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Irritable Bowel Syndrome and Functional Dyspepsia: Different Diseases or a Single Disorder With Different Manifestations?

Posted 08/29/2005

Laura Noddin, MD; Michael Callahan, PhD; Brian E. Lacy, MD, PhD

Introduction
Functional gastrointestinal disorders (FGIDs) are common, chronic ailments that affect millions of adults on a daily basis. FGIDs are characterized by recurrent symptoms (ie, abdominal pain or discomfort, bloating, nausea, vomiting, early satiety, constipation, or diarrhea) that indicate a dysfunctional GI tract despite that an organic reason for the symptom generation is not identified on diagnostic studies.

It is estimated that 40% of all gastroenterology clinic visits are for FGIDs,[1] and a recent survey of generalists and gastroenterologists found that nearly one third of their patient population had symptoms of irritable bowel syndrome (IBS).[2] Many patients with IBS have dyspepsia; likewise, many patients with dyspepsia also have overlapping symptoms of IBS. These 2 groups of patients are similar in that symptoms are typically chronic in nature, may wax and wane, are aggravated by psychosocial stressors, and are often worsened by meals. In addition, both disorders are considered difficult to diagnose by many physicians and in the absence of warning signs or "red flags," extensive testing is unlikely to be helpful. These similarities raise the issue of whether IBS and dyspepsia are just different manifestations of the same disorder or whether they represent distinct clinical entities. Elucidating this clinical dilemma is important because it may improve our ability to diagnose and treat these common disorders.

At present, the ROME II committee classifies IBS as a distinctly separate functional bowel disorder from dyspepsia.[3] IBS is characterized by lower abdominal pain or discomfort in association with disordered defecation ( Table 1 ). Dyspepsia presents as recurrent upper abdominal pain or discomfort associated with symptoms of early satiety, fullness, bloating, and nausea ( Table 2 ). Because upper GI function regularly affects lower GI tract function (ie, the gastro-colic reflex), and lower GI function routinely affects upper GI function (ie, constipation slows gastric emptying), it should not be surprising that these 2 areas are intimately linked.[4]

This article reviews the prevalence, natural history, etiology, pathogenesis, and treatment of these 2 common FGIDs, and discusses whether these disorders are different manifestations of the same disorder or whether they are truly distinct clinical entities.

Laura Noddin, MD, Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire

Michael Callahan, PhD, Regional Scientific Director, Novartis Pharmaceuticals, East Hanover, New Jersey

Brian E. Lacy, MD, PhD, Associate Professor of Medicine, Dartmouth Medical School, Hanover, New Hampshire; Director, GI Motility Laboratory, Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Disclosure: Laura Noddin, MD, has disclosed no relevant financial relationships.

Disclosure: Michael Callahan, PhD, has disclosed that he is an employee of Novartis Pharmaceuticals, East Hanover, New Jersey, and holds stock options in the Company.

Disclosure: Brian E. Lacy, MD, PhD, has disclosed that he has received grants for clinical research from Novartis Pharmaceuticals, AstraZeneca, and GlaxoSmithKline.

Medscape General Medicine. 2005;7(3) �2005 Medscape

To read this article in full, please click here:

http://www.medscape.com/viewarticle/506798?src=mp

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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