Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathological features, 2021, Pasricha

Discussion in ''Conditions related to ME/CFS' news and research' started by ME/CFS Skeptic, Jun 10, 2024 at 7:27 PM.

  1. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)


    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.

    Adult patients with chronic upper gastrointestinal symptoms were followed prospectively for 48 weeks in multi-center registry studies. Patients were classified as gastroparesis if gastric emptying was delayed; if not, they were labeled as FD if they met Rome III criteria. Study analysis was conducted using ANCOVA and regression models.

    Of 944 patients enrolled over 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. 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 FD patients were reclassified as 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 to obese controls.

    A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable by clinical and pathological features or by 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 pathological features and should be considered as part of the same spectrum of truly “organic” gastric neuromuscular disorders.
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  2. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

    This study does not have a direct relation to ME/CFS but it thought it was interesting as a criticism of the term 'functional' for symptoms of nausea and fullness.

    In short, there is a test where they can measure how fast the stomach empties and patients who have abnormal results for this test are given a diagnosis of gastroparesis, while those who have normal results are usually given the label functional dyspepsia (often with an implication that there is nothing wrong with their body and that their symptoms are psychosomatic).

    In this study the authors show the limitation of the gastric emptying test, as a lot patients switch from normal to abnormal results and vice versa in a time period of a year even though their symptoms did not change.

    In an interview one of the researchers said:

    "....gastroenterologists should listen to their patients and take their chronic nausea seriously, regardless of what a gastric emptying test indicates.

    “Let’s stop using the term ‘functional,’” Pasricha urges. “There’s a stigma associated with that word that implies a person isn’t actually sick. These patients have disease that is serious, and it’s very real. Now that we have shown what the pathology is, it’s time to focus on developing new treatments that could reverse this.”​

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  3. Ash

    Ash Senior Member (Voting Rights)

    Thank you @ME/CFS Skeptic very interesting.
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  4. rvallee

    rvallee Senior Member (Voting Rights)

    Oh, it doesn't imply it, it means exactly that. Although there are definitions of functional that mean something closer to what it should, the problem is in how the organs work, not with their structure, but that's exactly why psychosomatic ideology has increasingly been using this term: because it sounds legitimate/organic and is meant to convey that double meaning. It's all there in writing, none of this is some hidden secret or anything like that.

    So now there is a term that would actually make sense, but it's been co-opted to have a double meaning precisely because it's a good descriptor. So it's doing the wrong thing for the wrong reasons.

    And studies like this show the fundamental flaw with the ideology: they can't tell the difference. They use tests that make them thing that they can, but actually doesn't do that, it only tells them "this is that thing", and even at that biology has that pesky problem of being chaotic and fluctuating like this. It's maddening.

    The problem was never with using one term or another, or any particular label. The problem is with the entire foundation of psychologizing every ill and symptom that possibly can be, in large part to exaggerate the prevalence and seriousness of a fake problem. It's using language as a weapon, and in effect only accomplishing two things: 1) harming people and 2) invalidating terms that have valid uses.

    If they want to help their patients, they have to push back against psychosomatic ideology, there is no other way.

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