Ulcer-like Functional Dyspepsia Research Articles

Effect of Amitriptyline and Escitalopram on Functional Dyspepsia: A Multicenter, Randomized Controlled Study

Antidepressants are frequently prescribed to treat functional dyspepsia (FD), a common disorder characterized by upper abdominal symptoms, including discomfort or postprandial fullness. However, there is little evidence of the efficacy of these drugs in patients with FD. We performed a randomized, double-blind, placebo-controlled trial to evaluate the effects of antidepressant therapy on symptoms, gastric emptying (GE), and meal-induced satiety in patients with FD. We performed a study at 8 North American sites of patients who met the Rome II criteria for FD and did not have depression or use antidepressants. Patients (n = 292; 44 ± 15 years old, 75% were female, 70% with dysmotility-like FD, and 30% with ulcer-like FD) were randomly assigned to groups given placebo, 50 mg amitriptyline, or 10 mg escitalopram for 10 weeks. The primary end point was adequate relief of FD symptoms for ≥5 weeks of the last 10 weeks (of 12). Secondary end points included GE time, maximum tolerated volume in Nutrient Drink Test, and FD-related quality of life. An adequate relief response was reported by 39 subjects given placebo (40%), 51 given amitriptyline (53%), and 37 given escitalopram (38%) (P = .05, after treatment, adjusted for baseline balancing factors including all subjects). Subjects with ulcer-like FD given amitriptyline were >3-fold more likely to report adequate relief than those given placebo (odds ratio = 3.1; 95% confidence interval: 1.1-9.0). Neither amitriptyline nor escitalopram appeared to affect GE or meal-induced satiety after the 10-week period in any group. Subjects with delayed GE were less likely to report adequate relief than subjects with normal GE (odds ratio = 0.4; 95% confidence interval: 0.2-0.8). Both antidepressants improved overall quality of life. Amitriptyline, but not escitalopram, appears to benefit some patients with FD, particularly those with ulcer-like (painful) FD. Patients with delayed GE do not respond to these drugs. ClinicalTrials.gov ID: NCT00248651.

Laboratory parameters and nutritional status in patients with functional dyspepsia

Background To investigate differences in laboratory markers, nutritional status parameters and eating patterns among newly diagnosed patients with functional dyspepsia. Method The investigation was performed on 180 newly diagnosed patients with functional dyspepsia, aged 20–79, which were referred to the gastroenterology unit of the Clinical and Hospital Center “Bezanijska Kosa” from April to October 2009. Rome II criteria were used for further classification. Results ANOVA Bonferroni post hoc correction outlined that concentrations of serum magnesium and calcium were significantly lower in subjects with ulcer-like dyspepsia, while vitamin B12, glucose and immunoglobulin G level was significantly higher in group with dismotility-like dyspepsia. Statistical analysis revealed that the numbers of meal taken per day were significantly different. There was a statistical trend to skipping meals and to eat fast in patients with ulcer-like and dismotility-like functional dyspepsia when compared with non-specific dyspeptic subjects. Conclusion Patients with ulcer-like functional dyspepsia suffered from epigastric pain and burning and from heartburn, while persons with dismotility-like dyspepsia were complaining about postprandial fullness, bloating and early satiety. They skipped meals more frequently and avoided intake of certain supplies which, together with eating habits, provoked or emphasized the annoying symptoms.

MS256 FEATURES OF METABOLIC SYNDROME IN DEPRESSIVE DISORDER

To investigate differences in laboratory markers, nutritional status parameters and eating patterns among newly diagnosed patients with functional dyspepsia.The investigation was performed on 180 newly diagnosed patients with functional dyspepsia, aged 20–79, which were referred to the gastroenterology unit of the Clinical and Hospital Center “Bezanijska Kosa” from April to October 2009. Rome II criteria were used for further classification.ANOVA Bonferroni post hoc correction outlined that concentrations of serum magnesium and calcium were significantly lower in subjects with ulcer-like dyspepsia, while vitamin B12, glucose and immunoglobulin G level was significantly higher in group with dismotility-like dyspepsia. Statistical analysis revealed that the numbers of meal taken per day were significantly different. There was a statistical trend to skipping meals and to eat fast in patients with ulcer-like and dismotility-like functional dyspepsia when compared with non-specific dyspeptic subjects.Patients with ulcer-like functional dyspepsia suffered from epigastric pain and burning and from heartburn, while persons with dismotility-like dyspepsia were complaining about postprandial fullness, bloating and early satiety. They skipped meals more frequently and avoided intake of certain supplies which, together with eating habits, provoked or emphasized the annoying symptoms.

Efficacy and safety of pantoprazole 20 mg once daily treatment in patients with ulcer-like functional dyspepsia

ABSTRACTObjective: To investigate the efficacy of pantoprazole 20 mg once daily (o.d.) in relieving epigastric pain associated with ulcer-like functional dyspepsia.Research design and methods: In this double-blind, placebo-controlled, multicentre study, patients experiencing ulcer-like functional dyspepsia, with epigastric pain as the predominant symptom, were randomised to receive pantoprazole 20 mg or placebo o.d. for 28 days. Primary endpoint was the complete relief (i.e. absence) from epigastric pain after 28 days’ treatment. The odds ratio (OR) for pantoprazole/placebo and its 95% confidence intervals (CIs) were determined. Significant superiority of pantoprazole was concluded if the value 1.0 was above this interval.Results: Of 419 patients (intention-to-treat [ITT]) randomised to treatment, 207 received pantoprazole and 212 received placebo. Epigastric pain relief was achieved after 28 days’ treatment in 55% of pantoprazole recipients and 45% of placebo recipients (per-protocol [PP]: 58% and 47%, respectively). Pantoprazole demonstrated statistically significant superiority compared with placebo in the ITT (OR: 0.68; 95% CI: 0.46−0.99) and PP populations (OR: 0.64; 95% CI: 0.42−0.98). Pantoprazole was more efficacious than placebo in relieving heartburn and acid regurgitation after 7, 14 and 28 days of treatment. The sum score of gastrointestinal symptoms after 28 days was statistically significantly lower in the pantoprazole than placebo group. Fewer patients receiving concomitant psychotropic medication experienced relief from epigastric pain than those not receiving such medication. Adverse events did not significantly differ between pantoprazole and placebo.Conclusions: Results of this study suggest that pantoprazole 20 mg is more efficacious than placebo, and is a well-tolerated treatment for relieving epigastric pain in patients with ulcer-like functional dyspepsia. Further research is needed to confirm these findings.

BEHAVIORAL VARIABLES IN FUNCTIONAL DYSPEPSIA: THE TYPE A BEHAVIOR PATTERN, SYMPTOMS OCCURRENCE, AND EFFECTIVENESS OF PHARMACOLOGIC TREATMENT IN SCHOOL-AGED CHILDREN

INTRODUCTION: Functional dyspepsia (FD) is the most prevalent type of abdominal pain. Several organic disorders that result in FD have been identified, whereas psychological trials have suggested that patients with functional gastrointestinal disorders may present behavioral disorders simultaneously. Defining the relationship between common personality aspects, type A and/or type B behavioral patterns (TABPs/TBBPs), and coexisting symptoms as well as their change during FD treatment might be helpful in establishing focused therapy strategies, including appropriate psychological interventions. OBJECTIVE: Our goal was to evaluate the grade of TABPs in children with FD and FD subtypes to reveal correlations of behavioral patterns and experienced symptoms and to assess the relationship between analyzed factors and symptom relief during therapy. METHODS: A total of 66 children (aged 11–18 years) were diagnosed with FD following the Rome II criteria. The control group consisted of 86 healthy children who denied recurrent abdominal pain. In all children, severity of 10 dyspeptic symptoms was measured with the FACES Pain Rating Scale and the created visual-analog Dyspepsia Symptoms Questionnaire. Psychological evaluation was carried out by using the Type A/B Behavior Scale for Children and Adolescents (TAB) by Ogińska-Bulik and Juczyński. All patients received typical treatment for 4 weeks. After 8 weeks, children were asked to complete the symptoms questionnaires again. RESULTS: The general TABP pattern was significantly decreased in the FD group compared with the controls (P = .0016), especially in boys. Moderate or extreme TABP was diagnosed in 4.2% of the boys with FD in comparison with 29.7% of the male controls; 66.7% of the boys with FD (vs 24.3% of the controls) and 37.2% of the girls with FD (vs 22.5% of the controls) met criteria for moderate or extreme TBBP. Boys with ulcer-like FD revealed scores lower than those of the controls on total TABP (P < .001) and all of the TABP subscales: competition, impatience, sense of time urgency, and hostility. Correlation analysis exposed the positive relationship between total TABP, competition, and hostility with dysmotility-like symptoms. Sense of time urgency and total TABP correlated negatively to the pain. During the therapy observation, hostility was conducive to increasing most of the dyspeptic symptoms (P < .037), and competition was related to the nausea release in boys and to aggravation of heartburn and feeling full long after eating in both genders. The sense of time urgency was related to belching intensifying. CONCLUSIONS: The behavioral pattern varied in the FD and control groups. The children with FD were more likely to present a TBBP than TABP, which is strongly restricted, especially in boys with ulcer-like FD. The TBBP constituents are connected to dysmotilities, whereas reduced TABP compounds are more common among pain-suffering patients.Behavioral pattern influences efficacy of FD treatment: behavioral compounds centered on emotions are conducive to increase dysmotilities, whereas behaviors connected with defeating stress situations encourage pain-symptom aggravation.

Improvement of gastrointestinal quality of life scores in cases of Helicobacter pylori‐positive functional dyspepsia after successful eradication therapy

Functional dyspepsia (FD) refers to a broad range of chronic upper abdominal symptoms associated with food intake. A definitive treatment for FD has not yet been established, and the effect of Helicobacter pylori (H. pylori) eradication still remains under debate. The Gastrointestinal Symptom Rating Scale (GSRS) is a specific questionnaire for patients with gastrointestinal symptoms. The present study examined the quality of life (QOL) of patients with H. pylori-positive FD following H. pylori eradication. Sixty-eight patients with FD who gave informed consent were recruited for the study. H. pylori infection was diagnosed by the culture and histological methods, and the H. pylori eradication consisted of a 7-day course of lansoprazole, amoxicillin and clarithromycin. The overall success of the treatment was confirmed by a 13C urea breath test (UBT) conducted 3 months after the eradication. The GSRS questionnaire was administered to the patient just before the start of the eradication therapy and at 3 months after the therapy, just before the UBT was performed. In successfully eradicated patients, the total GSRS and the abdominal pain score significantly decreased. In particular, the abdominal pain score and indigestion score were significantly decreased after successful eradication in patients with ulcer-like FD or dysmotility-like FD. Conversely, in patients in whom the eradication was unsuccessful, neither the total GSRS nor any of the individual symptom scores showed any significant change. Successful H. pylori eradication improved the QOL of patients with FD, in particular H. pylori-positive patients with ulcer-like FD or dysmotility-like FD.

Functional (Nonulcer) Dyspepsia.

Functional (nonulcer) dyspepsia refers to upper abdominal pain or discomfort with or without symptoms of early satiety, nausea, or vomiting with no definable organic cause. The current Rome II criteria help to diagnose functional dyspepsia and avoid misdiagnosis of gastroesophageal reflux disease and irritable bowel syndrome as functional dyspepsia. Assessment of gastric emptying with scintigraphy or breath testing may be useful in identifying delayed gastric emptying in patients with dyspeptic symptoms and may be helpful in patient management. Electrogastrography is a noninvasive test that evaluates for gastric dysrhythmias. Satiety testing is being evaluated as an indirect test for impaired fundic relaxation and visceral hypersensitivity. The symptom response to Helicobacter pylori therapy in patients with functional dyspepsia and a negative endoscopy examination but a positive H. pylori test is marginal. Lifestyle modifications often are suggested for initial treatment of functional dyspepsia. Dietary changes such as frequent small meals, low-fat diet, and avoidance of certain aggravating foods may improve symptoms. Additional measures include cessation of smoking, avoiding excess alcohol intake, and minimizing coffee intake. Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an "on-demand" therapy for intermittent symptoms. They are safe and relatively inexpensive. Different subgroups of functional dyspepsia are based on the predominant symptom and may help in choosing an appropriate drug to initiate therapy. If the predominant symptom is epigastric pain (ulcer-like functional dyspepsia), histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice. If fullness, bloating, early satiety or nausea is the predominant complaint (dysmotility-like functional dyspepsia), a prokinetic agent may help. Metoclopramide is the only available effective prokinetic agent at present. If metoclopramide is used, short-term treatment and discussion of possible side effects with the patient are advised. If there is no response to these initial treatments, switching therapy from proton pump inhibitor to prokinetic or vice versa can be tried. If these treatment options fail, patient re-evaluation for other disorders (including other functional bowel disorders) is advised. A low-dose tricyclic antidepressant at bedtime may be helpful for treatment of visceral hypersensitivity.