B Altered Gastrointestinal Motility

Another hypothesis is that disturbances in gastrointestinal motility represent the underlying causative factor in functional dyspepsia. Motor disorders such as gastroesophageal reflux, gastroparesis, small bowel dysmotility, and biliary dyskinesia may cause dyspeptic symptoms. Disturbances in gastric emptying and gastrointestinal motor function occur in subgroups of patients with functional dyspepsia, and studies of these patients show female sex predominance. The prevalence of motility disorders has varied markedly between studies, likely due to subject selection criteria and study methodology. A meta-analysis of studies investigating functional dyspepsia and disturbed solid phase gastric emptying found 40% of patients with functional dyspepsia had slower emptying, and the pooled estimate of slowing was 1.5 times that of normal patients. However, the decrease in gastric emptying was modest.

As mentioned, symptoms of GERD often overlap with dyspepsia symptoms. Poor visceral localization of symptoms can often cause a reflux event to be confused with other upper gastrointestinal sources of discomfort. Both acid and nonacid reflux can cause symptoms. A recent report noted that patients with functional dyspepsia swallow air more frequently than controls; this finding was associated with an increase in nonacid reflux, which can also cause epigastric symptoms.

Conchillo JM, Selimah M, Bredenoord AJ, et al. Air swallowing, belching, acid and non-acid reflux in patients with functional dyspepsia. Aliment Pharm Ther. 2007;25:965-971. [PMID: 17403001]

Talley NJ, Locke GR, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut. 2006;55: 933-939. [PMID: 16322108]

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