unrelated reasons, and 2 could not be reached. Of the 94 participants, 68% were female with a mean age of 53 years old. Manometric findings were normal in 63 (67%), weak peristalsis in 23 (25%), frequent failed peristalsis in 2 (2%), and hypertensive peristalsis in 6 (6%). No patients with normal studies or borderline manometric abnormalities had undergone myotomy or dilation. Further, PPI use and fundoplication rates were similar in patients with borderline manometric abnormalities when compared to those with normal esophageal manometry. Significant dysphagia at follow up (IDQ>8) was rare, seen in only 9 patients. The main indications for HRM were dysphagia (46%) and gastroesophageal reflux (35%), with no association between these indications and peristaltic abnormalities or persistence of dysphagia at follow up. (Table) Conclusion: Patients defined as normal or having borderline esophageal motor function using the Chicago classification appear to have minimal symptoms or medical interventions related to esophageal dysfunction during a 5 year follow-up.Only 14% of patients had significant dysphagia. Thus, identification of normal and borderline motor function is a good prognostic indicator as these patterns are associated with minimal long term consequences. Natural history of peristalsis patterns on HRM