- Patho/Etiology
- A disorder of gut-brain interaction.
- Key mechanisms: Delayed gastric emptying, impaired gastric accommodation (failure of stomach to relax with meals), and visceral hypersensitivity.
- Can be post-infectious. Associated with psychosocial factors like anxiety/depression.
- Clinical Presentation
- Based on Rome IV Criteria: Chronic (>6 mo) symptoms of bothersome postprandial fullness, early satiation, or epigastric pain/burning.
- Two subtypes that often overlap: Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS).
- Diagnosis
- Primarily a diagnosis of exclusion.
- Rule out alarm features: Unintentional weight loss, bleeding, persistent vomiting, dysphagia.
- Age <60 yrs: Non-invasive “test and treat” for H. pylori.
- Age >60 yrs or alarm features: Upper endoscopy (EGD) to rule out PUD, malignancy.
- DDx (Differential Diagnosis)
- GERD: Heartburn/regurgitation are primary sx.
- PUD: More severe pain, distinguished by EGD.
- Gastroparesis: Prominent N/V; confirmed by gastric emptying study.
- IBS: Abdominal pain linked to altered bowel habits.
- Biliary Colic: RUQ pain, post-prandial (fatty meals).
- Management/Treatment
- 1st-line: Eradicate H. pylori if positive. Trial of PPI (e.g., Omeprazole) or H2 blocker for 4-8 weeks.
- 2nd-line: If PPIs fail, use neuromodulators like low-dose tricyclic antidepressants (TCAs) (e.g., Amitriptyline) for pain.
- Prokinetics (e.g., Metoclopramide) can be considered, particularly for PDS-type symptoms.
- Key Associations/Complications
- High overlap with IBS, anxiety, and depression.
- No increased mortality, but significantly impairs quality of life.