Mark Radetic, MD, Scott Gabbard, MD
Cleveland Clinic Foundation, Cleveland, OH
Introduction: Functional Dyspepsia is characterized by epigastric pain/burning, early satiety, and post-prandial fullness in the absence of any gastrointestinal pathology. It affects 5-10% of patients world-wide and is responsible for up to 75% of all cases of chronic dyspepsia. Although the pathophysiology is not fully understood, several mechanisms have been proposed: abnormalities in gastric compliance, visceral hypersensitivity, and post-infectious complications.
A subset of patients with Functional Dyspepsia have rapid gastric emptying (RGE) – defined as < 30% gastric retention at 1-hour on Gastric Emptying Scintigraphy (GES). A case is reported of Functional Dyspepsia with RGE responsive to treatment with buspirone – a 5-HT1A agonist that has been shown to improve post-prandial symptoms in Functional Dyspepsia.
Case Description/Methods: The patient is a 60-year old male with advanced COPD s/p bilateral lung transplant who initially presented with heartburn and acid regurgitation. Esophageal pH testing demonstrated increased esophageal acid exposure consistent with GERD. He was treated with a proton pump inhibitor (PPI) with improvement in his symptoms.
Over the next year, he started experiencing persistent epigastric discomfort, nausea/vomiting, early satiety, and loose stools culminating in 5 hospitalizations over a 1-year period. An EGD and colonoscopy were unremarkable with negative biopsies for H pylori. A GES revealed 7% gastric retention at the 1-hour mark – consistent with rapid gastric emptying (RGE). The patient was diagnosed with Functional Dyspepsia with RGE and started on buspirone. Within 1 week, he reported complete resolution of his symptoms.
Discussion: The natural history of Functional Dyspepsia results in symptom relapse and/or persistence in up to 50% of patients. Guidelines recommend a step-wise approach to therapy: a 4-8 week trial of a PPI followed by a tricyclic anti-depressant (TCA) for persistent symptoms. While treatment with PPIs and/or TCAs provides relief for some, a significant number of individuals continue to experience refractory symptoms.
A fraction of patients with Functional Dyspepsia are found to have RGE, which may provide us with an additional therapeutic target. Buspirone has been shown to promote fundic relaxation/increase gastric accommodation which may help normalize the rate of gastric emptying by preventing early redistribution of a meal to the distal stomach. Thus, buspirone may be of benefit in patients with Functional Dyspepsia found to have RGE.
Citation: Mark Radetic, MD, Scott Gabbard, MD. P0354 - BUSPIRONE FOR THE MANAGEMENT OF FUNCTIONAL DYSPEPSIA WITH RAPID GASTRIC EMPTYING (RGE). Program No. P0354. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.