Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

doi:10.1111/jgh.16046

Review

. 2023 Feb;38(2):197-209.

doi: 10.1111/jgh.16046. Epub 2022 Nov 28.

Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

Kok-Ann Gwee¹, Yeong Yeh Lee^{2

3}, Hidekazu Suzuki⁴, Uday Chand Ghoshal⁵, Gerald Holtmann⁶, Tao Bai⁷, Giovanni Barbara⁸, Min-Hu Chen⁹, Andrew Seng Boon Chua¹⁰, Peter R Gibson¹¹, Xiaohua Hou⁷, Jinsong Liu⁷, Atsushi Nakajima¹², Nitesh Pratap¹³, Sanjeev Sachdeva¹⁴, Kewin Tien Ho Siah¹⁵, Alex Yu Sen Soh¹⁵, Kentaro Sugano¹⁶, Jan Tack¹⁷, Victoria Ping Yi Tan¹⁸, Xudong Tang¹⁹, Marjorie Walker²⁰, Deng-Chyang Wu²¹, Ying-Lian Xiao⁹, Khairil Khuzaini Zulkifli^{3

22}, Clarissa Toh²³

Affiliations

¹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore.
² School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
³ GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan.
⁵ Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
⁶ Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁷ Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁸ Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy.
⁹ Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁰ Ipoh Gastro Center, Ipoh, Malaysia.
¹¹ Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
¹² Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
¹³ Krishna Institute of Medical Sciences, Secunderabad, India.
¹⁴ Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
¹⁵ Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
¹⁶ Jichi Medical University, Shimotsuke, Tochigi, Japan.
¹⁷ Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
¹⁸ Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
¹⁹ Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
²⁰ Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia.
²¹ Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²² Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
²³ Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore.

PMID: 36321167
DOI: 10.1111/jgh.16046

Review

Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

Kok-Ann Gwee et al. J Gastroenterol Hepatol. 2023 Feb.

. 2023 Feb;38(2):197-209.

doi: 10.1111/jgh.16046. Epub 2022 Nov 28.

Authors

Affiliations

¹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore.
² School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
³ GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan.
⁵ Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
⁶ Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁷ Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁸ Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy.
⁹ Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁰ Ipoh Gastro Center, Ipoh, Malaysia.
¹¹ Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
¹² Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
¹³ Krishna Institute of Medical Sciences, Secunderabad, India.
¹⁴ Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
¹⁵ Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
¹⁶ Jichi Medical University, Shimotsuke, Tochigi, Japan.
¹⁷ Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
¹⁸ Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
¹⁹ Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
²⁰ Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia.
²¹ Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²² Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
²³ Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore.

PMID: 36321167
DOI: 10.1111/jgh.16046

Abstract

Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.

Keywords: dyspepsia; epidemiology; functional; gastrointestinal; management; overlap; pathophysiology.

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References

1. Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries. Am. J. Gastroenterol. 2018; 113: 86-96.
1. Xiong L, Gong X, Siah KT-H et al. Rome foundation Asian working team report: Real world treatment experience of Asian patients with functional bowel disorders. J. Gastroenterol. Hepatol. 2017; 32: 1450-1456.
1. von Wulffen M, Talley NJ, Hammer J et al. Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors. Dig. Dis. Sci. 2019; 64: 480-486.
1. Schmulson M, Corazziari E, Ghoshal UC et al. A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders. Neurogastroenterol. Motil. 2014; 26: 1368-1385.
1. Siah KTH, Gong X, Yang XJ et al. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67: 1071-1077.

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[1] Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries. Am. J. Gastroenterol. 2018; 113: 86-96.

[2] Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries. Am. J. Gastroenterol. 2018; 113: 86-96.

[3] Xiong L, Gong X, Siah KT-H et al. Rome foundation Asian working team report: Real world treatment experience of Asian patients with functional bowel disorders. J. Gastroenterol. Hepatol. 2017; 32: 1450-1456.

[4] Xiong L, Gong X, Siah KT-H et al. Rome foundation Asian working team report: Real world treatment experience of Asian patients with functional bowel disorders. J. Gastroenterol. Hepatol. 2017; 32: 1450-1456.

[5] von Wulffen M, Talley NJ, Hammer J et al. Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors. Dig. Dis. Sci. 2019; 64: 480-486.

[6] von Wulffen M, Talley NJ, Hammer J et al. Overlap of Irritable Bowel Syndrome and Functional Dyspepsia in the Clinical Setting: Prevalence and Risk Factors. Dig. Dis. Sci. 2019; 64: 480-486.

[7] Schmulson M, Corazziari E, Ghoshal UC et al. A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders. Neurogastroenterol. Motil. 2014; 26: 1368-1385.

[8] Schmulson M, Corazziari E, Ghoshal UC et al. A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders. Neurogastroenterol. Motil. 2014; 26: 1368-1385.

[9] Siah KTH, Gong X, Yang XJ et al. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67: 1071-1077.

[10] Siah KTH, Gong X, Yang XJ et al. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67: 1071-1077.

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Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

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Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms

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