Postprandial Distress Syndrome Research Articles

Functional dyspepsia: How to manage the burn and the bloat.

Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.

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

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

Functional gastrointestinal disorders, quality of life, and behaviour in adolescents with history of infant colic.

To assess the prevalence of functional gastrointestinal disorders (FGIDs), health-related quality of life (HRQOL), and behavioural problems in a cohort of adolescents with a history of infant colic (IC), as defined by Wessel's criteria. 388 adolescents, aged 15-18 years, who participated in a randomised controlled trial for infants with colic, were invited for our observational follow-up study. Prevalence of FGIDs was assessed with the Rome IV Questionnaire on Paediatric Gastrointestinal Disorders (RIV-QPGD), HRQOL through self-report of the Paediatric Quality of Life Inventory (PedsQL), and behavioural problems through parent-report of the child behaviour checklist (CBCL). Multivariable models were used to compare prevalence rates of FGIDs and HRQOL scores. 190 (49%) adolescents with a history of IC (cases) and 381 controls were included (median age 17.0 [IQR 16.0-17.0] and 16.0 [15.0-17.0] years, respectively). Cases had a significantly higher risk for postprandial distress syndrome compared to controls (aOR 2.49 (95%CI 1.18-5.25), p = 0.002). After multivariable regression, total, physical and school HRQOL scores were significantly lower in cases compared to controls (p = 0.003, 0.001, and 0.009). Adolescents with a history of IC demonstrate higher prevalence rates of postprandial distress syndrome compared to controls. However, conclusions should be made with caution due to attrition and information bias.

Dynamics of the level of hormones-regulators of gastric motility when drinking low-mineralized water

Purpose of the study: To assess the effect of low-mineralized sulfate-chloride-sodium mineral water (MW) on the level of motilin and cholecystokinin in the blood in functional dyspepsia and in healthy people. Materials and methods. 180 people aged 22.3±0.21 years were examined, divided into 3 groups: patients with postprandial distress syndrome (PDS) (62 people), patients with epigastric pain syndrome (EPS) (62 people), practically healthy (56 people). The severity of gastroenterological symptoms was determined using the GSRS questionnaire. In all examined patients, the concentrations of motilin and cholecystokinin in the blood were determined initially and after a single dose of 200 ml of MW. Results. The initial concentration of motilin in the blood of patients with EPS (8584,0 [7951,0; 9807,0] pg/ml) was lower than in patients with PDS (9876,0 [9340,0; 10219,0] pg/ml, p=0,000) and healthy (9779,5 [9230,0; 10027,0] pg/ml, p=0,000). The intake of MW in healthy people did not cause changes in the concentration of motilin in the blood (p=0,352), in patients with PDS it led to a decrease in its level (p=0,000), and to an increase in EPS (p=0,000). The initial level of cholecystokinin in the blood of patients with EPS (187,7 [124,0; 230,1] pg/ml) was higher (p=0,008), and in those examined with PDS (123,3 [83,5; 143,2 ] pg/ml) is lower (p=0,000) than in healthy people (145,3 [107,1; 186,2] pg/ml). MW intake led to an increase in its concentration in all three groups: healthy (p=0,014), patients with PDS (p=0,000) and EPS (p=0,000). Conclusion. Peculiarities of the dynamics of the level of motilin and cholecystokinin in the blood of patients with PDS, EPS and healthy people when taking low-mineralized sulfate-chloride-sodium MW, which must be taken into account when developing schemes for drinking balneotherapy for functional pathology of the stomach, were revealed.

The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

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

Clinical Trial: Efficacy of Mosapride Controlled-release and Nortriptyline in Patients With Functional Dyspepsia: A Multicenter, Double-placebo, Double-blinded, Randomized Controlled, Parallel Clinical Study.

Prokinetic agents and neuromodulators are among the treatment options for functional dyspepsia (FD), but their comparative efficacy is unclear. We aimed to compare the efficacy of mosapride controlled-release (CR) and nortriptyline in patients with FD after 4 weeks of treatment. Participants with FD were randomly assigned (1:1) to receive mosapride CR (mosapride CR 15 mg and nortriptyline placebo) or nortriptyline (mosapride CR placebo and nortriptyline 10 mg) in double-placebo, double-blinded, randomized controlled, parallel clinical study. The primary endpoint was defined as the proportion of patients with overall dyspepsia improvement after 4 weeks treatment. The secondary endpoints were changes in individual symptom scores, anxiety, depression, and quality of life. One hundred nine participants were recruited and assessed for eligibility, and 54 in the mosapride CR group and 50 in the nortriptyline group were included in the modified intention-to-treat protocol. The rate of overall dyspepsia improvement was similar between groups (53.7% vs 54.0%, P = 0.976). There was no difference in the efficacy of mosapride CR and nortriptyline in a subgroup analysis by FD subtype (59.3% vs 52.5% in postprandial distress syndrome, P = 0.615; 44.4% vs 40.0% in epigastric pain syndrome, P = > 0.999; 50.0% vs 59.1% in overlap, P = 0.565; respectively). Both treatments significantly improved anxiety, depression, and quality of life from baseline. Mosapride CR and nortriptyline showed similar efficacy in patients with FD regardless of the subtype. Both treatments could be equally helpful for improving quality of life and psychological well-being while also relieving dyspepsia.

Understanding functional dyspepsia and its subtypes and the role of prokinetics in its management: a cross-sectional clinician-based survey

Background: This survey evaluated opinions of consulting physicians or gastroenterologists on functional dyspepsia (FD) in the Indian population and the management of FD with prokinetics, especially itopride. Methods: A total of 243 clinicians involved in the clinical practice of FD were invited to complete an internet-based, structured survey questionnaire. Questionnaire comprised 29 questions on the diagnosis and treatment options for FD. Results: Majority of the clinicians opined that females were more affected by FD than males in both hospital-based (53.4%) and community-based (56.6%) practices. As per 33.3% of clinicians each, the age group of 21-40 years and 41-60 years were the two most commonly affected groups. FD symptoms were present for >6 months before patients seek consultation as reported by 62.6% of the clinicians. The participating clinicians preferred using detailed patient history (77.7%) and ROME IV criteria (71.1%) for diagnosing FD. Prokinetics were regarded as the therapy of choice primarily because of their efficacy in reducing FD symptoms. Among all prokinetics used, itopride was most preferred for postprandial distress syndrome (64.2% clinicians) and for epigastric pain syndrome in combination with PPIs (66.7% clinicians). Itopride was reported by 93.6% clinicians to be well tolerated, with the leading advantage being absence of extrapyramidal or cardiac side effects according to 40% of clinicians. Conclusions: The clinicians considered itopride to be most preferred to reduce FD symptoms and to be well-tolerated when taken alone or in combination with PPIs.

Functional dyspepsia: modern pathogenetic aspects and therapeutic approaches

Functional dyspepsia, affecting up to 20% of individuals worldwide, remains both a cause of decreased activity of patients’ daily life and an obvious economic burden due to healthcare costs. Despite extensive research, the etiology of dyspepsia is unknown in most patients. Intestinal motility dysfunction has long been considered the major culprit, but recent studies suggest that immune pathophysiological and molecular effects in the duodenum are far more likely predisposing factors. Eosinophilia and an increase in mast cells in both the duodenum and gastric mucosa are identified in most patients with this disease. More and more data on the significant role of impaired paracellular permeability of the intestinal mucosa are now available. It is associated with subclinical inflammation in the submucosal layer in patients with functional dyspepsia. This explains the poor effectiveness of the treatments taken. The evidence from practice suggests that symptoms persist or return after eradication therapy in most patients. Proton pump inhibitors and antidepressants do not ease postprandial distress syndrome. Montelukast and cromolyn therapy has been proposed, but this approach is not yet widely popular. Therefore, there is an obvious need in finding other therapeutic approaches. One of them is the increased use of prokinetics, the most recent of which is acotiamide. Its mechanism of action is similar to that of prior generation prokinetics (inhibition of acetylcholinesterase activity), but is distinguished by the absence of impact on dopaminergy, due to which the drug has far fewer side effects. In addition, its effect on the production of ghrelin, which physiological role is being actively studied, is discussed.

Treatment of functional dyspepsia in Chinese adult patients with domperidone: A multicenter, randomized, double-blind, placebo-controlled pilot study.

This pilot study aimed to evaluate the efficacy and safety of domperidone for the treatment of Chinese patients with functional dyspepsia (FD) who were diagnosed according to the Rome IV criteria and to identify the FD subtypes that potentially responded better to domperidone. This multicenter prospective study was conducted in China from August 2018 to July 2020, consisting of a 1-week screening phase and a 2-week double-blind treatment phase. Participants were randomized to receive domperidone 10 mg or matching placebo tablets thrice daily for 14 days. The primary end-point was the overall treatment effect (OTE) response rate after 2-week therapy. Altogether 160 patients were included, with 80 patients in each group. The OTE response rate after 2-week therapy was significantly higher for domperidone compared with placebo (60.7% vs 46.0%; relative risk [RR] 1.318, 95% confidence interval [CI] 0.972-1.787). Moreover, the OTE response rate after 2-week domperidone or placebo treatment was 60.3% versus 54.9% for postprandial distress syndrome (PDS) (RR 1.098, 95% CI 0.750-1.607) and 60.6% versus 35.2% for overlapping PDS-epigastric pain syndrome (EPS) (RR 1.722, 95% CI 0.995-2.980). Adverse events were reported by seven patients in the domperidone group and 12 patients in the placebo group. None of the adverse events in the domperidone group were serious. Domperidone showed a positive pattern regarding OTE response rates after 2-week therapy compared to placebo in patients with FD, as well as in subtypes of PDS and overlapping PDS-EPS. No new safety issue was observed.

Impaired gastric accommodation in patients with postprandial distress syndrome type of functional dyspepsia assessed by 2D ultrasonography.

The pathophysiology of postprandial distress syndrome includes impaired gastric accommodation, hypersensitivity to gastric distension and delayed gastric emptying. 2D-ultrasonography is one of the methods to assess gastric accommodation by measuring proximal gastric area and we evaluated its role in calculating proximal gastric area and thus assessing gastric accommodation in Indian patients with postprandial distress syndrome. In a hospital-based comparative analysis, proximal gastric area was measured with 2D-ultrasonography of postprandial distress syndrome(PDS) patients and compared with healthy controls. Five readings were measured every fiveminutes till 25minutes after 400mL of vegetable soup. The Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL score) and diets aggravating PDS symptoms were studied through detailed questionnaires. Sample size was calculated at 80% study power and alpha error of 0.05 to be 30 subjects in each group. The mean age of patients (18 males) vs. 30 healthy controls (25 males) was 40.8 ± 11.50years vs. 36.37 ± 7.58, respectively, (p = 0.084). Proximal gastric area was significantly lower in patients versus healthy controls at fiveminutes (22.54 ± 2.77 vs. 30.66 ± 2.55 cm2), 10minutes (23.03 ± 2.45 vs. 31.10 ± 2.06 cm2), 15minutes (23.06 ± 2.27 vs. 30.31 ± 2.11 cm2), 20minutes (22.21 ± 2.31 vs. 29.73 ± 1.71 cm2) and 25minutes (22.02 ± 2.33 vs. 28.39 ± 1.55 cm2); p < 0.001 at all intervals of time, indicating impaired gastric accommodation. The QOL was poor in all patients with PDS with mean PAGI-QOL score of 31.30 ± 15.05, median of 30, minimum score of 12 and maximum score of 66. Measurement of proximal gastric area with 2D-ultrasonography is simple and non-invasive. Proximal gastric area in patients was lower than controls, indicating impaired gastric accommodation. Poor quality of life was universal in patients with postprandial distress syndrome.

Patients with postprandial distress syndrome experience problems with their interoceptive perceptual function to the gastric region, but their heartbeat perception is normal: a case control study

BackgroundVisceral hypersensitivity in functional dyspepsia can be localized or widespread, and there is no simple method of assessment. Measuring interoceptive accuracy at different sites provides an assessment of perceptual hypersensitivity to specific ecological phenomena. The purpose of this study was to characterize visceral hypersensitivity by comparing gastric sensory and cardiac perceptual tests in patients with postprandial distress syndrome and in healthy volunteers.MethodsSixteen patients with postprandial distress syndrome (age = 47.5 ± 17.4, all female) and 16 healthy volunteers (age = 43.3 ± 16.1, all female) participated in the study after a six-hour fast. Each participant answered questionnaires about physical and mental quality of life, depression and anxiety, tendency of alexithymia, and somatosensory amplification. After completing the questionnaire, the participants took the heartbeat tracking task and the five-minute water load test. We performed statistical analysis using the Mann–Whitney U test and Spearman’s rank correlation coefficient.ResultsSubjects with postprandial distress syndrome had a lower drinking capacity than healthy volunteers (postprandial distress syndrome = 360.9 ± 170.0 mL, healthy volunteers = 644.1 ± 297 mL, P = 0.009), but there was no significant difference in the heartbeat perception score (postprandial distress syndrome = 0.599 ± 0.175, healthy volunteers = 0.623 ± 0.181, P = 0.647). There was a negative correlation (r = − 0.509, P < 0.05) between drinking capacity and the heartbeat perception score in healthy volunteers, but no correlation in postprandial distress syndrome (r = − 0.156, P = 0.564). Heartbeat perception score did not correlate with psychological measures.ConclusionsCompared with healthy volunteers, only the five-minute water load test values were reduced in patients with postprandial distress syndrome, and no difference was observed in the heartbeat tracking task. Combining the 5-minute water load test and the heart rate tracking task revealed a lost cardiac-gastric perceptual relationship in patients with postprandial distress syndrome that was not observed in healthy volunteers, suggesting that there is hypersensitivity in gastric interoceptive perceptual function. Performing sensory examinations at two different sites may be useful in clarifying whether visceral hypersensitivity is localized.Trial registrationUMIN000057586. Registered11 March 2023(retrospectively registered).

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.

Distribution of Pattern Identification According to BMI in Functional Dyspepsia Patients and Analysis of Frequently Used Herbal Medicines: A Retrospective Chart Review

Objectives: This study analyzed the clinical characteristics of patients with functional dyspepsia (FD) who received Korean medicine treatment.Methods: A retrospective chart review was conducted to investigate sociodemographic characteristics, clinical characteristics, and prescribed treatments. The clinical records of 192 patients who visited Kyung Hee University Korean Medicine Hospital for FD from May 1, 2022, to May 31, 2023, were analyzed. In addition, the distribution of pattern identification and symptom type according to body mass index (BMI), as well as prescription history, were analyzed.Results: As the degree of obesity increased, the proportion of Spleen-Qi deficiency pattern patients decreased (p=0.012), and the proportion of damp-phlegm pattern patients increased (p=0.000). Additionally, as the degree of obesity increased, the proportion of patients with excess differentiation increased (p=0.002). The PDS (Postprandial distress syndrome) symptom type was significantly more frequent in the underweight and normal groups than in the overweight and obese groups, and the EPS (Epigastric pain syndrome) symptom type was more frequent in the overweight and obese groups. Regardless of the type of pattern identification, the most frequently used prescriptions were &lt;i&gt;Naesowhajung-tang&lt;/i&gt;, Hanshin &lt;i&gt;Naeso-san&lt;/i&gt;, and &lt;i&gt;Sojeokgunbi-hwan&lt;/i&gt; granule.Conclusion: This study analyzed the medical records of patients with FD to elucidate the use of Korean medicine treatments. Our study is meaningful in that we found that the distribution of pattern identification and symptom patterns are linked to the degree of obesity in FD patients and identified the tendency for herbal medicine treatments to be prescribed in clinical practice.

Clinical efficacy of acotiamide in patients with functional dyspepsia: results of a multicenter study

Introduction. Despite the high prevalence of functional dyspepsia (FD), the question of effective treatment of this pathology remains open. This underlines the relevance of new approaches in the treatment of FD and the introduction of the drug Dyspevict® (acotiamide), a prokinetic with a new mechanism of action, into clinical practice to alleviate symptoms and improve the quality of life of patients with FD.Aim. Evaluate the efficacy and safety of the use of acotiamide in patients with FD with postprandial distress syndrome (PDS).Materials and methods. 389 patients were randomized in a 1:1 ratio into two groups. Patients of the first group took acotiamide, patients of the second group – placebo. Study drugs were taken orally for 4 weeks. The main criterion for the effectiveness of treatment was the “response to therapy”, assessed by patients on a 7-point Likert scale. Secondary efficacy criteria were: complete regression or relief of symptoms of FD with PDS, improvement in the quality of life of patients, which was assessed on the basis of the Nepean short dyspepsia index.Results and discussion. After 4 weeks, “response to therapy” was observed in 143/193 (74.1%) patients in the acotiamide group compared with 98/189 (51.9%) patients in the placebo group (p &lt; 0.001). Therapy with Acotiamide, in contrast to placebo, showed a complete regression and relief of some symptoms of FD with PDS. Also, after the use of acotiamide, there was an improvement in well-being and quality of life in 172/194 (88.7%) patients compared with 131/189 (69.3%) patients in the placebo group (p &lt; 0.001).Conclusion. The results of the conducted clinical study allow us to conclude that acotiamide is an effective treatment for FD with PDS in adults. The safety profile of the drug is comparable to placebo.

Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia—Integrating a Behavioral Intervention

ObjectivesFunctional dyspepsia (FD) includes postprandial distress and epigastric pain syndrome. Percutaneous electrical nerve field stimulation (PENFS) in addition to behavioral interventions (BI) has shown benefits in children with functional abdominal pain but not specifically in FD. We aimed to assess the efficacy of PENFS for treating FD and compare the outcomes with those who received the combination of PENFS + BI. Materials and MethodsCharts of patients with FD who completed four weeks of PENFS were evaluated. A subset of patients received concurrent BI. Demographic data, medical history, and symptoms were documented. Outcomes at different time points included subjective symptom responses and validated questionnaires collected clinically (Abdominal Pain Index [API], Nausea Severity Scale [NSS], Functional Disability Inventory [FDI], Pittsburgh Sleep Quality Index [PSQI], Children’s Somatic Symptoms Inventory [CSSI], Patient-Reported Outcomes Measurement Information Systems [PROMIS] Pediatric Anxiety and Depression scales). ResultOf 84 patients, 61% received PENFS + BI, and 39% received PENFS alone. In the entire cohort, API (p < 0.0001), NSS (p = 0.001), FDI (p = 0.001), CSSI (p < 0.0001), PSQI (p = 0.01), PROMIS anxiety (p = 0.02), and depression (p = 0.01) scores improved from baseline to three weeks and at three months. Subjective responses showed nausea improvement (p = 0.01) and a trend for improvement in abdominal pain (p = 0.07) at week three. Abdominal pain subjectively improved at week three and three months (p = 0.003 and 0.02, respectively), nausea at week three and three months (p = 0.01 and 0.04, respectively), and a trend for improvement in sleep disturbances at week three and three months (p = 0.08 and p = 0.07, respectively) in the PENFS + BI group vs PENFS alone. ConclusionAbdominal pain, nausea, functioning, somatization, sleep disturbances, anxiety, and depression improved at three weeks and three months after PENFS in pediatric FD. Subjective pain and nausea improvement were greater in the PENFS + BI group than in the group with PENFS alone, suggesting an additive effect of psychologic therapy.

Acupuncture is effective in the treatment of postprandial distress syndrome: A systematic review and meta-analysis.

Traditional Chinese medicine advocates the use of acupuncture for the treatment of postprandial distress syndrome (PDS) in people with Functional dyspepsia, but large clinical trials of acupuncture have produced controversial results. This study aims to confirm the clinical significance of acupuncture in the treatment of PDS . This study only randomized controlled trials were included from the following databases: CNKI, Medline, Cochrane Central, Web of Science, and Clinical Trial. The risk of bias in the included studies was assessed using Revman 5.4.1 (Revman 2020), and all 12 included studies were considered to have a low risk of bias. This study used Stata 16.1 for data analysis, including sensitivity analysis and publication bias test. The quality of each study was evaluated with the Cochrane tool. The main outcomes included the overall therapeutic rate, the SID score, the HADS Score, The NDI score, and Side effects. This study identified a total of 1532 studies interested in the curative effect of acupuncture on Postprandial discomfort syndrome (PDS) and finally included a total of 12 studies with 1113 patients after identifying their abstracts, titles, and full text. The process of literature searches and identifying is shown in Figure 1 and data analysis showed that acupuncture is effective in the treatment of PDS and promotes the life quality of patients. This study analyzed the effects of acupuncture on PDS from 5 aspects: overall therapeutic rate, SID, HADS, NDI, and side effects, overall therapeutic rate as primary outcome measure. Statistical analysis results showed that acupuncture has a significant effect on the treatment of PDS. In conclusion, it is an effective clinical treatment method. Also, the potential bias in the included studies, high-quality studies are needed to further confirm the possible side effects of acupuncture in treatment.

Association between genetic polymorphisms of NOD1, Interleukin-1B, and cagA strain with low-grade duodenal eosinophilia in Helicobacter pylori-related dyspepsia.

Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and host genetic polymorphism of innate and pro-inflammatory cascade, nucleotide-binding oligomerization domain 1 (NOD-1), and interleukin-1 beta (IL-1β) in HpD was not explored. To evaluate the association of NOD1-796G>A and IL-1B-511C>T gene variants and low-grade duodenal eosinophilia in HpD. A multicenter cross-sectional study was conducted. A total of 253 patients who met Rome-IV criteria were selected before upper endoscopy and 98 patients were included after unremarkable upper endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori cagA and duodenal histology, were evaluated. Sixty-four (65%) patients had epigastric pain syndrome (EPS), 24 (25%) postprandial distress syndrome (PDS), and 10 (10%) EPS/PDS overlap. FD subtypes were not associated with NOD1-796G>A and IL-1B-511C>T gene variants. Low-grade duodenal eosinophilia was significantly increased in NOD1-796 GG versus single A-allele, but not in IL-1B-511 single T-allele or CC-allele. This association is dependent of cagA infection, since harboring cagA strain was significantly associated with low-grade duodenal eosinophilia with isolated variants NOD1-796 GG and IL-1B-511 single T-allele, but not without cagA. When we performed combined polymorphism analysis with NOD1-796 GG/IL-1B-511 single T-allele, a synergistic effect on low-grade duodenal eosinophilia was found between these two loci irrespective of cagA strain status in HpD. Our findings suggest that low-grade duodenal eosinophilia is significantly associated with NOD1-796 GG allele specially in cagA strain and with allelic combination NOD1-796 GG/IL-1B-511 single T-allele independent of cagA strain infection in HpD patients.

Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms.

Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms. Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire. A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust. AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.

Overlap of some forms of functional pathology of organs of digestion in children

Introduction. In the adult population, a high prevalence of the gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) can vary from 3 to 79%. As for children, there are a few works on the overlap between functional dyspepsia and IBS, GERD and functional constipation. &#x0D; Aim. To determine the prevalence of overlap of the GERD syndrome with irritable bowel syndrome and functional dyspepsia in school-age children. &#x0D; Materials and methods. The study included ninety eight cases including 71 boy and 27 girls, aged of 7 to 17 years (mean age 11.4 ± 2.1 years) suffered from erosive GERD. The comparison group consisted of 30 patients (11 boys and 19 girls), of mean age of 12.7 ± 1.8 years without erosive GERD). The criterion for inclusion in the main group was the presence of erosive changes in the esophagus according to fibrogastroduodenoscopy, in the comparison group the — manifestation of heartburn, with occurrence, at least twice a week over the past three months and the absence of erosive changes in the esophagus according to fibrogastroduodenoscopy. The exclusion criterion was the presence of organic pathology with sides of the upper (peptic ulcer, etc.) and lower parts of the digestive tract (ulcerative colitis, Crohn’s disease, etc.) &#x0D; Results. Every fourth GERD patient (25.8%) has an overlap with functional bowel diseases, while GERD is more often combined with IBS with diarrhea (15.6%) than IBS with constipation/functional constipation (10.2%). Overlap of IBS with postprandial distress syndrome is much less common — only in 7.0% of children. &#x0D; Conclusion. School-age GERD children are characterized by frequent overlap with functional bowel diseases, the frequency of which reaches 25.8%. The combination of all three diseases (IBS, GERD and postprandial distress syndrome) was observed in 2.3% of cases. These patterns are typical for patients with both erosive and non-erosive forms of GERD.

Characteristics of disorders of gut-brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study.

The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others. Subjects were 2504 Japanese in the RFGES. We assessed DGBI/IBS diagnoses with Rome IV/III, IBS Symptom Severity Scale (IBS-SSS), Patient Health Questionnaire (PHQ) for anxiety/depression and non-GI somatic symptoms, PROMIS-10 for quality of life (QOL), Work Productivity and Activity Impairment (WPAI) Questionnaire, parts of Self-reported IBS Questionnaire (SIBSQ) for meal effect and stress effect, Food Frequency Questionnaire, and medication questions. The prevalence of Rome IV DGBI was as follows; IBS-C 0.5%, IBS-D 0.8%, IBS-M 0.8%, IBS-U 0.1%, unspecified functional bowel disorder 10.7%, postprandial distress syndrome 2.2%, and epigastric pain syndrome 0.3%. Rome III IBS prevalence; IBS-C 3.0%, IBS-D 3.1%, IBS-M 2.7%, and IBS-U 0.6%. Comparison among Rome IV IBS (n = 54), Rome III IBS (n = 197), other DGBI (n = 746), others (n = 1389) revealed significant order as Rome IV IBS > Rome III IBS > other DGBI > others in IBS-SSS, anxiety/depression, activity impairment, non-GI symptoms, physical QOL, mental QOL, exacerbated symptoms by meals and perceived stress (all p < 0.001). These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut-brain psychobehavioral involvement than Rome III IBS.