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The American Journal of Gastroenterology Feb 2021For up to 2 decades, pathophysiological research in functional dyspepsia focused on gastric sensorimotor dysfunction underlying symptom generation. Recent...
For up to 2 decades, pathophysiological research in functional dyspepsia focused on gastric sensorimotor dysfunction underlying symptom generation. Recent pathophysiological research has focused on low-grade inflammation in the duodenal mucosa. Emerging evidence confirms a loss of mucosal integrity in the duodenum in functional dyspepsia, and this is confirmed in a confocal laser endomicroscopy study demonstrating altered mucosal barrier function and pyroptosis. This technique may help to establish underlying mechanisms and evaluate novel therapeutic approaches to functional dyspepsia.
Topics: Duodenum; Dyspepsia; Gastrointestinal Microbiome; Humans; Lasers; Pyroptosis
PubMed: 33298703
DOI: 10.14309/ajg.0000000000001077 -
Nutrients Mar 2023Functional dyspepsia is a gastrointestinal disorder characterized by postprandial fullness, early satiation, epigastric pain, and epigastric burning. The pathophysiology... (Review)
Review
Functional dyspepsia is a gastrointestinal disorder characterized by postprandial fullness, early satiation, epigastric pain, and epigastric burning. The pathophysiology of the disease is not fully elucidated and there is no permanent cure, although some therapies (drugs or herbal remedies) try to reduce the symptoms. Diet plays a critical role in either the reduction or the exacerbation of functional dyspepsia symptoms; therefore dietary management is considered to be of high importance. Several foods have been suggested to be associated with worsening functional dyspepsia, such as fatty and spicy foods, soft drinks, and others, and other foods are thought to alleviate symptoms, such as apples, rice, bread, olive oil, yogurt, and others. Although an association between functional dyspepsia and irregular eating habits (abnormal meal frequency, skipping meals, late-night snacking, dining out, etc.) has been established, not many dietary patterns have been reported as potential factors that influence the severity of functional dyspepsia. A higher adherence to Western diets and a lower adherence to FODMAPs diets and healthy patterns, such as the Mediterranean diet, can contribute to the worsening of symptoms. More research is needed on the role of specific foods, dietary patterns, or specific eating habits in the management of functional dyspepsia.
Topics: Humans; Dyspepsia; Abdominal Pain; Diet; Feeding Behavior; Gastrointestinal Diseases; Postprandial Period
PubMed: 36986274
DOI: 10.3390/nu15061544 -
Expert Opinion on Therapeutic Targets Jun 2020: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders and is classified into postprandial distress and epigastric pain syndrome.... (Review)
Review
: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders and is classified into postprandial distress and epigastric pain syndrome. Despite the recognition of duodenal inflammation as a potential trigger of symptoms, only limited anti-inflammatory therapies exist.: This narrative review summarizes the recent advances in the pathophysiology and treatment of FD; it identifies potential therapeutic targets and gaps in the field. An electronic literature search was conducted in Pubmed up to 31st of December 2019.: There is compelling evidence for the role of duodenal inflammation and the eosinophil-mast cell axis in the pathogenesis of dyspeptic symptoms. Traditional prokinetic drugs and neuromodulators target gastric dysmotility and visceral hypersensitivity but are hampered by limited efficacy and side effects. Independent of acid suppression, the anti-inflammatory action of proton pump inhibitors, which remain the first-line therapy in FD, may also explain their therapeutic effect. Other existing and newly established anti-inflammatory drugs should be investigated while trials including probiotics and selective antibiotics should examine the host microbiome and immune activation. Targeted treatments for potential causes of duodenal pathology, such as impaired permeability and dysbiosis, are likely to emerge in the future.
Topics: Abdominal Pain; Animals; Anti-Inflammatory Agents; Duodenitis; Dyspepsia; Gastrointestinal Agents; Humans; Molecular Targeted Therapy
PubMed: 32249629
DOI: 10.1080/14728222.2020.1752181 -
Archives of Iranian Medicine Jul 2021Dyspepsia is a highly prevalent gastrointestinal problem. The present study was carried out to assess the prevalence of dyspepsia in Iran. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dyspepsia is a highly prevalent gastrointestinal problem. The present study was carried out to assess the prevalence of dyspepsia in Iran.
METHODS
The present study was registered at PROSPERO with the code CRD42019148610. It was carried out based on MOOSE and reporting was performed according to the PRISMA protocol. Systematic search of the literature was performed in July 2019 on international databases of PubMed/Medline, Web of Science (ISI), Cochrane Library, EBSCO, CINAHL, EMBASE, Scopus, Science Direct, and local databases as well as the Google Scholar search engine. Heterogeneity was evaluated using I2 and Chi-square tests. All analyses were done using Comprehensive Meta-Analysis software.
RESULTS
Overall, 14 studies with a sample size of 54,118 subjects entered in this meta-analysis. The prevalence of dyspepsia in Iran was 14.6% (95% CI: 9.6-21.7). Large heterogeneity was detected among studies (I2=99.62%, <0.001). The prevalence of dysmotility-like, ulcer-like, and unspecified dyspepsia was estimated to be 9.7% (95% CI: 4.9-18.4), 12.1% (95% CI: 5.2-25.7) and 17.0% (95% CI: 7.8-33.4), respectively. The prevalence of dyspepsia in Iranian men and women was found at 11.1% (95% CI: 6.3-18.8) and 17.8% (95% CI: 10.0-29.7), respectively.
CONCLUSION
The prevalence of dyspepsia in Iran is relatively high. However, it is lower than global estimates.
Topics: Databases, Factual; Dyspepsia; Humans; Iran; Prevalence
PubMed: 34488322
DOI: 10.34172/aim.2021.80 -
Journal of Paediatrics and Child Health Nov 2020Abdominal pain-predominant functional gastrointestinal disorders encompass a group of chronic conditions featuring abdominal pain where no serious gastrointestinal or... (Review)
Review
Abdominal pain-predominant functional gastrointestinal disorders encompass a group of chronic conditions featuring abdominal pain where no serious gastrointestinal or intra-abdominal pathology is present. The Rome IV classification system defines and categorises this group based on symptomatology as: functional dyspepsia, irritable bowel syndrome, functional abdominal pain - not otherwise specified and abdominal migraine. These conditions can impact the functioning of the child and family significantly and are challenging to manage. Although the causes of these conditions are not clear, recent years have seen an improved understanding of underlying pathophysiology and identification of effective management options for these conditions.
Topics: Abdominal Pain; Child; Dyspepsia; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Migraine Disorders
PubMed: 32468619
DOI: 10.1111/jpc.14857 -
Digestive Diseases (Basel, Switzerland) 2022Dyspepsia is one of the most common complaints in gastroenterology. While its etiology is usually benign, rare cases of malignancy have to be identified. Individualized... (Review)
Review
BACKGROUND
Dyspepsia is one of the most common complaints in gastroenterology. While its etiology is usually benign, rare cases of malignancy have to be identified. Individualized risk stratification is essential for cost-effective management of dyspepsia. Here, we discuss the challenges of investigating dyspepsia at the specialist level and provide a framework for rational workup and surveillance strategies.
SUMMARY
Causes of dyspepsia can be functional or organic, including gastritis, peptic ulcers, or malignancy. H. pylori gastritis represents a specific entity of dyspepsia and increases the risk of gastric cancer. H. pylori eradication can improve symptoms in a subset of patients and reduce gastric cancer risk. In young patients without alarm features, malignancy is rare, and noninvasive testing for H. pylori is appropriate. In elder patients and those with alarm features, high-quality endoscopy is the method of choice to rule out malignancy. Advanced corpus-predominant atrophic gastritis with or without intestinal metaplasia represent precancerous lesions.
KEY MESSAGES
Symptom assessment requires to distinguish dyspepsia of functional or organic origin. Risk stratification in dyspeptic patients is based on age, alarm features, and H. pylori status. Noninvasive test-and-treat is recommended in patients with low gastric cancer risk, while endoscopy is recommended in individuals at increased risk. H. pylori infection should be eradicated in order to obtain a symptomatic benefit and reduce gastric cancer risk. Advanced preneoplastic lesions require endoscopic surveillance.
Topics: Aged; Dyspepsia; Fear; Gastritis; Gastroenterology; Helicobacter Infections; Helicobacter pylori; Humans; Stomach Neoplasms
PubMed: 34348279
DOI: 10.1159/000518394 -
Journal of Gastrointestinal and Liver... Dec 2023Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The... (Review)
Review
Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.
Topics: Child; Humans; Dyspepsia; Yoga; Abdominal Pain; Gastrointestinal Diseases; Postprandial Period
PubMed: 38147600
DOI: 10.15403/jgld-4867 -
Scientific Reports Jan 2022Functional dyspepsia is very common in children of all ages and has a significant impact on the patient's family and quality of life. Since the revision of the Rome IV...
Functional dyspepsia is very common in children of all ages and has a significant impact on the patient's family and quality of life. Since the revision of the Rome IV criteria with the introduction of two subtypes, the prevalence of functional dyspepsia has increased, but currently no guidelines for the treatment are available. The aim of this study was to characterize patients, who have been diagnosed with functional dyspepsia and analyze the outcome of different treatments they received. This is a retrospective study of pediatric patients, diagnosed with functional dyspepsia between March 2017 and September 2020. All patients aged between 0 and18 years, who complained about gastric symptoms, have had a normal full blood count, a normal thyroid function, a negative coeliac screening, and most importantly normal macro- and microscopic findings on esophago-gastro-duodenoscopy were included in the study. Patient's data were extracted from the medical record and three months after the performance of the endoscopy, parents were interviewed about the effect of the treatment. A total of 154 patients (66.2% female, 33.8% male) between the age of 4 and 18 years were included. In 113 (73.4%) the leading symptom was epigastric pain, followed by nausea (22; 14.3%) and a fifth of the patients (females: 18.6%; males: 21.2%) self-reported a current stressor in clinic. After receiving the diagnosis of a functional nature, families chose following treatments: 50 STW5 (32.3%, overall, 10.4% added dietary changes, alternative treatment, and psychology support), psychological support (22.7%), alternative treatments (e.g., hypnotherapy, meditation; 19.5%), dietary changes (12.9%), lifestyle changes (9.7%), no treatment (11%) and in 10.4% no treatment was needed as symptoms resolved after endoscopy had been performed. Only lifestyle changes (p = 0.03) in females, dietary changes (p = 0.035 for girls, p = 0.06 for boys) and STW5 in males (p = 0.043) showed a statistically relevant correlation regarding duration of symptoms. There was no correlation between location of symptoms and effectiveness of treatment. It is recommended to treat patients from both subgroups of functional dyspepsia differently, in accordance with the currently available explanatory models of underlying pathophysiological processes. In this cohort of patients this could not be verified. As all patients did benefit from any treatment, it is likely that the treatment itself was not accountable for the relief of symptoms, but that most patients benefit from education on the diagnosis, reassurance and a recommendation of a healthy lifestyle. Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factor.
Topics: Adolescent; Child; Child, Preschool; Complementary Therapies; Dyspepsia; Female; Healthy Lifestyle; Humans; Male; Plant Extracts; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 35087113
DOI: 10.1038/s41598-022-05380-y -
BMJ Paediatrics Open Dec 2023To date, no international guidelines have been published for the treatment of paediatric functional abdominal pain disorders (FAPDs), subcategorised into functional...
INTRODUCTION
To date, no international guidelines have been published for the treatment of paediatric functional abdominal pain disorders (FAPDs), subcategorised into functional abdominal pain-not otherwise specified (FAP-NOS), irritable bowel syndrome (IBS), functional dyspepsia and abdominal migraine (AM). We aim for a treatment guideline, focusing on FAP-NOS, IBS and AM, that appreciates the extensive array of available therapies in this field. We present the prospective operating procedure and technical summary protocol in this manuscript.
METHODS
Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be followed in the development of the guideline, following the approach as laid out in the GRADE handbook, supported by the WHO. The Guideline Development Group (GDG) is formed by paediatric gastroenterologists from both the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, as well as the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Also, one clinical psychologist with expertise in FAPDs is a voting member in the GDG. A final consensus list of treatment options is translated into 'patient, intervention, comparison, outcome' format options. Prospective agreement on the magnitude of health benefits or harms categories was reached through a Delphi process among the GDG to support grading of the literature.There will be a detailed technical evidence review with randomised controlled trial data that will be judged for risk of bias with the Cochrane tool. Recommendations are preferably based on GRADE but could also be best practice statements following the available evidence. A full Delphi process will be used to make recommendations using online response systems. This set of procedures has been approved by all members of the GDG.
Topics: Child; Humans; Abdominal Pain; Dyspepsia; Gastroenterology; Irritable Bowel Syndrome; Migraine Disorders; Prospective Studies; Randomized Controlled Trials as Topic; Practice Guidelines as Topic
PubMed: 38128947
DOI: 10.1136/bmjpo-2023-002166 -
Journal of Gastrointestinal and Liver... Jun 2021Functional dyspepsia (FD) symptoms may lead to depression or anxiety in affected individuals and vice versa. These individuals often have more serious somatic symptoms,...
BACKGROUND AND AIMS
Functional dyspepsia (FD) symptoms may lead to depression or anxiety in affected individuals and vice versa. These individuals often have more serious somatic symptoms, longer disease recovery time, and tend to consume more medical resources and health care costs. Therefore, recognition of depression and anxiety is crucial to improve clinical outcome in FD patients. The aim of this study is to systematically review the association of functional dyspepsia with depression and anxiety.
METHODS
This systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A Literature search was carried out with PubMed and ProQuest databases from 1 January 2010 to 5 October 2020. The outcomes of interest were association of functional dyspepsia with depression and anxiety. The quality of each study was assessed using the Joanna Briggs Institute (JBI) tool.
RESULTS
A total of 13 studies involving 14,076 subjects were included in this review. Almost all of the studies showed that prevalence of depression or anxiety is higher in patients with FD compared to controls. This is implied by a higher mean score on the depression and anxiety questionnaire assessment tools or a positive correlation in the odds ratio. FD is known to affect more females than males, but psychological links were stronger in males. Moreover, prevalence of depression and anxiety symptoms in patients with refractory FD (63.3% and 61.5%) was higher compared to non-refractory FD (20.9% and 23.3%) and healthy patients (10% and 10%).
CONCLUSION
There is a significant association of FD with depression and anxiety. Thus, identifying psychological factors in FD patients is essential to help clinicians determine the best choice of treatment and improve the prognosis and quality of life of the patients.
Topics: Anxiety; Depression; Dyspepsia; Female; Humans; Male; Quality of Life; Surveys and Questionnaires
PubMed: 33951117
DOI: 10.15403/jgld-3325