Functional gastroduodenal disorders

While widely used in research, the 1991 Rome criteria for the gastroduodena l disorders, especially symptom subgroups in dyspepsia, remain contentious. After a comprehensive literature search, a consensus-based approach was ap plied, supplemented by input from international experts who reviewed the re port. Three functional gastroduodenal disorders are defined. Functional dys pepsia is persistent or recurrent pain or discomfort centered in the upper abdomen; evidence of organic disease likely to explain the symptoms is abse nt, including at upper endoscopy. Discomfort refers to a subjective, negati ve feeling that may be characterized by or associated with a number of non- painful symptoms including upper abdominal fullness, early satiety, bloatin g, or nausea. A dyspepsia subgroup classification is proposed for research purposes, based on the predominant (most bothersome) symptom: (a) ulcer-lik e dyspepsia when pain (from mild to severe) is the predominant symptom, and (b) dysmotility-like dyspepsia when discomfort (not pain) is the predomina nt symptom. This classification is supported by recent evidence suggesting that predominant symptoms, but not symptom clusters, identify subgroups wit h distinct underlying pathophysiological disturbances and responses to trea tment. Aerophagia is an unusual complaint characterized by air swallowing t hat is objectively observed and troublesome repetitive belching. Functional vomiting refers to frequent episodes of recurrent vomiting that is not sel f-induced nor medication induced, and occurs in the absence of eating disor ders, major psychiatric diseases, abnormalities in the gut or central nervo us system, or metabolic diseases that can explain the symptom. The current classification requires careful validation but the criteria should be of va lue in future research.