Dyspepsia Symptoms Research Articles

Lactase deficiency and gastrointestinal allergies in young children

Intestinal colic, food allergies are one of the common causes of the initial treatment of children in their first year of life in outpatient practice. Gastrointestinal allergy is a lesion of the gastrointestinal tract of an allergic nature, is in second place among the pathologies associated with food allergies, where allergy to cow’s milk proteins leads. In recent years, the diagnosis of lactase deficiency, unreasonably leads to an unreasonable transfer of the child to artificial curing and the appointment of lactose-free mixtures. In some patients with gastrointestinal manifestations, secondary LN is quite often formed. The article discusses the clinical forms of LN and GA. Undigested lactose increases the cell-mediated pro-inflammatory processes in the body, which, in turn, leads to the stimulation of the development of inflammatory and allergic processes in children. The possibilities and effectiveness of concomitant diet therapy are discussed, including using replacement therapy with the enzyme lactase, which eliminates the main cause of childhood colic, helps the absorption of breast milk or mixture, thus providing babies with the necessary nutrients for physiological development. The article presents results of the clinical observation carried out in a group of 20 full term babies aged 2–5 months with secondary lactase deficiency in the setting of gastrointestinal allergy with positive clinical response: highly quick control of symptoms of intestinal dyspepsia, improvement in stool frequency and consistency were detected on Day 7 from the start of enzyme therapy in 85% of children. Symptoms of intestinal colic (95%), flatulence (80%) were also reversed, regurgitation decreased in frequency and volume (85%) by the end of Week 1 of the therapy and completely disappeared by the end of Week 2. Lab tests confirmed the clinical efficacy of the therapy. A significant improvement in coprogram indicators was identified in 80% of children by the end of Week 2 from the start of therapy. The researchers found out that the carbohydrate content in the coprogram decreased by 1.8 times from 1.3% ± 0.5 to 0.7% ± 0.5 (p <0.05) in most children, and there was no significant decrease of this indicator in 20% of patients. The results show that the prescription of enzyme replacement therapy in combined gastrointestinal allergy and secondary lactase deficiency in children aged 6 months helped keep breastfeeding volumes, and reverse symptoms of lactase deficiency in most cases.

Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology

Background: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p = 0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.

Functional Dyspepsia: Diagnostic and Therapeutic Approaches.

Functional dyspepsia is a common functional gastrointestinal (GI) disorder of gastroduodenal origin, diagnosed clinically in the presence of prototypical symptoms of epigastric pain and meal-related symptoms, and without structural explanation. The most recent diagnostic criteria provide for two functional dyspepsia subtypes, epigastric pain syndrome (EPS) and post-prandial distress syndrome (PDS) based on the predominant symptom pattern. The evaluation of dyspepsia should keep laboratory, imaging, and invasive testing to a minimum, as extensive or repetitive investigations are of rather low diagnostic yield in the absence of localizing symptoms or alarm features. Factors with etiopathologic relationships to functional dyspepsia include micro-inflammation, GI infections, abnormalities of gastroduodenal motility, visceral hypersensitivity, disturbances along the brain-gut axis, and psychological factors; all of these causative mechanisms have potential to partially explain symptoms in some functional dyspepsia patients, thus providing a rationale for the efficacy of a diversity of therapeutic approaches to functional dyspepsia. Management of dyspepsia symptoms relies upon both pharmacologic treatments and non-pharmacologic approaches, including psychological and complementary interventions. The evidence in support of established functional dyspepsia therapies is reviewed, and forms the basis for an effective functional dyspepsia treatment strategy emphasizing the patient's current symptom severity, pattern, and impact on the function and quality of life of the individual.

The Combination of Cholecystokinin and Stress Amplifies an Inhibition of Appetite, Gastric Emptying, and an Increase in c-Fos Expression in Neurons of the Hypothalamus and the Medulla Oblongata.

Cholecystokinin (CCK) had been the first gastrointestinal hormone known to exert anorexic effects. CCK had been inferred to contribute to the onset of functional dyspepsia (FD) symptoms. To understand the pathophysiology of FD, the roles of stress have to be clarified. In this study, we aimed to clarify the influence of stress on the action of cholecystokinin (CCK) on appetite and gastric emptying. Using rats, stress was simulated by giving restraint stress or intraperitoneal injection of the stress-related peptide hormone urocortin 1 (UCN1). The effects of CCK and restraint stress, alone or in combination, on food intake and gastric motility were examined, and c-Fos expression in the neurons of appetite control network in the central nervous system was assessed by immunohistochemical staining. CCK inhibited food intake and gastric emptying in a dose-dependent manner. Food intake for 1h was significantly lower with UCN1 (2nmol/kg) than with the saline control. Restraint stress amplified the suppressive effects of CCK on food intake for 1h and on gastric emptying. With regard to brain function, the CCK induced c-Fos expression in the neurons of the nucleus tractus solitarius and paraventricular nucleus of the hypothalamus was markedly and significantly amplified by the addition of restraint stress with CCK. The results suggested that stress might amplify the anorexic effects of CCK through activation of the nuclei that comprise the brain neuronal network for satiation; this might play a role in the pathogenesis of the postprandial distress syndromes of functional dyspepsia.

Trimebutine Maleate Monotherapy for Functional Dyspepsia: A Multicenter, Randomized, Double-Blind Placebo Controlled Prospective Trial.

Background and Objectives: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD. Materials and Methods: A multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. The Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test. Results: Of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. The groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). The 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group, p = 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM. Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation.

Quality of Life and Level of Physical Activity In Students with and without Symptoms of Functional Dyspepsia and Irritable Bowel Syndrome Surveyed with Questionnaire “7×7” (7 Symptoms Per 7 Days)

Aim. Assessment of the quality of life and physical activity level in students with and without symptoms of functional dyspepsia (FD) and irritable bowel syndrome (IBS) according to questionnaire “7×7” (7 symptoms per 7 days).Materials and methods. Symptoms of FD and IBS were surveyed using the “7×7” questionnaire. Level of physical activity was evaluated according to the short IPAQ, and quality of life — to WAM questionnaires.Results. The study surveyed 92 students aged 20.7 ± 0.2 years (56 men and 36 women). We report borderline manifestations of functional disorders of the gastrointestinal tract (GIT) in 51.1 %, and FD and/or IBS symptoms of mild to moderate severity in 23.9 % of respondents. Symptoms of FD and/or IBS were equally common in men and women. Severity of FD and/or IBS symptoms was rated 4 [[3; 7] in men and 4 [[4; 11] in women (p = 0.25). Physical activity of 57.6 % in students corresponded to a moderate level. Healthy students were more likely to exhibit higher physical activity than individuals with FD and/or IBS symptoms, 56.5 and 31.9 %, respectively (p = 0.04). The level of wellbeing and severity of FD and/or IBS symptoms correlated negatively (r = –0.28, p = 0.01). Wellbeing and mood correlated directly with physical activity, r = 0.33, p = 0.001 and r = 0.27, respectively (p = 0.01).Conclusions. 1. Symptoms of FD and/or IBS occur widely among students and equally in men and women. Functional disorders of the gastrointestinal tract of mild to moderate severity occur in 23.9 % of students, with borderline symptoms registered with every second individual. 2. Healthy students significantly more often exhibited higher physical activity compared to individuals with FD and/or IBS symptoms of varying severity in the ratios of 56.5 and 31.9 % (p = 0.04). 3. Severity of FD and/or IBS in students negatively correlates with the wellbeing component of quality of life (r = –0.28, p = 0.01).

Excessive Belching: a Separate Syndrome or Another Symptom of Functional Dyspepsia?

Aim of review. Interpretation of published evidence on the relationship between the excessive belching syndrome and functional dyspepsia (FD) and their management in patient care.Key points. According to the Rome IV criteria of functional gastrointestinal disorders (FGID), excessive belching in the absence of other dyspeptic symptoms is to be considered a manifestation of the excessive belching syndrome, which can be of gastric or supragastric nature. Combination of high-resolution manometry and impedancemetry allows an accurate diagnosis of belching and selection of optimal treatment strategy. Belching complicated by other symptoms of dyspepsia is to be considered yet another FD symptom according to the Rome IV criteria of FGID. Prokinetics are recommended to relieve belching in such cases.Conclusion. Understanding the relationship between the excessive belching syndrome and FD requires further research.

Effect of Helicobacter pylori Infection on Autonomic Nervous Function and Calcitonin Gene-related Peptide in Patients with Functional Dyspepsia

Objective To investigate the effects of Helicobacter pylori(H.pylori)infection on autonomic nervous function and calcitonin gene-related peptide in patients with functional dyspepsia(FD). Methods Thirty-one patients with FD matching Rome Ⅳ criteria were included and divided into H.pylori-positive group and H.pylori-negative group.All patients were evaluated by Symptom Index of Dyspepsia(SID),Nepean Dyspepsia Index(NDI),and Hospital Anxiety and Depression Scale(HADS).Their heart rate variability(HRV)and calcitonin gene-related peptide(CGRP)level were also measured. Results There were no significant differences in SID(Z=-0.858, P=0.858),NDI(Z=-1.464, P=0.143),and Hospital Depression Scale score(Z=0.699, P=0.485).However,the Hospital Anxiety Scale score was significantly higher in H.pylori-positive group than the H.pylori-negative group(Z=-2.470, P=0.014).The level of CGRP in H.pylori-positive group[(0.999±0.274)ng/ml]was significantly higher than that in the H.pylori-negative group[(0.812±0.172)ng/ml;t=2.238, P=0.033].HRV data showed no significant difference between these two groups at very low frequency(t=-1.210, P=0.236),low frequency(LF)(t=0.419, P=0.678),high frequency(HF)(t=0.612, P=0.546),LF/HF(t=-0.882, P=0.399),and total power(t=-0.963, P=0.344). Conclusion In FD patients,patients with H.pylori-positive FD patients have higher depression and CGRP levels than those without H.pylori infection,although their dyspepsia symptoms and HRV show no notable changes.

Wheat Sensitivity and Functional Dyspepsia: A Pilot, Double-Blind, Randomized, Placebo-Controlled Dietary Crossover Trial with Novel Challenge Protocol.

Introduction: Functional dyspepsia (FD), characterised by symptoms of epigastric pain or early satiety and post prandial distress, has been associated with duodenal eosinophilia, raising the possibility that it is driven by an environmental allergen. Non-coeliac gluten or wheat sensitivity (NCG/WS) has also been associated with both dyspeptic symptoms and duodenal eosinophilia, suggesting an overlap between these two conditions. The aim of this study was to evaluate the role of wheat (specifically gluten and fructans) in symptom reduction in participants with FD in a pilot randomized double-blind, placebo controlled, dietary crossover trial. Methods: Patients with Rome III criteria FD were recruited from a single tertiary centre in Newcastle, Australia. All were individually counselled on a diet low in both gluten and fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) by a clinical dietitian, which was followed for four weeks (elimination diet phase). Those who had a ≥30% response to the run-in diet, as measured by the Nepean Dyspepsia Index, were then re-challenged with ‘muesli’ bars containing either gluten, fructan, or placebo in randomised order. Those with symptoms which significantly reduced during the elimination diet, but reliably reappeared (a mean change in overall dyspeptic symptoms of ≥30%) with gluten or fructan re-challenge were deemed to have wheat induced FD. Results: Eleven participants were enrolled in the study (75% female, mean age 43 years). Of the initial cohort, nine participants completed the elimination diet phase of whom four qualified for the rechallenge phase. The gluten-free, low FODMAP diet led to an overall (albeit non-significant) improvement in symptoms of functional dyspepsia in the diet elimination phase (mean NDI symptom score 71.2 vs. 47.1, p = 0.087). A specific food trigger could not be reliably demonstrated. Conclusions: Although a gluten-free, low-FODMAP diet led to a modest overall reduction in symptoms in this cohort of FD patients, a specific trigger could not be identified. The modified Salerno criteria for NCG/WS identification trialled in this dietary rechallenge protocol was fit-for-purpose. However, larger trials are required to determine whether particular components of wheat induce symptoms in functional dyspepsia.

Diagnostics of stomach cancer in Russia: fi rst results of the multicenter study “RADIUS” (Early diagnosis of stomach cancer in dyspepsia)

The aim of the study was to evaluate the timeliness and eff ectiveness of the diagnosis of precancerous diseases and early forms of gastric cancer in primary health care. Materials and methods. A multicenter retrospective descriptive study was conducted with an analysis of the medical records of 426 patients who were diagnosed with malignant neoplasm of the stomach at the time of going to outpatient facilities. We used data from 125 outpatient facilities in 7 centers for the period from 2009 to 2019. Results. The average age of patients with a fi rst established diagnosis of malignant neoplasia was 61,7 (95% CI 58.6 ÷ 64.8) years. The prevailing form of malignant neoplastic disease was the option “Adenocarcinoma, intestinal cancer” — 77,7%, diff use type cancer — 12,7%, other histological types — 9,6%. The diagnosis of malignant neoplastic disease at the III and IV stages of the disease was fi rst established in 67,4% of patients. The number of years lived by patients with a diagnosis of gastric gastric cancer was 2,0 years. Over a 10-year follow-up, 75% of patients died. Risk factors for gastric cancer were identifi ed in 41% of respondents. Signs of dyspepsia syndrome were observed in 31,5% of patients, and they appeared on average 4,6 (95% CI 4,4 ÷ 4,8) years before the diagnosis of gastric malignancy. Among people with gastric cancer, dyspepsia symptoms occur every day in every third patient. The features of the manifestations of dyspepsia in the observed patients were: daily manifestations of symptoms (33,3%), symptoms at night — 9,4%, an increase in the intensity of dyspepsia (21,3%), the lack of a clinical response to the therapy (proton pump inhibitors, prokinetics, eradication of Helicobacter pylori infection) in 58% of cases. Anxiety symptoms were recorded 2,4 years before a diagnosis of stomach cancer.

ДИНАМИЧЕСКОЕ НАБЛЮДЕНИЕ ГРУППЫ ВОЕННОСЛУЖАЩИХ С ГАСТРОДУОДЕНАЛЬНЫМИ ЭРОЗИЯМИ В ПЕРИОД СРОЧНОЙ ВОЕННОЙ СЛУЖБЫ

Background. Erosion of the stomach and duodenum is a common finding in endoscopic examination. The frequency of gastroduodenal erosion in the presence of dyspeptic complaints in conscripts is 16.4% (95% CI 10.7–24.2), and in military servicemen – 13.8% (95% CI 10.0–18.8). Objective – to assess the course of gastroduodenal erosion in military personnel during military service. Materials and methods. The object of the study was 34 people aged 18–26 from military service personnel of one of the garrisons of military units of the Air Force and Air Defense Forces with symptoms of dyspepsia and gastroduodenal erosion, who underwent dynamic observation with endoscopic control, morphological examination of the gastric mucosa and an additional laboratory and instrumental examination for recurrence of dyspepsia within 6-18 months. Results. During the dynamic observation of 34 patients with gastroduodenal erosion in 7 of them (20.6%; 95% CI 10.4–36.8) other diseases were identified or developed: in 2 (5.9%; 95% CI 1.6–19.1) – those associated with the main one (ulcer of the duodenal bulb), in 5 (14.7%; 95% CI 6.5–30.1) – those not associated with the underlying disease (chronic hepatitis 3, adaptation disorder 2). Conclusions. During the dynamic observation of military personnel with gastroduodenal erosion during the period of military service (from 6 to 18 months) without taking into account the results of eradication of Helicobacter pylori infection, recurrence of erosion occurred in 2 military servicemen (5.9%; 95% CI 1.6–19.1), a duodenal ulcer in 2 (5.9%), 5 (14.7%) developed or were diagnosed with diseases that were not associated with the upper gastrointestinal tract, affecting the quality and completion of military service.

Efficacy of pyonex in the treatment of functional dyspepsia with mild to moderate depression

Objective: To observe efficacy of pyonex in the treatment of functional dyspepsia (FD) with mild to moderate depression.Methods: 64 FD patients with mild to moderate depression were randomly divided into control group ([Formula: see text]) and test group ([Formula: see text]). The test group was given mosapride combined with pyonex, acupuncture at Neiguan, Shenmen, Zusanli and Taichong, and the control group was given mosapride combined with sertraline. The course of treatment was 4 weeks in both groups. The changes of LDQ and HAMD scores were compared between the two groups before and after treatment, and the safety and efficacy were evaluated.Results: ① LDQ scores: The total efficacy of the test group was 87.5%, and that of the control group was 81.3% after treatment. The curative effect of the test group was similar to that of the control group ([Formula: see text]). The total LDQ scores and single symptom scores of the test group were significantly better than those of the control group ([Formula: see text]). ② HAMD scores: The both groups were significantly improved as compared with those before treatment ([Formula: see text]). ③ Safety evaluation: There were no obvious adverse reactions in the two groups during the treatment.Conclusions: Pyonex combined with mosapride can be safe and may improve the clinical symptoms of dyspepsia and depression.

Characteristics of Helicobacter pylori infection in a National Referral Hospital in Bhutan

Introduction: Helicobacter pylori (H. pylori) is a bacterium causing chronic gastric infection and may cause gastric cancer. It was necessary to see the trend of infection, especially in symptomatic patients. This retrospective descriptive study was aimed to describe the characteristics of H. pylori infection in Bhutanese patients referred for an endoscopy to the National Referral Hospital, Thimphu. Methods: The sample of the study was randomized 380 medical records of the patients who underwent upper gastrointestinal endoscopy and Rapid Urea Test for symptomatic dyspepsia and peptic ulcer. Data was collected using a survey form designed by the researchers. Data analysis was done using descriptive statistics and either Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori infection was very high (76.6%). The mean age of the infection was 42 with a range from 15 to 84 years. The highest prevalence of infection was observed in the age group 20-29 years (82.7%) and lowest in the oldest age group 70-84 years (66.7%). The analysis showed no significant difference in infection amongst age groups, gender, and endoscopic findings to the positive results at 5% significant level except for monthly prevalence (p<0.001). Gastritis was the commonest endoscopy finding (153/380) and gastro-duodenitis had the highest positivity rate (88.9%). Conclusion: The prevalence of infection was relatively high compared with previous studies. Young and middle-aged adults had a high prevalence and this group needs to be given priority for screening and eradication treatment considering limited resources to prevent associated gastric cancer in Bhutan.

The Effect of Ursodeoxycholic Acid on Small Intestinal Bacterial Overgrowth in Patients with Functional Dyspepsia: A Pilot Randomized Controlled Trial.

Functional dyspepsia (FD) is associated with small intestinal bacterial overgrowth (SIBO). Several animal studies have reported that ursodeoxycholic acid (UDCA) has antibacterial and anti-inflammatory effects in the intestine. We hypothesized that UDCA may be effective against dyspeptic symptoms and SIBO in patients with FD. We conducted this randomized controlled trial to investigate the effects of UDCA in FD patients with SIBO. Twenty-four patients diagnosed with FD and SIBO based on lactulose breath test (LBT) were randomly assigned to either a UDCA treatment group or an untreated group. The treatment group received 100 mg of UDCA three times per day for two months; the untreated group was monitored for two months without intervention. After two months in both groups, we reevaluated LBT and FD symptoms using the Nepean dyspepsia index-K. FD symptoms in the UDCA-treated group were significantly reduced after two months compared with baseline and FD symptom scores between the UDCA-treated and untreated groups showed statistically significant differences after two months. In addition, the total methane gas levels for 90 minutes in LBT were significantly decreased after two months compared with baseline in the UDCA-treated group. In this preliminary exploratory study, we found that two months of UDCA treatment resulted in FD symptom improvement and reduced methane values during 90 minutes on the LBT, suggesting that methane-producing SIBO were associated with symptoms of dyspepsia and that UDCA was helpful in these patients. These findings need to be validated via large-scale controlled and well-designed studies.

Efficacy and Safety of Clidinium/Chlordiazepoxide as an Add-on Therapy in Functional Dyspepsia: A Randomized, Controlled, Trial.

The treatment of refractory functional dyspepsia (FD) is a challenge. Clidinium/chlordiazepoxide is a combination of antispasmodic and anxiolytic drugs that has been used as an adjunct treatment for FD in clinical practice with limited supporting evidence of efficacy. The aim of the study is to assess the efficacy and safety of clidinium/chlordiazepoxide as an adjunct treatment to a proton pump inhibitor (PPI) in refractory dyspepsia. We performed a study of patients who met the Rome IV criteria for FD who failed to respond to PPIs. Patients were randomly assigned to groups that received clidinium/chlordiazepoxide or placebo as an add-on treatment to PPI for 4 weeks. The primary outcome was the rate of responders, which was defined as a > 50% reduction in dyspepsia symptom score after 4 weeks of treatment. The secondary outcomes were an improvement in the quality of life and the safety profile. Between March 2017 and February 2018, 78 patients were enrolled. The rates of responders in the clidinium/chlordiazepoxide group and placebo groups were 41.03 % and 5.13% at week 4 (P < 0.001). The clidinium/chlordiazepoxide group also showed significant improvement in overall quality of life over placebo. However, the clidinium/chlordiazepoxide group had more frequent drowsiness than the placebo group (30.27% vs 6.52%, P = 0.034). There were no major adverse events in either group. Clidinium/chlordiazepoxide significantly improved dyspeptic symptoms and quality of life. This combination may be used as an add-on therapy in FD patients without major adverse events.

Efficacy and safety of different nonsteroidal anti-inflammatory drugs for acute neck and back pain

Objective: to comparatively study several nonsteroidal anti-inflammatory drugs (NSAIDs) (their analgesic effect; dynamics of quality of life; side effects, such as NSAID-gastropathy and gastric dyspepsia) in acute pain in the neck and back (dorsalgia). Patients and methods. The investigators followed up 120 patients (4 groups, each having 30 people) with acute dorsalgia who took different oral NSAIDs for 7 days: long-acting ketoprofen, aceclofenac, naproxen, and dexketoprofen (Flamadex). To evaluate their possible side effects, dyspepsia symptoms were monitored and blood pressure (BP) was measured daily; gastroscopy was repeated after completion of a treatment cycle. The Nottingham Quality of Life Questionnaire and the Visual Analogue Scale (VAS) for pain were used. Results and discussion. A gradual and substantial reduction in pain measured according to VAS was noted in all the NSAID-treated groups. The intensity of pain syndrome decreased faster in the dexketoprofen group; the analgesic effect of naproxen and long-acting aceclofenac was significantly less (p=0.012 and 0.002, respectively). This patient group showed a tendency to maximum improvement according to the Nottingham Quality of Life Questionnaire and VAS. Elevated BP was observed in all the groups, but statistically significantly more frequently in the naproxen group (p=0.05). Gastric dyspepsia was also registered in all the groups, but a tendency to its lower frequency was seen in the dexketoprofen group. Conclusion. Dexketoprofen showed fewer side effects and a more pronounced analgesic effect than ketoprofen, aceclofenac, and naproxen in acute dorsalgia.

Systematic review with meta-analysis: Effects of probiotic supplementation on symptoms in functional dyspepsia

Abstract The pathophysiology of functional dyspepsia (FD) remains poorly understood, but alterations of the small intestinal microbiome have been observed. The place of probiotics in treatment is uncertain. We performed a systematic review and meta-analysis of the currently available randomized, controlled trials (RCTs) to evaluate the potential beneficial effects and risks of probiotics in FD. Pubmed, EMBASE, Scopus, Web of Science and the Cochrane Controlled Trials Register were searched (up to May 2019) for RCTs evaluating the effects of probiotic supplementation compared to placebo in adults with FD. Two reviewers independently assessed eligibility, trial quality and extracted information from identified articles. To compare the effects of probiotics with placebo, risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random effects models. Six trials, including 422 participants were included but only three RCTs could be included in the meta-analysis. Lactobacillus strains showed potential positive effects in terms of improving upper gastrointestinal (GI) symptoms in patients with FD. Probiotic supplementation tended to improve global dyspepsia score (n = 3 RCTs, risk ratio [RR]: 1.35, 95% CI 0.99 to 1.84; P = 0.061) and bacterial composition in the GI tract. Probiotics were well tolerated without any serious adverse events. While the available data suggest that supplementation with probiotics may improve GI symptoms in patients with FD, the evidence is insufficient to draw clear conclusions regarding efficacy. Thus, high-quality RCTs are needed to establish the beneficial effects of probiotic supplementation on FD outcomes.

Effects of Low-Dose Amitriptyline on Epigastric Pain Syndrome in Functional Dyspepsia Patients

AimTo observe the therapeutic effect of low-dose amitriptyline (AMT) on epigastric pain syndrome (EPS) in patients with functional dyspepsia.MethodsSixty patients with EPS were randomly divided into the following two groups for a four-week clinical trial: routine treatment with pantoprazole (RT group) and the AMT group. The RT group was treated with 40 mg of pantoprazole once daily. The AMT group received 25 mg of AMT once daily before bedtime. The Nepean Dyspepsia Index (NDI) checklist, Hamilton Rating Scale of Anxiety/Depression (HAMA/HAMD), and Pittsburgh Sleep Quality Index (PSQI) were employed to evaluate dyspepsia symptoms, psychological distress, and sleep, respectively.ResultsAll items were similar between the two groups before treatment (0 week). After 4 weeks of treatment, the NDI–symptom checklist score as well as the severity and bothersomeness of EPS in the AMT group was significantly decreased compared with those in the RT group (p < 0.05). However, no differences were found in the frequency of NDI checklist, psychological status (HAMD/HAMA scores) of EPS, or sleep quality (PSQI score) between the two groups after treatment. In addition, the time to fall asleep was shorter in the AMT group compared with the RT group after 4 weeks of treatment (p < 0.05).ConclusionLow-dose AMT effectively improved the dyspepsia symptoms and the time to fall asleep in the EPS patients, compared with pantoprazole, although it did not reduce the psychological distress. Therefore, AMT could be considered as a good candidate for EPS treatment in the clinic.

The participation of basolateral amygdala in the efficacy of acupuncture with deqi treating for functional dyspepsia.

Deqi is taken as an indispensable requirement to achieve acupuncture efficacy. This study aimed to explore the central influence of deqi on the efficacy of acupuncture for functional dyspepsia (FD). 70 FD patients were randomized to receive 20 sessions' acupuncture treatment with (n = 35) and without deqi (n = 35). In each group, 25 FD patients randomly selected underwent functional magnetic resonance imaging (fMRI) scans before and after treatment. After group re-division according to deqi response, changes of amygdala subregions-based resting-state functional connectivity (rsFC) were compared between the acupuncture with and without obvious deqi group. The clinical changes of the Nepean Dyspepsia Symptom Index (NDSI) measuring FD symptoms were also used to further assess the correlation with amygdala subregions rsFC in FD patients. The decrease in the NDSI scores (pre-pos) in the obvious deqi group was significantly greater than that in the acupuncture without obvious deqi group (p < 0.05). Compared to the without obvious deqi group, the obvious deqi group showed significantly decreased the left basolateral amygdala (BLA) rsFC with bilateral insular (INS), putamen and middle/posterior cingulate cortex (MCC/PCC), right pallidum and hippocampus (HIPP) after treatment. The changed NDSI scores(pre-post) of all 41 FD patients was significantly positively correlated with their Fisher's transformed z value of the left BLA rsFC with left INS (r = 0.376, FDR corrected p = 0.015), and rsFC with right HIPP (r = 0.394, FDR corrected p = 0.015). The changed NDSI scores(pre-post) of the obvious deqi group was significantly negatively correlated with their Fisher's transformed z value of the right centromedial amygdala (CMA) rsFC with left medial prefrontal cortex (mPFC) (r = -0.463, p = 0.035). The results tested the hypothesis that the advantage of deqi on efficacy is related to affecting the BLA and CMA rsFC. It suggested that deqi might influence the abnormal rsFC within the salience network (SN), and participate in the adaptive modulation of disrupted relationship between the SN and default mode network (DMN).

Alterations of bone tissue metabolism in celiac disease

The problem of osteopenia and early osteoporosis in celiac disease has a great socio-economic importance and is an important area of medicine, primarily from the point of view of a diagnostic search and treatment. This article presents a clinical case of the atypical form of celiac disease with a lesion of skeletal system, osteopenia and secondary osteoporosis without symptoms of intestinal dyspepsia and obvious signs of malabsorption. The basic mechanisms for the development of osteopenic complications in celiac disease are described, and recommendations for follow-up and treatment of such patients are presented.