Chronic stomach pain usually worsened by meals

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - In most patients with a condition known as functional dyspepsia, eating a meal aggravates the symptoms, which include persistent upper abdominal pain, fullness, bloating, nausea and other symptoms, according to a new report published in the journal “Gut.”

The condition is diagnosed after ruling out any apparent underlying cause or disease, such as gastrointestinal reflux disease or peptic ulcer.

A subset of patients with functional dyspepsia report meal-related symptoms, senior author Dr. J. Tack, from University Hospital Gasthuisberg in Leuven, Belgium, and colleagues explain.

The goal of their study, which involved 218 patients, was to assess the prevalence of meal-related symptoms and to examine the relationship between meal ingestion and specific symptoms. The symptoms studied included abdominal pain, fullness, bloating, nausea, burning, and belching.

The subjects completed symptom questionnaires and were asked to rate the various symptoms while they were undergoing a gastric emptying breath test, according to the report.

The intensity of all of the symptoms increased 15 minutes after the meal and persisted for the full 4-hour study period. The peak severity of fullness and bloating occurred early, followed the peak severity of nausea and belching, and lastly by pain and burning.

Overall, 79 percent of patients reported meal-aggravated symptoms. In these patients, excessive fullness after a meal was the strongest symptom, whereas in patients without meal-aggravated symptoms, upper abdominal pain was the most severe.

Gastric hypersensitivity was more common in patients with meal-aggravated symptoms than in those without them: 27.5 percent vs. 7.7 percent, the authors note.

The findings “convincingly demonstrate that symptoms are meal-related in the vast majority of functional dyspepsia patients,” Tack’s team concludes. “The major distinction between patients with and without self-reported meal-related symptoms is the type of symptom that has the highest intensity.”

SOURCE: Gut, November 2008.

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