Dyspeptic Symptoms Research Articles

Dysbiosis of the Upper Gastrointestinal Tract in Head-and-Neck Cancer Survivors: A Pilot Study Using the Capsule Sponge Device

Background: A non-endoscopic capsule-sponge device allows sampling the entire length of the esophagus. Here, we compared microbiomes of the oral cavity, esophagus, and gastric corpus collected by oral swab, capsule-sponge device, and endoscopic biopsy, respectively, in patients representing three distinct risk profiles for esophageal squamous cell carcinoma (ESCC). Methods: The study enrolled 11 patients with esophageal squamous intraepithelial neoplasia, 21 patients after curative treatment for head and neck squamous cell cancer (HNSCC) (HNSCC survivors), and 40 patients with functional dyspeptic (FD) symptoms. Microbial genomic DNA was analyzed using 16S rRNA gene amplicon sequencing. Results: The Shannon index of the capsule-sponge sample microbiota was significantly higher in FD group than in patients after treatment for HNSCC, and the Chao index of gastric samples differed between HNSCC survivors and FD patients. Analysis of the β-diversity of FD patients, HNSCC, and esophageal squamous intraepithelial neoplasia showed that different genera formed at each location. The abundance of 205, 116, and 9 genera differed between FD patients and HNSCC survivors in the gastric, capsule-sponge, and oral samples, respectively; 33 genera differed between the FD group and patients with esophageal squamous intraepithelial neoplasia in capsule-sponge samples. Conclusions: The bacterial communities of the upper digestive tract were clustered according to the anatomic site. Despite substantial differences in gastric and esophageal microbiota samples between FD patients and HNSCC survivors, the microbial members and diversity showed small differences between FD patients and those with esophageal squamous intraepithelial neoplasia. It remains unclear whether gastric and esophageal dysbiosis is associated with or is a consequence of treatment for HNSCC.

A comparative study between current and past Helicobacter pylori infection in terms of microalbuminuria in patients with type 2 diabetes

BackgroundThe prevalence of Helicobacter pylori (H. pylori) infection and its potential relationship to various diseases is currently a focus of attention. The aim of this study is to investigate the association between current and past H. pylori infections and elevated levels of microalbuminuria in type 2 diabetic patients.MethodsTwo hundred patients with type 2 diabetes mellitus were tested for the presence of H. pylori infection. They were divided into three groups: 52 had a current H. pylori infection, 38 had a past H. pylori infection, and 110 had no H. pylori infection. All study participants underwent assessments of plasma glucose levels, glycated hemoglobin (HbA1c), albuminuria levels, inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as other relevant investigations.ResultsThe prevalence of H. pylori infection (current and past) was detected in 90 out of 200 diabetic patients (45%). There was no statistically significant difference between the three groups in terms of age, diabetes duration, family history of DM, family history of hypertension, residence, or dyspeptic symptoms, indicating that current or past infection with H. pylori has no association with these variables. The current H. pylori infection group showed the highest levels of inflammatory markers, ESR and CRP, which were significantly different from those in the non-infected group (p = 0.013 and p < 0.001, respectively). The median (IQR) of albuminuria levels in the current H. pylori infection group, the past H. pylori infection group, and the non-infected group were 125 (4.8–290), 7.6 (2.4–271), and 5.1 (1.2–173), respectively. The current H. pylori infection group showed the highest albuminuria level, which was significantly different from that of the non-infected group (p = 0.001).ConclusionThere might be an association between microalbuminuria levels, general inflammatory markers (ESR and CRP), and current H. pylori infection in type 2 diabetic patients.

Transabdominal Ultrasound of the Stomach in Patients with Functional Dyspepsia: A Review.

Background/Aim: Dyspepsia is a very common condition worldwide and has an immense impact on quality of life. Functional dyspepsia (FD) is defined by dyspeptic symptoms with the absence of any structural abnormality that can explain the cause. Ultrasonography (US) is a non-invasive imaging modality that can be applied to assess gastric function. The aim of this review paper is to assess how ultrasonography can sort out patients with dyspepsia and help diagnose functional dyspepsia. Methods: Using the keywords "functional dyspepsia" and "ultrasonography", the PubMed database was screened for publications on the use of ultrasonography to identify functional dyspepsia. Afterward, two screening processes were performed to narrow the articles down to a rational number. Results: A total of 169 articles were obtained from the literature search, and 31 of these were included after the screening process. Ultrasonography was capable of identifying functional dyspepsia pathophysiology using both two-dimensional (2D) and three-dimensional (3D) ultrasound. Conclusions: We conclude that ultrasonography is a non-invasive, safe, low-cost, and widely accessible method that can help diagnose functional dyspepsia through the exclusion of organic dyspepsia and assessing FD pathophysiology. Incorporation of ultrasound in the work-up of patients with functional dyspepsia allows for a sound diagnostic approach and can further improve patient management.

The Efficacy of a Traditional Herbal Medicine Compound for Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: Herbal medicines have recently been incorporated into the treatment algorithm for functional dyspepsia (FD). Persian-FACT, a traditional herbal medicine compound, has been used for centuries in Persian medicine to alleviate dyspeptic symptoms. This compound includes anise, fennel, ajwain, and cumin seeds. Objectives: To investigate the efficacy of Persian-FACT as a therapeutic agent for FD. Methods: We conducted an add-on, single-center, double-arm, parallel-group, double-blind, randomized controlled clinical trial at the Imam-Reza Clinic, affiliated with Shiraz University of Medical Sciences in Shiraz, Iran, in 2022. Adults aged 18 to 65 years with a confirmed diagnosis of FD, as referred by a gastroenterologist, were included in the study. After block randomization, participants received sachets containing either Persian-FACT or a placebo (oat) to be taken twice daily for two weeks. The severity of dyspepsia, postprandial distress syndrome (PDS), and epigastric pain syndrome (EPS) (PPI) was assessed using the Gastrointestinal Symptom Rating Scale and the Rome IV questionnaire every week. Results: Thirty-two patients in the Persian-FACT group and twenty-three in the placebo group completed all visits. According to the results of the GEE analysis, the severity of dyspepsia symptoms in the Persian-FACT group was significantly lower than in the placebo group after the intervention (P-value = 0.019). Patients with EPS showed significant improvement from the first week, and those with PDS showed significant improvement after two weeks in the Persian-FACT group compared to the placebo group (P-value = 0.001 vs. P-value = 0.028). Additionally, constipation, gastroesophageal reflux, postprandial fullness, and bloating were significantly reduced with Persian-FACT. Conclusions: Persian-FACT appears to be effective in improving dyspepsia symptoms.

Prevalence of Trehalase Enzymopathy Genetic Determinants in Siberian and Russian Far East Populations.

. Using the Infinium iSelect HD Custom BeadChip biochip (Illumina, United States) on the iScan platform and real-time polymerase chain reaction on a Bio-Rad CFX96 Touch amplifier, genotyping of 1068 DNA samples was carried out, of which 667 represent 10 ethnic groups of the indigenous people of the North of Siberia and the Far East of the Russian Federation. Two reference groups (357 samples) of Russians (n=311) and Yakuts (n = 46) represent the "Caucasoid" and "Mongoloid" poles of the Russian population. : The reduced trehalase activity that the heterozygous GA*TREH genotype determines can manifest itself in 19.8-53.7% of indigenous northerners. An additional 1.0 to 19.7% of the population are carriers of the AA*TREH genotype, which is associated with apparent trehalose malabsorption. The carriers may experience nausea, abdominal pain, and other dyspeptic symptoms after eating trehalose containing foods. The total risk of trehalase enzymopathy among the indigenous northerners in the Asian part of the Russian Federation is very high and can reach 60-70%. There is a gradient in the A*TREH allele frequencies in the small-numbered indigenous northern groups of Russia from the west (Khanty, Mansi, Nenets) to the east (peoples of the Far East). : The results are consistent with previously reported data on the higher carriage of the A*TREH mutant allele in Mongoloid populations compared to Caucasoid groups. It was hypothesized that, while the initial A*TREH allele prevalence in Mongoloid groups was moderately high, an adaptation to a low-sugar protein-lipid "high-latitude" diet led to a weaker control over the maintenance of the carriage of the ancestral G* allele. Trehalose malabsorption requires special attention of specialists in the field of nutrition, gastroenterology, public health, and medical genetics working in high-latitude regions.

435. PREVALENCE OF OESOPHAGEAL PREMALIGNANT LESIONS AMONG PATIENTS REFERRED FOR GASTRO-OESOPHAGEAL-DUODENOSCOPY AT A TERTIARY CARE HOSPITAL IN NORTHERN, SRI LANKA

Abstract Background Oesophageal cancer is the second leading cause of cancer-related mortality in Sri Lanka, where a higher prevalence is found among Tamil-speaking Sri Lankans. Endoscopic screening with Lugol’s chromo endoscopy in high-incidence populations reduces mortality from oesophageal cancer. The objective of this study is to determine the prevalence of premalignant oesophageal lesions - squamous dysplasia and Barrett’s oesophagus and the associated risk factors among Tamil patients undergoing oesophageal-gastro-duodenoscopy (OGD). Methods Consecutive patients undergoing OGD for dyspeptic and gastric acid reflux symptoms were recruited. An interviewer-administered questionnaire was used for data collection. During OGD, the oesophagus was examined under white light imaging, narrow band imaging (NBI), and Lugol’s iodine chromo endoscopy. Biopsies were taken from abnormal mucosa and sent for pathological diagnosis. Statistical software SPSS (V25) was used to analyse the data. Results The study incorporates 410 participants. The majority (61.7%) were females and the median age was 57 (Interquartile range 21) years. On Endoscopy under white light and NBI 11.0%(n=45) had squamous neoplasia. Of them, 16.0% had Low grade dysplasia (LGD), 2.0% had invasive carcinoma and the remaining 82.0% had inflammatory or reactive changes. Endoscopic Barrett’s oesophagus (BO) was found in 17.0% (n=69) and 5.0% (n=19) had both endoscopic and histological confirmation of BO. Of them, 21.0% had LGD. In regression analysis, male gender was at higher risk for BO (OR- 1.251, 95%CI 0.420 – 3.730). Overall, 3.0% of the participants had premalignant lesions. Conclusions The prevalence of premalignant lesions in a symptomatic population was only 3.0%. Further studies with a larger number of targeted population is needed to assess the exact prevalence.

РАСПРОСТРАНЕННОСТЬ И КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ВОДОРОДНО –МЕТАНОВОГО ВАРИАНТА ТЕЧЕНИЯ СИНДРОМА ИЗБЫТОЧНОГО БАКТЕРИАЛЬНОГО РОСТА У ДЕТЕЙ С ФУНКЦИОНАЛЬНОЙ ДИСПЕПСИЕЙ

Prevalence of small intestinal bacterial overgrowth (SIBO) syndrome, improved diagnostic accuracy and therapeutic approaches require further study. The purpose of this research was to evaluate the effect of hydrogen dominant or hydrogen-producing SIBO (H-SIBO) and methane dominant or methane-producing SIBO (M-SIBO) types on the severity of clinical manifestations in children with functional dyspepsia (FD). Materials and methods used: a single-center cross-sectional study of 90 pediatric patients: 41 (45.6%) aged 11.0 [9.0:13.0] y/o with FD, of which 20 (48.8%) girls/21 (51.2%) boys, and 49 (54.4%) evaluatively healthy children (“control group”) aged 12.0 [9.5:13.6] y/o, of whom 27 (55.1%) girls/22 (44.9%) boys. The SIBO was determined with the domestically-produced “Lactophan” hydrogen breathing test by AMA Co., Ltd. (Saint Petersburg, Russia) and the “GastroCH4ECK Gastrolyzer” CH4 &amp; H2 monitor by Bedfont Scientific Ltd. (Harrietsham, Maidstone, Kent, England, UK). Results: SIBO (41/100% and 28/57.1%, p&lt;0.001) and H-SIBO (29/70.7% and 18/36.7%, p=0.045) were statistically significantly more often detected in children with FD than in the control group. The M-SIBO incidence (12/29.3% and 10/20.4%, p=0.467) did not differ statistically significantly between the groups. The methane output at the 60th to 90th minutes of the breathing test was 1.7 to 1.8 times higher in FD patients. The hydrogen threshold values at the 60th minute of the breathing test in FD patients for predicting of complaints were as follows: above 35 ppm (ROC-AUC=0.88, 95% CI=0.61-1.00, SE 87.5%, SP 97.2%) for “Sour taste in the mouth,” and above 33 ppm (ROC-AUC=0.80, 95% CI=0.53-1.00, SE 80.6%, SP 75.0%) for “Diarrhea.” The hydrogen threshold value at the 90th minute of the breathing test for “Flatulence” symptom was 44 ppm (ROC-AUC=0.71, 95% CI=0.36-0.88, SE 60.9%, SP 75.0%). Conclusion: testing for methane had increased the accuracy of SIBO diagnosis by 29.3% in patients with FD, i.e. from 70.7% to 100%! The relationship between the hydrogen and the methane concentrations coupled with the presence of dyspeptic symptoms may require the correction of SIBO in patients with FD.

A child is worried about heartburn: modern views on the problem and possibilities of non-pharmacological support

Background. The relevance is associated with a significant spread of dyspeptic symptoms in children. On average, every third-fourth child with such symptoms complains of heartburn, which is a frequent reason for consulting a doctor. For the pediatric category of patients, not only the timely diagnosis and effective treatment of pathological conditions associated with heartburn are important, but also the awareness of the parents of our patients and the children themselves about the possibilities of providing ade­quate first aid, safe and effective use of effective non-medicinal means. The purpose: to study the clinical effectiveness of using the special drink ISOTA for the first aid and preliminary treatment of children with heartburn in non-erosive reflux disease, functional dyspepsia and a combination of these conditions (overlap of non-erosive gastroesophageal reflux disease and functional dyspepsia). Materials and methods. Design: a single-center, open-label, pilot clinical trial. Fifty-four children aged 7–18 years with heartburn and other dyspeptic complaints were under observation. The study included 2 stages. The diagnosis was verified by means of surveys (GERDQ and QOLRAD questionnaires) and the use of fibrogastroscopy, endoscopic pH-metry. The results were recorded in the developed individual patient card and statistically processed. Results. Results of the study presented in the corresponding section testify to the high effectiveness of using ISOTA to eliminate heartburn and reduce other dyspeptic symptoms, as well as to a reliable improvement in the psychoemotional state, general well-being and quality of life of patients. Conclusions. The obtained results make it possible to recommend a slightly carbonated hydrocarbonate-containing special drink developed in Ukraine for a long-term use in a treatment course or as needed, and prophylactically to prevent heartburn and other dyspeptic symptoms in children, taking into account the high profile of effectiveness, safety and good tolerabi­lity.

Factors Predicting Effectiveness of Eradication Therapy for Helicobacter pylori-Associated Dyspepsia Symptoms.

Functional dyspepsia is distinguishable from Helicobacter pylori-associated dyspepsia. However, distinguishing H. pylori-associated dyspepsia from functional dyspepsia before H. pylori eradication is difficult. Therefore, in the present study, we aimed to investigate whether serum pepsinogen levels before H. pylori eradication are associated with the amelioration of dyspepsia after successful H. pylori eradication. Additionally, we examined the usefulness of serum pepsinogen levels and other factors in predicting dyspepsia outcomes. H. pylori eradication was effective in 14 patients (Responders) and ineffective in 19 patients (Non-responders). The pepsinogen I/II ratio in Responders (3.4 ± 1.2) and Non-responders (2.3 ± 1.0) differed significantly (p = 0.006). The optimal cut-off pepsinogen I/II value was 2.3. Multivariate logistic regression analysis showed that the adjusted odds ratio for Non-responders was 26.1 (95% confidence interval: 2.0-338.0, p = 0.012) for a pepsinogen I/II ratio ≤ 2.3 and 8.10 (95% confidence interval: 1.1-57.6, p = 0.037) for smoking habits. The pepsinogen I/II ratio and smoking habits were associated with the effects of H. pylori eradication on dyspeptic symptoms. Thus, the pepsinogen I/II ratio cut-off value can be used to identify patients likely to respond to H. pylori eradication after the resolution of dyspeptic symptoms.

Antimicrobial resistance pattern of Helicobacter pylori in patients evaluated for dyspeptic symptoms in North-Eastern India with focus on detection of clarithromycin resistance conferring point mutations A2143G and A2142G within bacterial 23S rRNA gene

PurposeIn India there is evidence of antimicrobial resistance in Helicobacter pylori, a definitive pathobiont whose only known niche is human gastric mucosa. This in turn can lead to failure of treatment, persistence or chronicity of infection. This hospital based, prospective, observational study investigates the presence of antimicrobial resistance in the organism with focus on detection of A2143G and A2142G major point mutations in domain V of H. pylori 23S rRNA gene as a molecular mechanism of conferring resistance. MethodsEndoscopic gastric biopsy samples from 52 patients presenting with dyspeptic symptoms from January 2016 to December 2016 were subjected to culture in a microaerophilic environment using Campylobacter agar with for 2–5 days. Isolates were identified using gram-staining, motility test and biochemical reactions. Modified Kirby-Bauer Disc diffusion method was used to determine antimicrobial susceptibility against Clarithromycin, Metronidazole, Amoxycillin, Levofloxacin, Tetracycline, Cotrimoxazole and Erythromycin. Additionally, detection of A2143G and A2142G point mutations conferring Clarithromycin resistance was carried out using real time PCR following extraction and quantification of bacterial DNA. Histopathological examination was carried out on all biopsy samples. Descriptive and inferential statistical analytical methods were used. Differences were considered significant for p < 0.05. ResultsCulture positivity for H. pylori by phenotypic method was found to be 36.54%. Histopathologic Examination detected H. pylori in 55.7% and PCR detected 48.08% for either the wild type or one of two mutant strains A2143G and A2142G. No sample was found positive for both mutations. Metronidazole showed the highest resistance among antibiotics (78.9%) followed by Clarithromycin (47.3%). ConclusionPrevalence of antimicrobial resistance in H. pylori in North-Eastern India is substantially high with A2143G mutation being clinically most important in conferring Clarithromycin resistance. This resistance might be associated with low eradication rates despite initiation of therapy. ROC analysis of PCR proved it to be a good diagnostic tool.

Analysis of Clinical Features and Treatment of Patients Presenting Dyspepsia Related to COVID-19: Retrospective Chart Review

Objectives: The main purpose of this study is to investigate the clinical characteristics of patients complaining of indigestion after COVID-19 infection (CI) or COVID-19 vaccination (CV) and to confirm the effectiveness and safety of Korean medical treatment.Methods: We retrospectively collected and investigated the medical records of 39 patients admitted to the Kyung Hee University Korean Medicine Hospital with a chief complaint of dyspepsia from January 1, 2020 to February 29, 2024 who reported the onset or significant exacerbation of dyspepsia after CV or CI. Patients were divided into vaccination and infection groups, and their demographic characteristics, Ryodoraku results, presenting symptoms, traditional Korean medicine treatments, and treatment outcomes were analyzed.Results: When comparing the groups with dyspepsia after CV and after CI, it was observed that the CI group had significantly lower average body weight, and the measurements of LH6, LF1, and LF6 in the Ryodoraku test were significantly lower. Additionally, compared to the CV group, the CI group showed significantly more abdominal distension, nausea, and abdominal pain. Significant relief of upper gastrointestinal symptoms was observed in both the CV and CI groups after treatment. No adverse reactions were observed during the course of treatment.Conclusion: The CI group tended to complain more severely of various dyspeptic symptoms and had a tendency to lower body weight than the CV group, as was also reflected in the results of the Ryodoraku test. Korean medical treatment can be effective and safe in treating these patients.

Biopsy-Proven Gastric Pathological Findings in Mechanically Ventilated Intensive Care Unit Patients.

Objectives Helicobacter pylori (H. pylori) is known to affect a large proportion of the world population. It plays a role in the pathogenesis of peptic ulcer (PU) and increases the likelihood of bleeding. In critically ill patients in intensive care units (ICUs), the risk of bleeding may be much higher due to many concomitant factors. The study aimed to determine the activation of H. pylori in mechanically ventilated (MV) intensive care patients and compare this with the general population. Methods This study was performed retrospectively by screening patients who underwent esophagogastroduodenoscopy and histopathological sampling in our hospital between January and June 2023. The study included 79 patients aged between 18 and 85 years. The patients were categorized into two groups: 35 patients in the ICU with mechanical ventilation (MV) support (EMV) and 44 patients who presented to the gastroenterology department due to dyspeptic symptoms and underwent endoscopy (ED). Age; sex characteristics; laboratory parameters such as hemoglobin (Hb), hematocrit (Htc), mean cellular volume (MCV), white blood cell (WBC), neutrophil, platelet, glucose, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), C-reactive protein (CRP), albumin, ferritin, thyroid-stimulating hormone (TSH), anti-hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti-HIV; and biopsy results (H. pylori positivity, intestinal metaplasia, and atrophy) were recorded. Results A total of 79 patients who underwent gastric biopsy were assessed. There were 35 patients in the EMV group and 44 patients in the ED group. There was no difference in gender and age distribution between the groups. Hb and Htc were significantly lower in EMV compared to ED (p=0.001). Hb was 9.4±1.7 g/dL in EMV and 10.8±2.1 g/dL in ED. Htc was 29.6±5.1 in EMV and 33.5±5.7 in ED. MCV, WBC, glucose, urea, AST, ALT, CRP, and ferritin values were statistically significantly higher in EMV (p<0.05). Albumin and creatinine levels were statistically significantly lower in EMV (p<0.05). There was no significant difference between the groups in terms of neutrophils, platelets, and TSH. In the EMV group, H. pylori activity was negative in 31 (88.6%) patients and positive in four (11.4%) patients. In the ED group, H. pylori activity was negative in 30 (68.2%) patients and positive in 14 (31.8%) patients. There was a statistically significant difference between the groups in terms of H. pylori positivity (p=0.032). Conclusions The prevalence of H. pylori in MV patients in the ICU is low compared to the average population. The incidence of atrophic gastritis and intestinal metaplasia is the same. The present study supports that ICU cases do not have a higher risk of gastric premalignant lesions compared to the average population.

Extensive scintigraphic gastric motor function testing with concurrent symptom recording predicts prospectively measured daily dyspeptic symptoms.

Absent "organic" disease, dyspeptic symptoms may arise from abnormal gastric sensation, accommodation, motility or emptying (GE). Extensive gastric sensorimotor evaluation is rarely undertaken because testing is prolonged, invasive, poorly tolerated or unavailable. To investigate whether gastric antral motor function, evaluated with scintigraphy, predicts GE. To explore whether motor testing with symptom recording predicts day-to-day symptoms in patients with dyspepsia. GE was determined using a scintigraphic solid-meal protocol (296 kcal, 35% fat). Antral motility was estimated from 10 min of scintigraphic time-activity curves acquired 40 min after meal consumption. An antral motility index (MI) was derived from contraction amplitude and frequency. Intra-gastric distribution of the meal on scintograms at 1 h (IGD1) was determined. Meal-induced symptoms were evaluated by questionnaire. Patients completed the Gastroparesis Cardinal Symptom Index Daily Diary (GCSI-DD) for 14 days. Twelve healthy participants and 23 prospectively recruited patients completed the study. Nine patients had delayed, and 2 had rapid, GE. In univariate analysis MI explained 42% of GE half-time. In multivariate analysis MI and GE half-time explained 25% of the variance in meal-induced symptoms. While scintigraphic evaluation of gastric motor function with symptom recording explained 80% of the variance in the GCSI-DD, meal-induced symptoms were the only significant predictor. However, among patients with delayed GE, MI, GE half-time, IGD1, and meal-induced symptoms all significantly predicted GCSI-DD. Antral motility predicts GE. In exploratory analyses, only meal-induced symptoms predicted daily symptoms among patients with dyspepsia. However, motor function also predicted symptoms in patients with delayed GE.

Clinical study on microscopic syndrome differentiation and traditional Chinese medicine treatment for liver stomach disharmony in chronic gastritis.

Chronic gastritis (CG) is a common gastrointestinal disorder characterized by inflammation of the stomach lining. Liver-stomach disharmony (LSD) syndrome is believed to contribute to CG symptoms. To evaluate the efficacy and safety of microcosmic syndrome differentiation and Chinese herbal medicine (CHM) treatment in patients with CG and LSD syndrome. Sixty-four patients with CG and LSD syndrome were randomly divided into two groups: The treatment group received CHM based on microcosmic syndrome differentiation and the control group received conventional Western medicine. The treatment course lasted 12 wk. The primary outcome was improvement in dyspeptic symptoms, measured using the Nepean Dyspepsia Index. The secondary outcomes included the improvement rate of endoscopic findings, histopathological findings, and microcosmic syndrome scores and the incidence of adverse events. After 12 wk of treatment, the treatment group showed significantly greater improvement in dyspeptic symptoms than the control group (93.75% vs 65.63%, P < 0.01). The treatment group also showed a significantly higher improvement rate in endoscopic findings than the control group (81.25% vs 53.13%, P < 0.05). The improvement rates of histopathological findings and microcosmic syndrome scores were not significantly different between the two groups (P > 0.05). No serious adverse events were observed in either group. Microcosmic syndrome differentiation and CHM treatment can effectively improve dyspeptic symptoms and endoscopic findings in patients with CG and LSD syndrome and have a good safety profile. Further studies with larger sample sizes and longer follow-up periods are required to confirm the long-term efficacy and mechanism of action of this treatment.

The relationship between peritoneal membrane permeability and dyspepsia in peritoneal dialysis patients.

The aim of this study is to determine whether there is a relationship between peritoneal membrane permeability and dyspepsia in peritoneal dialysis patients. This study included 95 peritoneal dialysis patients aged 18 and older. The presence of dyspepsia in patients was recorded according to the 2016 ROME-IV Functional Dyspepsia Diagnostic Criteria. Subsequently, the Glasgow Dyspepsia Severity Score questionnaire was administered to assess the severity of dyspepsia. Endoscopy was performed for those who agreed to exclude organic pathology, or the results of endoscopy conducted within the last 2years were recorded. Furthermore, stool samples were examined for H. pylori to exclude organic causes of dyspepsia. PET (peritoneal equilibration test) and Kt/V values of patients were calculated using the "PD Adequest" computer software. PET values were categorized as low and low-normal for low permeability and high and high-normal for high permeability. Dyspepsia was detected in 51.6% of all peritoneal dialysis patients. H. pylori was found positive in 11.6% of all patients and 12.2% of those with dyspeptic symptoms. There was no significant difference in the rate of H. pylori occurrence between low and high permeability groups. The Glasgow Dyspepsia Severity Score did not differ significantly between H. pylori-positive and -negative patients. Dyspepsia was more frequent and severe in the low permeability group. Dyspepsia in the low permeability group was mostly considered as functional dyspepsia due to the predominance of normal endoscopic findings. Dyspepsia is a common health problem in approximately half of peritoneal dialysis patients. Dyspepsia observed in those with low peritoneal membrane permeability is generally of functional origin. Furthermore, the frequency and severity of dyspepsia are higher in individuals with low permeability. When planning peritoneal dialysis for these patients, the current status should be taken into consideration, and patients should be informed about necessary precautions and recommendations.

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.

Efficacy of Tegoprazan in Patients With Functional Dyspepsia: A Prospective, Multicenter, Single-arm Study.

Acid-suppressive drugs, such as proton pump inhibitors (PPIs), are treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid blockers (P-CABs) in treating FD has not yet been established. This prospective multicenter clinical trial-based study aimed to assess the efficacy and safety of tegoprazan as a P-CAB treatment in patients with FD. FD was diagnosed using the Rome IV criteria. All patients received tegoprazan 50 mg once daily for 8 weeks. Dyspeptic symptoms were assessed using a dyspepsia symptom questionnaire (5-point Likert scale, Nepean Dyspepsia Index-Korean [NDI-K], and gastroesophageal reflux disease-health-related quality of life [GERD-HRQL]). The main outcome was satisfactory symptom relief rates at 8 weeks. In this study, from the initial screening of 209 patients, 173 were included in the per-protocol set analysis. Satisfactory symptom relief rates at 8 and 4 weeks were 86.7% and 74.6%, respectively. In addition, the NDI-K and GERD-HRQL scores significantly improved at 8 and 4 weeks compared with the baseline scores. The efficacy of tegoprazan was not influenced by the FD subtype or Helicobacter pylori status. In patients with overlapping FD and GERD, there was a greater improvement in the NDI-K and GERD-HRQL scores than in patients with FD symptoms only. No serious drug-related adverse events occurred during this study. Tegoprazan (50 mg) administered once daily provided satisfactory symptom relief for FD.

Living tape worms in the duodenal lumen: A rare case report

Fascioliasis is an infection caused by a trematode of the liver, Fasciola hepatica, which affects sheep, goats and cattle. Humans become accidental hosts through drinking contaminated water or ingesting raw green vegetables that has been contaminated with encysted metacercariae, which is the infective form. Fascioliasis has a hepatic phase and a biliary phase, each displaying different clinical signs and symptoms. Common signs and symptoms of the hepatic phase are abdominal pain, fever, eosinophilia, and abnormal liver function tests. The biliary phase of the disease usually presents with intermittent right upper quadrant pain with or without cholangitis or cholestasis. However, it is very rare to find a living flukes in the common bile duct (CBD) and duodenal lumen as it usually lives in gall-bladder and smaller biliary tracts. Here we report a case of human infestation of Fasciola hepatica, who presented with respiratory tract infection with abdominal pain &amp; dyspeptic symptoms and eventually during evaluation, an upper gastro-intestinal endoscopy revealed several flat worms at the second part of the duodenum. The worms were sent to microbiology department for identification. The organisms were confirmed to be Fasciola hepatica. The patient was given tablet Nitazoxanide 500mg 12 hourly for 7 days. The symptoms reduced in intensity after two days of nitazoxanide. The patient was then discharged with an advice of a stool routine examination after one month of completion of nitazoxanide. As fasciolosis is non endemic in our country, a high degree of suspicion is required to ensure early detection and management of such cases. Patients with abdominal pain, altered liver function tests &amp; eosinophilia should always be evaluated for a suspected Fasciola hepatica infection and should be kept as a differential in these cases. Bangladesh Crit Care J March 2024; 12 (1): 54-57

Gastric Microbiota in Patients with Dyspepsia: Metatranscriptomic Analysis

Aim: to assess the composition of the microbiota of the mucous membrane of the body and the antrum of the stomach.Materials and methods. Sixty patients with dyspeptic symptoms were included into the study. Two biopsy samples of the gastric mucosa (from the body of the stomach and the antrum) were obtained from each patient. The presence of H. pylori infection was confirmed by PCR; RNA was isolated and then libraries were prepared for metatranscriptomic analysis of the 16S rRNA gene. Sequencing was performed on MiSeq (Illumina, USA) using MiSeq Reagent Kit v3 (600-cycle) (Illumina, USA).Results. The bacterial diversity decreases with the predominance of Helicobacter pylori species in H. pylori-positive patients. These results were confirmed by the Shannon index, the average value of which was 3.6 in the H. pylori-positive group and 5.4 in the H. pylori-negative group. In H. pylori-negative patients an increase in the representation of Streptococcus, Prevotella and Alloprevotella genera was observed. The level of H. pylori contamination of the gastric mucosa varies in the antrum and body of the stomach, in some cases reaching a 3.5-fold difference. Representation of other bacteria in the body and antrum of the stomach does not differ significantly.Conclusion. The bacterial composition of the stomach is dependent on the presence of H. pylori. H. pylori leads to the decrease of the bacterial diversity with the predominance of H. pylori in gastric microbiome.

Autoimmune Atrophic Gastritis: A Clinical Review.

Autoimmune atrophic gastritis (AAG) is a chronic condition characterized by the presence of atrophy in the oxyntic mucosa due to anti-parietal cell antibodies. This review provides a comprehensive and up-to-date overview of autoimmune atrophic gastritis, reporting recent evidence on epidemiology, pathogenesis, diagnosis, clinical presentation, risk of malignancies, and management. The prevalence of AAG has been estimated at between 0.3% and 2.7% in the general population. The diagnosis of AAG is based on a combination of the serologic profile and the histological examination of gastric biopsies. Patients with AAG are often asymptomatic but can also have dyspeptic or reflux symptoms. The atrophy of the oxyntic mucosa leads to iron and vitamin B12 malabsorption, which may result in anemia and neurological affections. Autoimmune atrophic gastritis is associated with an increased risk of type I neuroendocrine tumors (NETs) and gastric cancer, with an incidence rate of 2.8% and 0.5% per person/year, respectively. Management is directed to reinstate vitamins and iron and to prevent malignancies with endoscopic surveillance. In conclusion, atrophic autoimmune gastritis is an infrequent condition, often asymptomatic and misdiagnosed, that requires an early diagnosis for appropriate vitamin supplementation and endoscopic follow-up for the early diagnosis of NETs and gastric cancer.