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Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
Correspondence to: Seiji Futagami, MD, PhD. Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Nippon
Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. Email: seiji.futagami@gmail.com.
Comment on: Aziz I, Palsson OS, Törnblom H, et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional
dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol 2018;3:252-62.
Functional dyspepsia (FD) is one of the gastrointestinal that almost ten percentage in the adult population fitted
disorders and can be severely disturbed with quality of into symptoms-based criteria for Rome IV FD (11). They
life (QOL). Visceral hypersensitivity (1), disturbed gastric have reported that the proportion of Rome IV FD in the
accommodation (2) and disturbed gastric motility are mostly USA was significantly higher than in Canada (8%) and UK
reported in FD patients (3-5). According to the Rome III (8%) (11). They have also reported that 9% participants
classification, FD symptoms were chiefly consisted of four accompanying with symptom-based diagnosis for Rome
symptoms, such as bothersome postprandial fullness, early IV FD patients, 6% having PDS, 2% EPS, and 2% having
satiety, epigastralgia and epigastric burning (6). FD patients the overlapping variant (11). Then, in our data, although
were divided two groups. One group was epigastric pain we evaluated clinical symptoms, quality of life, sleep
syndrome (EPS) and the other was postprandial distress disturbance and anxiety in FD subgroups, these parameters
syndrome (PDS). These two groups require different and the score of questionnaires were not significantly linked
treatments. EPS patients were mainly treated with acid to the criteria of respective subgroups (12). Anyway, the
secretion inhibitors, whereas PDS patients were mainly definition of subtypes of FD patients is important for the
treated with prokinetic drugs, such as mosapride and determination of the treatment for FD patients. Recently,
acotiamide (7). Chen et al have demonstrated that FD subgroups had
Recently, Rome IV classification has been reported various regional brain activities at rest and under stress and
the definition of FD determined by bothersome clinical compared to PDS patients, EPS patients exhibited more
symptoms (8,9). In the Rome IV classification of significant differences in the distribution of brain activities
FD patients, slight modifications were mentioned as from healthy volunteers (13).
compared to last Rome III classification. In new Rome In addition, Aziz et al. have reported that the proportion
IV classification, not only postprandial fullness, but also of subgroups was 61% PDS,18% EPS and the incidence of
EPS symptom and early satiation should be determined irritable bowel syndrome (IBS) was also significantly higher
as “bothersome symptoms”. Then, Rome IV classification among those with overlapping PDS and EPS than in those
involves not only PDS and EPS, but also the overlap of with EPS alone and was lowest in those with PDS alone (11).
PDS and EPS. PDS-EPS overlapped syndrome in the Ford et al have also reported that the incidence of IBS is 8
hospital—based population is more frequent than in the times higher in subjects with FD and suggests that IBS and
general population (10). FD share the process of the progression of their diseases (14).
Aziz et al. have tried to determine enrolled subjects fitted In our data, the severity of symptom, such as heartburn and
into Rome IV criteria using online questionnaire in the hunger in the overlapped syndrome were significantly higher
USA, Canada, and the UK. Aziz et al. have demonstrated compared to that in FD patients (15).
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Translational Gastroenterology and Hepatology, 2018 Page 3 of 3
sleep disorders in functional dyspepsia. J Nippon Med Sch randomized, placebo-controlled trials. Aliment Pharmacol
2013;80:362-70. Ther 1998,12,1055-65.
16. Wang WH, Huang JQ, Zheng GF, et al. Effects of proton- 19. Hashimoto S, Futagami S, Yamawaki H, et al. Epigastric
pump inhibitors on functional dyspepsia: a meta-analysis of pain syndrome accompanying pancreatic enzyme
randomized placebo-controlled trials. Clin Gastroenterol abnormalities was overlapped with early chronic
Hepatol 2007;5:178-85. pancreatitis using endosonography. J Clin Biochem Nutr
17. Peura DA, Kovacs TO, Metz DC, et al. Lansoprazole 2017;61:140-5.
in the treatment of functional dyspepsia: two double- 20. Yamawaki H, Futagami S, Kaneko K, et al. Camostat
blind, randomized, placebo-controlled trials. Am J Med mesilate, pancrelipase and rabprazole combination therapy
2004;116:740-8. improves epigastric pain in early chronic pancreatitis and
18. Talley NJ, Meineche-Schmidt V, Paré P, et al. Efficacy functional dyspepsia with pancreatic enzyme abnormalities.
of omeprazole in functional dyspepsia: double-blind, Digestion. [Epub ahead of print].
doi: 10.21037/tgh.2018.09.12
Cite this article as: Futagami S, Yamawaki H, Agawa
S, Higuchi K, Ikeda G, Noda H, Kirita K, Akimoto T,
Wakabayashi M, Sakasegawa N, Kodaka Y, Ueki N, Kawagoe T,
Iwakiri K. New classification Rome IV functional dyspepsia and
subtypes. Transl Gastroenterol Hepatol 2018;3:70.
© Translational Gastroenterology and Hepatology. All rights reserved. tgh.amegroups.com Transl Gastroenterol Hepatol 2018;3:70