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Cited by 271Gastrointestinal motility and disordersGastroesophageal reflux and treatmentsPsychosomatic Disorders and Their Treatments

Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features

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Pasricha, Pankaj J., Grover, Madhusudan, Yates, Katherine P., Abell, Thomas L., Bernard, Cheryl E., Koch, Kenneth L., McCallum, Richard W., Sarosiek, Irene +89 more·2021·Gastroenterology
DOI 10.1053/j.gastro.2021.01.230PMC PMC8547190
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Abstract

Background The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. Methods Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. Results Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. Conclusions A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. CLINICALTRIALS. Gov identifier NCT00398801, NCT01696747.

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  • DGP remains underrecognized because of nonspecific symptomatology overlapping with functional dyspepsia or gastroesophageal reflux disease (GERD).

    “Despite its clinical relevance, DGP remains underrecognized because of nonspecific symptomatology overlapping with functional dyspepsia or gastroesophageal reflux disease (GERD) [24].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [24]

    The Introduction and Discussion (pages not provided) describe substantial symptom overlap between gastroparesis and functional dyspepsia, including in a cohort with diabetic patients. They do not establish that diabetic gastroparesis is underrecognized because of that overlap, or discuss symptom overlap with GERD. (LLM, conf=0.86)

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  1. [1]Abell TL, Bernstein RK, Cutts T, Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil 2006; 18: 263– 83. 16553582

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Authors
Pasricha, P. J., Grover, M., Yates, K. P., Abell, T. L., Bernard, C. E., Koch, K. L., McCallum, R. W., Sarosiek, I., Kuo, B., Bulat, R., Chen, J., Shulman, R. J., Lee, L., Tonascia, J., Miriel, L. A., Hamilton, F., Farrugia, G., Parkman, H. P., Pasricha, P. J., Bulat, R., Burns, R., Hernandez, G. B., McKnight, M., Kuo, B., Mendez, A., Staller, K., Thurler, A., Velez, C., Silvernale, C., Parkman, H. P., Malik, Z., Maurer, A., Palit, A., McCallum, R. W., Sarosiek, I., Vega, N., Vasquez, D., Connery, S., Espino, K., Friedman, M., Abell, T., Stocker, A., Cannon, B., McElmurray, L., Cooper, K., McBride, C., Koch, K., Baxter, L., Brown, A., Stuart, P., Abdullah, A., Snape, W., DeVole, N., Earle, K., Kirkeby, K., Lee, C., Lin, M., Troyer, D., von Bakonyi, A., Shulman, R., Chumpitazi, B., Febo-Rodriguez, L., Hollier, J., Bouette, C., Charron, H., Nurko, S., Wall, S., Kane, M., Williams, K., Yossef-Salameh, L., Woodley, F., Farrugia, G., Grover, M., Bernard, C., Serrano, J., Hamilton, F., Hall, S., James, S., Torrance, R., Tonascia, J., Adamo, M., Belt, P., Dodge, J., Donithan, M., Isaacson, M., Lee, L., Meinert, J., Miriel, L., Sharkey, E., Smith, J., Smith, M., Sternberg, A., Van Natta, M., Wagoner, A., Wilson, L., Yamada, G., & Yates, K.
Affiliations
  • Baylor College of Medicine (US)
  • Massachusetts General Hospital (US)
  • Temple University (US)
  • Texas Tech University (US)
  • University of Louisville (US)
  • Wake Forest University (US)
  • Johns Hopkins University (US)
  • Mayo Clinic (US)
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2021-05
Volume
160
Issue
6
Pages
2006-2017
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2021.01.230
PMC
PMC8547190
OpenAlex
W3128851695
Cited by
268
References
19
Citations by year
2026: 47 · 2025: 52 · 2024: 44 · 2023: 60 · 2022: 37 · 2021: 28
FWCI
37.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIDDK
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
functional dyspepsia, gastroparesis, gastric emptying, interstitial cells of Cajal, CD206+ macrophages, gastric mucosa, upper gastrointestinal symptoms, Rome III criteria, tertiary care hospital patients
MeSH terms
Adult, Dyspepsia, Female, Gastric Emptying, Humans, Male, Middle Aged, Nausea, Registries, Severity of Illness Index, Stomach, Vomiting, Abdominal Pain, Case-Control Studies, Gastroparesis, Interstitial Cells of Cajal, Tertiary Care Centers, Symptom Assessment

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