Functional Dyspepsia Cases Research Articles

The Presence of Ganglionic Acetylcholine Receptor Antibodies in Sera from Patients with Functional Gastrointestinal Disorders: A Preliminary Study.

Functional gastrointestinal disorders (FGIDs), including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are characterized by chronic and recurrent gastrointestinal symptoms. Clinically, FD and IBS often resemble gastrointestinal dysmotility caused by autoimmune autonomic neuropathy. We examined the seropositive frequency of autoantibodies against ganglionic nicotinic acetylcholine receptors (gnAChRs) in patients presenting with FGIDs. To elucidate the seropositivity of gnAChR antibodies and the clinical features of seropositive FD and IBS. We measured autoantibodies against the gnAChR α3 and β4subunits using luciferase immunoprecipitation systems. Serum samples from patients with any autonomic symptoms were obtained from hospitals in Japan between January 2012 and August 2018 (1787 serum samples of 1381 patients). We selected FD and IBS patients and compared the clinical characteristics and prevalence of autonomic symptoms between those with seropositive and seronegative IBS and FD. Nine IBS and two FD cases (one comorbid case with IBS) were found. We found four patients (36.4%) in whom gnAChR antibodies were positive in these eleven patients. Sicca symptoms were observed in three of four cases (75%) of seropositive FGID compared with zero of seven cases (0%) of seronegative FGID. We found patients with gnAChR antibodies in FD and IBS patients. These data will be valuable for elucidating the pathophysiology of these FGIDs and developing new treatment strategies.

Yoga Therapy in Functional Dyspepsia. A Narrative Review.

Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.

Association of vitamin D and functional dyspepsia: a case-control study.

Vitamin D plays a key role in responses of brain-gut axis. It has been suggested that functional dyspepsia (FD) may be associated with decreased levels of vitamin D. Hence this study wished to find the association between vitamin D in patients with FD. This case-control study was done at a tertiary care hospital with 150 cases and 150 controls. FD was diagnosed by the ROME IV criteria. Demographic profile and serum vitamin D levels including Perceived Stress Score (PSS) and salivary amylase were determined for both cases and controls. Majority of the FD cases were males (57.3%). Post-prandial distress syndrome represented the major type of FD cases (69.3%). A higher mean BMI was found among the control group (23.2 vs. 21.2, P<0.05) and higher percentage of obese individuals in the control group (42.7% vs. 29.3%, P= 0.05). Majority of the cases are from rural background (89.3% vs. 74%, P<0.001). Comparison of PSS showed that cases had significantly higher grades of PSS than control (P<0.001). However, no significant association was found in the levels of salivary amylase between the groups (P=0.728). Hypovitaminosis D (<30ng/ml) was found significantly more among cases than controls (73.3% vs. 60%; P<0.05) with an odds ratio of 1.833 (CI 95%= 1.126-2.985). After adjustment of age, place of residence and BMI, vitamin D levels were significantly associated with FD in the regression analysis. This study shows significant association of vitamin D deficiency in FD patients. It also opens up new avenues for further research into the role of vitamin D supplementation to further improve the management of such cases.

Eosinophil and mast cell-derived exosomes promote integrity of intestinal mucosa via the NEAT1/miR-211-5p/glial cell line-derived neurotrophic factor axis in duodenum.

Exosomes are applied as biomarkers in several diseases according to their disease-specific profiles. However, the exosomes effects in functional dyspepsia (FD) are still fragmentary. Here we examined the role of Eosinophil and mast cell derived-exosomes in FD progression. Fifty FD subjects and age- and sex-matched healthy controls were included in this retrospective cohort study. Duodenal mucosa and gastric juice were collected to analyze molecular difference. Eosinophil and mast cell were evaluated by immunofluorescence and microarray was subjected to examine the expression levels of NEAT1, miR-211-5p, and glial cell line-derived neurotrophic factor (GDNF), which were subsequently were tested by quantitative reverse transcription PCR (RT-qPCR) validation cohorts. CCK-8 assays, and wound healing assays were used to evaluate integrity of intestinal mucosal barrier in vitro. Rats' weights and gastric emptying rates were used as evaluation of FD severity in vivo. Eosinophil and mast cell were enriched and secreted more exosomes in duodenal mucosa of FD patients. We identified differential lncRNAs that were consistently and significantly up regulated in FD cases. Of these, NEAT1 was further validated by RT-qPCR and had closely relationship with GDNF. MiR-211-5p level was found to be reduced in FD and negatively related with NEAT1 and GDNF. Furthermore, NEAT1and GDNF relived FD while miR-211-5p made symptoms worse. The NEAT1/miR-211-5p/GDNF axis had a good predictive ability for FD. The NEAT1/miR-211-5p/GDNF could be a potential FD biomarker.

Pancreatitis and the Risk of Developing Gastric Neuromuscular Dysfunction.

Most gastroparesis and functional dyspepsia cases (collectively, gastric neuromuscular dysfunction [GND]) remain idiopathic. It is believed that some idiopathic cases of GND may be triggered by an inflammatory insult to the gastrointestinal tract. We theorized that the profound foregut inflammation induced by pancreatitis could result in increased risk of GND. This was a case-control study of all patients undergoing gastric emptying scintigraphy between October 2017 and 2020 in an urban medical center with presumed GND. These were age-, sex-, and comparative health-matched to control patients with newly diagnosed microscopic colitis. Adjusted odds ratios (aORs) were calculated using conditional logistic regression. Among the 650 patients with GND, 359 had gastroparesis, and 9.2% had a history of acute pancreatitis (vs 3.1% of controls). Patients with GND demonstrated increased odds of having a history of acute pancreatitis (aOR 2.27, 95% confidence interval [CI] 1.33-4.03, P = 0.004) and recurrent pancreatitis (aOR 2.08, 95% CI 1.67-3.48, P = 0.002). Median time to GND diagnosis after first acute pancreatitis episode was 1,544 days (477.5, 3,832). Patients with a history of pancreatitis-associated GND had increased mortality vs controls (aOR 3.41, 95% CI 0.96-5.48). In addition, patients with pancreatitis-associated GND had more hospitalizations vs GND alone (13.8 vs 3.7, P < 0.0001) during the study period. This is the first study demonstrating an independent association between pancreatitis and the risk of GND, which occurred ∼4.2 years after the first episode of acute pancreatitis. Pancreatitis should therefore be regarded as a possible risk factor for developing GND with important consequences for healthcare utilization.

S575 Rate and Reasons for Non-Elective 30-Day Readmissions for Functional Dyspepsia in the U.S.

Introduction: Functional dyspepsia (FD), a diagnosis of exclusion, has a 10–20% prevalence(1,2). The pathophysiology is unclear, often multifactorial, and involves treatment with a detailed education about its benign nature. Tricyclic antidepressants and psychotherapy are warranted if functional dyspepsia (FD) is refractory or severe (1). Functional dyspepsia (FD) can present with postprandial distress (70% of FD cases) or epigastric pain syndrome (30% of FD cases) (3). FD can decrease quality of life and place a significant cost burden on healthcare services. Our study sought to determine the rate and reasons for 30-day all-cause readmissions for FD to help identify potentially modifiable factors and decrease the burden of readmissions. Methods: From the NRD, we identified all adults discharged with a principal diagnosis of FD after hospitalization from 2016 to 2019. Then, we identified any readmission of the same patient within 30-days for FD, excluding elective and traumatic encounters. Outcomes assessed included 30-day all-cause readmissions, top principal diagnosis for the readmitted patients, comparison of mortality, length of stay (LOS), and total hospital charges (THC) following readmission. Results: 4 917 patients with FD during index admissions were identified. The 30-day all-cause readmission rate was 19.3%. The Kaplan-Meier curve for 30-day all-cause readmissions was split by sex (Figure). There was no significant difference in age and sex distribution between patients with initial hospitalizations and those with readmissions. The most common reasons for readmissions in patients with FD were gastroparesis (5.9%), FD (5.8%), sepsis unspecified (5.2%), unspecified nausea and vomiting (3.1%), unspecified abdominal pain (2.1%), and acute renal failure (2.0%). Readmission was associated with higher odds of mortality (2.8% vs. < 0.01%, p< 0.001), longer LOS (6.0 vs. 5.0 days, p< 0.001), and higher THC. Over the period, readmissions for FD accounted for a cumulative 5.694 days of hospitalization, costing over $14 million. Conclusion: 1 in 4 patients was readmitted with FD within 30 days. Gastroparesis contributed more to readmissions than a primary diagnosis of FD. Higher rates of poorer outcomes were found with 30-days readmissions. Cohort studies are needed to validate these results.Figure 1.: Survival estimates for 30-day all-cause readmissions in male and Female patients with functional dyspepsia

Usefulness of Curcuma longa in the Cases of Functional Dyspepsia—A Parallel Arm-Controlled Study

Abstract Background Functional dyspepsia is one of the common gastrointestinal (GI) disorders. This prospective experimental, randomised, single-blind placebo-controlled clinical trial was conducted at SKHMC, Jaipur, for a period of 1 year (March 2018–March 2019) with a 3 -month intervention and follow-up period, aiming to ascertain the usefulness of Curcuma longa in the cases of functional dyspepsia. Materials and Methods In this study, after screening of 220 patients using ROME III diagnostic criteria, 88 cases of functional dyspepsia fulfilling the eligibility criteria were included and enrolled in the study in a ratio of 1:1. Assuming 10% drop-outs to obtain 80 evaluable cases, that is, 40 cases were randomly allocated to experimental group (Curcuma longa), while another 40 cases were allocated to controlled group (Placebo). Both the arms followed dietary and lifestyle modifications. Usefulness of homoeopathic medicine and placebo in cases with functional dyspepsia on day 35 was compared with baseline. Potency used was 30 CH. Assessment and reassessment were done using gastrointestinal symptom (GIS) score. Results Eighty cases completed the study, in (50%) subjects marked improvement was seen in 12 (30%) cases in Curcuma longa group and 00(0%) cases in placebo group, moderate improvement was seen in 8 (20%) cases in Curcuma longa and 01 (2.5%) in placebo group, mild improvement was seen in 6 (15%) cases in Curcuma longa and 2 (5%) cases in placebo group, no relief was seen in 14 (35%) cases in Curcuma longa and 37 (92.5%) cases in placebo group. Functional dyspepsia is found in middle-aged persons of 36 to 45 years, with predominance in females. To analyse the change in the GIS scores of symptoms of functional dysplasia, paired t-test was applied for both treatment group and control group. It was observed from the paired t-test result that there is a one-point increase in the pre- and post-average GIS score (from 28.65 to 29.65) in the control group and it is not statistically significant (t = −0.760 and p = .452). Whereas there is 13.3-point decrease (from 29.55 to 16.25) in the treatment group and it is statistically significant (t = 9.347 and p = 0.000). Conclusion It indicates medicine is effective in lowering down the GIS score, which was statistically significant to conclude that homoeopathic medicine Curcuma longa was effective in the cases of functional dyspepsia.

Profile of Helicobacter pylori cagA &vacA genotypes and its association with the spectrum of gastroduodenal disease

PurposeGlobally, H. pylori virulence factors cagA and vacA genotypes and its variation is leading to the austere form of the gastroduodenal disease. Our objectives were to detect H. pylori in dyspeptic patients from biopsy samples with the validation of the various existing diagnostic tools and to screen the cagA, vacA genotypes profile from biopsy specimens and how it impacts in progression of gastroduodenal disease in southern India. Methods374 patients who attended endoscopy unit at Kasturba Hospital, Manipal with their consent obtained their biopsies. H. pylori were detected by HPE, Culture, RUT and PCR and its virulence gene were patterned with PCR. ResultsThe positive rate of H. pylori by HPE, RUT, Culture and PCR were 51.33%, 47.1%, 32.4% and 50.3% respectively and comparison by Bayesian LCMs analysis showed PCR is superior among them. The frequency of H. pylori virulence gene viz cagPAI (cagA) were 80.9%, and vacA alleles-s1m1 (42%), s1m2 (33%) and s2m2 (25%) genotypes by PCR respectively. Four combinations of cagA/vacA genotypes were noted, majority of strains harboured cagA+/vacA s1m1 genotypes (42.6%), interestingly this hyper-virulent strain more frequently seen in severe gastroduodenal disease whereas cagPAI negative strains as well as cagA−/vacA s2m2 combinations (19.1%) are seen most commonly in functional dyspepsia cases and depicted significant association by Chi-square test. ConclusionsThis study validates and compares the existing diagnostic methods for detecting H. pylori in biopsies. Also, it reveals some pattern of virulence gene combination will play a vital role in disease progression.

Characterizing clinical features and location-specific gene expression profiles associated with pain burden in children with functional dyspepsia.

In children with functional dyspepsia (FD), genes involved in pain modulation may be differentially expressed contributing to chronic pain. Children with suspected FD (cases) and known eosinophilic esophagitis (controls) undergoing esophagogastroduodenoscopy completed the Rome IV Diagnostic, Pain Burden and Frequency Severity-Duration questionnaires. Two antral and two duodenal biopsies were collected and relative fold differences in gene expression for 84 pain-associated genes compared to pain-free controls were calculated. Sixty-six subjects with FD (postprandial distress syndrome=34, epigastric pain syndrome=7, both=25; 65% female; mean age 13.7years) and 13 pain-free controls (8% female; mean age 12.7) were studied. There were no significant differences in antral and duodenal eosinophilic counts or distribution between the pain and pain-free groups. Pain severity and burden did not differ significantly between FD subgroups and neither measure significantly correlated with eosinophil counts in the antrum or duodenum. Analysis of 47 antral and 39 duodenal biospecimens revealed 5 candidate genes significantly associated with pain burden: antral EDN1, PTGES3 and duodenal HTR1A, P2Y1, SCN3A (p<0.01). Subsequent stringent statistical analysis comparing those with significant pain versus no pain revealed antral PTGES3 and duodenal SCN3A were the highest priority candidate genes (p<0.001). Pain burden in pediatric FD may be linked to antral EDN1, PTGES3 and duodenal HTR1A, P2Y1, SCN3A differential expression. These genes are known to be involved in pain conduction, modulation, and neurotransmission, suggesting potential therapeutic targets for managing pain in FD.

Functional dyspepsia in children: A study of pathophysiological factors.

Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post-infectious FD. Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty-seven healthy children were enrolled for assessing PS and satiety drink test. Fifty-five FD children (33 boys, age 12 [6-18] years) with symptoms for 4 (2-48) months and dyspeptic score of 5 (1-13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P<0.001). Median satiety drink volume was 360mL (180-1320mL); no patients had satiety drink volume of <5th centile of healthy children. The frequency (98% vs 85%; P=0.01) and severity (65 [10-175] vs 50 [5-130]; P<0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P=0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post-infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. Abnormality of gastric sensorimotor function is seen in one-fourth of FD cases. HP infection and post-infectious FD are present in 11% and 13% cases, respectively.

Association of duodenal eosinophilia with Helicobacter pylori-negative functional dyspepsia

Background and study aimsThe pathogenesis of functional dyspepsia (FD) is complex and still remains to be established. Recent studies support duodenal inflammation with increased infiltration of eosinophils and a higher level of systemic cytokines among patients with FD. These findings may help to understand the underlying pathophysiology of FD. The aim of this study was to evaluate the association between duodenal eosinophilia and FD. Patients and methodsA total of 84 patients (42 cases of FD and 42 subjects without dyspepsia as control, mean age 31 years, 56% female) were recruited for this prospective observational study. FD was diagnosed by validated Bangla version of the ROME III criteria. Patients with no symptoms of FD who were referred for upper gastrointestinal endoscopy for other reasons were included as control. Biopsy specimens were taken from the second part (D2) of the duodenum of all participants. The eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. The association between duodenal eosinophilia (defined as ≥22/5HPF a priori) and FD was assessed. ResultSignificantly increased duodenal eosinophil count was found in patients with FD than patients without dyspepsia (p = 0.001). 57.1% of patients with FD had duodenal eosinophilia. A significant positive association was found between duodenal eosinophilia and FD (OR = 5.67, 95% CI 1.92–17.2, p = 0.001). A positive association was also observed between duodenal eosinophilia and postprandial distress syndrome (OR = 5.54, 95% CI 0.86–45.24, p = 0.036). A higher odds ratio was noticed among those who complain of early satiety. ConclusionA significant positive association was found between duodenal eosinophilia and FD especially among those with postprandial distress syndrome. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of FD.

Exosomal hsa-miR-933 in Gastric Juice as a Potential Biomarker for Functional Dyspepsia.

MicroRNAs (miRNAs) in exosomes represent disease-specific profiles and are applied as biomarkers in oncology. However, in functional dyspepsia (FD), the role of exosomal miRNAs has not been fully elucidated. To investigate exosomal miRNAs as potential biomarkers of FD using liquid biopsy. This retrospective cohort study included 11 subjects with FD and 11 age- and sex-matched healthy controls (HCs). We collected gastric juice and isolated exosomal miRNAs. In a discovery cohort, expression levels of 2565 miRNAs were evaluated by 3D-Gene® microarray. miRNA expression profiles from exosomes of subjects with FD and HCs were compared by two normalization methods: (1) global normalization and (2) normalization by internal control. Subsequently, in a validation cohort, the expression levels of miRNAs were validated by quantitative reverse transcription PCR (RT-qPCR). Through microarray analysis using the two methods, we identified 39 miRNAs that were consistently and significantly downregulated in FD cases compared with those in HCs. Of these, 12 miRNAs (hsa-miR-933, hsa-miR-345-5p, hsa-miR-708-5p, hsa-miR-203a-3p, hsa-miR-619-5p, hsa-miR-4294, hsa-miR-4481, hsa-miR-196a-5p, hsa-miR-3918, hsa-miR-372-3p, hsa-miR-658, and hsa-miR-3654) were further validated by RT-qPCR. Our results indicated that hsa-miR-933 was significantly downregulated in FD compared with HCs (0.317 ± 0.205-fold, P = 0.0317). Furthermore, the expression level of hsa-miR-933 was negatively associated with dyspepsia score and the frequency of epigastric pain and/or burning (P < 0.01, r = - 0.835; P = 0.0280, r = - 0.688, respectively). Exosomal hsa-miR-933 in gastric juice could be a candidate biomarker for FD.

Evaluation of Mast Cell and Eosinophil Count in Duodenal Mucosa- A Study on 69 Functional Dyspepsia Cases from Bangladesh

Evaluation of Mast Cell and Eosinophil Count in Duodenal Mucosa- A Study on 69 Functional Dyspepsia Cases from Bangladesh

Effect of Sini powder and scattered seven Atractylodes in the treatment of functional dyspepsia with hepatic stagnation and spleen deficiency syndrome

Objective To discuss the clinical efficacy of Sini powder and scattered seven Atractylodes in the treatment of functional dyspepsia with hepatic stagnation and spleen deficiency syndrome. Methods A total of 100 cases of functional dyspepsia with hepatic stagnation and spleen deficiency syndrome in our hospital were selected and randomly divided into the western medicine group and Chinese medicine group by envelope grouping method.The patients in western medicine group were treated with mosapride tablets, 5mg each time, and the patients in Chinese medicine group were treated with Sini powder and scattered seven Atractylodes, 150mL each time, two times a day for 4 weeks.The efficacy, abdominal distension scores and adverse drug reactions were compared between the two groups. Results In the Chinese medicine group, 40 cases were obviously improved, 8 cases were improved, 2 cases were invalid, and the total clinical effective rate was 96.0%.In the western medicine group, 30 cases were obviously improved, 12 cases were improved and 8 cases were invalid.The total clinical effective rate was 80.4%.The total effective rate of the Chinese medicine group was higher than that of the western medicine group, the difference was statistically significant(χ2=8.239, P=0.041). The abdominal distension scores of the two groups after treatment was lower than those before treatment, but the abdominal distension score of the Chinese medicine group[(2.4±2.7)points]was significantly lower than that of the western medicine group[(2.9±2.2)points], the clinical efficacy of the traditional Chinese medicine group was better than that of the Western medicine group(t=3.794, P=0.006). No serious adverse reactions were found in the two groups. Conclusion Sini powder and scattered seven Atractylodes can effectively improve the clinical symptoms of liver stagnation and spleen deficiency in patients with functional dyspepsia, and has no obvious adverse reactions. Key words: Functional dyspepsia; Sini powder and scattered seven Atractylodes; Liver stagnation and spleen deficiency

Prevention of Functional Dyspepsia with Carica Papaya Extract

Functional dyspepsia (FD) is a set of relapsing or chronic dyspeptic symptoms in the absence of structural organic lesions. Approximately 15-20% of the general population in many developed countries suffers from dyspeptic symptoms at any time in a year, whereas in Pakistan, 14-22 % of general population suffers from FD. Objective: This study was designed to evaluate the effectiveness of carica papaya extract (CP) in preventing functional dyspepsia in human volunteers.Methodology: A community based, placebo-controlled, double -blind, multi-centered, and randomized clinical trial through systematic random sampling was conducted in Lahore urban community. After initial diagnostic investigations in 200 patients diagnosed as cases of FD fulfilling Rome III criteria were recruitedafter taking written consent and randomly assigned to one of 2 treatment groups (CP extract group or placebo) in equal number. A 7 days medication free period was observed before the start of trial. Each patient received the treatment for 6 weeks. The primary outcome variable was the improvement in gastrointestinalsymptom score (GIS) consisting of evaluation of 10 dyspeptic symptoms rated on Likert scale. Dyspeptic symptoms were assessed at the start of trial then after 2, 4 and 6 weeks. Results: In this trial, 200 patients fully participated in this study (age 36.31±9.711 years, range 18-55, 60% female). Compared with placebo, Carica papaya extract (CP group) showed a clinically significant improvement. The GIS significantly decreased in CP group during the first 2 weeks, compared to the placebo (p &lt; 0.05). During the second and third 2-week period, symptoms further improved in CP group (p &lt; 0.05). After 6 weeks, 95.7% on CP treatment and 3.1% on placebo were completely relieved of FD symptoms (p &lt; 0.001). Conclusions: CP extract was significantly effective gastro-protective as compared with placebo.

Functional dyspepsia and duodenal eosinophilia: A new model

Functional dyspepsia (FD) is a highly prevalent disorder that affects more than 10% of the population. In the past decade, the theoretical underpinning of the concept of FD has begun to change, in light of new data on the underlying pathophysiological mechanisms of this disorder, with a focus on the duodenum. The Rome IV criteria, published in 2016, note that gastroesophageal reflux disease and irritable bowel syndrome overlap with FD more than expected by chance, suggesting that they may be part of the same disease spectrum. Infection by Helicobacter pylori (H. pylori) may explain a minority of cases of FD and in the Rome IV criteria H. pylori-associated dyspepsia (defined as symptom relief after eradication therapy) is considered a separate entity. Duodenal inflammation characterized by increased eosinophils and in some cases mast cells, may impair the intestinal barrier. Post-infectious gastroenteritis is now an established risk factor for FD. Other risk factors may include atopy, owning herbivore pets and exposure to antibiotics, together with gastroduodenal microbiome disturbances. Small bowel homing T cells and increased cytokines in the circulation occur in FD, correlating with slow gastric emptying, and a possible association with autoimmune rheumatological disease supports background immune system activation. A genetic predisposition is possible. FD has been linked to psychological disorders, but in some cases psychological distress may be driven by gut mechanisms. Therapeutic options are limited and, aside from responders to H. pylori eradication, provide only modest and temporary relief. Advances in understanding FD may alter clinical practice, and the treatment of duodenal inflammation or microbiome alterations may lead to a cure for a subset of these patients in the future.

Clinical efficacy of trimebutine combined with Xiangsha Pingwei in the treatment of functional dyspepsia and its effect on gastrointestinal hormone

Objective To investigate the clinical efficacy of trimebutine combined with Xiangsha Pingwei in the treatment of functional dyspepsia and its effect on gastrointestinal hormone. Methods One hundred and twenty cases of functional dyspepsia were randomly divided into the control group and observation group, 60 cases in each group.The control group was treated with trimebutine 0.2 g, 3 times/d and the observation group was treated with trimebutine 0.2 g, 3 times/d and Xiangsha Pingwei 10 g, 2 times/d.Both groups were treated for four weeks, a course of treatment.Clinical efficacy and the influence on gastrointestinal hormone levels were compared between the two groups. Results The symptoms scores in both groups all decreased significantly after treatment.While the postprandial fullness scores, early satiety scores and epigastric pain scores in the observation group were significantly lower than those in the control group (0.62±0.12 vs.1.85±0.25, 0.56±0.14 vs.1.46±0.21, 0.48±0.15 vs.1.32±0.12, t=34.36, 27.62, 33.87, P<0.05). The total effective rate in the observation group was significantly higher than that in the control group (90.00% vs.73.33%, χ2=5.57, P<0.05). MOT and GAS levels in both groups increased significantly.While MOT and GAS levels in the observation group were significantly higher than those in the control group (MOT: (355.2±78.1) ng/L vs.(288.7±82.4) ng/L; GAS: (96.5±17.6) ng/L vs.(88.4±16.0) ng/L, t=4.54, 2.64, P<0.05). The somatostatin (SS) level in both groups decreased significantly.While the SS level in the observation group was significantly lower than that in the control group ((41.1±11.1) ng/L vs.(48.9±12.9) ng/L, t=3.55, P<0.05). Conclusion Trimebutine combined with Xiangsha Pingwei can significantly improve the clinical symptoms and gastrointestinal hormone in patients with functional dyspepsia. Key words: butine; Xiangsha Pingwei; Gastrointestinal hormone

Low-frequency fluctuation amplitude analysis of resting-state fMRI for functional brain response differences between acupuncture and moxibustion at Zusanli (ST 36) in patient with functional dyspepsia

To compare and analyze functional brain response characteristics by applying acupuncture or moxibustion to Zusanli (ST 36) in patients with functional dyspepsia (FD) and investigate the differences of central action mechanism resulting from acupuncture or moxibustion. A total of eligible 24 FD cases were divided into two blood-oxygen-level dependent (BOLD) sequences for functional magnetic resonance imaging (fMRI) scan. The amplitude of low frequency fluctuation (ALFF) analyses were conducted on the data of location phase, structure phase, resting state before acupuncture/moxibustion, working state during acupuncture/moxibustion and resting state after acupuncture/moxibustion using Data Processing Assistant for Resting-State fMRI (DPARSF) software. Acupuncture and moxibustion produced significant differences in functional brain response. The working state during acupuncture/moxibustion mainly decreased ALFF values in the right supramarginal gyrus, right superior parietal lobule, right frontal gyrus, upper right occipital lobe, right precuneus and right cingulate gyrus. At the same time, it increased ALFF values in the left cerebellum, right caudate nucleus, right cerebellum and left inferior gyrus. The differences during the resting state after acupuncture/moxibustion were significantly smaller than the working state in intensity and size. It mainly resulted in decrease in ALFF values in the right postcentral gyrus and right supramarginal gyrus and increase in ALFF values in the left precuneus, orbital part of inferior frontal gyrus and right cerebellar peduncles. Needling and moxibustion at Zusanli (ST 36) can produce significant differences in immediate functional brain response.

Histomorphological Spectrum of Duodenal Pathology in Functional Dyspepsia Patients.

Functional Dyspepsia (FD) is one of the most common causes of gastrointestinal symptoms aetiology of which is poorly understood. To study duodenal histomorphological features and their relationship with Helicobacter pylori (H Pylori) infection in patients of FD. This case control study included 50 cases of FD patients selected according to Rome III criteria and 30 age and sex matched controls. These were subjected to oesophago-gastro-duodenoscopy, rapid urease test for detection of H. pylori on gastric antral biopsy and duodenal biopsy from second part of duodenum for histopathological evaluation by light microscopy. Ten antral urease positive cases of FD with highest Intraepithelial Lymphocyte Count (IEL) were subjected to Immunohistochemistry (IHC). Duodenal inflammation was an invariable feature noted in FD. Morphological spectrum consisted of increased IEL in 72%, increased duodenal eosinophils in 92%, presence of focal villous atrophy in 16%, lymphoid aggregates, colonic metaplasia, and duodenal H. pylori infection in 4% each. Gastric H. pylori positivity was noted in 48% cases of FD. Increased duodenal IEL count and duodenal eosinophilia was noted in 75%, 87.5% such cases. Same was noted respectively, with 61.5% and 95.15% cases with gastric H. pylori negativity. In cases of FD, duodenal IEL and eosinophil count in lamina propria showed statistically significant rise when compared with control and had positive correlation with gastric H pylori infection. On IHC, increased expression of CD 8 was noted in duodenal IEL and lymphocytes in lamina propria as compared to CD4. Our study provided some insight in pathogenesis of FD and role of H. pylori in its aetiology.

OP‐23 FUNCTIONAL DYSPEPSIA IS ASSOCIATED WITH DUODENAL EOSINOPHILIA IN A PEDIATRIC COHORT

Objectives:Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder with unknown etiology. We aimed to assess the association between dyspeptic symptoms and duodenal eosinophilia in children referred for upper endoscopy.Methods:In this retrospective cohort study, all histopathology reports of normal upper endoscopies performed at a single tertiary center between 2010 and 2014 were reviewed. FD was defined as epigastric pain or discomfort for more than 2 months with no response to acid suppressants. Controls were those with non‐erosive reflux disease, dysphagia or rumination syndrome. Duodenal biopsies were analyzed by pathologists blinded to indication. Intramucosal eosinophils were counted per mm2 on haematoxylin and eosin stained digital imaged sections using Aperio eSlide Manager. Demographics, clinical variables, family history and histologic findings were compared between cases and controls.Results:In total, 36 cases and 36 non‐matched controls were identified of which 56% and 53% were female (p = 0.81). Mean (± SD) age was higher in cases compared to controls (13.6 (± 3.1) vs. 10.5 (± 4.0) years; p = .001). Dyspeptic symptoms (epigastric pain 81% and/or upper abdominal discomfort 33%) were food‐related in 69% and nocturnal in 31% of cases. Self‐reported nausea (64% vs. 17%; p &lt; .0001), lethargy (19% vs. 0%; p = .005) and a family history of functional gastrointestinal disorders (28% vs. 3%; p = .003) were more common in cases than controls. There was a higher but not significantly different rate of atopic history (39% vs. 25%; p = .21) and psychological co‐morbidity (53% vs. 39%; p = .24) in FD cases versus controls. Duodenal intraepithelial lymphocytes per 100 enterocytes were similar in cases and controls (median (IQR) 10 (8–13) vs. 12 (8–18); p = 0.12). Duodenal eosinophil counts per mm2 were significantly increased in cases compared to controls (151 (118–207) vs. 76 (60–106); p &lt; 0.001).Conclusions:This study confirms recent reports of duodenal eosinophilia in FD. The high rate of atopic and psychological co‐morbidity in FD suggests multi‐factorial mechanisms and may explain why current therapeutic options aimed at symptom control are largely unsatisfactory. Duodenal eosinophilia in FD should be considered a therapeutic target.