Epigastric tactile hypersensitivity as a bedside clinical marker for functional epigastric pain: A prospective multicenter diagnostic accuracy study

Abstract

Background/aims Functional dyspepsia is a common gut–brain interaction disorder. Identifying simple bedside markers that distinguish functional from organic epigastric pain remains a clinical challenge. This study assessed the diagnostic accuracy of tactile hypersensitivity over the epigastrium for recognizing the functional epigastric pain. Materials and methods A prospective multicenter diagnostic-accuracy study was conducted between April and October 2025 among adults (19–60 years) presenting with epigastric pain. Standardized history, tactile hypersensitivity assessment (Spontaneous-reported, physician-assessed, or negative), and validated anxiety screening (GAD-7) were obtained. Upper endoscopy with biopsy, abdominal ultrasound, and laboratory testing—including Helicobacter pylori —were performed with blinded interpretation. Results Of 285 screened patients, 210 were eligible; 51.4% were female, and the median age was 39 years. Overall tactile hypersensitivity showed sensitivity of 84% (95% CI, 74–91), specificity of 94% (95% CI, 88–97), PPV of 91.4%, NPV of 89.1%, and positive likelihood ratio of 14.66 for functional epigastric pain. Exploratory ROC model comparison showed high discrimination, with AUCs ranging from 0.892 to 0.921. Conclusions Tactile hypersensitivity in the epigastrium could represent a straightforward fast, and specific bedside indicator that enhances the Rome IV criteria for functional epigastric pain. It improves the accuracy of diagnoses and may help guide selection of patients for further evaluation. Further validation in diverse populations and integration into patient-reported tools are the next steps toward precision care in functional dyspepsia.