Frequency, Symptoms Evolution and Pathophysiological Correlates in Prospectively Identified Patients With Postinfectious Dyspepsia

Background and aims: Functional bowel disorders may follow acute intestinal infection. A single, large, retrospective study showed that a subset of dyspeptic patients had a history of gastroenteritis. No data are however currently available in patients with prospectively identified postinfectious dyspepsia (PD). Our aim was to characterize frequency, symptoms evolution and underlying mechanisms of functional dyspepsia, up to 12 months after acute gastroenteritis. Subjects and Methods: A total of 150 consecutive patients with undergoing acute gastroenteritis were screened and followed-up for 1 month. In patients with symptoms persistence upper GI endoscopy, gastric emptying study (13C-octanoic acid breath test) and satiety testing (as a surrogate of gastric fundus accommodation) were performed. Pattern and severity of dyspeptic symptoms were scored at 3, 6 and 12 months by standardized questionnaire. Gastric emptying and satiety testing were repeated at 6 months. Patients with previous diagnosis of FGIDs or organic disease at endoscopy were excluded. Cut-off values for normal gastric emptying rate and meal-induced satiety (120 min and 890 kcal, respect- ively) were obtained on 20 age/sex matched healthy subjects. Results: At baseline no signs of infection by common pathogens were found in the majority of the patients, except than giardia lamblia and salmonella tiphy in 3 and 1 patients, that were respectively treated and followed up. Persistence of dyspeptic symptoms at 1 month was observed in 31 subjects (18 male, age 28±10), with postprandial fullness, bloating, belching, nausea, epigastric pain, early satiety and vomiting being reported by 85, 70, 70, 56, 67, 48 and 19 % of the patients, respectively; systematic analysis revealed that such pattern of symptoms was quite stable along the times. Although severity was gradually reducing for the majority of the symptoms, only the proportion of patients reporting moderate or severe belching were significantly reduced at 12 months (70 vs. 12 %, p<0.05). At baseline, delayed gastric emptying and impaired satiety testing were present in 60% and 85% of the patients with a similar percentage at 6 months (58 and 90%, respectively). Conclusions: We showed that at least 20% of prospectively evaluated patients with acute gastroenteritis develop and maintain dyspeptic symptoms after the resolution of the acute phase. In these patients symptoms severity was gradually reducing, but still persistent up to 1 year. Persistent delayed gastric emptying of solid meal and impaired gastric accommodation are putative mechanisms involved in symptoms generation