Postprandial Distress Syndrome Symptoms Research Articles

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.

Efficacy of Slow Nutrient Drinking Test for Evaluating Postprandial Distress Symptom in Japanese Patients With Functional Dyspepsia.

Background/AimsFunctional dyspepsia (FD), one of the functional gastrointestinal disorders, is highly prevalent. Impaired gastric accommodation is proposed as a pathophysiology of FD. In order to assess gastric accommodation, a slow nutrient drinking test was developed. This study aims to evaluate the effectiveness of this slow nutrient drinking test among patients with FD in Japan.MethodsAsymptomatic/healthy participants (n = 26) and those with FD (n = 16), were enrolled. An infusion pump was used to deliver the liquid meal into cups. They were requested to score their meal-related and abdominal symptoms at 5-minute intervals, using a 100 mm visual analog scale. They were instructed to end the test when they felt unable to ingest more or until after 50 minutes.ResultsThe test ending time was significantly shorter in patients with FD than in healthy participants (22.3 ± 10.6 vs 45.0 ± 7.5 minutes, P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff time for detecting patients with FD was 30 minutes. The severity of meal-related and abdominal symptoms between healthy participants and those with FD was continuously different. Univariate and multivariate analyses revealed that the presence of symptoms of postprandial distress syndrome contributed to the short test ending time.ConclusionThe 30-minute slow nutrient drinking test is a minimally invasive method of effectively evaluating symptoms of postprandial distress syndrome among patients with FD, in Japan.

A Review on Acotiamide

Functional dyspepsia (FD) is mainly treated by drugs like H2 receptors antagonists, Proton pump inhibitors, prokinetics. A novel prokinetic drug to treat FD with 2 subtypes: Epigastric pain syndrome (EPS) &amp; postprandial distress syndrome (PDS), has been introduced recently by the approval of Acotiamide, the first in class, muscarinic receptor antagonist &amp; cholinesterase inhibitor. It has shown improvement in gastric motility in rodents &amp; dogs and reduced PDS symptoms in patients in Double- blinded multicentric study.

Клинические проявления предраковых состояний желудка: особенности и предостережения

Актуальность. Хронический гастрит в значительной степени связан с клиническими проявлениями в виде диспепсии, однако часто даже в тяжелой форме протекает бессимптомно, что и обусловливает трудности его своевременной диагностики. Взаимосвязь клинических проявлений функциональной диспепсии и гастрита до сих пор вызывает ряд противоречий в связи с неопределенностью формы коморбидности. Цель исследования: изучить клинические проявления у пациентов с предраковыми состояниями слизистой желудка с учетом симптомокомплексов гастроэзофагеального рефлюкса (ГЭР) и функциональной диспепсии — синдрома эпигастральной боли (СЭБ) и постпрандиального дистресс-синдрома (ПДС). Материалы и методы. Обследовано 79 пациентов, которые по результатам морфологического исследования биоптатов разделены на группы: 1 группа (n = 13) — атрофические изменения слизистой оболочки желудка; 2 группа (n = 20) — кишечная метаплазия только в антральном отделе; 3 группа (n = 33) — диффузная кишечная метаплазия; 4 группа (n = 13) — пациенты с дисплазией. При изучении клинической картины анализировали базовые характеристики наличия, частоты и степени выраженности основных жалоб пациентов. Степень выраженности определяли по 5-балльной шкале Лайкерта. Все симптомы были сгруппированы в симптомокомплексы, характерные для ГЭР и для функциональной диспепсии с определением ПДС и СЭБ согласно Римским критериям. Результаты. Проявления функциональной диспепсии во всех случаях сочетались с клинической симптоматикой ГЭР. По интенсивности симптомов у всех обследованных доминировали симптомы функциональной диспепсии с преобладанием ПДС. Для пациентов с мультифокальной кишечной метаплазией характерной является максимальная симптоматика ГЭР, что в три раза больше, чем у пациентов с атрофией (р &lt; 0,05). Также при мультифокальной кишечной метаплазии наблюдается максимальная частота симптомов как ПДС (71,4 %), так и СЭБ (63,6 %). При дисплазии ведущее значение имеют проявления ПДС — максимальное количество симптомов у 63,6 %, при этом частота СЭБ значительно меньше, чем у пациентов других групп (45,4 %). Для пациентов с дисплазией характерна максимальная интенсивность жалобы на горечь во рту по сравнению с пациентами с кишечной метаплазией в антральном отделе (р &lt; 0,01) и максимальная выраженность тошноты, что достоверно больше по сравнению с пациентами с кишечной метаплазией в антральном отделе (р &lt; 0,01) и с мультифокальной метаплазией (р &lt; 0,01). У пациентов с дисплазией выражена интенсивность негативного влияния симптомов на выполнение работы днем, которая была достоверно выше, чем у пациентов с атрофией (р &lt; 0,05) и мультифокальной кишечной метаплазией (р &lt; 0,01). Выводы. Клиническая симптоматика у пациентов с предраковыми состояниями и изменениями слизистой желудка характеризуется многообразием клинических проявлений функциональной диспепсии и не исключает проявлений ГЭР, что ставит под сомнение оценку состояния пациента без проведения эзофагогастродуоденоскопии и гистологического исследования для должной верификации диагноза. Особого внимания требуют пациенты с симптомами ГЭР, которые не исключают атрофических и перестроечных процессов в слизистой оболочке желудка.

Improvement in dyspepsia related symptoms treated with acupuncture in 278 patients with postprandial distress syndrome: a secondary analysis of a multi-center randomized controlled trial

To evaluate the clinical effect of acupuncture for the improvements in various dyspeptic symptoms of postprandial distress syndrome. The secondary analysis on the data of a multi-center randomized controlled trial (RCT) was conducted. 278 patients with postprandial distress syndrome were randomized into an acupuncture group (138 cases) and a sham-acupuncture group (140 cases). In the acupuncture group, acupuncture was applied to Baihui (GV 20), Danzhong (CV 17), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), Zusanli (ST 36), etc. In the sham-acupuncture group, 6 sites, neither located on meridians nor belonged to meridian acupoints, were selected and punctured shallowly. The duration of treatment was 20 min each time, 3 times a week, for 4 weeks totally in the two groups. The follow-up visit lasted for 12 weeks. The scores of dyspeptic symptoms were compared between the two groups before treatment, during treatment (in week 1, 2, 3 and 4) and during follow-up (in week 8, 12 and 16) separately. Besides the scores of early satiety and vomiting in the sham-acupuncture group in week 1, the scores of the other dyspepsia symptoms during treatment and follow-up were all reduced in the two groups as compared with those before treatment (P<0.05). In week 2 and 3, the score of early satiety in the acupuncture group was lower than that in the sham-acupuncture group (P<0.05). In week 3, the scores of postprandial fullness, upper abdominal bloating and belching in the acupuncture group were lower than those in the sham-acupuncture group (P<0.05). In week 4 and during follow-up, the scores of postprandial fullness, early satiety, upper abdominal bloating and belching in the acupuncture group were all lower than those in the sham-acupuncture group (P<0.05). Acupuncture remarkably relieves postprandial fullness, early satiety, upper abdominal bloating and belching in patients with postprandial distress syndrome.

Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour.

BACKGROUNDObese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy subjects. Anhedonia is the lowered ability to experience pleasure. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.AIMTo assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.METHODSEighty-one Ob without SG, 45 Ob with SG and 55 healthy controls (HC) were studied. All subjects fulfilled the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess Anhedonia as well as the Beck Depression Inventory-II (BDI II) and State Trait Anxiety Inventory (STAI) questionnaires to screen for depression and anxiety. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (0-6) of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria.RESULTSOb without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED (OR: 4.7; 95.0%CI 1.23-18.24; P = 0.02). STAI-Y2 scores were significantly higher in Ob without SG positive for BED (42.2 ± 1.5 vs Ob negative for BED: 39.6 ± 1 .0, P = 0.04), while SHAPS scores and BDI II did not differ in the two groups (1.16 ± 1.30 vs 0.89 ± 1.02, P = 0.49). A lower prevalence of BED (BES > 17: 11.4% vs 40.7%, P = 0.001) and BDI-II (6.8 ± 1.2 vs 13.8 ± 1.9, P = 0.005) was reported in Ob with SG than Ob without SG, on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG. Thirty-five percent of Ob with SG fulfilled the diagnosis of FD. SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups (18.2 vs 8.1%, P = 0.2). Fifty-four percent of Ob with SG achieved surgical success excess weight loss > 50%. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B: -7. 099 (95%CI: -13.91 to -0.29), P = 0.04].CONCLUSIONOb without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior, whereas no differences were found in SHAPS score. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.

Assessment of gastric acidity by short-duration intragastric pH-monitoring with standardised breakfast in functional and some other dyspepsias

IntroductionPreliminary assessment of gastric secretion in the treatment of organic and functional dyspepsia may offer advantages over the empirical administration of proton pump inhibitors suggested by most clinical guidelines.AimTo develop a simplified pH-metric test with standardised meal, and on its basis to perform an assessment of the functional state of gastric secretion in the most common dyspepsias.Material and methodsSerum pepsinogen 1 and 2 were used for reference. Intragastric pH-monitoring was performed during 45 min in basal phase and 135 min after provocative breakfast (507 kcal, 100 mg caffeine). Consecutive adults enrolled in the study were divided into groups: 1 – “Non-dyspeptic” – 30 persons; 2 – “Duodenal peptic ulcer” – 13; 3 – “GERD” – 82; and 4 – “Functional dyspepsia” – 125 patients.ResultsThere was a moderate association between concentration of pepsinogen-1 and parameters of pH-monitoring. The best correlation coefficients were for the nadir pH in basal conditions and the time of acid neutralisation > 3.5 after the meal – r = –0.534 and r = –0.541, respectively (p < 0.0001). Using these two parameters we considered discriminants for four patterns of acidity. Proposed criteria of Hipo-anacidity included an absence of active secretion of hydrochloric acid in basal (pHmin > 5) and postprandial phases, with the achievement of stable pH < 3.5 after 80 min from meal time. They showed sensitivity 88.9% and specificity 100%. In cases of a detected pattern of hyperacidity, these parameters were 80% and 66.67%, respectively. According to the prevalence of hyperacidic cases, the groups were ranked in the following order: duodenal ulcer (76.9%) – GERD (51.1%) – functional dyspepsia (40.8%) – non-dyspeptic (19.0%).ConclusionsAcid production is increased among patients with functional dyspepsia. There is a small number of patients with functional dyspepsia (12.1%) with hypochlorhydria due to atrophic gastritis. The latter was independently associated with age > 50 years (OR = 20.139), symptoms of postprandial distress-syndrome (OR = 9.821), and signs of atrophy (OR = 5.914) after conventional endoscopy.

Analysis of Postprandial Symptom Patterns in Subgroups of Patients With Rome III or Rome IV Functional Dyspepsia

Among patients with functional dyspepsia (FD), there is overlap in symptoms between those in the Rome III subgroups of postprandial distress syndrome (PDS) and those with epigastric pain syndrome (EPS). The Rome IV consensus proposed to incorporate all patients with postprandial symptoms into the PDS group. We aimed to evaluate the assessment of meal-related dyspepsia symptoms in patients with FD according to the Rome III vs Rome IV subdivisions. Consecutive patients with FD referred for a gastric emptying test (n = 96) were asked to fill out the Rome III gastroduodenal questionnaire, with questions on meal-related occurrence. Study participants underwent a gastric emptying breath test, during which the intensity of dyspeptic symptoms (fullness, bloating, belching, nausea, epigastric pain, and burning) was scored before and up to 4 hours after a meal. We analyzed the association between the Rome subdivision and symptom severity and pattern during the breath test. According to Rome III, 10% had EPS alone, 29% PDS alone, and 61% overlapping EPS and PDS. The frequency of the symptoms reported in the Rome questionnaire associated with the intensity of the symptoms during the breath test in the PDS group and in the groups with PDS and EPS overlap, but not in the group with EPS. We adapted the definition of the PDS subgroup to include patients with meal-related non-PDS symptoms (Rome IV); this reduced the proportion of patients with overlap of EPS and PDS symptoms from 61% to 18% and in this group the association of symptoms with the meal was reduced. In an analysis of patients with FD, a meal induced or exacerbated symptoms in most patients. The Rome IV criteria for PDS reduce the proportions categorized as having both PDS and EPS and identify a patient group whose symptoms are associated with the meals. University hospital of Leuven study no: S55426.

A Novel, Duodenal-Release Formulation of a Combination of Caraway Oil and L-Menthol for the Treatment of Functional Dyspepsia: A Randomized Controlled Trial.

OBJECTIVES:We conducted a randomized, placebo-controlled trial, which evaluated a novel formulation of caraway oil and L-menthol using microsphere-based site-specific targeting (COLM-SST) vs placebo in patients with functional dyspepsia (FD).METHODS:Adult men and women with FD defined by Rome III criteria were recruited. Patients were randomized to COLM-SST (25 mg of caraway oil and 20.75 mg of L-menthol per capsule, at 2 capsules per dose, twice per day) or placebo. Efficacy was measured at 24 hours, 2 weeks, and 4 weeks. Patients were allowed to take concomitant medications for their FD throughout the trial, and rescue medicines were allowed, 48 hours after start of dosing.RESULTS:Ninety-five patients were enrolled (mean age = 43.4 years; 75.8% women). At 24 hours, the active arm reported a statistically significant reduction in postprandial distress syndrome symptoms (P = 0.039), and a nonsignificant trend toward benefit of epigastric pain syndrome symptoms (P = 0.074). In patients with more severe symptoms, approximately 3 quarters of patients showed substantial global improvement (i.e., clinical global impressions), after 4 weeks of treatment, vs half in the control arm. These differences were statistically significant for patients with epigastric pain syndrome (P = 0.046), and trending toward significance for patients with postprandial distress syndrome (P = 0.091). There was no statistically significant difference between groups for Global Overall Symptom scores for the overall population at 2 and 4 weeks. Treatment emergent adverse events were mild to moderate, and no serious adverse events were reported.DISCUSSION:In patients taking their usual medications for FD, COLM-SST provided rapid relief (within 24 hours) and relief of severe FD symptoms. It was safe and well tolerated.

PGI3 - Real World, Non-Interventional, Observational Study to Evaluate Effectiveness and Tolerability of Acotiamide Hydrochloride Hydrate in Indian Patients with Functional Dyspepsia

To assess effectiveness & tolerability of Acotiamide hydrochloride hydrate in management of Indian patients with functional dyspepsia over 4 weeks period This was prospective, observational, real world study involving 132 patients (85 male, 47 female), aged >18 years, having functional dyspepsia as per Rome III criteria and treated with Acotiamide 100mg three times daily for 4 weeks at a tertiary care centre in India. Primary outcome was responders based on Overall Treatment Efficacy (OTE) recorded on a 7-point Likert scale for post-prandial distress syndrome (post-prandial fullness, early satiety and upper abdominal bloating), epigastric pain syndrome (Upper abdominal pain & discomfort) and associated symptoms of dyspepsia (nausea, vomiting and excessive belching) at the end of 2 and 4 weeks. Secondary outcomes were elimination of symptoms (post-prandial fullness, early satiety and upper abdominal bloating), quality of life assessed on Short-Form Nepean Dyspepsia Index (SFNDI) questionnaire and tolerability over 4 weeks of treatment The responder rates with Acotiamide at 2 and 4 weeks were 51.5% and 65.9% for post-prandial distress syndrome, 31.8%, and 41.7% for epigastric pain syndrome and 16.7% and 17.4% for associated dyspeptic symptoms respectively. Symptom elimination rates were 9.8% and 18.9% for post-prandial fullness, 12.9% and 22.0% for early satiety, and 18.9% and 24.2% for upper abdominal bloating at 2 and 4 weeks respectively. Significant improvement in quality of life as measured on SFNDI total scores, was reported from 25.91 (5.00) at 2 weeks to 23.76 (4.84) at 4 weeks(p<0.0001). Total 7 (5.30%) patients reported mild intensity adverse events which were dizziness (4 patients), headache (3 patients) and nausea (1 patient). Acotiamide demonstrates effectiveness through improvement in symptoms of post-prandial distress syndrome, epigastric pain syndrome and associated dyspepsia symptoms, along with significant improvement in quality of life over a 4-wk treatment period and is well tolerated in Indian patients with functional dyspepsia.

Seroreactivity to Microbial Antigens and Gut‐Homing Immune Responses in Functional Dyspepsia Patients with Postprandial Distress Syndrome

Functional dyspepsia (FD) is characterised by recurrent upper gastrointestinal symptoms with no explainable structural changes seen at endoscopy. FD can be classed by two symptom‐based subtypes: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Although FD is associated with an altered microbiome, the nature and consequence of the host‐microbiota interactions and how they relate to FD symptom subtypes is not well understood. We have previously identified an increase in the abundance of Streptococcus spp. in the duodenal microbiota of FD patients compared to controls (Zhong et al. 2017 Gut). We hypothesised that the microbiota of FD patients influenced immune homeostasis and aimed to investigate whether specific species provoked immune responses in patients with FD.New isolates of Streptococcus and Corynebacterium spp. found to be abundant in the duodenal microbiota of FD patients were selected for further analysis. Whole cell lysates from cultures of these bacteria were separated by polyacrylamide gel electrophoresis and transferred to a PVDF membrane for immunoblotting. Immunoblots were probed with plasma from FD patients or non‐FD controls. Density gradient separation was used to isolate peripheral blood mononuclear cells from blood. Cells were then stained with fluorophore conjugated markers for CD3, CD4, integrins α4 &amp; β7 before analysis by flow cytometry to examine changes in proportions of gut‐homing associated lymphocytes (α4+β7+).For lysate isolated from a Streptococcus spp. strain, seroreactive IgG antibody bands were observed at approximately 70kDa in 9 out of 10 FD patients. This band was absent in all but 2 of the control cohort (total n=8). A further band was observed around 30kDa in 9 FD patients (total n=10) that was only present in 3 controls (total n=8). 8 of the 10 patients reported PDS symptoms, of which all demonstrated seroreactivity at 70kDa, and 7 of the total 8 demonstrated a further band at approximately 30kDa. Cross‐reactivity was also observed with a different strain of the same Streptococcus spp. An increase in the proportion of peripheral α4+β7+ T cells (p&lt;0.05) was seen in PDS patients (n=4) but not in EPS (n=3) or EPS/PDS overlap (n=3) patients.Our data suggest an adaptive immune response against duodenal Streptococcus spp. in PDS but not EPS patients. In addition, PDS patients had significantly higher proportions of circulating gut‐homing T cells. These data suggest that PDS is the result of altered microbiota‐immune interactions. With further work, this finding may become a diagnostic indicator of PDS, and provide further insight into the mechanisms that drive FD.Support or Funding InformationNational Health and Medical Research Council Project Grant.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Management of functional dyspepsia: state of the art and emerging therapies.

Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. Several etiologies have been associated with the disorder. In the Rome IV criteria, the brain-gut axis was acknowledged as an important factor in the etiology of functional gastrointestinal (GI) disorders. The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. A previous study has reported that proton pump inhibitors (PPIs) and H2-blockers were equally effective in functional dyspepsia. A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. The pharmacological mechanisms of acotiamide remain unknown; whether acotiamide alters gastric emptying and gastric accommodation in patients with functional dyspepsia remains an open question. Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs). Different drugs are needed to accommodate the clinical symptoms and etiology in individual patients.

Severely impaired gastric accommodation is a hallmark of post-Nissen functional dyspepsia symptoms.

Laparoscopic Nissen fundoplication is a commonly performed antireflux surgery, after which reflux symptoms are well controlled, however, complications such as inability to belch or dyspeptic symptoms (mimicking those of functional dyspepsia [FD]) might occur. The aim of the study was to prospectively evaluate symptom pattern and underlying pathophysiological mechanisms in patients with post-Nissen dyspepsia. Twenty-four patients (12f, mean age 44.5±2.8years) with post-Nissen dyspepsia symptoms, five patients (3f, mean age 38.8±3.2years) with post-Nissen dysphagia symptoms and 14 pre-fundoplication patients (3f, mean age 42.1±2.5years) were evaluated. Patients filled out a Rome II-based dyspepsia symptom severity score, performed a gastric emptying test, and a gastric barostat study was used to evaluate the function of the proximal stomach. Upper abdominal bloating scores were higher in post-Nissen dyspepsia patients (P=.016) and symptoms of postprandial distress syndrome (PDS) were more present in post-Nissen dyspepsia patients compared to the other two groups (P=.07). Weight loss was significantly higher in the post-Nissen groups compared to the pre-fundoplication (P=.02). Gastric emptying rates were similar in the three groups. Gastric accommodation (GA) was significantly impaired in the post-Nissen dyspepsia group (dyspepsia -30[-86-83] vs dysphagia 163[148-203] vs pre-fundoplication 147[75-174]mL, P=.004) and the prevalence of patients with impaired GA was higher in the post-Nissen group (P=.007). Postprandial fullness was more prevalent in patients with impaired GA compared to those with normal GA (P=.01). Patients with post-Nissen dyspepsia show a symptom pattern similar to that in FD patients with PDS, and the main underlying mechanism seems to be impaired gastric accommodation to a meal.

Rome III functional dyspepsia symptoms classification: Severity vs frequency.

The Rome III criteria subdivide functional dyspepsia (FD) in the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS) based on the frequency of the symptoms to optimize the diagnostic and therapeutic approach. However, it is unclear to which extent the frequency of the symptoms is related to their severity. Our aim was to explore the frequency and severity of dyspeptic symptoms and their relationship in FD patients. Functional dyspepsia patients fulfilling the Rome III diagnostic completed a questionnaire that evaluated the frequency and severity of FD symptoms. The concordance between the severity and frequency categories was analyzed by means of spearman correlation and the concordance correlation coefficient (ρc ). In the entire patient cohort (n=421), the classification of symptoms severity and frequency showed good concordance for all symptoms. In the EPS subgroup (n=….), the symptom severity and frequency score of epigastric pain showed a poor correlation (r=.28; ρc =0.07). The PDS subgroup (n=…) showed a good correlation for most of the symptoms. Due to its limited occurrence in this group, the correlation of the severity and frequency scores for epigastric pain is of little relevance (r=.79; ρc =0.58). The overlap EPS-PDS group showed good correlation for most of the symptoms, except for epigastric pain (pain r=.24; ρc =0.09). We conclude that the information given by the assessment of frequency and severity of PDS symptoms is comparable and hence one of the scores sufficiently identifies symptom pattern in PDS patients. In EPS patients, both the symptom frequency and severity should be taken into account as two separate entities.

Pathophysiological Abnormalities in Functional Dyspepsia Subgroups According to the Rome III Criteria.

The Rome III criteria proposed to subdivide functional dyspepsia (FD) into a postprandial distress syndrome (PDS) group, characterized by the presence of postprandial fullness and/or early satiety, and an epigastric pain syndrome (EPS) group, characterized by the presence of epigastric pain and/or epigastric burning. It has been suggested that different pathophysiological mechanisms underlie the symptom presentations in these subgroups that might determine treatment choices. The aim of this study was to investigate the prevalence of gastric sensorimotor dysfunction in the PDS, EPS, and overlap groups and to evaluate potential differential associations with dyspeptic symptom scores. Consecutive FD patients fulfilling Rome III criteria were recruited and they scored frequency of dyspeptic symptoms (postprandial fullness, early satiety, nausea, bloating, epigastric pain, and epigastric burning) over the past 3 months (0-5; 1=once a month or less, 2=two or three times a month, 3=once a week, 4=several times a week, 5=every day). The cumulative symptom score was calculated by adding up the score of these dyspeptic symptoms. Based on these symptom scores, the patients were subdivided into subgroups according to the Rome III consensus: (i) PDS, characterized by postprandial fullness and/or early satiety at least several times a week, (ii) EPS, characterized by epigastric pain and/or epigastric burning at least once a week, and (iii) overlap, fulfilling the criteria for both PDS and EPS. Gastric sensitivity and gastric accommodation were measured using barostat testing, and solid gastric emptying was determined using the [14C]octanoate breath test. A total of 560 FD patients (165 men, age 41.8±0.7 years) were classified into PDS (n=131), EPS (n=50), and overlap (n=379) groups. The prevalence of gastric hypersensitivity, impaired gastric accommodation, and delayed gastric emptying were 37%, 37%, and 23%, respectively, without any differential distribution in Rome III subgroups (P=0.16, P=0.27, and P=0.39 respectively). Comparing the physiological parameters for these gastric sensorimotor functions, there was only a significant difference in the gastric half emptying time between subgroups, with the overlap group having a higher t1/2 (P<0.05) compared with the EPS group. In the overlap group, gastric hypersensitivity was associated with the severity of PDS symptoms (P=0.03), EPS symptoms (P=0.02), and the cumulative symptom score (P=0.02), whereas delayed gastric emptying was associated with nausea (P=0.02) and the cumulative symptom score (P=0.02). Except for gastric emptying in the overlap group, FD subgroups as defined by the Rome III criteria are not differentially associated with putative pathophysiological mechanisms. These observations question the utility of this classification for guiding therapeutic choices in clinical practice.

Validation of the Leuven Postprandial Distress Scale, a questionnaire for symptom assessment in the functional dyspepsia/postprandial distress syndrome.

A validated patient-reported outcome instrument is lacking for the functional dyspepsia/postprandial distress syndrome. To validate the Leuven Postprandial Distress Scale (LPDS). The LPDS diary, comprising eight symptoms with verbal descriptors rated for severity (0-4), was derived from focus groups and cognitive debriefing. It was used in a 2-week run-in, 8-week double-blind placebo-controlled trial of itopride 100 mg t.d.s. Results in 60 patients, with concealed treatment allocation, were used to analyse LPDS content validity, consistency, reliability and responsiveness. Patients also filled out Patient Assessment of Gastrointestinal Symptoms (PAGI-SYM), Nepean Dyspepsia Index, overall treatment evaluation and overall symptom severity questionnaires. Construct validity was evaluated by known-group analyses and by correlating LPDS with these additional questionnaires. Minimum Clinically Important Difference was determined from threshold changes in anchor questionnaires. Symptom patterns and factor analysis identified three cardinal symptoms of postprandial distress syndrome (early satiation, postprandial fullness, upper abdominal bloating), whose mean intensities generate weekly LPDS scores. Known-groups analysis showed large-effect-size differences in LPDS scores (Cohen's d = 2.16). Strong correlations (r > 0.57) between LPDS scores and relevant anchors at baseline indicate good convergent validity. Internal consistency of LPDS was good (α > 0.85) with high inter-item correlations (0.67-0.76), and test-retest reliability (r = 0.85). Changes in LPDS scores were highly convergent with changes in overall treatment evaluation, overall symptom severity and PAGI-SYM (r > 0.52). minimum clinically important difference analysis generated thresholds of 0.4-0.6. The Leuven Postprandial Distress Scale, which is supported by the European Medicines Agency, is a sensitive and reliable patient-reported outcome instrument to assess symptoms in the functional dyspepsia/postprandial distress syndrome.

The Efficacy of Mentha longifolia in the Treatment of Patients With Postprandial Distress Syndrome: A Double-Blind, Randomized Clinical Trial

Background: Functional dyspepsia (FD) is a common gastrointestinal disease that has various treatments, including medicinal plants. Objectives: The current study aimed to investigate the effect of Mentha longifolia on relieving the symptoms and improving the quality of life (QOL) in patients with functional dyspepsia from the subgroup of postprandial distress syndrome (PDS). Patients and Methods: This randomized, double-blind, placebo-controlled trial was conducted in a gastroenterology clinic affiliated with Isfahan University of Medical Sciences. One hundred patients diagnosed with PDS according to the ROME III criteria were assigned to two groups: the M. longifolia capsules (three times daily for four weeks) group and the placebo group. Tools for gathering data were the FD severity scale and QOL (Persian version of the SF-36 questionnaire). Assessments of FD symptoms were obtained at baseline and also at the end of weeks 2, 4, and 12. QOL was evaluated at baseline and at the end of week 12. Results: At the end of treatment period, the M. longifolia group reported a more significant improvement in the mean severity scales of FD symptoms than the placebo group (P < 0.001). A significant difference was also observed between FD symptoms and severity scores in the two groups eight weeks after the medication was stopped. At the end of the fourth week, the greatest degrees of relief regarding epigastric bloating (70.5% vs. 21.4%, P < 0.001), epigastric fullness (68.2% vs. 31%, P < 0.001), loss of appetite (34.1% vs. 9.5%, P = 0.014) and early satiety (36.3% vs. 21.4%, P = 0.02) were observed ‎in the control group. With M. longifolia, significant improvement in the scores of QOL was observed for the dimensions of general health, role-physical, social functioning, bodily pain, vitality, and mental health. Conclusions: This study showed the efficacy of M. longifolia in relieving PDS symptoms and improving the QOL of patients with PDS.

Chinese herbal formula for postprandial distress syndrome: Study protocol of a double-blinded, randomized, placebo-controlled trial

IntroductionFunctional dyspepsia is one of the typical functional gastrointestinal disorders and can be further categorized into postprandial distress syndrome and epigastric pain syndrome. The clinical response to conventional medicine treatment is unsatisfactory so that a majority of the population will seek help from Traditional Chinese Medicine. In clinical practice JianPi’I, derived from a classical TCM formula Xiangshaliujunzi decoction, appears to have a satisfactory effect on functional dyspepsia. Therefore, in order to further verify the benefit of JianPi’I, we designed a strict clinical trial to evaluate the safety and efficacy of JianPi’I in postprandial distress syndrome patients. MethodsThis is a 10-week, multicenter, randomized, double-blinded, placebo-controlled trial. Eligible 144 patients will randomly be assigned to JianPi’I or placebo. The primary outcome is the change in the postprandial discomfort severity scale from baseline to treatment endpoint. The secondary outcomes include the changes in the clinical global impression scale, Traditional Chinese Medicine symptoms scores, MOS 36-Item Short-Form Health Survey and gastric emptying from baseline to treatment endpoint. DiscussionThe main ingredients of JianPi’I contain Radix Codonopsis (Dangshen), Rhizoma Atractylodis Macrocephalae (Baizhu), Poria (Fuling), Fructus Amomi (Sharen), Radix Glycyrrhizae (Gancao), Radix Aucklandiae (Muxiang), Pericarpium Citri Reticulatae (Chenpi), and Rhizoma Pinelliae (Banxia), which are expected to alleviate symptoms of postprandial distress syndrome. This randomized placebo-controlled trial will comprehensively examine the efficacy and safety of JianPi’I in postprandial distress syndrome patients, and aim to provide a new treatment option for clinical practice in postprandial distress syndrome management.

Emerging treatments in neurogastroenterology: Acotiamade, a novel treatment option for functional dyspepsia.

Acotiamide hydrochloride (Z-338) is a new therapeutic agent for functional dyspepsia (FD). In 2013, the use of acotiamide was approved by the Japanese health insurance system. The aim of this review is to summarize the present staus of basic and clinical approach to acotiamide for the treatment of functional dyspepsia. The agent inhibits acetylcholinesterase in vitro and enhances muscle motility ex vivo. In phase-II studies, 100 mg three times daily (t.i.d.) was determined to be the optimal dose for the treatment of FD. In phase-III studies, overall treatment efficacy (OTE) was significantly better in the acotiamide group (52.2%) than in the placebo group (34.8%). However, the mechanism of its efficacy needs to be further elucidated. Acotiamide effectively improved FD symptoms, particularly postprandial distress syndrome symptoms, without causing major adverse effects.

The effect of acotiamide on epigastric pain syndrome and postprandial distress syndrome in patients with functional dyspepsia.

The effect of acotiamide on gastrointestinal symptoms is undefined. The aim of this study is to evaluate the effect of acotiamide on abdominal symptoms in patients with functional dyspepsia. We retrospectively reviewed 51 patients treated with acotiamide. We evaluated patient quality of life using the Izumo scale that detects changes in quality of life caused by abdominal symptoms. Acotiamide ameliorated the symptoms of functional dyspepsia at one and three months (improved: 61% vs 80%, p=0.029 and resolved: 17% vs 33%, p=0.069). We then evaluated the effect of acotiamide on epigastric pain syndrome (EPS) (n=33) and postprandial distress syndrome (PDS) (n=41). Acotiamide treatment showed an early effect on rates of improvement (63%) and resolution (42%) of EPS symptoms at one month, maintained up to three months (69% and 39%, respectively). Both rates of improvement and resolution of PDS symptoms showed a significant increase from one month to three months (56% vs 78%, p=0.021 and 17% vs 46%, p=0.004, respectively). The severity of functional dyspepsia symptoms before treatment was significantly associated with failed resolution of functional dyspepsia symptoms (p=0.013). Acotiamide improves and resolves EPS symptoms as well as PDS symptoms. PDS symptoms take longer to resolve than EPS symptoms. J. Med. Invest. 63: 230-235, August, 2016.