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COMPARISON OF THE PREVALENCE OF MEAL-RELATED NAUSEA IN DIFFERENT FUNCTIONAL DYSPEPSIA SUBGROUPS
Date
May 21, 2024
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Background
According to the ROME IV criteria, Functional dyspepsia (FD) can be subdivided into PDS (postprandial distress syndrome) with meal-related symptoms such as early satiation and postprandial fullness and EPS (epigastric pain syndrome) with meal-unrelated complaints such as epigastric pain or burning. Nausea can also co-exist in FD but the literature is poor in reporting whether this symptom is mainly triggered by meal ingestion. This study describes the difference in prevalence rates of meal-related nausea within each FD subgroup.
Methods
Adult patients with disorders of gut-brain interaction (DGBI) recruited in 8 European and 6 Asian secondary and tertiairy care facilities between the ages of 18 and 70 years completed the Enhanced Asian Rome IV questionnaire (EARQ4) with additional questions to address the relationship between nausea and food intake. Patients were asked how often they experienced nausea, whether nausea was triggered or worsened by meal intake, how often nausea occurred after a meal and if so, how soon after a meal nausea started. Questions about nausea relieving factors were also included. FD patients were divided into PDS, EPS and PDS-EPS overlap (OVP) subgroups. Patients were furthermore classified as having clinically significant nausea (CSN) when they reported a nausea frequency of at least once per week. A comparison of CSN and the prevalence of meal-related nausea was made among FD subgroups and also with patients fulfilling Rome IV criteria for functional nausea (FN).
Results
Of the 1074 DGBI patients that completed the survey, 483 were classified as having FD (62.5% PDS, 27.5% EPS, 9.9% OVP) and 18.5% of the total cohort fulfilled diagnostic criteria for FN. The OVP group was significantly younger (median age in years (IQR) OVP 28 (22-42) vs PDS 39 (28-45) vs EPS 40.5 (32-55), p=0.036) with higher prevalence of CSN (58.3%) than PDS (35.4%) and EPS (25.6%) patients (p<0.001). In PDS patients with CSN, nausea was significantly more triggered or worsened by a meal (72.9%) than in OVP, EPS and FN patients (39.3%, 35.3%, 28.9% respectively; p<0.001). All groups reported that meal-related nausea started mostly (> 85%) within 60 minutes after the meal. When comparing FN patients with or without FD, meal-related nausea was more prevalent in FN patients with FD (60.9% vs 28.9% p<0.001). 95% of FN without FD and 91% of EPS did not experience symptom relief after vomiting compared to 70 % in PDS and 75% in OVP (p=0.003).
Conclusions
Clinically significant nausea is mostly present in the FD overlap group. Meal-related nausea is more common in PDS than in overlap, EPS or functional nausea patients. Moreover, also in functional nausea the prevalence of meal-related nausea is higher in case of overlapping FD. This supports nausea as a meal-related symptom in PDS and OVP, but not EPS or pure FN.
According to the ROME IV criteria, Functional dyspepsia (FD) can be subdivided into PDS (postprandial distress syndrome) with meal-related symptoms such as early satiation and postprandial fullness and EPS (epigastric pain syndrome) with meal-unrelated complaints such as epigastric pain or burning. Nausea can also co-exist in FD but the literature is poor in reporting whether this symptom is mainly triggered by meal ingestion. This study describes the difference in prevalence rates of meal-related nausea within each FD subgroup.
Methods
Adult patients with disorders of gut-brain interaction (DGBI) recruited in 8 European and 6 Asian secondary and tertiairy care facilities between the ages of 18 and 70 years completed the Enhanced Asian Rome IV questionnaire (EARQ4) with additional questions to address the relationship between nausea and food intake. Patients were asked how often they experienced nausea, whether nausea was triggered or worsened by meal intake, how often nausea occurred after a meal and if so, how soon after a meal nausea started. Questions about nausea relieving factors were also included. FD patients were divided into PDS, EPS and PDS-EPS overlap (OVP) subgroups. Patients were furthermore classified as having clinically significant nausea (CSN) when they reported a nausea frequency of at least once per week. A comparison of CSN and the prevalence of meal-related nausea was made among FD subgroups and also with patients fulfilling Rome IV criteria for functional nausea (FN).
Results
Of the 1074 DGBI patients that completed the survey, 483 were classified as having FD (62.5% PDS, 27.5% EPS, 9.9% OVP) and 18.5% of the total cohort fulfilled diagnostic criteria for FN. The OVP group was significantly younger (median age in years (IQR) OVP 28 (22-42) vs PDS 39 (28-45) vs EPS 40.5 (32-55), p=0.036) with higher prevalence of CSN (58.3%) than PDS (35.4%) and EPS (25.6%) patients (p<0.001). In PDS patients with CSN, nausea was significantly more triggered or worsened by a meal (72.9%) than in OVP, EPS and FN patients (39.3%, 35.3%, 28.9% respectively; p<0.001). All groups reported that meal-related nausea started mostly (> 85%) within 60 minutes after the meal. When comparing FN patients with or without FD, meal-related nausea was more prevalent in FN patients with FD (60.9% vs 28.9% p<0.001). 95% of FN without FD and 91% of EPS did not experience symptom relief after vomiting compared to 70 % in PDS and 75% in OVP (p=0.003).
Conclusions
Clinically significant nausea is mostly present in the FD overlap group. Meal-related nausea is more common in PDS than in overlap, EPS or functional nausea patients. Moreover, also in functional nausea the prevalence of meal-related nausea is higher in case of overlapping FD. This supports nausea as a meal-related symptom in PDS and OVP, but not EPS or pure FN.
CSN clinically significant nausea, FD functional dyspepsia, PDS postprandial distress syndrome, EPS epigastric pain syndrome, OVP overlap syndrome.
CSN clinically significant nausea, PDS postprandial distress syndrome, OVP overlap syndrome, EPS epigastric pain syndrome, FN functional nausea, FD functional dyspepsia.
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