Functional Dyspepsia In Adults Research Articles

Efficacy of antidepressants in functional dyspepsia: Systematic review and meta-analysis with trial sequential analysis of randomized controlled trials.

The beneficial effects of using antidepressants in improving functional dyspepsia (FD) symptoms have been reported in previous meta-analyses; however, the results have not been conclusive. The aim was to perform an updated meta-analysis coupled with trial sequential analysis (TSA) to assess the efficacy of the use of any antidepressants in the treatment of FD in adults. Electronic databases were searched up to March 2024 for randomized controlled trials (RCTs) recruiting adults with FD. Data of overall symptoms improved between the antidepressants and placebo groups was pooled to obtain risk ratio (RR) employing the random-effects model. The effect of random errors was evaluated with TSA. The Grading of Recommendations Assessment, Development and Evaluation (GRADE)approach was used to assess the certainty of evidence. Analyses were performed using STATA version 16.0. Nine RCTs with 924 patients met the eligible criteria. The RRs of FD symptoms improving with any antidepressants, tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors were (n = 9, RR = 1.30 [95% CI, 1.02-1.67]), (n = 5, RR = 1.41 [95% CI, 1.07-1.85]) and (n = 2, RR = 0.97 [95% CI, 0.72-1.29]),respectively. TSA demonstrated conclusive evidence for the beneficial effect of TCAs. The number needed to treat (NNT) with any depressants and TCAs were 11 (95% CI, 7-36) and 6 (95% CI, 4-15), respectively. The certainty of the evidence for an effect of TCAs was that of moderate GRADE quality. The benefit, however, was limited to the western population (n = 3, RR = 1.43 [95% CI, 1.04-1.96]) and did not extend to the Asian population (n = 2, RR = 1.32 [95% CI, 0.75-2.32]). Conversely, antidepressant-using patients experienced adverse events more frequently. However, no statistically significant association was found between TCAs and any adverse events (n = 3; RR = 1.36 [95% CI, 0.91-2.04]). Evidence was obtained suggesting TCAs can be an effective alternative in the treatment of FD, but more evidence from high-quality large trials is required to support their use, especially in the Asian population.

Global prevalence of functional dyspepsia according to Rome criteria, 1990–2020: a systematic review and meta-analysis

Although functional dyspepsia (FD) is a common functional gastroduodenal disorder with a high socioeconomic burden, little is known about its global prevalence. Thus, we performed a comprehensive study to estimate long-term trends in the prevalence of FD. We searched PubMed/MEDLINE, Embase, and Google Scholar from 1990 to 2022 for population-based studies that reported the prevalence of FD in adults (≥ 18 years old) according to Rome I, II, III, or IV criteria. The prevalence of FD was extracted from included studies to obtain pooled prevalence with 95% confidence intervals (CI) and 95% prediction intervals. Subgroup analysis was performed according to certain characteristics, including geographic region. A total of 44 studies met the eligibility criteria, including 256,915 participants from 40 countries across six continents. The overall global pooled prevalence of FD was 8.4% (95% CI 7.4–.9.5). The prevalence was the highest in Rome I (11.9%; 95% CI 5.1–25.4) and lowest in Rome IV (6.8%; 95% CI 5.8–7.9). Developing countries showed a higher prevalence than developed countries (9.1% versus 8.0%), and prevalence was higher in women, irrespective of the definition used (9.0% versus 7.0%). The pooled prevalence gradually decreased from 1990 to 2020 (12.4% [8.2–18.3] in 1990–2002 versus 7.3% [6.1–8.7] in 2013–2020). The prevalence of FD differs by country, economic status, geographical region, and sex, and the global prevalence has been gradually declining. Despite the heterogeneity of sample population, our study estimates the current global burden of FD and provides information to heath care policy decisions.

Transcutaneous Auricular Vagal Nerve Stimulation Is Effective for the Treatment of Functional Dyspepsia: A Multicenter, Randomized Controlled Study.

Vagal nerve stimulation (VNS) can be used to modulate gastrointestinal motility, inflammation, and nociception. However, it remains unclear whether VNS is effective in adult patients with functional dyspepsia (FD). We investigated the effectiveness of transcutaneous auricular VNS (taVNS) in patients with FD. Consecutive patients with FD meeting Rome IV criteria with modified FD Symptom Diary score ≥10 were enrolled. Patients were randomly allocated to 10-Hz taVNS (V10 group), 25-Hz taVNS (V25 group), or sham group, with 30 minutes of treatment twice a day for 4 weeks. The primary outcome was the response rate at week 4, defined as the proportion of patients whose modified FD Symptom Diary score was reduced ≥5 when compared with the baseline. Secondary outcomes included adequate relief rate and adverse events. A total of 300 patients were randomized to V10 (n = 101), V25 (n = 99), and sham groups (n = 100). After 4 weeks of treatment, V10 and V25 groups had a higher response rate (81.2% vs 75.9% vs 47%, both P < 0.001) and adequate relief rate (85.1% vs 80.8% vs 67%, both P < 0.05) compared with the sham group. There was no significant difference between V10 and V25 in response rate and adequate relief rate (both P > 0.05). The efficacy of taVNS (both 10 and 25 Hz) lasted at week 8 and week 12 during follow-up period. Adverse events were all mild and comparable among the 3 groups (1%-3%). Our study firstly showed that 4-week taVNS (both 10 and 25 Hz) was effective and safe for the treatment of adult FD ( clinicaltrials.gov number: NCT04668534).

Meta-analysis of Simotang Oral Liquid in treatment of functional dyspepsia in adults

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

Effects of a Traditional Rose-Based Polyherbal Formula ‎on Clinical Symptoms of Patients with Functional Dyspepsia: A Double-Blind Randomized Controlled Trial

Functional dyspepsia (FD) is a common gastroduodenal disorder that can be long-lasting. In the present study, we aimed to investigate the effect of herbal medicine, Ghors-e-Vard (Vard), on clinical symptoms in FD patients. Seventy adult FD patients according to the Rome IV criteria and without Helicobacter pylori infection were included. Participants were randomly allocated to either Vard or placebo group for 4 weeks of intervention. Treatments were given orally in a double-blind fashion (500 mg, three times a day, and half an hour after each meal). Patients were evaluated prior to and following 2, 4, and 8 weeks after the intervention, in terms of changes in the total score of gastrointestinal symptoms rating scale (GSRS), Depression Anxiety Stress Scales (DASS-21), scores of various components of the 36-item short-form health survey (SF-36), and any reported side effects. The differences of GSRS and DASS-21 total scores from baseline to the end of intervention were significantly larger in Vard group (P&lt;0.001). Except for reflux, the other subtypes of FD symptoms were decreased with a significantly greater effect in Vard group (P &lt; 0.05). Also, changes in the total score of SF-36 at 4 and 8 weeks after the intervention were significantly greater in Vard group (P&lt;0.001). Except for the reflux, improvement of gastrointestinal symptoms, along with depression, stress, and anxiety, as well as the quality of life in Vard group, was significantly superior to the placebo group. These findings suggest that the Vard, as a complementary therapy, may have a promising effect on resolving the FD symptoms.‎

Duodenum at a crossroads: Key integrator of overlapping and psychological symptoms in functional dyspepsia?

AbstractThe study of the interaction between gastrointestinal (GI) function and psychological features is a complex and developing field. The bidirectional communication between the gut and the brain or gut‐brain axis is considered as a pivotal player in the pathogenesis of the highly prevalent functional GI disorders, including irritable bowel syndrome and functional dyspepsia (FD), which have been redefined as disorders of gut‐brain interaction. However, the mechanisms through which changes in the gut alter brain functioning, feelings, and behavior remain unclear. Based on the presence of duodenal pathology in adult FD patients, Ronkainenet al. provide the first prospective evidence for duodenal eosinophils potentially driving anxiety. Also in this edition, associations between gastroduodenal pathology and rumination syndrome, which may coexist with FD, have now been confirmed in children by Friesenet al. Together these findings confirm not only the potential role of duodenal alterations in determining overlapping upper GI but also psychological symptoms, which result from bidirectional and complex interactions. In this review, we provide an overview of the recent advances in this field and highlight the novel contributions of the original studies of Ronkainen et al. and Friesen et al. to this topic.

The relationship between fruit and vegetable intake with functional dyspepsia in adults.

The association of fruit and vegetables with functional dyspepsia (FD) has been less studied, especially in Middle Eastern populations. This study investigated the relationship between fruit and vegetable consumption with FD and its related symptoms among a large group of Iranian adults. This cross-sectional research was conducted on 3362 middle-age participants. Usual dietary intakes, including fruit and vegetable intake, during the last year were assessed using a validated 106-item dish-based food frequency questionnaire (FFQ). A modified Persian version of the Rome III questionnaire was used for assessment of FD. The prevalence of FD among study participants was 14.5%. After adjustment for confounders, the highest energy-adjusted tertile of fruit consumption was related to 32% lower risk of FD, compared to the lowest intake (OR=0.68, 95% CI:0.51-0.90). Fruit consumption was also significantly related to lower risk of early satiation (OR=0.67, 95% CI:0.54-0.85) and post-prandial fullness (OR=0.75, 95% CI:0.61-0.92). Vegetable consumption was not related to the risk of FD in all models. Men who were in the third tertile of fruit and the third tertile vegetable consumption had lower risk of FD compared to the first tertile; but, in women, just fruit consumption was related to the reduced risk of FD, after adjustment for all confounders. We found an inverse association between fruit intake and dyspepsia symptoms. In addition, high consumption of fruit was related to lower odds of early satiation and post-prandial fullness. Higher intake of vegetables was associated with lower risk of FD, only in men.

The Alignment of Dietary Intake and Symptom-Reporting Capture Periods in Studies Assessing Associations between Food and Functional Gastrointestinal Disorder Symptoms: A Systematic Review.

Food ingestion is heavily implicated in inducing symptoms of irritable bowel syndrome (IBS) and functional dyspepsia (FD), which affect over one-third of adults in developed countries. The primary aim of this paper was to assess the alignment of dietary assessment and symptom-reporting capture periods in diet-related studies on IBS or FD in adults. Secondary aims were to compare the degree of alignment, validity of symptom-reporting tools and reported significant associations between food ingestion and symptoms. A five-database systematic literature search resulted in 40 included studies, from which data were extracted and collated. The food/diet and symptom capture periods matched exactly in 60% (n = 24/40) of studies, overlapped in 30% (n = 12/40) of studies and were not aligned in 10% (n = 4/40) of studies. Only 30% (n = 12/40) of studies that reported a significant association between food and global gastrointestinal symptoms used a validated symptom-reporting tool. Of the thirty (75%) studies that reported at least one significant association between individual gastrointestinal symptoms and dietary intake, only four (13%) used a validated symptom tool. Guidelines to ensure that validated symptom-reporting tools are matched with fit-for-purpose dietary assessment methods are needed to minimise discrepancies in the alignment of food and symptom tools, in order to progress functional gastrointestinal disorder research.

Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study

The population prevalence, clinical characteristics, and associations for Rome IV functional dyspepsia are not known. Following the publication of the Rome IV criteria for functional gastrointestinal disorders, we aimed to assess the prevalence, characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults across the USA, Canada, and the UK. We sent an internet-based cross-sectional health survey to adults in the general population of three English-speaking countries: the USA, Canada, and the UK. We used quota-based sampling to generate demographically balanced and population-representative samples. Individuals were invited to complete an online questionnaire on general health, without mention that the purpose of this survey was to examine gastrointestinal symptoms. We excluded participants who failed two attention-test questions or were excessively inconsistent on the three gastrointestinal questions that were presented twice in the survey for this particular purpose. The survey enquired about demographics, health-care visits, medications, somatisation, quality of life, and symptom-based criteria for Rome IV functional dyspepsia as well as for irritable bowel syndrome (IBS) and functional heartburn. We made subsequent comparisons between participants with Rome IV functional dyspepsia and controls without dyspepsia. The primary objective was to identify participants who fulfilled symptom-based criteria for Rome IV functional dyspepsia and categorise them into postprandial distress syndrome, epigastric pain syndrome, or overlapping subtypes. 6300 general population adults completed the health survey; 2100 each from the USA, Canada, and the UK. 369 responses were deemed inconsistent, leaving data for 5931 adults. Rome IV functional dyspepsia was significantly more prevalent in the USA (232 [12%] of 1949) than in Canada (167 [8%] of 1988) and the UK (152 [8%] of 1994; p<0·0001). The subtype distribution was 61% postprandial distress syndrome, 18% epigastric pain syndrome, and 21% overlapping variant with both syndromes; this pattern was similar across the countries. Participants with functional dyspepsia had significantly greater health impairment and health-care usage than those without dyspepsia. Participants with the overlapping variant showed greater somatisation and poorer quality-of-life scores than did individuals with either postprandial distress syndrome or epigastric pain syndrome alone. In multivariate analysis, independent factors associated with all functional dyspepsia subtypes included worsening quality of life and the presence of symptoms compatible with functional heartburn and IBS, with functional heartburn and IBS having the strongest association with overlapping postprandial distress syndrome and epigastric pain syndrome. Notably, somatisation showed a positive association with postprandial distress syndrome and the overlapping variant, and use of antidepressants showed a negative association with postprandial distress syndrome. Approximately 10% of the adult population fulfils symptom-based criteria for Rome IV functional dyspepsia and incurs considerable associated health impairment. The functional dyspepsia subtypes show differing associations, suggesting differences in pathophysiological processes or influences. The Rome Foundation, the US National Institute of Diabetes and Digestive and Kidney Diseases, the Swedish Medical Research Council, AFA Insurance, Ferring Pharmaceuticals, and the Faculty of Medicine, University of Gothenburg, Gothenburg, Sweden.

Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study

Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study

Up-regulation of transient receptor potential vanilloid (TRPV) and down-regulation of brain-derived neurotrophic factor (BDNF) expression in patients with functional dyspepsia (FD).

The role of immune activation in Functional Dyspepsia (FD) patients without previous infection is unclear. We compare the gastric and circulating brain-derived neurotropic factor (BDNF), receptor potential vanilloid type (TRPV) families and various cytokines in FD patients. Consecutive adult FD patients (Rome III) with no recent history of gastroenteritis and asymptomatic healthy controls were recruited for upper endoscopy. Subjects with GERD and IBS as predominant symptoms, diabetes mellitus, current or previous Helicobacter pylori infection, psychiatric illness and recent use of NSAID or PPI were excluded. Corpus biopsies and serum samples were collected. Forty three [M:F=8:35, mean age: 35.0 (9.3)] FD patients were compared with 23 healthy controls [M:F=8:15, mean age: 36.6 (10.2)]. FD patients had postprandial distress syndrome (PDS) as predominant sub-type (PDS: 36, EPS: 2). There was no significant difference in the median inflammation score (FD:0 (0-1) vs Control:0 (0-1), P=.79). However, FD patients had significantly higher mRNA expression of TRPV1 (FD:0.014±0.007, Control:0.003±0.001, 4.6 fold, P=.02) and TRPV2 (FD:0.012±0.006, Control:0.003±0.001, 4 fold, P=.02) compared to controls. The serum (FD:258.0±12.3ngml-1 , Control:319.7±18.1ngml-1 , P<.01) and gastric BDNF mRNA (FD:0.06±0.008, Control:0.092±0.01, 0.65 fold, P=.02)levels significantly lower in FD patients. Secretion of cytokines (IL-4, IL-5, IL-6, IL-8, IL-10, G-CSF, TGF-β2, MCP-1)was also highly correlated with dyspeptic symptoms in patients with FD. Despite lacking gastric mucosal inflammation, up-regulation of TRPV1 and TRPV2, down-regulation of BDNF were observed in FD patients. These suggest that immune alteration may contribute to the pathogenesis of FD without any previous infection.

Prevalence of overlap syndromes and symptoms in pediatric functional dyspepsia.

BackgroundThe purpose was to evaluate the overlap frequency of irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and overactive bladder syndrome (OBS), as well as other gastrointestinal and systemic symptoms, in functional dyspepsia (FD). Additionally, we sought to determine whether adult Rome III FD subtypes were uniquely related to overlap syndromes or symptoms.MethodsThe study was a retrospective review of 100 consecutive pediatric patients, age 8–17 years, diagnosed with FD. All had completed a standardized medical history including gastrointestinal and systemic symptoms as well as specific symptoms related to GERD and OBS. The frequency of overlap with IBS, GERD, and OBS were determined for the whole group and for those fulfilling adult FD subtype criteria. Individual symptoms were also compared by FD subtype.ResultsOverlap IBS was present in 33 % of the FD patients. At least one GERD symptom was present in 74 % of patients with 41 % reporting heartburn. At least one OBS symptom was present in 44 % of patients with 29 % reporting urinary urgency. Other than pain, the most common reported gastrointestinal symptom was nausea (86 %). Systemic symptoms were common. Overlap syndromes/symptoms did not vary by FD subtype. Postprandial distress syndrome was associated with pain with eating, weight loss, and waking at night to have a stool.ConclusionsFD is a heterogeneous condition in children and adolescents with significant variability in the presence of gastrointestinal and non-gastrointestinal symptoms and overlap syndromes. Varying symptom profiles need to be accounted for and analyzed in studies involving subjects with FD.

Validation of the Portuguese Rome III Questionnaire for Diagnosis of Functional Dyspepsia in adults

Introducao: A validacao de instrumentos e essencial na investigacao epidemiologica, especialmente para a definicao consensual de caso e comparacao de resultados. Atualmente, o instrumento mais utilizado para identificar a dispepsia funcional e o questionario Roma III, o qual nao se encontra validado para a populacao portuguesa. Objetivos: Validar o questionario Roma III para dispepsia funcional em adultos Portugueses. Metodos: O questionario foi traduzido seguindo as recomendacoes de Roma III. Um total de 166 individuos responderam ao questionario. A identificacao da categoria dispepsia funcional em adultos baseou-se em um ou mais sintomas dos 4 sintomas que a escala permite avaliar atraves de 6 itens. A consistencia interna, reprodutibilidade e analise de conteudo foram avaliados com recurso ao SPSS 23.0. Resultados: O coeficiente de alfa de Cronbach no total dos 18 itens avaliados foi de 0.89. Para a categoria dispepsia funcional (avaliada atraves de 6 itens) foi de 0.76 e o alfa de Cronbach com base em itens padronizados foi de 0.85. Conclusoes: validamos, para Portugal, o Questionario Roma III para o diagnostico de doencas gastrointestinais funcionais, designadamente para a categoria dispepsia funcional em adultos. Estes resultados sugerem que este instrumento sera util para a investigacao na populacao Portuguesa.

Duodenal eosinophilia and early satiety in functional dyspepsia: Confirmation of a positive association in an Australian cohort

Functional dyspepsia (FD), defined by unexplained pain or discomfort centered in the upper abdomen, is common. Diagnosis and treatment of FD based on the symptom-based Rome criteria remains challenging. Recently, eosinophilia in the duodenum has been implicated in the pathophysiology of FD in adults, specifically increased eosinophils in early satiety and postprandial distress, but the association remains controversial. The aim of this study was to characterize upper gastrointestinal (GI) tract pathology, specifically duodenal eosinophilia, in an Australian cohort of patients with FD. Patients prospectively referred for an upper GI endoscopy (n = 55; mean age, 49.6 years; 61.8% female) were stratified to FD cases (n = 33) and controls (n = 22) using Rome II criteria. All subjects completed a validated bowel symptom questionnaire. The eosinophil count per square millimeter in the duodenal bulb (D1) and second part (D2) was assessed and Helicobacter pylori status determined by gastric histology. Associations with clinical symptoms were assessed. Cases and controls were demographically similar. Duodenal eosinophilia was significantly increased in subjects experiencing early satiety (P = 0.01) and postprandial fullness (P = 0.001). This association was seen in D2 but not D1. Abdominal pain was associated with eosinophilia in both D1 (P = 0.02) and D2 (P = 0.005). Smoking was also associated with higher eosinophil counts in D2 (P = 0.007) and symptoms of early satiety (P = 0.02). Duodenal eosinophilia occurs in a subset of FD. The potential role of duodenal eosinophils in FD has implications for diagnosis and therapeutic trials.

An epidemiological survey of functional dyspepsia and its relationship with psychological factors in college students of Zhejiang Province

Objective To investigate the prevalence of functional dyspepsia (FD) and its relationship with psychological factors in college students of Zhejiang Province. Methods The students of two colleges in Zhejiang Province were selected.The multi-stage stratified random cluster sampling method was conducted.The Rome Ⅲ adult FD diagnosis questionnaire (ROME Ⅲ-DQ) and psychological symptoms self rating scale questionnaire (SCL-90) was applied in the investigation.The data were analyzed by x2 test and t test.Results A total of 1870 college students of Zhejiang Province were surveyed.The prevalence of FD was 5.78％.The prevalence in female was higher than that in male (7.53 ％ vs 4.14 ％,x2 =9.884,P＜0.05).The prevalence in senior students was highest in all grade (x2 =13.83,P＜0.05).In FD subtypes,postprandial distress syndrome was more than epigastric pain syndrome.The functional constipation and functional defecation disorders were most common in the overlap with other functional gastrointestinal disorders. In SCL-90 questionnaire survey,the scores of each factor of FD group were higher than those of the healthy control group.Conclusions The prevalence of FD was high in the college students of Zhejiang Province. The incidence was correlated with psychological factors. Key words: Dyspepsia; Reference standards; Epidemiology; Psychology, medical

PWE-175 Duodenal eosinophilia and early satiety in functional dyspepsia (FD): confirmation of a positive biomarker association for FD in an Australian Cohort

IntroductionFunctional dyspepsia (FD), defined by unexplained pain or discomfort centred in the upper abdomen, affects 15% of the population. Diagnosis and treatment of FD based on the symptom-based Rome III...

975 Duodenal Eosinophilia and Early Satiety in Functional Dyspepsia (FD): Confirmation of a Positive Biomarker Association for FD in an Australian Cohort

Introduction Functional dyspepsia (FD), defined by unexplained pain or discomfort centred in the upper abdomen, affects 15% of the population. Diagnosis and treatment of FD based on the symptom-based Rome III criteria remains challenging. Recently, subtle eosinophilic inflammation in the duodenum has been implicated in the pathophysiology of FD in adults based on a Swedish case-control study. 1 Specifically, increased eosinophils in early satiety and postprandial distress have been replicated in the UK, 2 in paediatric dyspepsia in the USA 3 and in post-infectious FD in Japan, 4 but the association remains controversial. The aim of this study was to characterise upper gastrointestinal tract pathology in an Australian cohort and correlate this with available clinical data in FD cases and controls. Methods Patients prospectively referred for an upper gastrointestinal endoscopy (n=55; mean age, 49.6 years; 61.8% female) were entered to the study (with informed consent), stratified to FD cases (n=33) and controls (n=22) by Rome II criteria and completed a validated Bowel Symptom Questionnaire. Two blinded independent observers assessed the eosinophil count in five high power fields, in the duodenal bulb (D1) and second part (D2). H pylori status was assessed by gastric histology. Associations with clinical symptoms were assessed by Mann–Whitney U test. Results Cases and controls were demographically similar. There was a significant increase in eosinophils in D1 vs D2 for both cases (p=0.0003) and controls (p=0.008). Abdominal pain was associated with eosinophilia in both D1 (p=0.03) and D2 (p=0.007). Duodenal eosinophilia was significantly increased in subjects experiencing early satiety, (p=0.015). This association remained after exclusion of coeliac disease (n=2) and H pylori (n=9, 16%) (p=0.04) in D2 but not in D1. Subjects who “felt food staying in their stomach” similarly had increased D2 eosinophilia (p=0.002); this remained significant on exclusion of coeliac disease and H pylori (p=0.004). Smoking was also associated with eosinophilia in D2 (p=0.008). Conclusion Data supporting subtle duodenal eosinophilia in subsets of FD has become credible. The potential role of duodenal eosinophils as biomarkers has implications for diagnosis and therapeutic trials. Competing interests None declared.

Cigarette Smoking and its Association with Overlapping Gastroesophageal Reflux Disease, Functional Dyspepsia, or Irritable Bowel Syndrome

Gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and irritable bowel syndrome (IBS) are common gastrointestinal diseases. Several studies have shown a significant occurrence of overlap among these 3 diseases. The purpose of this study was to examine the factors associated with such disease overlap in Japanese adults. We performed a cross-sectional study on Japanese workers who visited a clinic for a routine health check-up and asked them to fill out a self-report questionnaire. GERD was defined as episodes of heartburn and/or acid regurgitation at least once a week, and the diagnosis of FD and IBS was based on Rome III criteria. A logistic regression model was used to identify risk factors, and odds ratio (OR) was calculated with 95% confidence intervals (CIs). Disease overlaps were found in 160 (6.0%) of the 2680 eligible subjects. Female gender was associated with GERD + IBS (OR=1.99; 95% CI, 1.06-3.75), and FD + IBS (OR=1.72; 95% CI, 1.03-2.85), and lower body mass index was negatively associated with FD + IBS (OR=0.54; 96% CI, 0.34-0.87). Cigarette smoking was a common factor associated with the overlaps: GERD + FD (OR=2.14; 95% CI, 1.22-3.76), GERD + IBS (OR=3.16; 95% CI, 1.75-3.71), FD + IBS (OR=2.26; 95% CI, 1.40-3.66), and GERD + FD + IBS (OR=4.08; 95% CI, 1.66-10.07). The associations between smoking habits and overlaps were stronger in smokers who smoked ≥1 pack per day as compared to those who smoked <1 pack per day. Cigarette smoking was significantly associated with overlaps among GERD, FD, and IBS in Japanese adults.

385 Is Duodenal Eosinophilia a Biomarker for Functional Dyspepsia in Adults?

Introduction: Functional dyspepsia (FD) is a common unexplained disorder; abnormalities of duodenal function (e.g. duodeno-gastric reflex abnormalities) have been observed. Increased eosinophil counts in the 1st portion of duodenum have also been reported in FD, and in turn this finding has been associated with early satiety[1]; duodenal eosinophilia may be a biomarker for FD. We aimed to evaluate if duodenal eosinophilia is a biomarker for FD in adults. Methods: A case-control study using the endoscopy database at a major tertiary referral center; consecutive patients undergoing endoscopy and duodenal biopsies (2nd portion) were enrolled. An extensive chart review identified patients with FD by Rome criteria (n=126). Controls were chosen patients with iron deficiency (n= 52), gastroesophageal reflux (n= 4) and constipation (n=1). Information regarding any abuse (yes/no) and life stress (scaled one to five; values > 4 scored as major stress) was obtained. Quantification of the number of eosinophils /high power field (HPF) in 5 HPFs was performed by a single experienced GI histopathologist blinded to diagnosis, chart review and endoscopy. Results: Eosinophil counts were not significantly associated with case-control status after adjusting for age, gender and other potential confounders. The median eosinophil count in cases was 10.9/hpf vs. 8.0/hpf in controls (OR=1.07, 95% CI 0.96-1.3). Taking a normal eosinophil cut-off score as 15 or higher based on population-based normal data [1], there was a numerically greater proportion of subjects with abnormal eosinophil counts in FD cases (38.3%) vs. controls (25.9%) but this was not statistically significant (p=0.11). A total of 27 patients complained of early satiety in the FD group while none of the controls did. Of these 27 patients, 10 had abnormal eosinophil counts and 17 had normal eosinophil counts; there was not an association between early satiety and eosinophil count (p=0.62). FD and eosinophil counts were not associated with a history of asthma, hay fever or nasal polyps (all p>0.64, Wilcoxon rank sum test). Conclusions:We did not detect a significant association between duodenal eosinophilia and FD. Limitations include the lack of biopsies from the 1st portion of duodenum where the yield of eosinophils may be higher [1] and the likely heterogeneous nature of FD. [1]Clin Gastroenterol Hepatol. 2007;5:1175-83.

Impact of rikkunshito, an herbal medicine, on delayed gastric emptying in profoundly handicapped patients

Rikkunshito is used to treat functional dyspepsia in adults. This study investigated the effects of rikkunshito on delayed gastric emptying in handicapped patients. A retrospective review was performed in nine profoundly handicapped patients (aged 1-19 years). All were diagnosed with delayed gastric emptying based on their half gastric emptying time (T(1/2)) over 90 min. Gastric emptying was evaluated after the ingestion of liquid meals using the (13)C-acetate breath test and the BreathID system. Participants were given rikkunshito [0.3 g/(kg day)] with the aim of accelerating gastric emptying. Parameters related to gastric emptying before and during rikkunshito administration were compared using the Wilcoxon signed-rank test. Data were expressed as the median (range). Emesis and hematemesis were relieved with rikkunshito administration in four symptomatic patients. The T(1/2) and T(lag) decreased significantly during rikkunshito administration from 115 min (94-167 min) to 107 min (64-66 min; p = 0.02), and from 60 min (42-90 min) to 47 min (29-59 min; p = 0.03), respectively. The gastric emptying coefficient did not show a significant change [3.1 (2.8-3.8) vs. 3.2 (2.6-4.0), p = 0.15)] with rikkunshito treatment. The administration of rikkunshito resulted in symptomatic relief and improved gastric emptying in profoundly handicapped patients with delayed gastric emptying.