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Current Opinion in Gastroenterology Nov 2016Functional dyspepsia affects 10% of the population. Emerging data are beginning to unravel the pathogenesis of this heterogeneous disorder, and new data on treatment are... (Review)
Review
PURPOSE OF REVIEW
Functional dyspepsia affects 10% of the population. Emerging data are beginning to unravel the pathogenesis of this heterogeneous disorder, and new data on treatment are helping to guide evidence-based practice. In this review, the latest advances are summarized and discussed.
RECENT FINDINGS
The Rome IV criteria were published in 2016 and are similar to Rome III but further emphasize the subtypes (postprandial distress syndrome and epigastric pain syndrome) rather than focussing on the syndrome as a whole, and conclude that gastroesophageal reflux disease and irritable bowel syndrome are part of the functional dyspepsia spectrum. Environment is dominant in the pathogenesis. New data implicate herbivore pets and antibiotic exposure for a nongastrointestinal infection but require confirmation. Further experimental data suggest duodenal eosinophils and mast cells can alter enteric neuronal structure and function in functional dyspepsia.
SUMMARY
Advances in our understanding of functional dyspepsia are changing clinical practice.
Topics: Bacterial Infections; Diet; Duodenitis; Dyspepsia; Gastrointestinal Agents; Humans
PubMed: 27540688
DOI: 10.1097/MOG.0000000000000306 -
Annals of Internal Medicine Jun 2020Postprandial distress syndrome (PDS) is the most common subtype of functional dyspepsia. Acupuncture is commonly used to treat PDS, but its effect is uncertain because... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postprandial distress syndrome (PDS) is the most common subtype of functional dyspepsia. Acupuncture is commonly used to treat PDS, but its effect is uncertain because of the poor quality of prior studies.
OBJECTIVE
To assess the efficacy of acupuncture versus sham acupuncture in patients with PDS.
DESIGN
Multicenter, 2-group, randomized clinical trial. (ISRCTN registry number: ISRCTN12511434).
SETTING
5 tertiary hospitals in China.
PARTICIPANTS
Chinese patients aged 18 to 65 years meeting Rome IV criteria for PDS.
INTERVENTION
12 sessions of acupuncture or sham acupuncture over 4 weeks.
MEASUREMENTS
The 2 primary outcomes were the response rate based on overall treatment effect and the elimination rate of all 3 cardinal symptoms: postprandial fullness, upper abdominal bloating, and early satiation after 4 weeks of treatment. Participants were followed until week 16.
RESULTS
Among the 278 randomly assigned participants, 228 (82%) completed outcome measurements at week 16. The estimated response rate from generalized linear mixed models at week 4 was 83.0% in the acupuncture group versus 51.6% in the sham acupuncture group (difference, 31.4 percentage points [95% CI, 20.3 to 42.5 percentage points]; < 0.001). The estimated elimination rate of all 3 cardinal symptoms was 27.8% in the acupuncture group versus 17.3% in the sham acupuncture group (difference, 10.5 percentage points [CI, 0.08 to 20.9 percentage points]; = 0.034). The efficacy of acupuncture was maintained during the 12-week posttreatment follow-up. There were no serious adverse events.
LIMITATION
Lack of objective outcomes and daily measurement, high dropout rate, and inability to blind acupuncturists.
CONCLUSION
Among patients with PDS, acupuncture resulted in increased response rate and elimination rate of all 3 cardinal symptoms compared with sham acupuncture, with sustained efficacy over 12 weeks in patients who received thrice-weekly acupuncture for 4 weeks.
PRIMARY FUNDING SOURCE
Beijing Municipal Science and Technology Commission.
Topics: Acupuncture Therapy; Adolescent; Adult; Aged; Dyspepsia; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postprandial Period; Quality of Life; Retrospective Studies; Syndrome; Treatment Outcome; Young Adult
PubMed: 32422066
DOI: 10.7326/M19-2880 -
Current Opinion in Gastroenterology Nov 2017This review summarizes recent progress in the epidemiology, pathophysiology and treatment of functional dyspepsia and gastroparesis. (Review)
Review
PURPOSE OF REVIEW
This review summarizes recent progress in the epidemiology, pathophysiology and treatment of functional dyspepsia and gastroparesis.
RECENT FINDINGS
The definition of functional dyspepsia and its subgroups has been revised in the recent Rome IV consensus. In gastroparesis, the symptom pattern and its similarities and differences from functional dyspepsia have been a focus of recent research. In functional dyspepsia, pathophysiological research continued to evaluate gastric sensorimotor dysfunctions, but low-grade inflammatory changes and loss of mucosal integrity in the duodenum is a new topic of intense research. Treatment advances include new prokinetics such as acotiamide and the ghrelin receptor agonist relamorelin. The efficacy of tricyclic antidepressants was recently reviewed and mirtazapine is a new agent used in the treatment of functional dyspepsia and gastroparesis. In gastroparesis, research has focused on the role of macrophages in loss of interstitial cells of Cajal, and on the role of pyloric resistance as a target for therapy, using botulinum toxin injection and gastric per-endoscopic pyloric myotomy.
SUMMARY
The functional dyspepsia definition and subgrouping were updated in the Rome IV consensus. Research focuses on duodenal mucosal alterations in functional dyspepsia and pyloric resistance in gastroparesis. New treatments include novel prokinetics and pylorus-directed interventions.
Topics: Diagnosis, Differential; Dyspepsia; Gastrointestinal Agents; Gastroparesis; Humans
PubMed: 28832359
DOI: 10.1097/MOG.0000000000000393 -
Acta Bio-medica : Atenei Parmensis Jul 2020Dyspepsia is a functional GI disorder consisting in a wide range of symptoms. The main diagnostic challenge has been whether to perform an EGD or an abdominal US in...
Dyspepsia is a functional GI disorder consisting in a wide range of symptoms. The main diagnostic challenge has been whether to perform an EGD or an abdominal US in order not to miss organic lesions, but to avoid unnecessary and sometimes invasive tests. Pepsinogen serology has been proposed as an useful non-invasive test to explore the status of the gastric mucosa, suggesting this strategy as an adequate approach in management of dyspepsia. In a primary care setting, 266 dyspeptic patients were investigated to establish the proper diagnosis. The workup included upper GI endoscopy with biopsies, a structured questionnaire including type and severity of symptoms, serological determination of serum pepsinogens, gastrin 17 and IgG against Hp. Inclusion criteria were dyspeptic symptoms (epigastric pain, nausea and/or vomiting, post prandial fullness, early satiation) lasting more than 1 year and the association between symptoms and food ingestion.. Helicobacter pylori infection was present in 114 subjects, characterized by high levels of pepsinogen II and IgG against Hp. Twenty subjects were classified according with the diagnosis of chronic body atrophic gastritis. Nausea and post prandial fullness were the most frequent symptoms (48% and 41%, respectively) in the studied population, followed by epigastric pain and early satiation (37% and 26% respectively). A diagnosis of normality by serological diagnosis was found in half of patients experiencing epigastric pain and in about 60% of subjects with the three other symptoms (nausea, post prandial fullness, and early satiation). In conclusion, this experience confirms the clinical usefulness of serology in dyspepsia, contributing to correctly diagnosing CAG and H.p. infection in such patients and providing a good correlation with the clinical picture.
Topics: Adult; Aged; Dyspepsia; Female; Humans; Male; Middle Aged
PubMed: 32921764
DOI: 10.23750/abm.v91i3.10150 -
Digestive Diseases (Basel, Switzerland) 2022The purpose of this review is to take a deep dive into general problems and challenges of diagnosis and treatment of patients with symptoms of dyspepsia in primary care... (Review)
Review
BACKGROUND
The purpose of this review is to take a deep dive into general problems and challenges of diagnosis and treatment of patients with symptoms of dyspepsia in primary care practice.
SUMMARY
Primary care physicians become acquainted with a broad range of clinical problems and therefore require a wide span of knowledge in taking care of patients from their first medical examination within the health care system. Dyspepsia and Helicobacter pylori infection are two of the most frequent reasons of digestive-related health care issues, despite that in primary care practice, current recommendations for diagnosis and differential therapy are often not implemented. The "test-and-treat" strategy is the initial management of the condition, reserving gastroscopy for patients refractory to symptomatic treatment and for patients presenting with any of the following alarm signs: age of above 55, dysphagia, anemia, weight loss, frequent vomiting, family history of GI malignancy, or a physical examination with key pathological findings.
KEY MESSAGES
Examination and treatment of dyspepsia symptoms is the diagnostic and therapeutic challenge dictated by organizational and economic potentials of the health system, professional resources, and primary health care capabilities to accept and treat patients with dyspepsia and to properly refer those with alarm symptoms and findings indicative of organic disease to a gastroenterologist.
Topics: Dyspepsia; Gastroenterology; Helicobacter Infections; Helicobacter pylori; Humans; Primary Health Care
PubMed: 34126614
DOI: 10.1159/000517668 -
Digestive Diseases (Basel, Switzerland) 2016Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination... (Review)
Review
BACKGROUND
Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed.
KEY MESSAGES
Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a 'meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification.
CONCLUSION
Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.
Topics: Adolescent; Adult; Diagnosis, Differential; Dyspepsia; Feeding and Eating Disorders of Childhood; Female; Gastroparesis; Humans; Male
PubMed: 27332558
DOI: 10.1159/000445226 -
Clinical Nutrition ESPEN Dec 2022Treatments for Gastroesophageal Reflux Disease (GERD) symptoms include pharmaceutical, surgical, dietary, and lifestyle behaviors; however, dietary interventions lack... (Meta-Analysis)
Meta-Analysis
What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis.
BACKGROUND
Treatments for Gastroesophageal Reflux Disease (GERD) symptoms include pharmaceutical, surgical, dietary, and lifestyle behaviors; however, dietary interventions lack evidence synthesis.
RESEARCH QUESTION
What is the effect of dietary, probiotic, and nutraceutical interventions on GERD symptoms, with or without pharmaceutical therapy, in adults with a history of GERD or functional dyspepsia compared to no intervention, placebo, or usual care?
METHOD
A systematic review and meta-analysis was performed according to PRISMA. The search strategy was implemented in MEDLINE, CINAHL, CENTRAL, and Embase on the 28th October 2020 and updated to 27th July 2021. Intervention studies were eligible if they evaluated the effect of a dietary, nutraceutical, or probiotic intervention on GERD symptoms in adults with a history of GERD or functional dyspepsia. The internal validity of studies was assessed using the Academy Quality Criteria Checklist; Review Manager software was used to perform meta-analysis; and certainty in the body of evidence was assessed using GRADE.
RESULTS
6,608 study records were retrieved from the search, with 21 studies (n = 24 highly heterogenous intervention groups) included (n = 10 restrictive dietary interventions; n = 3 non-restrictive dietary interventions; n = 8 nutraceutical interventions; and n = 3 probiotic interventions). GERD symptoms were clinically and statistically improved by a test-based elimination diet (n = 1 study), low nickel diet (n = 1 study), probiotic yoghurt (n = 1 study), psyllium husk (n = 1 study), prickly pear and olive leaf extract supplement (n = 1 study), and melatonin, amino acid and b-group vitamin supplement (n = 1 study) according to qualitative synthesis. Ginger-containing supplements could be meta-analyzed, and improved incidence of GERD symptom alleviation (n = 2 studies, OR: 7.50 [95%CI: 3.62-15.54], GRADE: high). No clinically and/or statistically significant effects were found for the remaining n = 16 highly heterogenous interventions.
CONCLUSION
Evidence to guide the dietary management of GERD symptoms is limited in scope, quality, and feasibility. Based on the limited evidence available, dietary GERD management should be long-term, individualized, and consider both dietary restrictions and/or additions.
PROSPERO ID
CRD42021224082.
Topics: Adult; Humans; Dyspepsia; Probiotics; Gastroesophageal Reflux; Dietary Supplements; Diet; Pharmaceutical Preparations
PubMed: 36513474
DOI: 10.1016/j.clnesp.2022.09.015 -
Deutsche Medizinische Wochenschrift... Apr 2022Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent...
Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. FGID are heterogenous with regards to the amount of symptoms and associated patient's impairment as well as to the underlying pathophysiological mechanisms. The biopsychosocial model of FGID assumes that biological, psychological and social factors interact in the predisposition to and in the initiation and course of FGID. The Rome Foundation defines FGID as disorders of the brain-gut interaction.Some physicians are hesitant to diagnose FGID due to the lack of specific biomarkers and/or structural changes in the gastrointestinal tract. In addition, some FGID to not respond well to conventional medications. Some patients are reluctant to accept the diagnosis of a FGID because they are afraid that a serious somatic disease has been missed and/or to be diagnosed as mentally ill.The use of interdisciplinary evidence-based guidelines for diagnosis and management of FGID can increase the certainty of diagnosis and the therapeutic options for physicians. In addition, these guidelines include recommendations how to explain the disorder and the management to the patient to establish a trustful doctor-patient relationship.FGID are diagnosed by the history of a typical cluster of symptoms and by guideline - recommended exclusion of somatic gastrointestinal disorders. FGID should be managed according to the main symptoms, the associated impairment and patients' preferences in a graduated approach by education and by dietary, pharmacological and psychological treatments.
Topics: Dyspepsia; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Physician-Patient Relations
PubMed: 35545068
DOI: 10.1055/a-1554-1739 -
Current Gastroenterology Reports Nov 2019Functional dyspepsia is a common condition, and the condition is defined by symptoms using Rome IV criteria. This review addresses the issue of functional dyspepsia in... (Review)
Review
PURPOSE OF REVIEW
Functional dyspepsia is a common condition, and the condition is defined by symptoms using Rome IV criteria. This review addresses the issue of functional dyspepsia in elderly patients, epidemiology, investigation, and treatment.
RECENT FINDINGS
Recent studies show that while the prevalence of dyspepsia declines in the elderly, it is still prevalant investigations to confirm the diagnosis (including mandatory upper gastrointestinal endoscopy) must exclude organic disease. These include ulcers (particularly associated with nonsteroidal antiinflammatory drugs), Helicobacter pylori pathologies, cancer, coeliac disease, and autoimmune gastritis. Recent research is unraveling pathophysiology beyond symptom-only definitions, focusing on the duodenum with innate immune disturbance (duodenal eosinophilia) and microbial disruption as possible cause. Management of functional dyspepsia includes making a secure diagnosis, treatment with first-line proton pump inhibitors (PPI), then tricyclic antidepressants, and careful choice of prokinetics. Herbal treatments (peppermint oil) and STW-5 have in this age group limited efficacy. Further studies are needed to define the prevalence of functional dyspepsia in the elderly and of prime importance, to exclude organic disease as a cause for symptoms of dyspepsia.
Topics: Aged; Aging; Anti-Inflammatory Agents, Non-Steroidal; Dyspepsia; Helicobacter Infections; Helicobacter pylori; Humans; Prevalence; Proton Pump Inhibitors; Stomach; Stomach Neoplasms
PubMed: 31720909
DOI: 10.1007/s11894-019-0722-5 -
Nature Reviews. Disease Primers Jul 2020
Topics: Anemia; Autoimmune Diseases; Disease Management; Dyspepsia; Gastritis, Atrophic; Humans; Satiety Response
PubMed: 32647157
DOI: 10.1038/s41572-020-0198-5