Asian Consensus Report on Functional Dyspepsia

BACKGROUND/AIMS: Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. METHODS: Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. RESULTS: Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. CONCLUSIONS: This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.

Comparison of noninvasive diagnostic tests for helicobacter pylori infection

Since the 13C-urea breath test [UBT] has become a highly reliable method for the noninvasive diagnosis of Helicobacter pylori infection, this study was performed in order to compare the sensitivity, specificity and accuracy among noninvasive tests including capsule UBT, conventional UBT and serology in the diagnosis of H. pylori infection. One hundred patients received capsule UBT, conventional UBT and gave blood samples for the diagnosis of H. pylori infection. Upper gastrointestinal endoscopy was performed in all patients. H. pylori infection was defined as the presence of a positive culture or positive results of both histology and rapid urease test [CLO test]. McNemar's test was used to determine the significance of differences among capsule UBT, conventional UBT and serology. Differences were considered significant at p < 0.05. According to the predefined criteria, the sensitivity, specificity, positive predictive value and negative predictive value of capsule UBT, conventional UBT and serology was 100, 95.7, 96.4 and 100%; 100, 85.1, 88.3 and 100%, and 90.6, 85.1, 82.7 and 88.9%, respectively. The accuracy of capsule UBT was higher than that of conventional UBT and serology [98 vs. 93 and 88%, respectively]. Capsule UBT had a similar ability for the detection of H. pylori infection compared with conventional UBT and serology [McNemar's test, p > 0.05]. According to our study, capsule UBT was highly accurate compared with other noninvasive tests including conventional UBT and serology. It could become a good alternative to endoscopy for the diagnosis of H. pylori infection