title: Symptom overlap between postprandial distress and epigastric pain syndromes of the Rome III dyspepsia classification.
abstract: OBJECTIVE
  The Rome III criteria for functional dyspepsia recognize two distinct subgroups: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The aim of this exploratory analysis was to evaluate the Rome III criteria and the validity of the PDS/EPS subgrouping in primary care patients with upper gastrointestinal symptoms.
  
  
  METHODS
  Primary care patients with frequent upper gastrointestinal symptoms included in the Diamond study (NCT00291746) underwent esophageal endoscopy and 24-h pH-metry. Gastroesophageal reflux disease (GERD) was defined as the presence of at least one of the following: reflux esophagitis, pathological esophageal acid exposure, positive symptom association probability (SAP ≥95%) for association of symptoms with acid reflux. Functional dyspepsia was defined by the absence of GERD and peptic ulcer disease on investigation. PDS and/or EPS were diagnosed according to Rome III criteria.
  
  
  RESULTS
  In total, 138 patients (41%) had upper gastrointestinal symptoms with normal endoscopy, pH-metry, and SAP results, consistent with the presence of functional dyspepsia. Of these patients, 130 (94%) met criteria for PDS and/or EPS: 13 (10%) had PDS alone, 31 (24%) had EPS alone, and 86 (66%) met criteria for both PDS and EPS.
  
  
  CONCLUSIONS
  PDS and EPS overlap in the majority of patients with functional dyspepsia. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. A new approach to classifying functional dyspepsia is needed.
authors.affiliation: University of Wisconsin, School of Medicine and Public Health, Madison, WI 53066, USA. nvakil@wisc.edu
authors.forename: Nimish
authors.initials: N
authors.lastname: Vakil
authors.forename: Katarina
authors.initials: K
authors.lastname: Halling
authors.forename: Lis
authors.initials: L
authors.lastname: Ohlsson
authors.forename: Börje
authors.initials: B
authors.lastname: Wernersson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D004415:Dyspepsia / Q000145:classification / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006356:Heartburn / Q000150:complications / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011237:Predictive Value of Tests; D013577:Syndrome