title: Fasting and postprandial gastric sensorimotor activity in functional dyspepsia: postprandial distress vs. epigastric pain syndrome.
abstract: OBJECTIVE
  Little information is available on the mechanisms responsible for dyspeptic symptoms in postprandial distress syndrome (PDS), characterized by the presence of prevalently meal-related early satiation and fullness, and the epigastric pain syndrome (EPS), characterized by the prominent symptom of epigastric pain, generally not meal related. In a group of PDS patients, the presence of hypersensitivity to gastric distension in both fasting and postprandial phases was described as the main pathophysiological mechanism; on the contrary, we have no information on the pathophysiology of EPS.
  
  
  METHODS
  Sixty Helicobacter pylori (HP)-negative, irritable bowel syndrome (IBS)-negative, and gastroesophageal reflux disease (GERD)-negative patients with functional dyspepsia according to Rome III criteria underwent symptom, anxiety, depression, and somatization evaluation, gastric barostat test, and gastric emptying time evaluation for solids. Fifteen age- and sex-matched healthy volunteers (HVs) were also enrolled as a control group.
  
  
  RESULTS
  In PDS patients, the prevalence of both fasting and postprandial hypersensitivity was higher than in EPS patients, and the extent of postprandial reduction of discomfort threshold was significantly correlated with symptom severity. In EPS patients, gastric volume at fasting discomfort threshold and fasting compliance were significantly lower than in PDS patients. Gastric emptying time and gastric accommodation were similar between the two dyspeptic groups. Dyspeptic patients showed a higher prevalence of psychiatric disorders than HVs, but the prevalence was similar between PDS and EPS patients.
  
  
  CONCLUSIONS
  Fasting and postprandial hypersensitivity characterize PDS patients and a reduction of gastric compliance is present in EPS patients. However, the pathophysiology of EPS appears more complex than PDS and further studies are needed to analyze central processing and integration of afferent pathways in order to clarify the role of the central nervous system in this condition.
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Stefano
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Miceli
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tana
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Mengoli
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergonzi
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pagani
authors.affiliation: 1st Department of Medicine, University of Pavia, IRCCS "S. Matteo" Hospital Foundation, Pavia, Italy.
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D000328:Adult; D016022:Case-Control Studies; D003187:Compliance / Q000502:physiology; D004415:Dyspepsia / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D005215:Fasting / Q000502:physiology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D019518:Postprandial Period / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology; D013577:Syndrome