Treatment of functional dyspepsia beyond proton pump inhibitors

Objective: Through the research on the application of ultrasound image technology in the diagnosis and treatment of functional dyspepsia, the value of ultrasound image technology in the treatment of functional dyspepsia is discussed, which verifies the effectiveness and superiority of ultrasound image technology in the diagnosis and treatment of functional dyspepsia. Methods: In this experiment, functional dyspepsia patients who are treated in the Department of Gastroenterology of a comprehensive third grade a hospital and healthy volunteers are taken as the research objects. Among them, healthy adults are in group A, i. e., control group. There is no obvious digestive tract disease within 2 years. Patients with functional dyspepsia are in group B. After that, the liquid standard nutrition meal is prepared. Both groups need to carry out liquid application meal load test according to the steps. Then, the initial and maximum satiety intake of each group is recorded, and ultrasound imaging technology is used to locate the distal and proximal gastric sections of the two groups. Then, the area of the distal and proximal stomach is recorded at the time of initial satiety, the time of maximum satiety and the time after drinking. After that, according to the area, volume and other relevant data are calculated, the data are input into the database, and SPSS22.0 is used to analyze the data. Results: The time of proximal gastric semi emptying is compared between group B and group A. It is found that the time of proximal gastric semi emptying is longer in group B. In addition, it is found that the time of distal gastric semi emptying in group B is longer than that in group A. There is significant difference in the time of proximal gastric semi emptying and distal gastric semi emptying between the two groups (P < 0.05). In group B, when the initial satiety of liquid standard diet is achieved, the intake is significantly less than that of healthy adults. It is found that the proximal gastric volume of group B is smaller than that of the control group. The intake and proximal gastric volume of the two groups are statistically significant (P < 0.05). There are significant differences between the two groups in the maximum satiety, 30 minutes after meal and 60 minutes after meal (P < 0.05). Conclusion: Ultrasonic imaging technology can monitor the patients' stomach volume and the maximum and minimum intake in real time. Through monitoring, the sensitivity of patients' stomach and some functional abnormalities can be known in time, which is of great significance for the treatment and diagnosis of functional dyspepsia.

Annals for Educators - 16 June 2020.

Efficacy and safety of spore-forming probiotics in the treatment of functional dyspepsia: a pilot randomised, double-blind, placebo-controlled trial

The purpose of this article is to review the recent literature and discuss the new approaches to the diagnosis and treatment of functional dyspepsia (FD). According to the recent American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guideline for dyspepsia, Helicobacter pylori (H. pylori) eradication is recommended as a first treatment option, and proton pump inhibitors (PPIs), tricyclic antidepressants, and prokinetics are listed as second-line therapy. On the other hand, in the Japanese guideline for FD, PPIs and prokinetics are recommended as the first-line treatment. In Japan, acotiamide, a recently launched prokinetic, showed significant efficacy in several clinical trials performed either in Japan or Europe. Regarding non-pharmacological treatment, recent topics include acupuncture, electrical stimulation, gastric peroral endoscopic myotomy, and meal and lifestyle modification. These treatments have provided significant efficacy, which provides some insights into the main pathophysiology of this disease. Although FD is common among functional gastrointestinal disorders, it is not easy to relieve the dyspeptic symptoms of FD patients. Combinations of pharmacological and non-pharmacological treatment options are expected.

Introduction and purpose: While irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common problems in everyday clinical practice, their treatment often remains inefficient. The aim of our work is to present the newest discoveries and research conducted in the topic, while putting special accents on methods available in Poland. We decided to refer to British Society of Gastroenterology guidelines of treatment of IBS and FD as commonly accepted treatment standards in Europe. Description of the state of knowledge: Number of patients suffering from IBS and FD remains high. According to current research, there are some new therapeutical options in IBS: fecal microbiota transplant, spinal catepsin S, olorinab and tenapanor. Methods already being in use in other applications such as vitamin D supplementation, losartan and fecal microbiota transplant are also being investigated. Fecal microbiota transplant seems the most promising one. There are no new treatment options in FD, however there are new research on already used rifaximin and prokinetics, which show their efficacy. Intensive research is being conducted on the use of herbal medicines in treatment of FD. Even though some papers prove the effectiveness of acupuncture we have decided to omit this topic due to its controversial nature. Conclusions: Treatment of IBS and FD remains difficult, there are few advances in that area. Unconventional methods such as herbal medicine and fecal microbiota transplant seem to be gaining in importance.

Effects of Proton-Pump Inhibitors on Functional Dyspepsia: A Meta-analysis of Randomized Placebo-Controlled Trials

Aim of investigation. To estimate the frequency of prescription of motility regulators and probiotics in the functional gastrointestinal diseases. To define efficacy of these agents according to results of «7×7» questionnaire (7 symptoms per 7 days) at treatment of functional dyspepsia (FD), irritable bowel syndrome (IBS) and combination of these diseases. Material and methods. Overall 502 patients aged 18 to 65 with symptoms complying to the «Rome-III» criteria and absence of «alarm symptoms» with the preliminary diagnosis of the functional gastrointestinal disorder: IBS, FD or combination of these diseases were started. During the first visit to the doctor patient was proposed to complete «7×7» questionnaire for baseline assessment of presence and severity of symptoms typical for FD and IBS. Later all patients underwent a set of laboratory and instrumental tests required according to «Guidelines on diagnostics and treatment of the irritable bowel syndrome in adults» of the Russian gastroenterological association and Russian Association of coloproctology and to «Clinical guidelines on diagnostics and treatment of the functional dyspepsia» of the Russian gastroenterological association. After primary investigation 108 patients were excluded from the study due to diagnosis change. Primary documentation data of 11 patients were unsuitable for statistical processing. The analysis of primary documentation and results symptom assessment of 383 patients with verified diagnosis of functional gastrointestinal disease by «7×7» questionnaire was carried out. Treatment algorithms, their conformity to establish diagnosis and efficacy were analyzed as well. Results. Motility regulator trimebutine was prescribed to 258 (67,4%) patients with various diseases: 30 (60%) IBS patients, 67 (73,6%) FD patients, and 157 (64,8%) patients with combination of both disorders. Modes of treatment which included trimebutine demonstrated higher efficacy in comparison to treatment algorithms, which included antispasmodic medications with respect to relief of all symptoms (according to the «7×7» questionnaire data), except for constipation and in disorders of stool consistency (firm stool): efficacy of trimebutinecontaining moods for those symptoms was comparable to those with application of spasmolytic drugs. Probiotic agents with various content in combination to other group drugs were prescribed to 127 patients: 29 FD patients (22,3%); 20 IBS patients (14,5%), and 78 FD to IBS combination (60%). It is established that presence of probiotic in the treatment mode leads to significant reduction in main symptoms severity typical both for FD and IBS according to the «7×7» questionnaire.

This study aims to investigate the efficacy, safety, and cost-effecctiveness of Qizhi Weitong Granules in the treatment of functional dyspepsia. Specifically, two commonly used clinical protocols for the treatment of functional dyspepsia were selected: Qizhi Weitong Granules+Mosapride vs Mosapride alone(control). Meta-analysis of previous clinical studies was performed to examine the efficacy and safety, and pharmacoeconomic evaluation was carried out according to the results of the Meta-analysis. The cost-effectiveness analysis was carried out to elucidated the incremental cost-effectiveness ratio(ICER), and the sensitivity was analyzed with tornado dia-gram and Monte Carlo simulation. The willingness-to-pay threshold of patients for functional dyspepsia was investigated and compared with the ICER to evaluate whether Qizhi Weitong Granules was cost-effective. The result showed that the effective rate of Qizhi Weitong Granules combined with Mosapride in the treatment of functional dyspepsia was 95.49%, which was higher than that of Mosapride alone(73.30%)(OR=8.52, 95%CI[4.36, 16.64])(P<0.000 1). The two groups showed no significant difference in safety. The price of Qizhi Weitong Granules+Mosapride was higher than that of Mosapride alone. The ICER was 640.29 CNY, 1 506.67 CNY lower than the willingness-to-pay threshold. The sensitivity analysis showed that the analysis results were relatively stable. Thus, Qizhi Weitong Granules+Mosapride is safe, effective, and economical in the treatment of functional dyspepsia, which should be further promoted in clinical settings.

Objective To explore the effect of domperidone oral liquid combined with multienzyme tablets for the treatment of functional dyspepsia. Methods 150 children with functional dyspepsia were selected, they were randomly divided into the observation group and control group by using the random number table method, with 75 cases each group. The control group received domperidone oral liquid treatment and the observation group were given domperidone oral liquid combined with multienzyme tablets treatment. The main clinical symptom score and improvement time of two groups, and assess the adverse reactions were observed. Results The satiety, loss of appetite, abdominal discomfort, nausea and vomiting and fecal condition score of the observation group after treatment were(0.48±0.13),(0.53±0.22),(0.21±0.18),(0.79±0.38),(0.28±0.19),which were lower than the control group after treatment(t=8.46,9.27,7.94,10.11,8.04,all P 0.05). Conclusion There was better effect on domperidone oral liquid combined with multienzyme tablets on functional dyspepsia in children, which could improve the patient's clinical symptoms or signs significantly. And could induce the improvement time. Key words: Domperidone; Multienzyme tablets; Child; Functional dyspepsia

Introduction: Functional dyspepsia (FD) is defined as a condition chronically presenting symptoms centered in the upper abdomen, such as epigastric pain or discomfort, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Proton pump inhibitors are main line agents to treat functional Dyspepsia. Omeprazole is conventional PPI and Lansoprazole is a new PPI both are said to be effective option to treat functional dyspepsia in individual trials.
 Aim and Objective: To compare efficacy of Omeprazole versus Lansoprazole for Relief of Functional Dyspepsia.
 Methodology: All randomised control trials which follows PRISMA guidelines 2009 and in which Omeprazole and Lansoprazole were first compared with placebo for the treatment of functional dyspepsia. Clinical trial registries, MEDLINE, SCOPUS, EMBASE database were searched for MeSH terms Omeprazole, Pantoprazole, Placebo which resulted in the treatment of Functional Dyspepsia. Observational studies, Unpublished studies, RCTs not following PRISMA guidelines were excluded. Data was analyzed using RevMan version 5.3 ® and Odd’s Ratio was calculated to determine the difference in Early and late phases. Both Fixed and Random effect model was utilized to calculate the difference. To compare the difference between Omeprazole and Lansoprazole Fischer’s exact test was used. P value less than 0.05 was considered as statistically significant. The I2 will be used to measure the heterogeneity between studies and a value >30.0 will be considered to reflect heterogeneity.
 Results: A total of 10 studies were included consisting of 3934 patients. Omeprazole was effective than placebo to treat functional dyspepsia(Odd’s ratio=1.603, CI=1.264 to 2.033, p value less than 0.01) Lansoprazole was also effective when compared to placebo to treat functional dyspepsia. (Odd’s ratio=0.748, CI=0.553 to 1.011, p=0.058). When Omeprazole was compared to lansoprazole indirectly statistically significant difference was seen (P=0.0001).
 Conclusion: Both Omeprazole and Lansoprazole are effective to treat functional dyspepsia when compared to placebo. Omeprazole is more effective than Lansoprazole to treat functional dyspepsia.

Functional dyspepsia is a clinical syndrome defined by chronic or recurrent pain or discomfort in the upper abdomen of unknown origin. Although generally accepted, investigators differently interpret this definition and clinical trials are often biased by inhomogeneous inclusion criteria. The poorly defined multifactorial pathogenesis of dyspeptic symptoms has hampered efforts to develop effective treatments. A general agreement exists on the irrelevant role played by Helicobacter pylori in the pathophysiology of functional dyspepsia. Gastric acid secretion is within normal limits in patients with functional dyspepsia but acid related symptoms may arise in a subgroup of them. Proton pump inhibitors appear to be effective in this subset of patients with dyspepsia. Non-painful dyspeptic symptoms are suggestive of underlying gastrointestinal motor disorders and such abnormalities can be demonstrated in a substantial proportion of patients. Postprandial fullness and vomiting have been associated with delayed gastric emptying of solids, and early satiety and weight loss to postcibal impaired accommodation of the gastric fundus. Prokinetics have been shown to exert beneficial effects, at least in some patients with dyspepsia. In contrast, drugs enhancing gastric fundus relaxation have been reported to improve symptoms, although conflicting results have also been published. An overdistended antrum may also generate symptoms, but its potential pathogenetic role and the effects of drugs on this abnormality have never been investigated formally. Visceral hypersensitivity plays a role in some dyspeptic patients and this abnormality is also a potential target for treatment. Both chemo- and mechanoreceptors can trigger hyperalgesic responses. Psychosocial abnormalities have been consistently found in functional digestive syndromes, including dyspepsia. Although useful in patients with irritable bowel syndromes (IBS), antidepressants have been only marginally explored in functional dyspepsia. Among the new potentially useful agents for the treatment of functional dyspepsia, serotonin 5-HT(4) receptor agonists have been shown to exert a prokinetic effect. Unlike motilides, 5-HT(4) receptor agonists do not appear to increase the gastric fundus tone and this may contribute to improve symptoms. 5-HT(3) receptor antagonists have been investigated mainly in the IBS and the few studies performed in functional dyspepsia have provided conflicting results. Also, kappa-opioid receptor agonists might be useful for functional digestive syndromes because of their antinociceptive effects, but available results in functional dyspepsia are scanty and inconclusive. Other receptors that represent potential clinical targets for antagonists include purinoceptors (i. e., P2X2/3 receptors), NMDA receptors (NR2B subtype), protease-activated receptor-2, the vanilloid receptor-1, tachykinin receptors (NK(1)/NK(2)) and cholecystokinin (CCK)(1) receptors.

Nonulcer Dyspepsia: A Look Into the Future

There is no clear evidence yet on the best treatment for functional dyspepsia. A variety of drugs are used to try and relieve dyspepsia. Antisecretory drugs are one of the mainstays of treatment. In a Cochrane meta-analysis of randomized trials, antisecretory drugs (H2 receptor antagonists and proton pump inhibitors) were found to be more effective than placebos, and there were no differences between H2 receptor antagonists and proton pump inhibitors. The effectiveness is independent of the subtype, dose, duration of treatment, and Helicobacter pylori status in both drugs. The effect of Helicobacter pylori eradication therapy, on the symptoms of functional dyspepsia, is modest. The effect of H2 receptor antagonists and proton pump inhibitors therapy on functional dyspepsia may be overestimated because most existing trials were performed utilizing the Rome I and II classification of functional dyspepsia.

Introduction: Functional dyspepsia (FD) is a gastrointestinal disorder of multifactorial etiology. Although present in about 20% of the world population, there is no satisfactory pharmacological treatment for these patients yet. Considering the fundamental role of serotonin in the pathogenesis of functional gastrointestinal disorders, the objective of this study was to review the literature related to the use of serotonergic drugs in the treatment of FD and assess their effectiveness. Method: We conducted a horizontal review in the PubMed® database on the treatment of FD and serotonin. Articles were selected using the PRISMA method, as well as the keywords “functional dyspepsia treatment” and “serotonin”. Result: We retrieved 180 studies and after eliminating articles based on titles and abstracts, languages other than English and on pathophysiology, 16 studies remained. Discussion: Overall, treatment with prokinetic agents 5-HT4 antagonists cisapride and tegaserod showed improvement in symptoms in patients with FD compared to placebos, while the efficacy of mosapride is still highly questioned. Regarding antidepressants, tricyclics were effective in the treatment of FD, especially amitriptyline in patients with epigastric pain syndrome. Mirtazapine also showed benefits compared to placebo, especially in patients with FD and weight loss. On the other hand, serotonin and norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors were not effective in the treatment of FD, in addition to causing several adverse effects. The anxiolytics buspirone and tandospirone, responsible for relaxing the gastric fundus, have proven effective for the treatment of FD. Conclusion: Considering the treatment of FD based on serotonergic drugs, tricyclic antidepressants and anxiolytics were the most efficient and indicated in FD cases. The importance of serotonin in the treatment of FD and consequently, in the pathophysiology of the gastrointestinal disorder is demonstrated.

This study was conducted to evaluate the efficacy and safety of Simotang Oral Liquid in the treatment of functional dyspepsia in adults. "Simotang Oral Liquid" "Simotang" "Si Mo Tang" "Si Mo Tang Oral Liquid" were used for retrieval of the relevant papers from CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Springer Link, and Web of Science from database inception to June 2021. Randomized controlled trial(RCT) of Simotang Oral Liquid in the treatment of functional dyspepsia in adults was screened out for Meta-analysis which was conducted in RevMan 5.3. A total of 16 RCTs were included. Meta-analysis showed that compared with the control group, Simotang Oral Liquid increased the total response rate and lowered the traditional Chinese medicine syndrome scores, serum cholecystokinin(CCK), serum nitric oxide(NO), and incidence of adverse reactions. However, the serum substance P(SP) had no statistical difference between the two groups. Simotang Oral Liquid is effective and safe in the treatment of functional dyspepsia in adults. However, this study has evidence and limitations, so the conclusions need to be further verified by large sample and multicenter clinical studies.