Diagnosis Of Functional Dyspepsia Research Articles

The impact of relaxing the requirements for dyspeptic Symptom Onset frequency or duration in Rome IV Criteria on the Symptom Pattern and diagnosis of functional dyspepsia

BackgroundThe Rome IV criteria for functional dyspepsia (FD) has strict requirements for symptom frequency and onset duration, making it difficult for patients to meet these criteria in clinical practice. This study aimed to investigate the impact of relaxing the Rome IV criteria on the diagnosis and symptom pattern of FD.MethodsA cross-sectional, multi-center study was conducted involving 2935 consecutive broadly defined FD patients without positive findings on upper gastrointestinal endoscopy or routine examinations. Questionnaires were used to collect demographic and upper gastrointestinal symptom data. Symptom pattern was compared between Rome IV criteria defined FD patients and those defined by relaxed Rome IV criteria.ResultsOnly 22.2% of broadly defined FD patients rigorously fulfilled Rome IV criteria. No significant difference was found for proportion of patients with dyspeptic symptoms, dysmotility-like symptoms, reflux-like symptoms, as well as severity and onset frequency of dyspeptic symptoms (all P > 0.05), between patients who didn’t fulfill Rome IV criteria for FD solely due to a duration of 3–6 months and Rome IV criteria defined FD patients. Patients with broadly defined postprandial distress syndrome (PDS) who didn’t fulfill Rome IV criteria solely due to a symptom frequency of 1–2 days per week had significantly lower symptom severity (P < 0.001), but similar postprandial symptom characteristics compared to those defined by the Rome IV criteria.ConclusionsA symptom duration criterion of 3 months may be sufficient for diagnosing FD. Reducing the symptom onset frequency to no less than 1 day per week in the Rome IV criteria for PDS does not affect its postprandial symptom characteristics.

Breaking Barriers in Functional Dyspepsia: A Systematic Review and Meta-analysis on Duodenal Tight Junction Protein Expression.

Disruptions in tight junction (TJ) protein expression leading to duodenal epithelial barrier impairment may contribute to increased intestinal permeability, potentially playing a role in functional dyspepsia (FD) pathophysiology. Currently published studies evaluated the role of several TJ proteins in FD patients with inconsistent results. Therefore, we conducted this systematic review and metaanalysis to evaluate the duodenal mucosal expression of several TJ proteins in FD. We performed a systematic electronic search on PubMed, EMBASE, and Scopus using predefined keywords. Diagnosis of FD by Rome III or Rome IV criteria was considered acceptable. Full articles satisfying our inclusion and exclusion criteria were included. The principal summary outcome was the mean difference of several TJ proteins in FD patients and control subjects. A total of 8 and 5 studies were included in our qualitative and quantitative synthesis, respectively, with a total population of 666 participants, out of which 420 were FD patients. No significant differences were observed between FD patients and controls in the expression of claudin-1 (-0.102 [95% CI, -0.303, 0.099]), claudin-2 (0.161 [95% CI, -0.134, 0.456)], claudin-3 (0.278 [95% CI, -0.280, 0.837]), claudin-4 (0.045 [95% CI, -0.264, 0.354]), ZO-1 (-0.221 [95% CI, -0.683, 0.241]), ZO-2 (-0.070 [95% CI, -0.147, 0.007]), ZO-3 (-0.129 [95% CI, -0.376, 0.118]), β-catenin (-0.135 [95% CI, -0.484, 0.214]), E-cadherin (-0.083 [95% CI, -0.229, 0.063]), and occludin (-0.158 [95% CI, -0.409, 0.093]). The expressions of all evaluated proteins including claudin-1, claudin-2, claudin-3, claudin-4, ZO-1, ZO-2, ZO-3, β-catenin, E-cadherin, and occludin did not significantly differ between FD patients and controls. However, due to the limited number of included studies, results should be interpreted with caution.

Functional magnetic resonance imaging and functional dyspepsia: Predictive value questioned

Functional dyspepsia is a challenging condition in gastroenterology, characterized by digestive symptoms without evidence of organic pathology. Conventional diagnostic methods have significant limitations in terms of sensitivity and specificity. This study aims to explore the potential of functional magnetic resonance imaging (fMRI) as an innovative diagnostic approach for functional dyspepsia, with a view to improving diagnostic accuracy and benefiting patients. This integrative literature review, following the PRISMA guidelines, investigated the use of fMRI in the diagnosis of functional dyspepsia. Sixteen articles were selected after rigorous screening, employing detailed descriptive analysis and narrative synthesis. As a result, it was noted that patients with functional dyspepsia exhibit alterations in brain activity, especially in areas associated with sensory processing and emotional control, indicating dysfunction in these regions. It is concluded that fMRI has promising potential in the diagnosis of functional dyspepsia, complementing conventional methods. Although specific pathognomonic patterns have not been identified, the affected brain areas offer a basis for applying fMRI, improving understanding of the condition and enabling more targeted therapies.

Sleep quality in functional dyspepsia patients: A cross-sectional study from a tertiary care hospital in Karachi.

Objective: To determine sleep quality among functional dyspepsia (FD) patients presenting to gastroenterology out-patient clinic in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2022 to December 2023. Methods: FD diagnosis was established in view of ROME-IV criteria. Sleep quality was evaluated using Pittsburgh Sleep Quality Index PSQI scoring tool. A global score of 5 or more indicates poor sleep quality. Binary logistic regression was applied and odds ratio with 95% confidence level were figured out to assess relationship of patients' profile with FD. Results: In a total of 240 patients, the mean age was 37.3±6.5 years. There were 122 (50.8%) male patients. The most common dyspeptic feature was postprandial fullness (60.4%) followed by early satiety epigastric pain (50%) and epigastric burning (39.6%). Mean PSQI score was 14.7±3.5. Frequency of poor sleep quality among FD patients was 79.2%. None of the parameter was significantly associated with sleep quality except urban residence (p=0.005). Conclusion: Very high burden of poor sleep quality was found among FD patients. While most dyspeptic symptoms did not show a significant association with sleep quality, urban residence emerged as a notable factor.

Multimorbidity of Allergic Diseases Is Associated With Functional Gastrointestinal Disorders in a Young Japanese Population.

Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people. A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

Abnormal functional connectivity of the reward circuit associated with early satiety in patients with postprandial distress syndrome

Postprandial distress syndrome (PDS) is the most common functional dyspepsia (FD) subtype. Early satiety is one of the cardinal symptoms of the PDS subtype in FD patients. The heterogeneity of symptoms in FD patients hampered therapy for patients based on specific symptoms, necessitating a symptom-based understanding of the pathophysiology of FD. To investigate the correlation between reward circuit and symptom severity of PDS patients, seed (Nucleus accumbens, NAc, a key node in the reward circuit) based resting-state functional connectivity (FC) was applied in the neuroimaging data analysis. The results demonstrated that the patients with PDS manifested strengthened FC between NAc and the caudate, putamen, pallidum, amygdala, hippocampus, thalamus, anterior cingulate cortex (ACC), and insula. Moreover, the FC between NAc and ACC, insula, thalamus, and hippocampus exhibited significant positive associations with symptom severity. More importantly, the strengthened FC between NAc and the ACC, insula, amygdala, and hippocampus were found associated with the early satiety symptom of patients with PDS. This study indicated that the altered FC of reward circuit regions may play a role in the pathophysiology of patients with PDS, and some of the aberrant NAc-based FC within the reward circuit were more related to the early satiety of patients with PDS. These findings improve our symptom-based understanding of the central pathophysiology of FD, lay the groundwork for an objective diagnosis of FD, and shed light on the precise prescription for treating FD based on symptoms.

The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

Abstract Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p&lt;0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p &lt;0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p &lt;0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p &lt;0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.

Associations among the Duodenal Ecosystem, Gut Microbiota, and Nutrient Intake in Functional Dyspepsia.

: Functional dyspepsia (FD) has long been regarded as a syndrome because its pathophysiology is multifactorial. However, recent reports have provided evidence that changes in the duodenal ecosystem may be the key. This study aimed to identify several gastrointestinal factors and biomarkers associated with FD, specifically changes in the duodenal ecosystem that may be key to understanding its pathophysiology. : In this case-control study, 28 participants (12 with FD and 16 healthy control individuals) were assessed for dietary nutrients, gastrointestinal symptom severity, immunological status of the duodenal mucosa, and microbiome composition from oral, duodenal, and fecal samples. Integrated data were analyzed using immunohistochemistry, real-time polymerase chain reaction, 16S rRNA sequencing, and network analysis. : Duodenal mucosal inflammation and impaired expression of tight junction proteins were confirmed in patients with FD. The relative abundance of duodenal Streptococcus (p=0.014) and reductions in stool Butyricicoccus (p=0.047) were confirmed. These changes in the gut microbiota were both correlated with symptom severity. Changes in dietary micronutrients, such as higher intake of valine, were associated with improved intestinal barrier function and microbiota. : This study emphasizes the relationships among dietary nutrition, oral and gut microbiota, symptoms of FD, impaired function of the duodenal barrier, and inflammation. Assessing low-grade inflammation or increased permeability in the duodenal mucosa, along with changes in the abundance of stool Butyricicoccus, is anticipated to serve as effective biomarkers for enhancing the objectivity of FD diagnosis and monitoring.

Evaluation of the physical activity in children with functional gastrointestinal disorders

Abstract. Functional gastrointestinal disorders have been known for centuries. However, this concept appeared quite recently, and is currently a common pediatric problem. Interest in functional pathology is fully justified and understandable: despite the fact that functional diseases of the gastrointestinal tract do not pose a direct threat to the patient’s life, they significantly reduce the quality of his life. The problem of functional disorders is also complicated by the fact that they affect all strata of society, regardless of age, socio-economic status, gender or race. The active process of studying the clinical and anamnestic features of various nosological forms, predictors of functional disorders, combined functional disorders and prevention approaches is also due to significant economic damage due to direct and indirect costs of their treatment. The prevalence of functional gastrointestinal disorders in the world reaches 40.3 %, and among children's gastro pathology they occupy one of the leading places. More than half of children of various age groups have at least one of the symptoms, which is a cause of concern for both the child and the parents, as well as entails a violation of the microclimate in the family. The peak prevalence of various symptoms of disorders of the gastrointestinal tract occurs at school age and adolescents, who almost fill the appointment of a pediatrician and a pediatric gastroenterologist. If we trace the evolution of ideas about functional disorders of the digestive organs, it can be noted that it changed many times and influenced the understanding of the pathogenesis and, especially, the etiology of this nasology. According to the Rome Consensus IV (2016), functional gastrointestinal disorders are defined as disorders of the interaction of the «gut-brain» axis, taking into account this concept, a lot of time has been devoted to studying the role of various factors: genetic predisposition, infection theory, nature of feeding at an early age, hormonal imbalance, psychological state, food preferences, lifestyle and physical activity. An important aspect of studying predictors of functional bowel disorders is the level of physical activity of children and adolescents. In the process of studying literary data, it was noted that the role of insufficient physical activity in the development of functional gastrointestinal disorders remains not fully determined. Most of the materials are related to the adult population and critically few among children. That complicates the study of forecasting and prevention of a more severe course of functional dyspepsia and irritable bowel syndrome, and, as a consequence, to optimize therapy. The aim of the study was to assess the level of physical activity in children with FGID. Materials and methods. 72 children aged 8–14 with FGIR were observed. I group of study included 26 patients with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the II group – 46 patients with FD. The control group included 22 healthy children. The diagnosis of FD and IBS were established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The PAQ-C questionnaire, developed by K. Kowalski, P. Kroker, and R. Donen, was used to assess PA in children. Research results. The total PA index in children with combined FD and SPC was 1,87 ± 0,07 and was lower compared to the group of children with FD (2,21 ± 0,05; p &lt; 0,05) and the control group (2,75 ± 0,05; p &lt; 0,01). The total PA index in children with FD is lower than in the control group (p &lt; 0,01). Conclusion. Insufficient physical activity can be considered a risk factor for the development of functional gastrointestinal disorders in children.

The influence of serotonin on the formation of clinical symptoms of functional gastrointestinal disorders in children

According to the Rome IV consensus (2016), functional gastrointestinal disorders (FGIDs) are disorders of the interaction between the gut and the brain. A crucial role in the realization of this mechanism is played by the key neurotransmitter serotonin. Aim - to investigate the influence of serotonin on the formation of clinical symptoms in children with FGIDs. Materials and methods. Under observation were 72 children aged 10-18 years with FGIDs. The Group I consisted of 30 children with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the Group II included 42 children with FD. A control group of 20 healthy children was established. The diagnosis of FD and IBS was established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The severity of clinical symptoms was assessed using the Likert scale from 0 to 5 points. The study of serotonin content in whole blood was conducted using a fluorometric method after adsorption on carboxymethylcellulose. Results. The intensity of abdominal pain and the severity of dyspeptic syndrome in children with combined FD and IBS is higher than in children with FD (p&lt;0.01; p&lt;0.05, respectively). The serotonin content in whole blood in children with FGIDs is lower than in healthy children (p&lt;0.001). In children with combined FD and IBS, the serotonin content is lower than in children with FD (p&lt;0.05). Reverse correlation links were found between serotonin content and the intensity of pain syndrome (r=-0.7), the severity of dyspeptic syndromes (r=-0.5), constipation (r=-0.7), and diarrhea (r=0.7). Conclusions. The obtained research results indicate the influence of serotonin on the formation of clinical symptoms in children with FD and combined FD and IBS. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

S1775 The Impact of Language in Utilization of Upper Endoscopy for Diagnosis of Functional Dyspepsia

S1775 The Impact of Language in Utilization of Upper Endoscopy for Diagnosis of Functional Dyspepsia

Nocebo response intensity and influencing factors in the randomized clinical trials of functional dyspepsia: A systematic review and meta-analysis.

In this study we aimed to evaluate the nocebo response rate in patients with functional dyspepsia (FD) and to explore its influencing factors. A literature search of the EMBASE, PubMed, and Cochrane Library databases was conducted for all articles published up to March 2021. Randomized, parallel-designed, placebo-controlled trials on pharmacological interventions for patients with FD were included. A meta-analysis that utilized random effects to analyze the incidence of adverse events (AEs) among participants who were given placebo was conducted, and the correlation between trial characteristics and the magnitude of the nocebo response rate was analyzed. Altogether, 27 studies including 1866 paitents were deemed eligible and included in the analysis. The total nocebo response rate was 26% (95% confidence interval [CI] 18%-33%). The most frequently reported AEs included nasopharyngitis (9%), constipation (6%), headache (5%), and diarrhea (3%). There were significant differences in nocebo response rates among studies conducted in different country or region, treatment duration, types of medication, sponsorship and different versions of theRome criteria used for FD diagnosis. While number of centers engaged in the study, types of FD diagnosis and dosing frequency were not significantly associated with the nocebo response rate. Patients with FD exhibit notable nocebo response strength in clinical trials. The researchers should adopt a more careful approach when analyzing the relationships between AEs and interventions in such trials.

Частота встречаемости функциональных заболеваний желудочно-кишечного тракта у школьников г. Красноярска, согласно Римским критериям IV

The prevalence of functional gastrointestinal diseases (FGDs) in adolescents of 11-18 years old in school (500 individuals) and in a specialized gastroenterology unit (141 individuals), identified by questioning the Russian-language version of the QPGS - RIV questionnaire (Questionnaire on Pediatric Gastrointestinal Symptoms, Rome IV Version) was analyzed. As a result, the prevalence of FGDs in school was as follows: functional dyspepsia (FD) - 5.3%, irritable bowel syndrome (IBS) - 0.6%, abdominal migraine (AM) - 1.0%, functional abdominal pain syndrome (FAPS) - 0.2%, functional constipation (FC) - 5.3%. In the study profile of recurrent abdominal pain (RAP) among children in hospital, FD was 73.6%, IBS - 22.6%, FAPS - 3.8%, 17% of children had both FD and IBS. Compared to the previous version, according to the new criteria, instead of IBS, the FD diagnosis prevailed (due to a decrease of the criterion for the prevalence of pain syndrome, as well as the inclusion of postprandial distress syndrome (PDS) for diagnosis), and the IBS incidence rate decreased threefold (due to the new limiting criteria). Keywords: adolescents, recurrent abdominal pain, functional gastrointestinal diseases, prevalence, ROME IV.

Effect of the nutrition violation on the of development of functional gastrointestinal disorders in school-age children

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children (FGID).&#x0D; Objective — to study the nutrition violations in children with FGID.&#x0D; Materials and methods. Observation involved 110 children with FGID aged 6 to 18 years. The patients were divided into two groups: I study group included 44 children with an overlap of functions dyspepsia (FD) and irritable bowel syndrome (IBS). The II study group consisted of 66 pediatric patients with FD. The control group consisted of 30 healthy children. The diagnosis of functional dyspepsia and IBS was established based on the clinical symptoms according to the Rome IV criteria (2016). To detect violations in the nutritional regimen and food preferences of schoolchildren, a questionnaire survey was performed with the use of the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children’s nutrition in Ukraine.&#x0D; Results. The frequency of violations in the nutritional regimen, such as refusal of breakfast or a full lunch at school, reducing the daily frequency of meals, was higher in children with FGID than in healthy children. The violations of nutrition in children with overlapping FD and IBS was observed more often than in children with FD. The frequency of consumption of vegetables, cereals and grains was lower in children with FGID, and the consumption of meat, sausages and confectionery, fast food, chips, nuts and seeds, energetics and sweet carbonated beverages was higher than in healthy children. In children with overlapping FD and IBS, the frequency of consumption of vegetables, cereals and grains is lower, and the consumption of confectionery, fast food, energetics, and sweet carbonated drinks was higher than in children with FD.&#x0D; Conclusions. Violations of the regimen and quality of nutrition is a risk factor for the formation of FGIR in children and should be considered in the treatment.&#x0D;

Функціональна диспепсія в дітей (огляд літератури)

Functional digestive disorders account for a significant proportion of gastrointestinal diseases in children. In recent years, we have seen the growth of functional dyspepsia in children, which is an urgent problem for both children's gastroenterologists and pediatricians. Purpose - to conduct a systematic review of the literature on etiopathogenesis, clinical manifestations, laboratory and instrumental studies, as well as methods of treatment and prevention of functional dyspepsia in children. The scientific literature is analyzed and the data on the complex etiopathogenesis of functional dyspepsia, the multifaceted pathogenetic links, the role of psychoneurological factors are presented. The modern classification of functional dyspepsia in children is given. It should be noted that, despite the widespread prevalence of this pathology, doctors sometimes face significant difficulties at the stage of diagnosis. «Symptoms of anxiety», in the presence of which the diagnosis of functional dyspepsia becomes impossible. According to domestic and international studies, the treatment of functional dyspepsia should be comprehensive, include dietary recommendations, recommendations on regime and lifestyle, and drug therapy. No conflict of interests was declared by the authors.

Maastricht VI/Florence Consensus for the treatment of Helicobacter pylori infection: updated recommendations for cancer prevention opportunities

For many decades, one of the most relevant issues remains the effectiveness of treatment of diseases associated with Helicobacter pylori (H. pylori) infection, the main goal of which is the prevention of gastric cancer (GC). The basic principles of diagnosis and treatment of helicobacter infection from the standpoint of evidence‑based medicine formulated in the Maastricht Consensus series. The data is constantly updated and refined by experts based on dynamic research. The new Maastricht VI/Florence Consensus clarified a number of provisions that were previously under discussion. One of the main provisions is that infection with H. pylori always causes gastritis regardless of symptoms or complications. Helicobacter gastritis must be excluded before establishing a clinical diagnosis of functional dyspepsia. About 90% of stomach cancer cases are associated with H. pylori. It is the the main etiological factor of gastric adenocarcinoma, including proximal gastric cancer. Eradication of H. pylori provides an opportunity for cancer prevention at any age in adults, but its effectiveness decreases with age. Therefore, carrying out the timely and effective eradication allows preventing negative consequences in H. pylori — infected patients. In the modern algorithm of eradication therapy in accordance with the Maastricht VI/Florence consensus, preference has been given to quadruple therapy with the use of bismuth drugs. The value of triple therapy with clarithromycin has decreased. There is a rapid increase in the resistance of H. pylori to fluoroquinolones. Bismuth‑containing quadruple therapy with amoxicillin and tetracycline and triple therapy with rifabutin are among the final eradication protocols. Research is underway on new candidate molecules for inclusion in antihelicobacter therapy regimens. Further research will need to optimize new opportunities to improve eradication efficiency, particularly in non‑Asian populations. We hope that the publication of this important international consensus document will allow practicing doctors to use the knowledge of modern gastroenterology and increase the percentage of effective cancer prevention in Ukraine.&#x0D;

Duodenal Eosinophilia in Functional Dyspepsia

Aim: to present observation of a patient diagnosed with functional dyspepsia based on current guidelines, and having increased eosinophil counts in the biopsy specimen of duodenal mucosa. To consider possible causes of duodenal eosinophilia in the light of present-day concepts.Highlights. Patient K., 40 years old, complained of dyspeptic phenomena, the first appearance of which she had noted at the age of 18. The patient noted poor tolerance to canned and fermented foods, which provoked an increase in dyspepsia and sometimes caused watery diarrhea. The examination excluded “symptoms of concern”. Successful antihelicobacter eradication therapy was carried out. Morphological examination of the stomach showed phenomena of mild chronic inflammation without intestinal metaplasia or glandular atrophy. A biopsy of the mucosa of the descending part of the duodenum showed a moderate increase in the levels of mononuclears and eosinophils in its lamina propria without penetration into the epithelium of the villi or formation of clusters. The patient suffers from pollinosis; sensitization to birch pollen was diagnosed by a skin prick test. However, she has no oral allergy symptoms, which does not allow linking duodenal eosinophilia to food allergy. Based on current guidelines, the patient was diagnosed with functional dyspepsia. In addition to dietary restrictions, treatment courses with a proton pump inhibitor, itopride, and S-methylmethionine sulfonium chloride, which has an antihistamine effect, were recommended for periods of worsening dyspepsia.Conclusion. The clinical significance of duodenal eosinophilia and local histamine production in patients with a clinical diagnosis of functional dyspepsia deserves special attention. Triggering factors provoking the worsening of symptoms should be analyzed; in particular, a food diary and exclusion of food allergies are recommended. Histamine-neutralizing drugs may play a role in the treatment of FD with duodenal eosinophilia in the future.

Оцінка якості життя в дітей із поєднанням функціональної диспепсії та синдрому подразненого кишечника

The prevalence of functional gastrointestinal disorders (FGID) in children ranges from 19% to 40%, depending on age. The combination of functional dyspepsia (FD) and irritable bowel syndrome (IBS) is detected in 15-44.6% of patients with FGID. Their course is characterized by more pronounced clinical symptoms: abdominal pain, which is combined with flatulence, nausea, difficulty in defecation or diarrhea, impaired stool consistency, feeling of incomplete bowel movement and deterioration in quality of life. Purpose - to assess the quality of life in children with a combination of FD and IBS to optimize therapy. Materials and methods. The study included 44 children with a combination FD and IBS aged 6 to 18 years (the main group). The control group consisted of 30 practically healthy children of the same age. Diagnoses of FD and IBS were made on the basis of clinical symptoms according to the Rome criteria IV (2016). A survey of children and their parents was conducted using the international questionnaire PedsQL™ 4.0 (Pediatrics Quality of Life Inventory), which is one of the most popular questionnaires in the world, has proven to be a simple, reliable, sensitive method for studying the quality of life of healthy and sick children of different ages (2-17 years). The questionnaire has general scales, but there is a separate version of the PedsQL™4.0 Generic Core Scales, which describes physical, emotional, social, and role functioning. Results. It was established that indicators of physical, emotional, social and school functioning and, as a result, indicators of psychosocial functioning and the overall quality of life assessment are significantly reduced in children with combined FD and IBS compared to the control group. Conclusions. Quality of life studies are an important component of a comprehensive assessment of the overall condition of a child with comorbid FD and IBS to prevent the development of these disorders, to improve quality of life, to reduce the time and cost of assessment, and to optimize therapy. The research was carried out in accordance with the principles of the Declaration of Helsinki. The Local Ethic Committee of the institution specified in the work adopted the study protocol. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Updated the Maastricht VI/Florence Consensus recommendations for the treatment of &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection: A review

The new Maastricht VI/Florence Consensus clarifies a number of provisions that were previously under discussion. It has been postulated that Helicobacter pylori infection always causes gastritis, regardless of symptoms or complications. Before making a convincing diagnosis of functional dyspepsia, it is necessary to exclude Helicobacters gastritis. Some provisions of the consensus, such as the test and treat tactic, require elements of a critical attitude, taking into account Russian regional conditions. About 90% of stomach cancers are due to H. pylori. Eradication of H. pylori makes it possible to prevent gastric cancer at any age in adulthood, but the effectiveness of such cancer prevention decreases with age. Bismuth quadruple therapy is preferred in the eradication therapy algorithm. Decreased value of triple treatment with clarithromycin. There is a rapid increase in H. pylori resistance to fluoroquinolones. Triple therapy with rifabutin is called the final eradication protocol.

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study