Treatment Of Dyspepsia Research Articles

Vonoprazan Therapy is as Effective for Functional Dyspepsia without Heartburn as Acotiamide Therapy

Acid suppression improves dyspepsia symptoms but the efficacy of vonoprazan for functional dyspepsia remains unclear. The aim of this study is to evaluate the effectiveness of vonoprazan therapy for functional dyspepsia without heartburn. Patients receiving vonoprazan 10 mg once daily or acotiamide 100 mg three times daily for more than one month were included and retrospectively reviewed. Functional dyspepsia was diagnosed based on the ROME IV criteria. Patients with heartburn were excluded. Eighty-five patients were divided into vonoprazan (n=48) and acotiamide (n=37) groups. There were no significant differences at baseline between the vonoprazan and acotiamide groups. The functional dyspepsia score significantly improved in both groups (p<0.001). The degree of score reduction (55% vs 59%, p=0.559) and the resolution rates (21% vs 30%, p=0.345) were similar. Epigastric pain and postprandial distress scores were significantly improved in both groups, and the degree of improvement of each score was similar. Constipation and diarrhea scores were significantly improved in both groups, and the degree of improvement similar. These preliminary results suggest that vonoprazan is effective for the treatment of functional dyspepsia without heartburn in the short-term, with results similar to acotiamide therapy.

Capsaicin: A Novel Approach to the Treatment of Functional Dyspepsia.

Capsaicin, the principal spicy component of red pepper, shows numerous bioactivities these years. Based on the results of past studies, capsaicin may have potential effects on the treatment of functional dyspepsia (FD). However, most studies mainly investigate functional dyspepsia-treatment effects of capsaicin by discussing the relationship between capsaicin and transient receptor potential vanilloid type 1 (TRPV1). In fact, capsaicin may relieve the symptoms of FD in various ways. These effects involve desensitizing C nociceptive fibers, regulating kinds of neurotransmitters, counteracting viruses and inflammation, balancing the gut microbiota, inhibiting the secretion of gastric acid, and reducing oxidative stress damage. A full understanding of these mechanisms will help further development and utilization of capsaicin in food and medical fields.

Neuromodulating agents in functional dyspepsia: a comprehensive review.

Functional dyspepsia is a common chronic condition with upper abdominal symptoms in the absence of an organic cause. The first line treatment consists of protonpomp inhibition or Helicobacter pylori eradication. However, this approach often does not provide enough symptom relief. Neuromodulating agents are commonly used in clinical practice but only tricyclic antidepressant (TCAs) are mentioned in European and American and Canadian guidelines. We performed a comprehensive review of the literature in Pubmed for full-text randomized controlled trials in English with adult participants (>18 years) who met the Rome II, III or IV criteria or were diagnosed by a physician with a negative upper endoscopy and that compared a neuromodulating agent with placebo. The search strategy identified 386 articles of which 14 articles met the eligibility criteria. TCAs like amitriptyline and imipramine have been shown to be effective in the treatment of functional dyspepsia whereas other neuromodulating agents like tetracyclic antidepressants, levosulpiride and anxiolytics might be beneficial but conclusive evidence is lacking. serotonin and noradrenaline reuptake inhibitors (SNRI) and selective serotonin reuptake inhibitors (SSRI) have not shown benefit in patients with functional dyspepsia. Selected neuromodulators have an established efficacy in functional dyspepsia. The best supporting evidence is available for TCAs with a potential role for tetracyclic antidepressants, levosulpiride and anxiolytics.

Novel insights in the pathophysiology and management of functional dyspepsia.

Functional dyspepsia is a common functional gastrointestinal disorder with bothersome symptoms in the upper abdomen without an organic lesion that is likely to explain the complaints. Traditionally, changes in gastric physiology were held responsible for the symptoms, including delayed gastric emptying, impaired gastric accommodation and hypersensitivity to distension. However, gastric sensorimotor disturbances correlated only poorly to symptom severity and treatments targeting these abnormalities are not very effective. In the last decade, the duodenum has been identified as a key integrator in the pathophysiology of functional dyspepsia with an impaired barrier function and immune activation with a particular role for eosinophils and mast cells. Moreover, changes in the duodenal microbiota were associated to dyspeptic symptoms and eosinophil counts. PPIs – still the first line treatment for functional dyspepsia – have been shown to reduce symptoms through anti-inflammatory effects in the duodenum, similar to their effect in eosinophilic esophagitis. Finally, specific probiotic strains were effective in improvement of postprandial symptoms, most likely through an anti-inflammatory effect as demonstrated by reduced Th17 signaling. These novel insights in pathophysiology and treatment provide novel hope for patients with this challenging condition.

Efficacy of omeprazole and domperidone fixed combination in the treatment of patients with functional dyspepsia: results from TANDEM study

Introduction. Functional dyspepsia (FD) is a multifactorial disease, and the combination of drugs with different mechanisms of action makes it possible to optimally influence various parts of the pathogenesis.Aim. Prospective observational study TANDEM evaluated the efficacy and tolerability of omeprazole and domperidone fixed combination therapy in the treatment of functional dyspepsia in patients with chronic Helicobacter pylori negative gastritis after 4 weeks course of treatment.Materials and methods. In accordance with the purpose of the study, a study cohort was formed of 50 patients with symptoms of functional dyspepsia (30 men, 20 women). The mean age was 29.06 (25.88–32.25). Efficacy and tolerability were assessed using the Visual Analog Scale and the Likert scale.Results. The study was completed by 47 patients. After 4 weeks of treatment, positive dynamics in the form of complete relief of symptoms was noted in all 47 patients; no clinically significant changes in the QT interval were detected.Conclusion. Evaluation of the efficacy of fixed combination omeprazole and domperidone in the treatment of functional dyspepsia in patients with chronic Hp-negative gastritis demonstrated 100% efficacy of the drug in relieving symptoms 4 weeks after the start of therapy. After 72 hours from the start of the treatment, the effect in the form of complete relief of symptoms was registered in 87.25% of patients. On the 14th day the symptoms were completely relieved in 95.74% of patients. Assessment of tolerability demonstrated a good safety profile of the drug, in particular, the absence of clinically significant changes in the QTс interval.

Chaihu Shugan San promotes gastric motility in rats with functional dyspepsia by regulating Drp-1-mediated ICC mitophagy

Context Chaihu Shugan San (CHSGS) was effective in the treatment of functional dyspepsia (FD). Objective To investigate the mechanism of CHSGS in FD through dynamin-related protein 1 (Drp-1)-mediated interstitial cells of cajal (ICC) mitophagy. Materials and methods Forty Sprague-Dawley (SD) rats were randomly divided into control, model, mdivi-1, mdivi-1 + CHSGS and CHSGS groups. Tail-clamping stimulation was used to establish the FD model. Mdivi-1 + CHSGS and CHSGS groups were given CHSGS aqueous solution (4.8 g/kg) by gavage twice a day. Mdivi-1 (25 mg/kg) was injected intraperitoneally once every other week for 4 w. Mitochondrial damage was observed by corresponding kits and related protein expressions were assessed by Immunofluorescence and (or) Western Blot. Results Compared with the mean value of the control group, superoxide dismutase (SOD) and citrate synthase (CS) in the model group were decreased by 11% and 35%; malondialdehyde (MDA) and reactive oxygen species (ROS) were increased by 1.2- and 2.8-times; ckit fluorescence and protein expressions were decreased by 85% and 51%, co-localization expression of LC3 and voltage dependent anion channel 1 (VDAC1), Drp-1 and translocase of the outer mitochondrial membrane 20 (Tom20) were increased by 10.1- and 5.4-times; protein expressions of Drp-1, Beclin-1, and LC3 were increased by 0.5-, 1.4-, and 2.5-times whereas p62 was decreased by 43%. After mdivi-1 and (or) CHSGS intervention, the above situation has been improved. Discussion and conclusion CHSGS could improve mitochondrial damage and promote gastric motility in FD rats by regulating Drp-1-mediated ICC mitophagy.

Evaluation of the dynamics of symptoms of dyspepsia after eradication therapy in patients with Helicobacter pylori-associated gastritis

The treatment of functional dyspepsia remains a complex and incompletely resolved issue of gastroenterology. Subjective sensations of the patient, described as a feeling of fullness in the epigastrium after eating, early satiety, pain in the epigastrium, may be a manifestation of dyspepsia associated with Helicobacter pylori (H. pylori) infection. Aim was evaluation of the effectiveness of standard triple eradication therapy enhanced with bismuth tripotassium dicitrate for the relief of symptoms of dyspepsia in patients with H. pylori-associated chronic gastritis. Materials and Methods. The study involved 38 patients with H. pylori-associated chronic gastritis with symptoms of dyspepsia. The Questionnaire “7 × 7” was used to describe the dynamics of symptoms of dyspepsia. Results. At the initial examination, dyspeptic disorders in most patients corresponded the criteria for mild and moderate severity, respectively - 44.7% and 28.9% of patients. The severity of pain in the stomach area on average corresponded to a moderate pain syndrome, and the burning sensation was of low intensity. A feeling of fullness in the stomach after eating and/or early satiety was experienced by 76.3% of patients, pain disorders were observed in 92.1% of individuals. Two months after successful eradication treatment, complete relief of dyspepsia symptoms was noted in 57.9% of patients, and significant relief of symptoms of the combined form of dyspepsia in 23.7% of individuals. Conclusions: Successful standard triple eradication therapy enhanced with bismuth tripotassium dicitrate is effective for the treatment of dyspeptic symptoms in patients with H. pylori-associated chronic gastritis.

Integrated untargeted and targeted metabolomics to reveal therapeutic effect and mechanism of Alpiniae oxyphyllae fructus on Alzheimer's disease in APP/PS1 mice.

Introduction: Alpiniae oxyphyllae Fructus (AOF) has been abundantly utilized for the treatment of diarrhea, dyspepsia, kidney asthenia, and abdominal pain in China. AOF is effective for treating AD in clinical trials, but its exact mode of action is yet unknown. Methods: In this study, metabolomics was combined to ascertain the alterations in plasma metabolism in APP/PS1 transgenic mice, the therapy of AOF on model mice, and the dynamic variations in 15 bile acids (BAs) concentration. Results: 31 differential biomarkers were finally identified in APP/PS1 group vs. the WT group. The levels of 16 metabolites like sphinganine (Sa), lyso PE (20:2), lysoPC (17:0), glycocholic acid (GCA), deoxycholicacid (DCA) were increased in APP/PS1 group, and those of 15 metabolites like phytosphingosine, cer (d18:0/14:0), and fumaric acid were reduced in APP/PS1 group. After AOF treatment, 29 of the 31 differential metabolites showed a tendency to be back-regulated, and 15 metabolites were significantly back-regulated, including sphinganine (Sa), lyso PE (20:2), glycocholic acid (GCA), deoxycholic acid (DCA). The relationship between BAs level and AD had been received increasing attention in recent years, and we also found notable differences between DCA and GCA in different groups. Therefore, a BAs-targeted metabonomic way was established to determine the level of 15 bile acids in different groups. The consequence demonstrated that primary BAs (CA, CDCA) declined in APP/PS1 model mice. After 3 months of AOF administration, CA and CDCA levels showed an upward trend. Conjugated primary bile acids (TCA, GCA, TCDCA, GCDCA), and secondary bile acids (DCA, LCA, GDCA, TDCA, TLCA GLCA) ascended in APP/PS1 group. After 3 months of AOF treatment, the levels of most BAs decreased to varying degrees. Notably, the metabolic performance of DCA and GCA in different groups was consistent with the predictions of untargeted metabolomics, validating the correctness of untargeted metabolomics. Discussion: According to metabolic pathways of regulated metabolites, it was prompted that AOF ameliorated the symptom of AD mice probably by regulating bile acids metabolism. This study offers a solid foundation for further research into the AOF mechanism for the therapy of AD.

Research progress of treatment of functional dyspepsia with traditional Chinese medicine compound based on cell signal pathway.

Functional dyspepsia (FD) is the most common clinical gastrointestinal disease, with complex and prolonged clinical symptoms. The prevalence of FD is increasing year by year, seriously affecting the quality of life of patients. The main causes of FD are related to abnormal gastrointestinal dynamics, increased visceral sensitivity, Helicobacter pylori (HP) infection, intestinal flora disturbance and psychological factors. A review of the relevant literature reveals that the mechanisms of traditional Chinese medicine (TCM) in the treatment of FD mainly involve the following pathways:5-HT signal pathway, AMPK signal pathway,C-kit signal pathway, CRF signal pathway, PERK signal pathway,NF-κB signal pathway. Based on a holistic concept, TCM promotes gastrointestinal motility, regulates visceral sensitivity and alleviates gastrointestinal inflammation through multiple signal pathways, reflecting the advantages of multi-level, multi-pathway and multi-targeted treatment of FD.

Updates in Gastroenterology: Acotiamide for Treatment of Functional Dyspepsia

Functional dyspepsia (FD) comprises of two types, the postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Acotiamide is a new prokinetic agent that acts by increased release of acetylcholine and is used in the treatment of FD-postprandial distress syndrome (FD-PDS). The drug initially launched in Japan is the world’s first approved treatment for FD. It exerts its activity via muscarinic receptor inhibition, which enhances acetylcholine (ACh) release, and via inhibition of acetylcholinesterase (AChE) activity in the stomach. It increases the availability of ACh on postsynaptic receptors in the enteric nervous system. The gastroprokinetic activity of acotiamide does not cause prolongation of the QT interval. Long-term studies of 48 weeks have shown a favorable clinical course with acotiamide in FD.

Meta-analysis of Simotang Oral Liquid in treatment of functional dyspepsia in adults

This study was conducted to evaluate the efficacy and safety of Simotang Oral Liquid in the treatment of functional dyspepsia in adults. &quot;Simotang Oral Liquid&quot; &quot;Simotang&quot; &quot;Si Mo Tang&quot; &quot;Si Mo Tang Oral Liquid&quot; were used for retrieval of the relevant papers from CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Springer Link, and Web of Science from database inception to June 2021. Randomized controlled trial(RCT) of Simotang Oral Liquid in the treatment of functional dyspepsia in adults was screened out for Meta-analysis which was conducted in RevMan 5.3. A total of 16 RCTs were included. Meta-analysis showed that compared with the control group, Simotang Oral Liquid increased the total response rate and lowered the traditional Chinese medicine syndrome scores, serum cholecystokinin(CCK), serum nitric oxide(NO), and incidence of adverse reactions. However, the serum substance P(SP) had no statistical difference between the two groups. Simotang Oral Liquid is effective and safe in the treatment of functional dyspepsia in adults. However, this study has evidence and limitations, so the conclusions need to be further verified by large sample and multicenter clinical studies.

Progress of Chinese and Western medicine research on the treatment of functional dyspepsia based on intestinal microecology

Functional dyspepsia (FD) is a disease in which gastroparesis and diet-related symptoms are the main clinical manifestations due to the dysfunction of the gastroduodenum, but there are no structural changes and its pathogenesis is still unclear. In recent years, intestinal microecology has been confirmed to be related to FD. In this paper, we intend to review the role and mechanism of microecological agents and Chinese medicine in the treatment of functional dyspepsia, starting from the relationship between intestinal microecology and FD, in order to provide reference for clinical treatment and research.

中医药联合心理疗法治疗功能性消化不良的研究进展

中医药联合心理疗法治疗功能性消化不良的研究进展

Pyrrole-type compounds from the flowers of Calotropis gigantea

Calotropis gigantea, a large shrub, has been used in traditional folk medicines for the treatment of fever, cough, swellings, bronchitis or dyspepsia. Previous studies on C. gigantea reported that its main constituents, specifically cardenolides and pregnanes, had cytotoxic activity against A549 human lung, Hela human cervical cancer cell lines and K562 human chronic myelogenous leukemia. This paper presents the isolation of chemical constituents from the flowers of C. gigantea (Apocynaceae) in order to provide more information about its chemical compounds to the database on medical plants in Vietnam. By using silica gel column chromatography, preparative TLC and eluting with organic solvents of different polarity, results showed that five pyrroles, including pollenopyrroside B (1), epi-acortatarin A (2), shensongine A (3), 5-methoxymethyl-1H-pyrrole-2-carbaldehyde (4), 1-[2-(furan-2-yl)-2-oxoethyl]pyrrolidin-2-one (5), were isolated from the CHCl3 extract of the flowers of C. gigantea (Apocynaceae), collected at Binh Thuan province in March, 2020. Their chemical structures were elucidated by HR-MS and 1D, 2D NMR spectra analysis and comparison with published data. All compounds were the first reported from C. gigantea.

Study of the potential mechanism of acupuncture treatment for functional dyspepsia based on association rule mining and bioinformatics/network pharmacology approach

Study of the potential mechanism of acupuncture treatment for functional dyspepsia based on association rule mining and bioinformatics/network pharmacology approach

The treatment of functional dyspepsia: present and future

ABSTRACT Introduction Functional dyspepsia (FD) is a prevalent, but frequently overlooked and/or under diagnosed disorder of gut-brain interaction (DGBI). Functional dyspepsia frequently co-exists with other DGBIs, and persistent symptoms have a significant impact on patients’ quality of life. A variety of therapies (e.g. diet, probiotics, antibiotics, acid suppressants, neuromodulators, prokinetics) are employed to treat the multiple symptoms of FD, although none are uniformly effective. Areas covered This review covers currently available therapies for the treatment of FD in addition to novel and emerging therapies that may change the treatment paradigm in the near future. PubMed, Embase and the Cochrane data bank were searched from 1990 to October 2022 for relevant articles. Expert opinion Dietary intervention, eradication of H. pylori, and/or a trial of acid suppression are reasonable initial treatment options for patients with FD. Neuromodulators and fundic accommodation agents are underemployed and should be used more routinely by healthcare providers, especially for patients with moderate-severe symptoms. Alternative therapies, such as cognitive behavioral therapy and hypnotherapy, are gaining recognition as safe and effective treatments for FD and can be used alone or in combination with medications. Virtual reality has the potential to significantly improve global FD symptoms.

Treatment of Functional Dyspepsia in Outpatients after COVID-19 Infection

Aim: to compare the efficacy of different therapeutic regimens for managing functional dyspepsia in outpatients after COVID-19 infection.Materials and methods. 42 post-COVID-19 outpatients (age: 26–47 years) diagnosed with functional dyspepsia (FD) according to the Rome IV Criteria were enrolled in two parallel groups. All patients were divided in 2 groups by randomization: Group 1 received omeprazole at a dose of 80 mg/day, Group 2 received a combination of omeprazole and Kolofort® (a combined action drug product containing technologically processed antibodies to S100, TNF-alpha, and histamine) at a dose of 80 mg/day. At baseline and after treatment, a 10-point VAS was used to measure symptoms and an SF-36 questionnaire to evaluate the quality of life.Results. By Day 28 of the treatment, the intensity of epigastric pain (VAS score) in the group receiving proton-pump inhibitor (PPI) + Kolofort® was significantly lower. In both groups, fully resolved dyspeptic syndrome was observed in up to 90 % of patients, without significant differences (p &lt; 0.06). According to the SF-36 data, a combination treatment resulted in higher scores (pain and general health subscales) as compared to the PPI alone.Conclusion. Kolofort® relieves symptoms and improves the quality of life when added to the treatment regimen against functional dyspepsia in post-COVID-19 patients.

Retracted: Clinical Effect of Acupuncture Combined with Traditional Chinese Medicine Application on the Treatment of Functional Dyspepsia in Children and the Influence on Serum 5-HT and NO Levels.

[This retracts the article DOI: 10.1155/2022/6800662.].

Priorities in choosing prokinetic for patients with functional dyspepsia: Focus on itopride

Functional dyspepsia is a widespread disease with many symptoms that reduce the patient's quality of life. The effectiveness of prokinetics, including in combination with proton pump inhibitors, has a high level of scientific evidence in the treatment of functional dyspepsia. The effectiveness of itopride hydrochloride is determined by a dual mechanism of action: antagonism to D 2-dopamine receptors and inhibition of acetylcholinesterase. The drug exceeds of metoclopramide and domperidone in safety in relation to cardiac and neurological disorders. Itopride hydrochloride is not expected to have pharmacokinetic interactions with other drugs metabolized by the CYP3A4 system. In addition to functional dyspepsia, itopride hydrochloride is indicated in the treatment of chronic gastritis, gastrointestinal symptoms associated with gastric dysmotility or delayed gastric emptying, such as bloating, rapid satiety, a feeling of fullness in the stomach after eating, pain or discomfort in the epigastric region, loss of appetite, heartburn, nausea and vomiting. The pharmacoeconomic analysis shows an advantage of Itopride-SZ in comparing of the direct cost of it with the original and several generic drugs. In this way, it allows recommend Itopride-SZ as an affordable drug for various cohorts of patients.

The effect of phytobiotic preparations on morphochemical blood parameters of calves with dyspepsia

The results of the effect of complex phytopreparations on blood parameters in the treatment of dyspepsia in young cattle are presented. Three groups of newborn Hereford calves with signs of dyspepsia were used as the research material. The first experimental group was given the developed preparation № 1 (bird cherry fruit, eleutherococcus rhizome, camomile flowers, probiotic) 2 times a day at 12-hour intervals at the rate of 2 ml/kg of live weight; the 2nd - was given the developed preparation № 2 (bergenia rhizome, fennel leaf, calendula flowers, probiotic) 2 times a day at 12-hour intervals at the rate of 2 ml/kg of live weight. Animals of the control group were not given the studied preparations and were treated according to the scheme adopted at the farm (they were given boiled water with NaCl 9 g/boiled water, pancreatin, tetracycline. Prior to the experiment, all clinical signs of dyspepsia were noted in sick calves. After the application of herbal preparations in the experimental groups in 7 days normalization of leukocytes by 60.4 and 48.7%, respectively, was observed. The number of erythrocytes in all studied groups was within the normal range, the level of hemoglobin in the control group was registered 10% lower than normal and 20.5% lower than in the second group of animals. Hematocrit in the experimental groups corresponded to the norm (35.2 and 38.7%, respectively), in the control group it exceeded the norm by 26% (p &amp;amp;lt; 0.01). The content of sodium and potassium in the blood serum in the control group was reduced by 44 and 17.1%, respectively, and in the experimental groups it was within the reference values. In the experimental groups, positive dynamics of normalization of calcium-phosphorus ratio and iron was noted. Glucose level significantly (p &amp;amp;lt; 0.05) increased by 2.7% in the 1st experimental group and by 3.9% in the 2nd group. The data obtained indicate high effectiveness of the preparations (90 and 100% respectively) and a positive effect on the physiological parameters of the calves, as well as on the consumer qualities of the products.