Gabapentin Improves Symptoms of Functional Dyspepsia in a Retrospective, Open-label Cohort Study.

GOALS: We sought to determine the efficacy of gabapentin in the treatment of functional dyspepsia among an observational cohort of patients. BACKGROUND: Gabapentin has an established role in the treatment of neuropathic pain, with evidence supporting a benefit in visceral hypersensitivity. There is currently no data on the use of gabapentin for the treatment of functional dyspepsia. STUDY: Consecutive patients presenting to a tertiary motility clinic for the evaluation of functional dyspepsia without concurrent gastric emptying delay completed a baseline Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) before evaluation and were started on gabapentin for functional dyspepsia by their providers. The primary endpoint was change in total PAGI-SYM score between initial and subsequent visits. RESULTS: Of 110 patients enrolled, 62 patients with functional dyspepsia completed pregabapentin and postgabapentin surveys. Subjects' mean PAGI-SYM score decreased by 0.44 (P<0.0001) with significant changes in all subscales (including upper abdominal pain, lower abdominal pain, postprandial fullness) except for bloating. Multivariable analysis showed that worsening pretreatment symptom severity was independently associated with improvement. Seven (11.3%) patients discontinued gabapentin with 5 (71.4%) discontinuing due to side effects. Using the minimum significant PAGI-SYM score change threshold, ≥50% of the cohort had significant improvement in their overall, postprandial fullness, and upper abdominal pain subscores. CONCLUSIONS: In a retrospective, open-label cohort of patients treated with gabapentin for functional dyspepsia, there were significant improvements in dyspeptic symptoms interpreted within the limitations of an open-label study design. Further studies are needed to place gabapentin in the functional dyspepsia treatment algorithm.

Dysphagia: A review.

Dysphagia is a common symptom with several differential diagnoses ranging from benign and functional to life threatening. Given the potential severity, it is essential to obtain an accurate and pointed history to dictate appropriate diagnostic testing. This article differentiates between oropharyngeal and esophageal dysphagia before outlining a systematic approach to subsequent testing, including when to refer to a specialist.