A Clinical Study On Functional Dyspepsia Based On Rome Ⅲ Criteria

Objective:Dyspepsia refers to a collection of complex upper gastrointestinal symptoms that is believed to be common world-wide. The prevalence of functional dyspepsia is high that the symptoms impair quality of life of patients and the management of the condition remains a considerable burden on health care resources, it has been estimated that FD accounts for billions of dollars per year in direct and indirect costs in Europe and American. So physicians pay more attention on FD nowadays.The RomeⅢcriteria committee reconvened and, in May 2006, published new diagnostic criteria for functional dyspepsia. As defined by this committee, an individual must have one or more of the following symptoms and no evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms:bothersome postprandial fullness, early satiety, epigastric pain, or epigastric burning. These symptoms must be present for the last 3 months with symptom onset at least 6 months before the diagnosis. Because of the confusion in nomenclature, new diagnostic categories of meal-induced dyspeptic symptoms, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS), have been created with discreet criteria.The symptoms usually overlap with FGIDs such as IBS,GERD.Although FD is a global disease,there are only a few studies and no large-scale epidemiologic survey that focuses on the clinical and etiological aspects of functional dyspepsia in China after the publication of Rome III criteria criteria in 2006.At present, the etiological factor and pathophysiologic mechanisms of functional dyspepsia is not clear,so we should master the epidemiologic information to guide the management of functional dyspepsia.In an effort to elucidate these aspects and to obtain a broad view of the current situation of functional dyspepsia in China,we studied the prevalence,risk factors,management course, overlap with other FGIDs, the influence on work or life and so on in a large series of patients with functional dyspepsia.Methods:Subjects were selected from patients who were diagnosed as functional functional in Department of Gastroenterology,Changhai Hospital,Second Military Medical University,Shanghai from April 2009 to April 2010.About 100 cases were involved in this study.Gender,age,body height,weight,body mass index(BMI),smoking,alcohol,case history,endoscope,symptoms, diarrhea/constipation,psychological association, Sleep quality,short-form Leeds dyspepsia score and therapeutic date for each case were collected on a standardized criteria.Otherwise, we collected endoscopy results of 1360 patients who were offered>1 times endoscopy in our endoscope center between April 2008 and May 2009.Statistical analysis of the date was performed with SPSS 10.0 for Windows on a personal computer.continuous variables are expressed as mean±standard deviation and ranges. Two-tailed P values less than 0.05 were considered statistically significant.Results:Of the 100 patients(39 men,61 women; mean age 40.98±12.3years; range,20-65 years).17(17%) had mild functional dyspepsia,67 (67%) had moderate FD and 16(16%) had the severe form.9(%) patients had low body mass index(BMI<18.5),63(63%) had normal body mass index (BMI between 18.5 and 25),27(27%) was overweight (BMI between 25 and 30),1(1%) was obese (BMI≥30.0). In the subgroups based on symptom, postprandial distress syndrome (PDS) was 30(30%),epigastric pain syndrome(EPS) was 22(22%). In addition,there were 38 patients coexisting functional dyspepsia on symptoms in Irritable Bowel Syndrome.After different treatment modalities to each subgroup,70% patients had no uncomfort symptoms after therapies,10-16% had the same or worse symptoms, the marked symptoms of 10-18% patients changed over longer periods. This analysis demonstrates a positive association between increasing BMI and the symptom score of FD,but the result showed no significant difference(p=0.08). Bothersome postprandial fullness is the independent forecast factor for FD+IBS (p=0.02). FD patients had limited value of endoscopy in short term, and no Upper Gastrointestinal Malignancies were found.Conclusion:Functional dyspepsia is digestive disease which appear to be related to any age group. The majority of FD patients have moderate symptoms that effect their work and life to some drgree. gender-related differences have been observed in our study of the prevalence of individual dyspepsia symptoms, with women suffering from more FD. FD symptoms can change continuously as time goes on. There is probably a positive association between increasing BMI and the symptom score of FD, the result supports the evaluation of weight reduction as a potential therapy for FD. FD+IBS is associated with hypersensitivity to distention,so FD is probably related to the underlying pathophysiology in IBS. FD patients had limited value of endoscopy in short term.