Overlap Functional GI Disorders: PDS-IBS (Fullness and Bloating)

Gwee KA, Singapore, on behalf of APAGE working team on Guidelines for Management of Functional Dyspepsia Overlap

A series of Asian-Pacific studies on functional GI disorers using factor analysis found loading of fullness, bloating, belching and flatulence, as a symptom cluster. Based on studies applying Rome II and III criteria, these subjects fulfilled criteria for FD (PDS) and IBS. Meal challenge studies have demonstrated the development of postprandial fullness and bloating in both FD and IBS subjects. Studies examining FD-IBS overlap validate fullness and bloating as predictive symptoms for this overlap. The prevalence of the PDS-IBS cluster is estimated to be at least 30% in gastroenterology clinics across Asia. Plausible pathophysiology consists of impaired transit of gas in the proximal small intestine, food intolerance and small intestinal bacteria overgrowth. Treatment suggestions include pan-GI prokinetics, low FODMAPs diet, herbal medicines and rifaximin.