title: Clinical presentations of gastric small gastrointestinal stromal tumors mimics functional dyspepsia symptoms.
abstract: OBJECTIVE
  To explore whether clinical presentations of gastric small gastrointestinal tumors (GISTs) mimics gastrointestinal dyspepsia symptoms.
  
  
  METHODS
  The endosonographic data of 167 patients who underwent endoscopic submucosal dissection at the Tianjin Medical University General Hospital, China between 2009 and 2011 were analyzed. GISTs and leiomyomas had a similar intragastric distribution and similar locations within the gastric wall. Therefore, patients with GISTs were chosen as the study group and those with leiomyomas were chosen as the control group. Dyspepsia symptom questionnaires were used to investigate and compare the gastrointestinal symptoms of patients with GISTs and those with gastric leiomyomas before and after endoscopic submucosal dissection (ESD). The questionnaires evaluated symptoms such as epigastric pain, heartburn, regurgitation, epigastric discomfort, nausea and vomiting, abdominal bloating, and eructation. Symptoms were assessed using a four-point scoring scale.
  
  
  RESULTS
  GISTs were the most common gastric submucosal lesion (67 cases, 40.12%), followed by leiomyomas (38 cases, 22.75%). Both groups were similar in terms of gender distribution (P = 0.49), intragastric location (P = 0.525), and originating layer within the gastric wall (P = 0.449), but leiomyomas were more commonly found in the proximal fundus (P < 0.05). Overall, 94.2% of the patients with small GISTs and 93.5% of those with gastric leiomyomas experienced some dyspepsia; however, total symptom scores were significantly lower in the GIST group than in the leiomyoma group (1.34 ± 1.27 vs 2.20 ± 1.70, P < 0.05). Each component of the symptom score demonstrated a statistically significant improvement in the GIST patients after ESD (P < 0.05), including epigastric pain (0.80 ± 0.90 vs 0.13 ± 0.46), heartburn (0.63 ± 1.08 vs 0.13 ± 0.41), regurgitation (0.55 ± 0.87 vs 0.22 ± 0.57), epigastric discomfort (0.70 ± 0.98 vs 0.32 ± 0.47), nausea and vomiting (0.27 ± 0.62 vs 0.05 ± 0.21), abdominal bloating (0.70 ± 0.90 vs 0.27 ± 0.49), and eructation (0.36 ± 0.61 vs 0.21 ± 0.46). For leiomyoma patients, symptoms such as heartburn, nausea, vomiting, and eructation improved after treatment; however, these improvements were not statistically significant (P > 0.05). Thus, the pathophysiology of dyspepsia symptoms may be different between the two groups.
  
  
  CONCLUSIONS
  Symptoms of gastric small GISTs may mimic those of functional dyspepsia. An alternative diagnosis should be considered in patients with functional dyspepsia and treatment failure.
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Qing-Xiang
authors.initials: QX
authors.lastname: Yu
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Zhan-Kun
authors.initials: ZK
authors.lastname: He
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Sun
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Qing-Xiang Yu, Zhan-Kun He, Jiang Wang, Chao Sun, Wei Zhao, Bang-Mao Wang, Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Bang-Mao
authors.initials: BM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004210:Dissection / Q000379:methods; D004415:Dyspepsia / Q000175:diagnosis / Q000209:etiology*; D019160:Endosonography; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D007889:Leiomyoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011795:Surveys and Questionnaires; D047368:Tumor Burden
keywords: Clinical presentation; Endoscopic ultrasonography; Gastric leiomyoma; Gastric small gastrointestinal stromal tumor