Leeds Dyspepsia Questionnaire Research Articles

The prevalence and severity of upper gastrointestinal complications among patients with chronic diseases: a cross-sectional study from Palestine

BackgroundMany old people have at least one chronic disease. As a result, multiple drugs should be used. Gastrointestinal complications may occur because of the harmful effects of these chronic drugs on the stomach. The study aimed to assess the prevalence of upper gastrointestinal complications in patients taking chronic medications, the severity of these symptoms, and whether they take any gastro-protective drugs or not.MethodologyThis was a cross-sectional study through face-to-face questionnaires from internal outpatient clinics at a specialized hospital. Patients with chronic diseases who were taking at least one chronic medication were included in the study. Data Collection Form was used to gather information. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to evaluate the severity of the upper gastrointestinal symptoms. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21.ResultsA total of 400 patients with chronic diseases and using multiple medications were included. Among them, 53.8% were females and 56% were married, 58.5% were unemployed, 70% were not smokers, the mean age was 54.7 ± 17.5 years. The most common comorbid diseases among the patients were diabetes, hypertension, and arthritis, with percentages of 44.3%, 38%, and 27.3%, respectively. The mean number of chronic medications used was 3.36 ± 1.6 with a range of 1 to 9. The most commonly used was aspirin with a percentage of 50%, followed by atorvastatin, bisoprolol, and insulin with percentages of 29.5%, 25%, and 20.3%, respectively. Among the 400 participants, 362 (90.5%) suffered from upper gastrointestinal side effects like indigestion (65.8%), heartburn (78.3%), nausea (48.8%), and regurgitation (52.0%). Based on SF-LDQ scoring, of the 400 respondents, 235(58.8%), 109(27.3%) and 18(4.5%) suffered from mild, moderate and severe dyspepsia, respectively. A high percentage 325 (81.3%) of participants were prescribed gastro-protective medications. Proton pump inhibitors were the most prescribed group in 209 (52.3%) patients. Dyspepsia was significantly associated with older age (p-value = 0.001), being educated (p-value = 0.031), not being single (p-value < 0.001), having health insurance (p-value = 0.021), being a smoker (p-value = 0.003), and using ≥ 5 medications (p-value < 0.001).ConclusionUpper gastrointestinal complications among patients with chronic diseases were very common. Fortunately, the symptoms were mild in most cases. The risk increased with age and using a higher number of medications. It is important to review patients’ medications and avoid overuse of them, in addition to use gastro-protective agents when needed.

Helicobacter pylori in gastrointestinal manifestation of systemic sclerosis

Aim: To study the prevalence of Helicobacter pylori in systemic sclerosis patients and its gastrointestinal manifestations in comparison with Helicobacter pylori-negative systemic sclerosis patients. Systemic sclerosis gastrointestinal outcome post Helicobacter pylori eradication was evaluated. Method: In total, 70 systemic sclerosis patients and 70 age-, gender- and race-matched healthy controls had their urea breath test done. Gastrointestinal manifestations in systemic sclerosis were assessed using University of California at Los Angeles 2.0 and Leeds Dyspepsia Questionnaire questionnaires. Systemic sclerosis patients with confirmed Helicobacter pylori infection were given standard Helicobacter pylori eradication therapy. Urea breath test was repeated 6 weeks posteradication therapy with their gastrointestinal symptoms reassessed. Results: The prevalence of Helicobacter pylori was low in both systemic sclerosis patients (10%) and healthy controls (2.9%). There was no significant difference in gastrointestinal symptoms between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. However, the Helicobacter pylori-positive patients reported higher median severity scores for the gastrointestinal symptoms of reflux (0.5 vs 0.35), abdominal distension (1.5 vs 0.75) and social functioning impairment score (0.5 vs 0.16) using the University of California at Los Angeles 2.0 score. The Helicobacter pylori-positive patients also indicated increased upper abdominal pain (3.0 vs 0.0), regurgitation (2.0 vs 0.0) and burping (3.0 vs 0.0), observed from the Leeds Dyspepsia Questionnaire scores. Gastrointestinal outcomes post- Helicobacter pylori eradication showed either an improvement or complete resolution of symptoms. Conclusion: Gastrointestinal symptoms in systemic sclerosis patients are unlikely to be caused by Helicobacter pylori in the recent years in our cohort of patients. No significant difference in gastrointestinal symptoms was seen between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. Helicobacter pylori can be readily tested by urea breath test to look for present infection.

Sequential therapy versus quadruple therapy for Helicobacter pylori eradication: A prospective double-blinded randomized controlled trial.

This controlled randomized clinical trial was designed to compare effectiveness, side effects, and severity of symptoms before and after therapy between quadruple (QT) and sequential regimens (SQ) for Helicobacter Pylori (H. pylori). Patients were randomly allocated into two groups. Group A received a 14-day QT including pantoprazole 40 mg q12 h, bismuth subcitrate 240 mg q12 h, clarithromycin 500 mg q12 h, and amoxicillin 1000 mg q12 h and group B received ST including pantoprazole 40 mg q12 h and amoxicillin 1000 mg q12 h for the initial 5 days followed by pantoprazole 40 mg q12 h, clarithromycin 500 mg q12 h and tinidazole 500 mg q12 h for the next 5 days. Adverse drug reactions and patients' compliance were assessed after finishing the treatment course and also 4 weeks after. All patients were naive, therefore ST and QT were first-line therapies. To evaluate severity of symptoms we used Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) before taking the first dose of regimens, at the end of therapy, and also 4 weeks after (follow-up). The mean age in Group A (n = 83) was 48.55 ± 12.56 and 47.24 ± 12.78 in Group B (n = 79). No statistically significant differences were observed between the two groups regarding age, gender, endoscopic findings, and also eradication rate. The analysis demonstrated a significant decrease in SF-LDQ score between baseline and after therapy and baseline and follow-up in both regimen groups. Both regimens were well tolerated by the majority of patients, and there were no significant differences between the two groups in terms of adverse drug reactions. This study showed that ST can be used as an alternative first-line therapy to QT in patients with H. pylori infection.

Stigma and Efficacy of Zhizhu Kuanzhong Capsules Versus Doxepin in the Treatment of Refractory Functional Dyspepsia: A Randomized Controlled Trial.

Stigma related with antidepressants is prevalent in patients with functional dyspepsia. It affects medication compliance and efficacy. Herbal medicine acquired a deep-rooted cultural identity in relieving dyspeptic symptoms in Asians. The research was designed to compare the effectiveness of Zhizhu Kuanzhong capsules (ZZKZ) versus doxepin hydrochloride (doxepin) on alleviating stigma and medication nonadherence among patients with refractory FD (rFD). Patients with rFD from February 2021 to February 2022 were randomly allocated to receive either doxepin (n = 56) or ZZKZ (n = 57) combined with omeprazole for 4 weeks. Medication possession ratio (MPR), the disease- and medication-associated stigma were analyzed. The scales were utilized to assess dyspeptic symptoms (Leeds Dyspepsia Questionnaire) and psychological conditions (Generalized Anxiety Disorder Questionnaire and Patient Health Questionnaire). The MPR values for ZZKZ were significantly higher than those for doxepin (P < 0.001). The stigma scores decreased in ZZKZ group while increased in doxepin group compared to baseline after treatment. The proportion of patients showing ZZKZ-associated stigma was significantly lower than doxepin-associated stigma (P < 0.001). The MPR values were negatively correlated with post-treatment stigma scores in both groups (P < 0.001). Dyspeptic symptoms and psychological condition were improved in both groups after treatment, with no significant difference on post-treatment Leeds Dyspepsia Questionnaire, Generalized Anxiety Disorder Questionnaire, or Patient Health Questionnaire scores between 2 groups. ZZKZ is superior to doxepin in alleviating stigma and medication non-adherence, with comparable efficacy in improving dyspeptic symptoms and psychological condition of patients with rFD.

Clinical, Endoscopic and Histopathological Patterns among Patients with Dyspepsia

Aim: Dyspepsia is a term differently understood, and associated with various upper gastro-intestinal endoscopic and histopathologic patterns. Most patients have regarded upper abdominal pain as ‘peptic ulcer disease’ with resultant late presentation of upper gastro-intestinal malignancies in some cases. This study examined the clinical presentation, endoscopic and histopathological patterns among patients with dyspeptic symptoms in Nnewi, South-East Nigeria.&#x0D; Methods: This hospital based descriptive cross-sectional study examined 352 patients presenting with dyspepsia. Abdominal ultrasound was used to exclude patients with dyspepsia of biliary or pancreatic origin. An interviewer administered questionnaire (using the short form Leeds dyspepsia questionnaire) was used to describe dyspepsia patterns, and gastroscopy done on the included patients following an overnight fast. Samples obtained from endoscopy were assessed histologically for morphology and presence of H. pylori organism.&#x0D; Results: Most participants belonged to 55 to 74 years age group with a mean age of 52.27±2.59 years. Epigastric discomfort (96.9%), heart burn (63.1%) and belching (55.4%) were the commonest symptoms. The commonest endoscopy and histopathologic findings was chronic gastritis (63.06% and 51.99% respectively), although there was poor agreement between the two modalities.&#x0D; Conclusion: Histology remains the goal standard for diagnosis. However, we recommend endoscopy for dyspeptic patients especially in the elderly to enhance early detection of cancers, which were significant in this study.

Dyspeptic Symptoms in Type 2 Diabetes Patients

Background: Nearly half of the patients with diabetes experience diabetic gastroparesis. Some diabetic patients present with complaints of epigastric pain, vomiting, nausea, or postprandial fullness, however only a few have severe symptoms. Objective: To determine the frequency of dyspepsia among T2DM patients. Methods: This cross-sectional study was performed in Ziauddin Hospital Kemari Branch, Karachi, Pakistan after acquiring ethical approval from the hospital ethics committee. Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to identify the presence of dyspepsia. Based on the sum of the frequency of symptoms, a cut-off value of 4 and above was used for the presence of dyspepsia. Results: A total of 368 patients were included in the study with a median age of 68.6 ± 14.2 years. The majority were females (62.8%). The mean duration of diabetes was 15 ± 10.4 years. The frequency of indigestion, heartburn, regurgitation, and nausea was 35.3%, 30.7%, 31.5%, and 11.4% respectively. Out of 368, 168 (45.7%) patients were found to have dyspepsia. The risk of dyspepsia was significantly lower among younger age, male gender, and patients having controlled glycemic status, patients doing physical activity twice a week, taking all three meals on time, and always having their breakfast early. The odds of having dyspepsia were higher among those who are currently and formerly addicted to alcohol, current and former smokers, having comorbidity, consuming &lt;8 glasses of water per day, and those who were always or sometimes sleeping within two hours of having dinner. Conclusion: This study analyzed that dyspeptic symptoms including indigestion, heartburn, and regurgitation were common in T2DM patients, and about half of these patients had dyspepsia which was common among patients with poor glycemic control and those with unhealthy lifestyles.

Correlation of Dyspepsia with the type of First Meal of the Day; Breakfast or Brunch: A Cross-Sectional Study from Karachi Pakistan

Background: Breakfast skipping is traditionally viewed as a bad habit. The customary choice for those who skip breakfast is brunch. Changes in gastrointestinal function are correlated with a range of dietary factors. Objective: To evaluate the correlation of the type of first meal of the day with dyspepsia among patients visiting gastroenterology clinics with dyspeptic symptoms. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, Liaquat National Hospital from August 2021 to April 2022. Short-Form Leeds Dyspepsia Questionnaire was used to identify the presence of dyspepsia (SF-LDQ). Breakfast was defined as the meal consumed in the morning and any beverages or food taken in the morning before 11:00 a.m. regularly in a week. Data were analyzed using the statistical package SPSS version 21. Results: A total sample of 390 patients were analyzed in this study with median age and duration of symptoms 35 (IQR=26-42) years 12 (IQR=8-24) months respectively. The frequency of breakfast skipping was 15.6%. The frequency of dyspeptic symptoms including indigestion, heartburn, regurgitation, and nausea was significantly higher among patients taking brunch as the first meal of the day than those who were having breakfast regularly. The frequency of dyspepsia was 75.1%. On univariate and multivariable analysis, the practice of consuming breakfast regularly was found to be associated with a lower risk of dyspepsia than those who were consuming brunch as the first meal of the day. Conclusion: The current study analyzed that type of first meal was significantly associated with dyspepsia. The frequency of dyspeptic symptoms was significantly higher among patients taking brunch at least once a week than patients who were regularly consuming breakfast.

Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial.

Long-course (LC) antidepressants for the treatment of disorders of gut-brain interaction, such as refractory functional dyspepsia (rFD), pose patients at risk of antidepressant discontinuation syndrome (ADS). Short-course (SC) therapy of rapid-acting antidepressant may reduce discontinuation syndromes while maintaining efficacy for dyspeptic symptoms. However, the evidence-based research is lacking. This study aims to determine whether SC therapy with antidepressants could decrease the risk of ADS with comparable treatment efficacy to LC therapy in rFD. This randomized clinical trial with rFD patients was conducted at a tertiary hospital in China. Participants (N = 240) were randomly allocated to receive flupentixol-melitracen (FM) plus omeprazole therapy for 2 (SC group) or 4 (LC group) weeks, respectively. Scores for Leeds Dyspepsia Questionnaire (LDQ), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 for Depression (PHQ-9) were assessed at baseline and every 2 weeks, ending at 4 weeks after treatment. ADS was assessed after drug cessation. Medication possession ratio (MPR) for FM was calculated. The severity and incidence of ADS of patients in SC group were significantly lower than those in LC group (0.60 ± 0.62 vs. 1.71 ± 1.58 and 3.64 vs. 39.45%; both P < 0.0001). The MPR values for FM were significantly higher in patients of SC group than in LC group (P < 0.0001). Scores for LDQ, GAD-7 and PHQ-9 decreased in patients of both groups, and the symptom improvement in SC group was comparable to that in LC group after treatment. Compared to 4-week FM therapy, the 2-week FM therapy reduces the risk of ADS with non-inferior treatment efficacy in patients with rFD. Clinical trials.gov, identifier NCT05099913.

Therapeutic effects and central mechanism of acupuncture and moxibustion for treating functional dyspepsia: study protocol for an fMRI-based randomized controlled trial

BackgroundFunctional dyspepsia (FD) is one of the most common functional gastrointestinal disorders, with a high prevalence and significant influence on the quality of life (QoL). Either acupuncture or moxibustion is effective for dyspepsia, which is confirmed by both ancient documents and modern research. However, the therapeutic advantage and underlying mechanism between acupuncture and moxibustion for FD remain unclear.MethodsThis randomized controlled fMRI trial aims to (i) evaluate the therapeutic advantages of acupuncture and moxibustion treatment for FD, (ii) investigate the similarities and differences in cerebral activity elicited by acupuncture and moxibustion, and (iii) analyze the possible correlations between brain responses and clinical variables thus to explore the potential central mechanism of acupuncture and moxibustion for treating FD. Ninety-two FD patients will be randomly assigned to either the acupuncture group or the moxibustion group in a 1:1 ratio. Twenty sessions of acupuncture or moxibustion treatment over 4 weeks will be performed on each patient. The short form Leeds Dyspepsia Questionnaire, the Nepean Dyspepsia Index, etc., are used to evaluate the therapeutic effects. The heart rate variability will be analyzed to investigate the autonomic nerve function. Thirty-six FD patients in each group will be randomly selected for the fMRI scan to detect cerebral activity changes.DiscussionWe expect the results will deepen our knowledge on the clinical value and underlying mechanism of acupuncture and moxibustion and provide a reference for a better selection of interventions for treating FD.Trial registrationChinese Clinical Trial Registry (www.chictr.org.cn) ChiCTR2100049496. Registered on 2 August 2021

Personality traits in headache patients with and without dyspepsia

Background &amp; Objectives: Personality trait plays an important role in determining the various presentations of tension-type headache (TTH) and migraine. The primary objective of this study was to evaluate the types of personality traits present among patients with migraine and TTH. The secondary objective was to determine whether the patients with headache and coexisting dyspepsia had different personality traits from the patients with headache alone without dyspepsia. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from February 2017 until March 2020. Patients who fulfilled the diagnostic criteria for migraine and TTH according to the International Headache Society (IHS) classification were recruited. The patients’ personality traits were evaluated using the Minnesota Multiphasic Personality Inventory-2-restructured Form (MMPI- 2-RF). The MMPI Personality Psychopathology-Five (PSY-5) Scales, comprising aggressiveness, psychoticism, disconstraint, neuroticism, and introversion were used. The presence of dyspepsia was diagnosed using the Leeds Dyspepsia Questionnaire. Results: There were no statistically significant differences when comparing types of personality traits between migraine and TTH patients. On univariate analysis, headache with dyspepsia was significantly associated with more neuroticism as compared to headache alone (p=0.027). On logistic regression, TTH with dyspepsia was significantly associated with neuroticism (p=0.024, OR=6.921). Psychoticism was significantly associated with chronic daily headache (p=0.001, OR=7.476). Aggression was significantly associated with male gender (p=0.018, OR= 7.580). Conclusion: Headache with coexistent dyspepsia was associated with more neuroticism as compared to headache alone. In particular, TTH with coexistent dyspepsia was significantly associated with neuroticism compared to TTH without dyspepsia.

A34 GLUTEN-FREE DIET IMPROVES DYSPEPTIC SYMPTOMS IN PATIENTS WITH TYPE 1 DIABETES IN WHOM CELIAC DISEASE WAS EXCLUDED

BackgroundPatients with type 1 Diabetes Mellitus (T1DM) often suffer from dyspeptic symptoms, such as abdominal pain, bloating, early satiety, nausea and vomiting. T1DM shares genetic risk factors (HLA-DQ2 and DQ8) with celiac disease, an autoimmune disorder caused by an immune reaction to gluten. Patients with concomitant T1DM and celiac disease benefit from a gluten-free diet (GFD), as it improves their symptoms, gastric emptying and small intestinal inflammation. However, it is unknown whether GFD has any benefit in patients with T1DM without celiac disease, who present with symptoms of dyspepsia or gastroparesis.AimsTo investigate the role of a GFD in the management of moderate to severe dyspeptic symptoms in non-celiac patients with T1DM.MethodsWe enrolled 13 adult T1DM patients, in whom celiac disease was ruled out, suffering from two or more upper GI symptoms. The patients were instructed to adhere to a strict GFD for a period of 1 month, under the supervision of a dietitian. Glycemic levels were monitored by a continuous glucose monitoring device (CGM) for 2 weeks before, and at the end of the GFD period. Standardized questionnaires were used to assess upper GI symptoms (Gastroparesis Cardinal Symptoms Index, Short Form Leeds Dyspepsia questionnaire), general quality of life (Patient Assessment of Upper GI Disorders Quality of Life), and anxiety and depression (Hospital Anxiety Depression scale). Blood samples were collected to assess glycaemia (Hb1Ac) and immune markers. Scintigraphy and videofluoroscopy were used to assess gastric emptying.ResultsAfter one month on a GFD, T1DM patients reported a significant improvement in nausea (p<0.05), sensation of fullness (p<0.001) and bloating (p<0.0001). Overall dyspepsia symptoms also improved (p<0.01), with 92% of patients reporting decreased dyspepsia scores. Moreover, there was an improvement in the quality of life (p<0.01), and decreased scores of anxiety and depression (p<0.01 and p<0.05, respectively). There were no changes in gastric emptying or glycemic management metrics, such as mean glucose level, time in target, glucose variance or HbA1c levels. Interestingly, one year after the end of the study, 63.6% of participants continued to follow a GFD. The most common reason to remain on a GFD reported by these patients was “because it improved GI symptoms”. Questionnaire data collected at the follow-up demonstrated that the improvement of dyspeptic symptoms persisted after 1 year on GFD (p<0.001).ConclusionsGFD improves dyspeptic symptoms in T1D patients without concomitant celiac disease, without affecting their glycemic levels or gastric emptying. Although these results need to be validated in a larger study, our data suggest that GFD could be used as a therapeutical tool for T1DM patients grappling with burdensome upper GI symptoms. Gluten-Free diet improves dyspepsia symptoms in Type 1 Diabetes patients, after 1 month and 1 yearFunding AgenciesCIHR

Management of Dyspepsia with Enterica®, Dyspepsia® and Natural Pain Killer® herbal-combination at the Centre for Plant Medicine Research Clinic, Ghana

IntroductionThis observational study validated the efficacy of a combination of three herbal preparations (Mist Dyspepsia®, Mist Enterica®, and Natural Pain Killer® (NPK)) in patients with symptoms of dyspepsia who visited the Clinic of the Centre for Plant Medicine Research (CPMR), Mampong-Akuapem, Ghana. MethodThe Short Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to assess the presence, severity, frequency, and the most troublesome symptoms in patients diagnosed with dyspepsia at the CPMR Clinic. The patients were put on Dyspepsia®, Enterica®, and Natural Pain Killer® (NPK). ResultsA total of 162 patients were enrolled in the study. This included a hundred and seven (107, 66%) females and fifty-five (55, 34%) males with a mean age of 36.79 years. The Cronbach’s alpha reliability test value was 0.74 indicating the reliability of the SF-LDQ. The prevalence rate of dyspepsia among the study participants on the day of recruitment was 98.7% (160/162). Almost 80% of study participants were classified as having severe or moderate dyspepsia. The presence or absence of Helicobacter pylori infections did not affect the dyspepsia severity. The most troublesome dyspeptic symptom was indigestion. There was a significant reduction in the severity of dyspepsia at the end of the study (p = 0.001) with no serious side effects. ConclusionDyspeptic patients at the CPMR-Clinic had improved symptoms as indicated by the reduction in the frequency and severity after treatment with the combination of Mist Dyspepsia®, Mist Enterica®, and Natural Pain Killer® (NPK).

Effectiveness of Buspirone in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study.

BACKGROUND Functional dyspepsia (FD) is a relatively common disorder whose pathogenesis has yet been poorly understood. There are still debates concerning definitions and the best possible treatments for this disorder. We aimed to assess the effectiveness of buspirone, a 5-hydroxytryptamine (HT)1A agonist, in improving the symptoms and quality of life (QoL) as well as psychological dimensions in patients with FD. METHODS This study was a randomized, double-blinded, placebo-controlled trial performed on 30 patients with FD, residing in the city of Sari, northern Iran, from December 2017 to October 2018. Consecutive patients referring to a tertiary hospital with a clinical diagnosis of FD, according to the Rome IV criteria, were recruited. All patients were ethnically Persian and had normal upper endoscopy and negative histological evaluation results for any gastrointestinal disease or helicobacter pylori (H. pylori) infection while evaluating biopsy samples endoscopically. Exclusion criteria were being diagnosed with major psychiatric disorders, suicidal thoughts, recent treatments with psychoactive drugs, as well as major cognitive impairments. Patients were randomly assigned to receive either buspirone (n=18) or placebo (n=12) for two months. The first group received buspirone 5mg three times a day for the first month and 10mg three times a day for the second month. During the treatment course, the patients were advised to report any adverse reactions. Also, both groups were evaluated by three questionnaires [demographic characteristics form, the 36-Item Short-Form Health Survey (SF-36), The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) and Hospital Anxiety and Depression Scale(HADS)] at the baseline and at the end of the 8th week by a blinded psychologist. Finally, data were analyzed using SPSS software (version 18). P values <0.05 were considered statistically significant. RESULTS The most common symptoms of the patients were FD followed by heartburn. No significant differences were observed between buspirone and placebo groups regarding QoL (p=0.58), anxiety and depression (p =0.36), and severity and frequency of FD symptoms (p =0.22) before and after the intervention. In both groups, the overall QoL as well as HADS and SF-LDQ scores had significantly improved at the end of the study compared with the baseline. CONCLUSION Our findings indicate no significant effects associated with buspirone on the clinical course of FD, compared with placebo. More studies are needed to introduce effective therapies according to the pathophysiology of FD.

Validation of the Arabic version of the Short Form Leed's Dyspepsia Index (SF-LDQ) amongst patients with type II diabetes

Since an unambiguous clinical definition of dyspepsia does not currently exist, the diagnosis is made on the basis of symptoms. For this purpose, a tool which is valid, reliable and convenient to use is needed that can accurately assess both frequency and severity of dyspepsia. Short-Form Leeds Dyspepsia Questionnaire meets all of these requirements and thus, has to be validated in native languages before it can be used to diagnose dyspepsia. We conducted a cross-sectional study at King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia. Adult patients with type II diabetes were recruited in the study after giving informed consent. A total of 245 patients were recruited in the study; 95 (38.8%) were males, while 149 (61.1%) were females. We found that 27.3% (n = 67) of the participants had dyspepsia according to the SF-LDQ Arabic version compared to 24.1% (n = 59) by physician's diagnosis. The Area Under the Curve was 0.86 (95% CI: 0.81–0.9). At a cut-off value of 7/32, the tool has a sensitivity of 69.49% and a specificity of 83.24%. In conclusion, The Short-Form Leeds Dyspepsia Questionnaire was found to be valid for assessment of frequency and severity of dyspepsia among Arab diabetes Type 2 patients.

Acupuncture therapy with point selection based on syndrome differentiation along the meridians for functional dyspepsia: a randomized controlled trial

To observe the difference in clinical efficacy between acupuncture with point selection based on syndrome differentiation along the meridians and acupuncture at non-meridian and non-acupoint points for functional dyspepsia (FD). A total of 74 FD patients were randomized into an observation group and a control group, with 37 cases in each group. Both groups received acupuncture treatment. Zusanli (ST 36) and Neiguan (PC 6) were selected in the observation group, with Taichong (LR 3) and Neiting (ST 44) added for excess syndrome, and Gongsun (SP 4) and Yinlingquan (SP 9) added for deficiency syndrome. Four non-meridian and non-acupoint points were selected in the control group. The treatments in both groups were performed once a day with a 2-day break after 5 consecutive treatments, which constituted one treatment course. A total of 4 courses were performed. The scores of Nepean dyspepsia index (NDI) and Leeds dyspepsia questionnaire (LDQ) were recorded before and after treatment, and during follow-up (8, 12, 16, 20 and 24 weeks after recruitment) to assess the clinical efficacy. The NDI scores in the two groups after treatment and at each time point during follow-up were higher than those before treatment (all P<0.05), and the LDQ scores were lower than those before treatment (all P<0.05). The NDI scores after treatment and at each time point during follow-up in the observation group were higher than those in the control group (all P<0.01); the total LDQ score and scores of upper abdominal pain, postprandial satiety and upper abdominal burning sensation after treatment and at each time point during follow-up in the observation group were significantly lower than those in the control group (P<0.01 or P<0.05). Acupuncture with point selection based on syndrome differentiation along the meridians has a better curative effect than acupuncture at non meridian and non-acupoint points in the treatment of FD.

Efficacy and Safety of Fingerroot (Boesenbergia rotunda) Extract in Patients with Functional Dyspepsia: A Randomized, Placebo-Controlled Trial

Background: Functional dyspepsia (FD) is a common upper gastrointestinal disorder, but the current treatments are still unsatisfactory. Fingerroot (Boesenbergia rotunda [L.] Mansf.; BR) is used as a traditional medicine for dyspepsia despite a lack of proven evidence. Objective: This study aimed to evaluate the efficacy and safety of BR extract in the treatment of patients with FD. Methods: In a randomized, double-blinded, placebo-controlled trial, 160 patients with FD based on Rome IV criteria were to be recruited and randomly assigned (1:1 ratio) to receive BR (350 mg extract powder) or placebo 3 times daily for 4 weeks. Primary end point was change in the summed total score of Short-Form Leeds Dyspepsia Questionnaire. Secondary end points were the rate of symptom relief, the reduction of blood inflammatory markers and the improvement in gastric histology according to the Updated Sydney System. Results: One hundred sixty patients (62 [38.8%] men, aged 56.9 ± 14.8 years) were randomized to the BR group (n = 80) and placebo group (n = 80), and 138 patients completed this study. Overall symptom improvement was significantly greater in the BR group than in the placebo group (−7.1 ± 2.0 vs. −3.7 ± 0.8, repeated measures ANOVA, p < 0.05). Total symptom scores significantly improved with decrease in blood inflammatory markers in the BR group compared with the placebo group (p < 0.05). Proportion of responders was higher in the BR group (58%) than in the placebo group (34.6%) according to the intention-to-treat analysis (p < 0.05) with the number needed to treat calculated as 4.3. No difference in gastric histology was observed in both groups. BR extract was well tolerated with few adverse events. These effects were associated with acute phase reactants reduction. Conclusions: BR extract represents an effective and safe alternative to manage dyspepsia symptoms in FD patients.

Helicobacter pylori Eradication in Parkinson's Disease: A Randomized Placebo‐Controlled Trial

Helicobacter pylori (HP) infection has been associated with worse motor function in Parkinson's disease (PD). We aimed to evaluate the effects of HP eradication on PD symptoms. In this parallel-group, double-blind, randomized placebo-controlled, single-center trial, patients with PD with positive HP urea breath test and serology were block randomized (1:1) to receive standard eradication triple therapy or identically appearing placebo capsules for 1 week. Prespecified motor (International Parkinson and Movement Disorder Society Unified PD Rating Scale [MDS-UPDRS], timed tests, and home-based wearable sensor measurements), nonmotor (Leeds Dyspepsia Questionnaire and Montreal Cognitive Assessment), and quality-of-life (Parkinson's Disease Questionnaire-39) outcome measures were assessed at weeks 6, 12, 24, and 52. The primary outcome was the baseline-to-week 12 change in ON medication MDS-UPDRS motor scores. Lactulose-hydrogen breath testing for concomitant small intestinal bacterial overgrowth was performed at baseline and repeated at week 24, together with the urea breath test. A total of 310 patients were screened for eligibility and 80 were randomly assigned, of whom 67 were included in the full-analysis set (32 treatment group patients, 35 placebo patients). HP eradication did not improve MDS-UPDRS motor scores at week 12 (mean difference 2.6 points in favor of placebo, 95% confidence interval: -0.4 to 5.6, P = 0.089). There was no significant improvement in any motor, nonmotor, or quality-of-life outcome at weeks 12 and 52. Both the full-analysis and per-protocol analyses (based on eradication status) supported these conclusions. Small intestinal bacterial overgrowth status did not influence treatment results. HP eradication does not improve clinical outcomes in PD, suggesting that there is no justification for routine HP screening or eradication with the goal of improving PD symptoms. © 2020 International Parkinson and Movement Disorder Society.

Prevalence and severity of dyspepsia in Saudi Arabia: A survey-based study

Background and aimDyspepsia is one of the gastrointestinal diseases that is very common worldwide. Despite its prevalence globally, which ranges between 1.8% and 57%, no study has assessed the prevalence in Saudi Arabia. This study was aimed to investigate the prevalence and severity of dyspepsia in the general population of Saudi Arabia. MethodsA modified Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was utilized to conduct our study. The questionnaire score ranges between 0 and 32, where zero indicated no dyspepsia, a score of 1–8 indicated mild dyspepsia, a score of 9–15 indicated moderate dyspepsia and a score of higher than 15 represented severe dyspepsia. Socio-demographic data of the participants including age, gender, marital status, BMI, job description, insurance, and education level were collected. Using Statistical Package for Social Sciences version 21.0 (SPSS), a univariate analysis was performed to assess the association of participants characteristics with the prevalence of dyspepsia, whereas logistic regression analysis was used to correlate their characteristics with the severity of dyspepsia. ResultsDuring a period of one month, March 1st to 31st 2019, a total of 778 participants have completed the survey. Most of them were females accounting for 68% of the population, married (63.9%), middle aged (range 34–51 years old) and literate with high school education (72.3%). Ninety two percent (92%) of the study population were found to experience dyspepsia. However, there is no significant association between socio-demographic characteristics and dyspepsia or its severity as well. ConclusionThe prevalence of dyspepsia in Saudi Arabia is the highest in the gulf region which would potentially lead to more GI complications, and associate to poor health and economic outcomes. Education programs are essential to raise the people awareness of dyspepsia and the appropriate ways to prevent it.

Prevalence and sociodemographic determinants of dyspepsia in the general population of Rwanda.

IntroductionDyspepsia accounts for a significant burden of worldwide disease, but there is a relative paucity of data from the sub-Saharan African setting. We undertook to describe the burden, risk factors and severity of dyspepsia across Rwanda.MethodsWe performed a population-based clustered cross-sectional survey between November 2015 and January 2016, nationwide in Rwanda, using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia, and the Short Form Nepean Dyspepsia Index to describe the concomitant quality of life effects. Univariate and multivariate logistic regression models were constructed to correlate measured sociodemographic factors with dyspepsia.ResultsThe prevalence of clinically significant dyspepsia in the general Rwandan population was 14.2% (283/2000). The univariate factors that significantly predicted severity were gender, profession, socioeconomic status, and non-steroidal anti-inflammatory drug, aspirin and alcohol use, with gender, current smoking, aspirin use both in the past and currently, and alcohol use in the past remaining significant on multivariate modelling. Dyspeptics had a significantly lower gastrointestinal-related quality of life, though the sociodemographic factors measured did not modify the observed quality of life.ConclusionDyspepsia is prevalent in the Rwandan setting and is associated with a significant burden on quality of life. More work is required to determine the pathological entities involved, and the optimal approach to mitigating this burden.

Herbal formula improves upper and lower gastrointestinal symptoms and gut health in Australian adults with digestive disorders

Gastrointestinal (GI) problems affect half of Western populations. Symptoms can vary from frequent reflux to irritable bowel syndrome. The Nutrition Care (NC) Gut Relief Formula contains a combination of herbs and nutrients including curcumin, Aloe vera, slippery elm, guar gum, pectin, peppermint oil, and glutamine shown to benefit the GI system. The 16-week pre-post study tested the hypothesis that the NC Gut Relief Formula would be tolerable and effective in improving GI symptoms and gut health in adults with digestive disorders. A total of 43 participants completed the study. After a control phase, participants took 5 g/d and then 10 g/d of the formula for 4 weeks. GI symptoms and GI health were assessed by a series of validated questionnaires, for example, Leeds Dyspepsia Questionnaire, Bristol Stool Chart, Birmingham IBS Symptom Questionnaire, and by intestinal permeability and gut microbiota profile. The NC Gut Relief Formula significantly improved the frequency and severity of upper and lower GI symptoms by 60%-80%, including indigestion, heartburn, nausea, constipation or diarrhea, abdominal pain, and troublesome flatulence, and significantly improved physical functioning, energy levels, mood, and sleep by 60%-80%. All participants with normal stool, 90% with hard stool, and 66% with soft stool recovered from intestinal permeability, evident by normal lactulose to mannitol ratios. The NC Gut Relief Formula generally improved microbial profile, with a marked increase in Lactobacillus, Clostridium, and Faecalibacterium prausnitzii. Almost half of the participants with upper GI symptoms taking proton pump inhibitors for heartburn no longer required proton pump inhibitors at the end of the study. A third of participants were able to reintroduce food triggers, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols garlic, onion, and beans, or reflux-causing acidic/spicy foods, for example, citrus, tomato, and caffeine, in their diet after 3 months without symptom aggravation. The NC Gut Relief Formula significantly improved GI symptoms and associated quality of life over 3 months while reducing intestinal permeability, improving the microbial profile, reducing the need for reflux medication, and enabling the consumption of previous food triggers.