Symptoms In Functional Dyspepsia Patients Research Articles

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.

Aberrant resting-state functional connectivity and topological properties of the subcortical network in functional dyspepsia patients.

Functional dyspepsia (FD) is a disorder of gut-brain interaction. Previous studies have demonstrated a wide range of abnormalities in functional brain activity and connectivity patterns in FD. However, the connectivity pattern of the subcortical network (SCN), which is a hub of visceral information transmission and processing, remains unclear in FD patients. The study compared the resting-state functional connectivity (rsFC) and the global and nodal topological properties of SCN between 109 FD patients and 98 healthy controls, and then explored the correlations between the connectivity metrics and clinical symptoms in FD patients. The results demonstrated that FD patients manifested the increased rsFC in seventeen edges among the SCN, decreased small-worldness and local efficiency in SCN, as well as increased nodal efficiency and nodal degree centrality in the anterior thalamus than healthy controls (p < 0.05, false discovery rate corrected). Moreover, the rsFC of the right anterior thalamus-left nucleus accumbens edge was significantly correlated with the NDSI scores (r = 0.255, p = 0.008, uncorrected) and NDLQI scores (r = −0.241, p = 0.013, uncorrected), the nodal efficiency of right anterior thalamus was significantly correlated with NDLQI scores (r = 0.204, p = 0.036, uncorrected) in FD patients. This study indicated the abnormal rsFC pattern, as well as global and nodal topological properties of the SCN, especially the bilateral anterior thalamus in FD patients, which enhanced our understanding of the central pathophysiology of FD and will lay the foundation for the objective diagnosis of FD and the development of new therapies.

Effect of Kvass on Improving Functional Dyspepsia in Rats.

Functional dyspepsia (FD) is a common digestive system disease, and probiotics in the treatment of FD have a good curative effect. Patients with gastrointestinal diseases often show a poor response to traditional drug treatments and suffer from adverse reactions. Kvass can be used as a functional drink without side effects to improve the symptoms of FD patients. The results showed that compared with those of the model group, the body weight and food intake of the treatment group were significantly increased (P < 0.05), and the gastric residual rate of the treatment group was significantly decreased (P < 0.05); the amount of pepsin in the treatment group was significantly higher than that in the model group (P < 0.05); a high dose of Kvass could increase the contents of ghrelin, motilin (MTL), and gastrin (GAS) in the plasma and decrease the contents of vasoactive intestinal peptide (VIP) in the plasma; the contents of ghrelin, MTL, and GAS in the gastric antrum were also increased in the high-dose group. Kvass beverage can significantly improve the gastrointestinal function of rats, which may be because it can improve the contents of ghrelin, MTL, GAS, and VIP in both the serum and gastric antrum by regulating the expression of short-chain fatty acids in the colon.

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.‎

Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology.

Functional dyspepsia (FD), a common disorder of gastrointestinal function, originated from the gastroduodenum. Although the therapeutic effect of acupuncture has been investigated by various high-quality randomized controlled trials, the potential mechanisms showed obvious heterogeneity. This review summarized the potential mechanisms of acupuncture on FD in order to guide for future laboratory and clinical studies. Here, we argued that the primary cause of FD was gastroduodenal low-grade inflammation and acid exposure, which impaired mucosal integrity, caused brain-gut axis dysfunction, and impaired brain network connectivity, all of which generated various symptom patterns. Overall the clinical studies indicated that acupuncture was a promising treatment to alleviate symptoms in FD patients, whose efficacy was influenced by acupoints and individual variance. Mechanistically, studies with animal models of FD and patients have shown that acupuncture, a non-invasive strategy for nerve stimulation, may have the potential to control intestinal inflammation and suppress acid-secretion via different somatic autonomic reflex pathways, regulate the brain-gut axis through intestinal microbiota, and has the potential to ameliorate FD-symptoms. The cumulative evidence demonstrated that acupuncture is a promising treatment to alleviate symptoms of FD patients.

Ultrasonic diagnosis of functional dyspepsia under adaptive partial differential denoising model and its relationship with Helicobacter pylori infection

This work was to study the relationship between functional dyspepsia (FD) and Helicobacter pylori (HP) based on the adaptive partial differential denoising model. The adaptive partial differential denoising model was adopted to analyze the ultrasound images, which was then utilized in the ultrasound diagnosis of FD after its related performance was evaluated. Fifty patients with gastrointestinal disease who came to our hospital were recruited and rolled into group A (HP positive) and group B (HP negative), and the clinical symptoms of the two groups were compared. The results showed that the maximum peak signal-to-noise ratio (PSNR) and the running time based on the adaptive partial differential denoising model were both superior to the total variation image restoration (TV) model, with statistical differences (P < 0.05). The PSNR of the partial differential denoising model was superior to that of the TV model, and the mean square error (MSE) was inferior to that of the TV model, both with considerable differences (P < 0.05). For the ultrasound manifestations of the stomach of FD patients, the number of dysfunctional patients in gastric emptying dyskinesias was the largest, accounting for 38%. The overall symptoms of FD patients and HP-infected patients were more severe than those of uninfected patients, especially the symptom of upper abdominal pain, and that in group A was remarkably higher than that of group B (P < 0.05). In summary, the quality of ultrasound images based on the adaptive partial differential denoising model was ideal, and the edge retention capability was strong. In addition, HP was an important factor in causing FD, among which upper abdominal pain was the most obvious.

Psychometric evaluation of an experience sampling method-based patient-reported outcome measure in functional dyspepsia.

BackgroundDue to important biases, conventional end‐of‐day and end‐of‐week assessment methods of gastrointestinal symptoms in functional dyspepsia (FD) are considered suboptimal. Real‐time symptom assessment based on the experience sampling method (ESM) could be a more accurate measurement method. This study aimed to evaluate validity and reliability of an ESM‐based patient‐reported outcome measure (PROM) for symptom assessment in FD.MethodsThirty‐five patients with FD (25 female, mean age 44.7 years) completed the ESM‐based PROM (a maximum of 10 random moments per day) and an end‐of‐day symptom diary for 7 consecutive days. On day 7, end‐of‐week questionnaires were completed including the Nepean Dyspepsia Index (NDI) and Patient Assessment of Gastrointestinal Symptom Severity Index (PAGI‐SYM).Key ResultsExperience sampling method and corresponding end‐of‐day scores for gastrointestinal symptoms were significantly associated (ICCs range 0.770–0.917). However, end‐of‐day scores were significantly higher (Δ0.329–1.031) than mean ESM scores (p < 0.05). Comparing ESM with NDI and PAGI‐SYM scores, correlations were weaker (Pearson's r range 0.467–0.846). Cronbach's α coefficient was good for upper gastrointestinal symptoms (α = 0.842). First half‐week and second half‐week scores showed very good consistency (ICCs range 0.913–0.975).Conclusion and InferencesGood validity and reliability of a novel ESM‐based PROM for assessing gastrointestinal symptoms in FD patients was demonstrated. Moreover, this novel PROM allows to evaluate individual symptom patterns and can evaluate interactions between symptoms and environmental/contextual factors. ESM has the potential to increase patients' disease insight, provide tools for self‐management, and improve shared decision making. Hence, this novel tool may aid in the transition toward personalized health care for FD patients.

New endoscopic method for gastric hypersensitivity testing: Pilot study.

Background and AimAlthough one of the causes of dyspeptic symptoms in functional dyspepsia patients is gastric hypersensitivity, there is currently no routine endoscopic gastric hypersensitivity test. We developed a new endoscopic method for gastric hypersensitivity testing. The aim of the present study was to investigate whether this method is useful for evaluating gastric hypersensitivity in drug‐resistant functional dyspepsia patients who were strongly suspected of having gastric hypersensitivity.MethodsTwenty‐seven drug‐resistant functional dyspepsia patients and 27 nonfunctional dyspepsia patients were recruited. Gastric pressure was assessed using an external pressure transducer, and the CO2 insufflation volume was measured using an endoscopic CO2‐supplied device and flow meter. The following variables were examined: gastric pressure at baseline and gastric pressure, the CO2 insufflation volume, and compliance of the stomach when patients initially felt abdominal tension following CO2 insufflation.ResultsNo significant differences were observed in baseline gastric pressure or compliance of the stomach between the groups. Drug‐resistant functional dyspepsia patients had a significantly smaller CO2 insufflation volume and lower gastric pressure when symptoms developed than nonfunctional dyspepsia patients. Based on a cutoff value of 1.25 L by receiver operating characteristic curves, sensitivity and specificity for gastric pressure were 85.0 and 96.3%, respectively. Similarly, based on a cutoff value of 12.7 mmHg, sensitivity and specificity for the CO2 insufflation volume were 81.5 and 81.5%, respectively.ConclusionThis endoscopic gastric hypersensitivity testing is a useful tool for evaluating the presence of gastric hypersensitivity.

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.

Impaired decision-making under risk in patients with functional dyspepsia

ABSTRACT Introduction The cognitive processing in patients with functional dyspepsia (FD) has not been well established. Decision-making is an important component of cognitive function. Most brain regions involved in decision-making are abnormal in FD patients. This study aimed to investigate the decision-making under ambiguity and risk in FD patients. Methods We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls (HCs) matched for age, sex, marital status, and education level. The Hamilton Anxiety Scale (HAMA) and the 17-item Hamilton Depression Scale (HAMD-17) were used to evaluate their anxiety and depression emotions. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to evaluate decision-making under ambiguity and risk, respectively. Helicobacter pylori status, disease duration, dyspeptic symptom score, and the Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients. Results In IGT, FD patients had a lower total net score, chose more adverse choices, and showed a slower response to change their behavior than HCs. However, there was no significant difference in the net score of the first 2 blocks between the two groups. In GDT, FD patients had a lower total net score, higher risk score, and lower use of negative feedback than HCs. In addition, FD patients showed better GDT performance than those without early satiation. Conclusions FD patients showed impaired decision-making under risk. The deficiency might be related to dyspeptic symptoms of FD patients.

Effects of acotiamide on functional dyspepsia patients with heartburn who failed proton pump inhibitor treatment in Japanese patients: A randomized, double-blind, placebo-controlled crossover study.

Functional dyspepsia (FD) and non-erosive reflux disease (NERD) are gastrointestinal disorders that often overlap. In this randomized, double-blind, placebo-controlled crossover study, the effects of adding acotiamide to treatment with proton pump inhibitors (PPI) were investigated in FD patients with heartburn who failed PPI treatment, corresponding to PPI-resistant NERD. The subjects included 16 FD patients with heartburn who failed PPI treatment, and they were administered acotiamide or a placebo for 28days. After suspending medication for 28days, the trial drug and placebo were crossed over and administered for 28days. Before the study began and after each administration period, high-resolution impedance manometry (HRiM) was performed, and the modified frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire was administered. Postprandial fullness in the FD assessment and all modified FSSG items were significantly lower in the acotiamide group than in the placebo group. Esophagogastric junction pressure was significantly higher in the acotiamide group. The distal contractile integral (DCI) pressure and the highest DCI pressure both increased significantly in the acotiamide group. Moreover, in the acotiamide group, the frequency of abnormal primary peristalsis decreased to normal levels; complete bolus transit (CBT), an indicator of esophageal clearance, increased; and CBT time decreased. Acotiamide was considered to improve upper gastrointestinal functions not only in the stomach but also in the esophagus. Adding acotiamide to PPI therapy appears to improve upper abdominal symptoms in FD patients with heartburn who failed PPI treatment.

The effect of rikkunshito on gastrointestinal symptoms and gastric motor function: The first study in a Belgian functional dyspepsia population.

Rikkunshito, a traditional Kampo medicine, has shown efficacy to treat functional dyspepsia (FD) in controlled trials in Japan. Its putative benefit for European patients and mechanism of action has not been established. This study examined the effect of rikkunshito on gastric motility and GI symptom perception in FD-PDS patients in a randomized, placebo-controlled, cross-over study. After a 2-week run-in period, patients received rikkunshito or matching placebo (2.5g t.i.d.) for 4weeks, separated by a 4-week washout period. Symptoms were assessed by the Leuven Postprandial Distress Scale (LPDS) diary throughout the study. At baseline and after both treatment arms, intragastric pressure (IGP) was measured to evaluate gastric accommodation and gastric motility. Simultaneously, GI symptoms were scored on a 100mm visual analogue scale. Validated symptom questionnaires (PAGI-SYM, VSI, DSS, and PHQ) were completed each study visit. Twenty-three patients completed the study (33±14years, 22.7±3.22kg/m2 ). Intragastric pressure was numerically, but not significantly, lower after rikkunshito compared with baseline and placebo (P=.14). No differences were found in gastric accommodation, nutrient volume tolerance, and symptoms assessed during IGP measurements. Early satiation and postprandial fullness (daily diary) decreased after rikkunshito compared with baseline (P<.041 for both). Placebo also improved most other symptoms assessed. No significant changes in VSI scores occurred. No adverse reactions occurred. Rikkunshito did not alter gastric motility. Treatment with rikkunshito improved upper GI symptoms in FD patients but similarly high placebo effects were observed using the LPDS diary, PAGI-SYM, SF-NDI, and DSS scores. Rikkunshito was safe and well-tolerated.

Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence.

Background: Previous studies on the effect of Helicobacter pylori eradication on functional dyspepsia (FD) are conflicting. We performed a comprehensive meta-analysis on this issue according to region and prevalence of H. pylori. Methods: Randomized controlled trials (RCTs) evaluating the effect of eradication of H. pylori on functional dyspepsia up to December 2018 were searched through PubMed, EMBASE, and the Cochrane Library. Subgroup analyses by the outcome measure, region, and prevalence of H. pylori were performed. All data were analyzed with Review Manager 5.3. Results: Eighteen RCTs were included in our meta-analysis. Overall, the H. pylori eradication group showed significant improvement of symptoms compared with the control group (risk ratio (RR) = 1.18; 95% confidence interval (CI): 1.07–1.30, p < 0.01). There was moderate heterogeneity among studies (I2 = 34%) and the number needed to treat (NNT) was 15.0. Helicobacter pylori eradication improved dyspeptic symptoms both in low (<50%) and high (≥50%) H. pylori prevalence regions (RR = 1.21 and 1.17; 95% CI: 1.02–1.44 and 1.06–1.29, I2 = 49% and 5%, respectively.) In the analysis of studies from Asia, however, the effect of eradication on improvement of dyspepsia was not significant (RR = 1.14; 95% CI: 0.99–1.33, p = 0.08, I2 = 37%). Conclusion: Overall, H. pylori eradication provides significant improvement of symptoms in functional dyspepsia patients regardless of H. pylori prevalence. However, in the analysis of studies from Asia, the eradication did not significantly improve dyspeptic symptoms. In this region, eradication for dyspepsia can be individualized.

Predictive Value of Fissured Tongue in Functional Dyspepsia Combined with Depression.

Anxiety and depression are common in functional dyspepsia (FD) patients. Although fissured tongue (FT) is often observed in FD, its clinical value in such patients is rarely reported. We analyzed clinical data of FD patients with FT with the aim of elucidating the clinical value of FT in FD. This study suggests FD patients with different types of FT with the course of disease and the 9-item Patient Health Questionnaire (PHQ9) showed a significant difference. The PHQ9, course of disease, and self-rated dyspepsia symptoms (SRDS) correlated positively with the types of FT by the Spearman rank analysis. Epigastric pain, bloating, nausea, and SRDS showed a significant difference between FT-FD and nonfissured tongue- (NFT-) FD as well as between FD patients with and without symptoms of depression. Many FD patients also have FT, which may be associated with depressive symptoms. The longer the course of disease, the more serious the fissured tongue; thus, it may provide a predictive value for the diagnosis of depressive symptoms in FD patients.

Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study.

Functional dyspepsia (FD) is a highly prevalent disorder having nonspecific symptoms and varied pathophysiology. Its treatment remains a challenge as therapeutic options are limited, unsatisfactory, and elusive. Thus, safety and efficacy of DigeZyme®, a proprietary multienzyme complex (MEC), was evaluated as a dietary supplement in FD patients. In this randomized, double-blind, placebo-controlled, parallel-group study, 40 patients were randomly assigned (1:1 ratio) to receive either MEC (50 mg, TID; n = 20) or placebo (n = 20) for 60 days. Reports of adverse or serious adverse events (AEs), abnormal results of vital signs, abnormal findings during physical examination, and abnormal laboratory investigations were monitored closely. Efficacy measures were change in Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Nepean Dyspepsia Index-Short Form (NDI-SF), Visual Analog Scale (VAS), Clinical Global Impression Severity Rating Scale (CGI-S), and Glasgow Dyspepsia Severity Score (GDSS) at baseline and follow-up visits on day 15, 30, and 60. Supplementation with MEC was associated with statistically significant differences (P value ranging from .0401 to .0033) in all efficacy parameters compared with placebo. The between-group comparison also revealed that MEC supplement had a significantly greater effect (P < .001) versus placebo. No investigation product-related AEs were reported. There were no clinically significant abnormalities in physical findings and no statistically significant changes in biochemical and hematological parameters, vital signs, body weight, and body mass index observed between the two groups at baseline and follow-up visits. MEC supplementation represents an effective and safe alternative to manage dyspepsia symptoms in FD patients.

Changes of gastric mucosal mast cells in patients with functional dyspepsia after Hylicobacter pylori infection

Objective To investigate the changes of gastric mucosal mast cells in patients with functional dyspepsia (FD) after Helicobacter pylori (H.pylori) infection, and to explore the correlation between the changes and dyspeptic symptoms. Methods From November 2012 to March 2014, 32 patients with FD and 16 asymptomatic patients (control group) from Beijing Jishuitan Hospital were enrolled. H. pylori infection situation was examined. The mucosal biopsies from gastric antrum and gastric body were taken for histological examination. The mast cells of gastric mucosa were detected by immunohistochemical stain. T test was performed for statistical analysis. Results Among 32 FD patients, 17 had H. pylori infection (one with gastric body involved, two with gastric antrum involved, 14 with both gastric antrum and gastric body involved), and 15 had no H. pylori infection. Among 16 asymptomatic patients, 12 had H. pylori infection and four had no H. pylori infection. Among FD patients, the percentage of degranulated mast cells in gastric mucosa with H. pylori infection group was (61.45±24.86)%, which was higher than that without H. pylori infection group ((48.34±21.63)%), and the difference was statistically significant (t=-2.145, P=0.036). The percentage of degranulated mast cells in gastric mucosa with H. pylori infection group was (29.73±12.99)%, which was higher than that without H. pylori infection group ((20.77±10.86)%), and the difference was statistically significant (t=-2.856, P=0.006). In H. pylori infection group, the percentage of degranulated mast cells in gastric body mucosa of FD patients was (66.99±18.85)%, which was higher than that of asymptomatic patients in control group ((46.77±8.43)%), and the difference was statistically significant (t=3.642, P=0.002). The ratio of degranulated mast cells in gastric body mucosa and the density of mast cells in gastric antrum mucosa of prandial distress syndrome (PDS) patients, the density of mast cells in gastric body mucosa of epigastric pain syndrome (EPS) patients and the ratio of degranulated mast cells in gastric body mucosa and the degree of degranulation of mast cells of PDS and EPS patients were all higher than those of asymptomatic patients in control group, and the differences were statistically significant (t=2.750, 3.601, 2.799, 9.522 and 5.755, all P<0.05). Conclusions The dyspeptic symptoms of FD patients with H. pylori infection is correlated with the changes of mast cells. With the infection of H. pylori, dyspeptic symptoms of different subtypes of FD may be correlated with the changes of mast cells in different gastric region. H. pylori infection may cause the dyspeptic symptoms of FD patients by increase the number and activation of mast cells. Key words: Helicobacter pylori; Mast cells; Functional dyspepsia; Dyspeptic symptom

Effectiveness of Menthacarin on symptoms of irritable bowel syndrome.

SummaryIrritable bowel syndrome (IBS) and functional dyspepsia (FD) are common functional gastrointestinal disorders with overlapping symptoms. Effectiveness and safety of Menthacarin (Menthacarin® is the active ingredient of the product Carmenthin® [Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany]) in FD treatment were already demonstrated. We assessed the effectiveness of Menthacarin in reducing concomitant IBS-associated symptoms in FD patients. A systematic search to identify eligible double-blind, randomized controlled trials (RCTs) investigating Menthacarin in FD patients and focusing on IBS-associated symptoms was performed. Three out of five identified RCTs included a total of 111 eligible subjects, which allowed for summary statistics and inclusion into subgroup analysis for FD patients with IBS-associated symptoms. With pain intensity values decreasing by 50–75% on average during 28 days of treatment in patients with accompanying IBS, the subgroup analysis indicates beneficial treatment effects of Menthacarin that are similar to those found for FD patients in the primary analyses. The reduction of IBS-associated symptoms in FD patients suggests Menthacarin as a treatment option for IBS patients.

Abnormal brain structure implicated in patients with functional dyspepsia.

Recent studies suggest dysfunctional brain-gut interactions are involved in the pathophysiology of functional dyspepsia (FD). However, limited studies have investigated brain structural abnormalities in FD patients. This study aimed to identify potential differences in both cortical thickness and subcortical volume in FD patients compared to healthy controls (HCs) and to explore relationships of structural abnormalities with clinical symptoms. Sixty-nine patients and forty-nine HCs underwent 3T structural magnetic resonance imaging scans. Cortical thickness and subcortical volume were compared between the groups across the cortical and subcortical regions, respectively. Regression analysis was then performed to examine relationships between the structure alternations and clinical symptoms in FD patients. Our results showed that FD patients had decreased cortical thickness compared to HCs in the distributed brain regions including the dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), medial prefrontal cortex (mPFC), anterior/posterior cingulate cortex (ACC/PCC), insula, superior parietal cortex (SPC), supramarginal gyrus and lingual gyrus. Significantly negative correlations were observed between the Nepean Dyspepsia Index (NDI) and cortical thickness in the mPFC, second somatosensory cortex (SII), ACC and parahippocampus (paraHIPP). And significantly negative correlations were found between disease duration and the cortical thickness in the vlPFC, first somatosensory cortex (SI) and insula in FD patients. These findings suggest that FD patients have structural abnormalities in brain regions involved in sensory perception, sensorimotor integration, pain modulation, affective and cognitive controls. The relationships between the brain structural changes and clinical symptoms indicate that the alternations may be a consequence of living with FD.

Effect of Apium graveolens and Trachyspermum copticom on clinical symptoms of patients with functional dyspepsia.

This study aimed at investigating the effect of Iranian traditional remedy prepared from Apium graveolens and Trachyspermum copticom (AT) on the severity and frequency of symptoms in patients with functional dyspepsia (FD). In total, 150 FD patients were included in this randomized double-blind trial, based on the ROME III diagnostic criteria, and they were divided into three intervention groups namely, AT, Placebo and omeprazole. Then, severity and frequency of symptoms during this eight-week trial were measured. Obtained information was analyzed using Chi-square test and repeated measures test. In general, the severity and frequency of symptoms after the 4th week significantly decreased in the AT group as compared to the omeprazole and placebo groups, and continued to reduce by the end of the eighth week. General reduction of symptom severity and frequency in the omeprazole group was significantly different from the placebo group by the end of the 4th and 8th weeks. With respect to each individual symptom, AT markedly improved symptoms, such as burning, pain, early satiation, fullness, bloating, belching and nausea, as compared to placebo-treated group. Moreover, AT significantly improved symptoms, like vomiting, and nausea, except for pain, as compared to omeprazole-treated subjects. According to the results, AT, as Iranian traditional remedy, was more effective than omeprazole and placebo in reducing the symptoms in FD patients.

Improvement of meal-related symptoms and epigastric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan.

The aim of this study is to clarify whether acotiamide and rabeprazole combination therapy can improve clinical symptoms, gastric emptying, and satisfaction with treatment in functional dyspepsia (FD) patients more effectively than acotiamide or rabeprazole monotherapy alone. We also aimed to determine whether acotiamide affects these changes via its effect on gastric emptying and appetite-related hormones such as ghrelin. We used Rome III criteria to evaluate upper abdominal symptoms and anxiety by the State-Trait Anxiety Inventory (STAI). Gastric motility was evaluated by the (13) C-acetate breath test. Eighty-one FD patients were treated with acotiamide (300 mg/day) (n = 35), acotiamide (300 mg/day) and rabeprazole (10 mg/day) (n = 28), or rabeprazole (10 mg/day) (n = 18) for a period of 4 weeks and followed after 4 weeks of no treatment. Adenocorticotropic hormone (ACTH), cortisol, leptin and ghrelin levels were measured in all FD patients. Acotiamide and rabeprazole combination therapy significantly improved postprandial distress syndrome (PDS)-like symptoms (p = 0.018, p = 0.04 and p = 0.041, respectively) and epigastric pain (p = 0.024) as wells as STAI-state scores (p = 0.04) compared to rabeprazole monotherapy. Both acotiamide monotherapy, and acotiamide taken in combination with rabeprazole, significantly (p = 0.001 and p = 0.02, respectively) improved satisfaction with treatment, compared to rabeprazole monotherapy. Acotiamide and rabeprazole combination therapy had no significant effect on ACTH and cortisol levels in FD patients. Of interest, acotiamide monotherapy, and acotiamide and rabeprazole combination therapy, significantly (p < 0.0001 and p = 0.018, respectively) increased acylated ghrelin/total ghrelin ratios and significantly (p = 0.04) improved impaired gastric emptying compared to rabeprazole monotherapy. Further studies are warranted to clarify how acotiamide treatment improves clinical symptoms in FD patients.