Letters To The Editor
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World J Gastroenterol. Dec 21, 2013; 19(47): 9137-9138
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.9137
Assessment of proximal gastric accommodation in patients with functional dyspepsia
Paola Iovino, Antonella Santonicola, Carolina Ciacci
Paola Iovino, Carolina Ciacci, Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
Antonella Santonicola, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy
Author contributions: Iovino P wrote the letter; Santonicola A and Ciacci C revised the letter.
Correspondence to: Paola Iovino, MD, Professor, Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Via S Allende, Baronissi, 84081 Salerno, Italy. piovino@unisa.it
Telephone: +39-89-965030 Fax: +39-89-672452
Received: September 7, 2013
Revised: September 23, 2013
Accepted: September 29, 2013
Published online: December 21, 2013

Impaired gastric accommodation is one of the most important etiologic factors in the pathophysiology of functional dyspepsia. Ultrasound is a potential alternative method to study changes in gastric volume as a reflection of gastric accommodation. Ultrasound is suitable for patients because it is a non-invasive, easily repeated and non-radioactive procedure, and a previous study has demonstrated the feasibility of 3-dimensional ultrasound in examining functional dyspepsia. The brief article by Fan et al demonstrated that both the proximal gastric area and volume, measured by 2- and 3-dimensional ultrasound respectively, were significantly smaller in patients with functional dyspepsia than in healthy controls. These results are very interesting, but we raise the relevant point that it should have been mandatory to study both changes in gastric volume and their relationship with upper gastrointestinal symptoms in functional dyspepsia. In fact, the relationship between cardinal symptoms and several pathophysiologic mechanisms in functional dyspepsia remains a matter of debate. Moreover, further evaluation of distal gastric volume that has been previously implicated in the origin of functional dyspeptic symptoms is advisable. Therefore, impaired gastric accommodation does not serve as a clear marker of the cardinal symptoms experienced by patients with functional dyspepsia in daily life.

Keywords: Proximal gastric function, Gastric accommodation, 2-Dimensional ultrasound, 3-Dimensional ultrasound, Functional dyspepsia, Rome III criteria

Core tip: Proximal gastric area and volume measured respectively by 2- and 3-dimensional ultrasound were significantly smaller in patients with functional dyspepsia compared to those of healthy controls. Hence, they could be used to assess accommodation impairment, but further prospective studies are needed to establish their clinical role in diagnosis of functional dyspepsia.