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PloS One 2024Previous cross-sectional studies have identified multiple potential risk factors for functional dyspepsia (FD). However, the causal associations between these factors...
BACKGROUND
Previous cross-sectional studies have identified multiple potential risk factors for functional dyspepsia (FD). However, the causal associations between these factors and FD remain elusive. Here we aimed to fully examine the causal relationships between these factors and FD utilizing a two-sample MR framework.
METHODS
A total of 53 potential FD-related modifiable factors, including those associated with hormones, metabolism, disease, medication, sociology, psychology, lifestyle and others were obtained through a comprehensive literature review. Independent genetic variants closely linked to these factors were screened as instrumental variables from genome-wide association studies (GWASs). A total of 8875 FD cases and 320387 controls were available for the analysis. The inverse variance weighted (IVW) method was employed as the primary analytical approach to assess the relationship between genetic variants of risk factors and the FD risk. Sensitivity analyses were performed to evaluate the consistency of the findings using the weighted median model, MR-Egger and MR-PRESSO methods.
RESULTS
Genetically predicted depression (OR 1.515, 95% confidence interval (CI) 1.231 to 1.865, p = 0.000088), gastroesophageal reflux disease (OR 1.320, 95%CI 1.153 to 1.511, p = 0.000057) and years of education (OR 0.926, 95%CI 0.894 to 0.958, p = 0.00001) were associated with risk for FD in univariate MR analyses. Multiple medications, alcohol consumption, poultry intake, bipolar disorder, mood swings, type 1 diabetes, elevated systolic blood pressure and lower overall health rating showed to be suggestive risk factors for FD (all p<0.05 while ≥0.00167). The positive causal relationship between depression, years of education and FD was still significant in multivariate MR analyses.
CONCLUSIONS
Our comprehensive MR study demonstrated that depression and lower educational attainment were causal factors for FD at the genetic level.
Topics: Humans; Dyspepsia; Risk Factors; Mendelian Randomization Analysis; Genome-Wide Association Study; Depression; Gastroesophageal Reflux; Polymorphism, Single Nucleotide; Genetic Predisposition to Disease
PubMed: 38718064
DOI: 10.1371/journal.pone.0302809 -
Saudi Pharmaceutical Journal : SPJ :... Jun 2024Complementary and alternative medicine (CAM) is a common practice among patients, who experience functional gastrointestinal disorders (FGID). Among the Saudi...
BACKGROUND AND OBJECTIVE
Complementary and alternative medicine (CAM) is a common practice among patients, who experience functional gastrointestinal disorders (FGID). Among the Saudi population, less is known about CAM use for FGID. Therefore, this study aimed to determine the prevalence of CAM utilization for FGID amongst the Saudi population and determine the types of CAM used for treatment.
METHOD
A cross-sectional study was carried out in Riyadh, Saudi Arabia during February 2023 through social media platforms using questionnaires adopted from the literature. There were three sections in the questionnaire including demographic information, questions to determine the prevalence of CAM use for FGID, the types of FGID, and the types of CAM utilization, and questions on the sources of information about CAM. Multivariable logistic regression was applied to find factors associated with CAM use. All statistical analyses were performed using SPSS version 26.
RESULTS
A total of 828 people participated in this study. The overall prevalence of CAM use for FGID problems was 87.2 %. There were no significant differences in CAM use for FGID problems between men (87.5 %) and women (86.3 %) (P = 0.727). The most commonly used types of CAM for FGID were ginger (73.4 %), chamomile (66.6 %), mint (61.6 %), turmeric (59.0 %), anise (55.5 %), fennel (43.1 %), and Activia yogurt©️ (42.7 %). The most common FGID disorders for utilizing CAM were IBS (29.9 %), followed by constipation (29.8 %), dyspepsia (22.7 %), and bloating (17.0 %). In the multivariable regression, age, gender and employment status did not have an impact on the odds of using CAM. The subjects who had high school, university, and postgraduate education had significant odds ratios of CAM use (OR = 2.73; 95 % CI: 1.22-6.13), (OR = 4.18; 95 % CI: 2.03-8.58), and (OR = 20.85; 95 % CI: 5.51-78.80), respectively, compared to subjects who did not complete high school. Participants who had private insurance had a significant odds ratio (OR = 0.27; 95 % CI: 0.14-0.55) compared to governmental insurance.
CONCLUSION
The use of CAM among the Saudi population is alarmingly high; however, the lack of standardized medical recommendations and treatment options may be the cause. Although there were no significant gender differences, participants with higher educational levels and private insurance coverage were more likely to use CAM for FGID. Patients suffering from FGID and limited access to medical advice and treatment options are vulnerable to being exposed to dubious and incredible information sources. Expanding access to preventative medical services, funding governmental medical websites to provide credible information, educating healthcare professionals about FGID, and conducting more research in safe and effective treatments for FGID is recommended.
PubMed: 38716111
DOI: 10.1016/j.jsps.2024.102084 -
Cureus Apr 2024Neuroendocrine tumors (NETs) are slow-growing cancers derived from neuroendocrine cells that typically affect the pancreas, lungs, and gastrointestinal tract. A rare...
Neuroendocrine tumors (NETs) are slow-growing cancers derived from neuroendocrine cells that typically affect the pancreas, lungs, and gastrointestinal tract. A rare form can develop in the duodenum and can be difficult to diagnose and treat. The case below describes a rare incidence of a well-differentiated duodenal bulb NET in a 77-year-old man who had early satiety and persistent dyspepsia. Endoscopy, biopsies, and immunohistochemistry staining were used to confirm the diagnosis. According to the features of the tumor, management techniques, including endoscopic, surgical, and medicinal procedures, are being implemented.
PubMed: 38711691
DOI: 10.7759/cureus.57696 -
Journal of Neurogastroenterology and... May 2024Acid-suppressive drugs, such as proton pump inhibitors (PPIs), are treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid...
BACKGROUND/AIMS
Acid-suppressive drugs, such as proton pump inhibitors (PPIs), are treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid blockers (P-CABs) in treating FD has not yet been established. This prospective multicenter clinical trial-based study aimed to assess the efficacy and safety of tegoprazan as a P-CAB treatment in patients with FD.
METHODS
FD was diagnosed using the Rome IV criteria. All patients received tegoprazan 50 mg once daily for 8 weeks. Dyspeptic symptoms were assessed using a dyspepsia symptom questionnaire (5-point Likert scale, Nepean Dyspepsia Index-Korean (NDI-K), and gastroesophageal reflux disease-health-related quality of life (GERD-HRQL). The main outcome was satisfactory symptom relief rates at 8 weeks.
RESULTS
In this study, from the initial screening of 209 patients, 173 were included in the per-protocol set analysis. Satisfactory symptom relief rates at 8 and 4 weeks were 86.7% and 74.6%, respectively. In addition, the NDI-K and GERD-HRQL scores significantly improved at 8 and 4 weeks compared with the baseline scores. The efficacy of tegoprazan was not influenced by the FD subtype or status. In patients with overlapping FD and GERD, there was a greater improvement in the NDI-K and GERD-HRQL scores than in patients with FD symptoms only. No serious drug-related adverse events occurred during this study.
CONCLUSION
Tegoprazan (50 mg) administered once daily provided satisfactory symptom relief for FD.
PubMed: 38710534
DOI: 10.5056/jnm23150 -
European Review For Medical and... Apr 2024The aim of this study was to investigate and evaluate the risk of dyspepsia and anorexia in patients with type 2 diabetes mellitus (T2DM) induced by glucagon-like... (Meta-Analysis)
Meta-Analysis
Network meta-analysis of the risk of dyspepsia and anorexia in patients with type 2 diabetes mellitus induced by glucagon-like peptide 1 receptor agonist hypoglycemic drugs.
OBJECTIVE
The aim of this study was to investigate and evaluate the risk of dyspepsia and anorexia in patients with type 2 diabetes mellitus (T2DM) induced by glucagon-like peptide 1 receptor agonist (GLP-1 RA) hypoglycemic drugs.
MATERIALS AND METHODS
We searched papers in PubMed, Web of Science, Cochrane Library, Google Scholar, CNKI, Wanfang, Embase, and VIP databases, and the retrieval time limit was set from the establishment of the database to May 2023. Randomized Controlled Trials (RCTs) were collected in which the subjects were T2DM patients, the intervention was GLP-1RA compared with placebo or traditional hypoglycemic drugs, and the outcome indicators included dyspepsia and anorexia. A meta-analysis and a network meta-analysis were performed.
RESULTS
The results of the traditional meta-analysis showed that the risk of dyspepsia and anorexia of total GLP-1 RA was 3.01 and 2.56 times that of placebo, respectively. All types of GLP-1RA were compared with placebo and the results also showed a trend towards increased risk of digestive system adverse events (DSAEs). Among all interventions included, liraglutide was the one with the highest risk of dyspepsia in patients with T2DM, and dulaglutide was the one with the highest risk of anorexia.
CONCLUSIONS
The results of the two meta-analyses are consistent, and both clearly show that GLP-1RA can increase the risk of dyspepsia and anorexia in T2DM patients.
Topics: Humans; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Dyspepsia; Hypoglycemic Agents; Anorexia; Network Meta-Analysis; Randomized Controlled Trials as Topic
PubMed: 38708466
DOI: 10.26355/eurrev_202404_36023 -
Medicine May 2024Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally and often develops on the foundation of chronic liver disease or cirrhosis. Cirrhosis... (Observational Study)
Observational Study
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally and often develops on the foundation of chronic liver disease or cirrhosis. Cirrhosis is a clinically prevalent chronic progressive liver disease characterized by diffuse liver damage resulting from long-term or repeated actions of 1 or more etiological factors. However, the impact of CENPF and nuclear division cycle 80 (NDC80) genes on rehabilitation nursing of HCC and cirrhosis remains unclear. HCC and cirrhosis datasets GSE63898 and GSE89377 profile files were downloaded from the gene expression omnibus database generated on platforms GPL13667 and GPL6947, respectively. Differentially expressed genes (DEGs) screening, weighted gene co-expression network analysis (WGCNA), construction and analysis of protein-protein interaction (PPI) networks, functional enrichment analysis, gene set enrichment analysis (GSEA), survival analysis, immune infiltration analysis, and comparative toxicogenomics database (CTD) analysis were conducted. Gene expression heatmaps were plotted. miRNAs regulating central DEGs were selected through TargetScan. A total of 626 DEGs were identified. According to gene ontology (GO) analysis, they were primarily enriched in small molecule metabolic processes, drug metabolic processes, binding of identical proteins, and lipid metabolic processes. Kyoto Encyclopedia of Gene and Genome (KEGG) analysis results indicated that the target genes were mainly enriched in metabolic pathways, phagosomes, glycine, serine, and threonine metabolism. The construction and analysis of the PPI network revealed 3 core genes (NDC80, CENPF, RRM2). Gene expression heatmaps showed that core genes (CENPF, NDC80) were highly expressed in HCC and cirrhosis samples. CTD analysis found that 2 genes (CENPF and NDC80) were associated with liver, jaundice, ascites, fever, dyspepsia, and hepatic encephalopathy. CENPF and NDC80 are highly expressed in HCC and cirrhosis, and CENPF and NDC80 might be the biomarkers of rehabilitation nursing of HCC and cirrhosis.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver Cirrhosis; Nuclear Proteins; Protein Interaction Maps; Gene Expression Profiling; Cytoskeletal Proteins
PubMed: 38701255
DOI: 10.1097/MD.0000000000037984 -
JGH Open : An Open Access Journal of... May 2024Herbal products are widely used to treat patients with disorders of gut brain interaction but clinical efficacy and safety data for treatments lasting >4 weeks are...
BACKGROUND AND AIM
Herbal products are widely used to treat patients with disorders of gut brain interaction but clinical efficacy and safety data for treatments lasting >4 weeks are widely lacking. We evaluated the efficacy and safety of 8 weeks of treatment with the herbal combination product STW 5-II for patients with functional dyspepsia (FD) meeting Rome II criteria. We also conducted a post hoc analysis including patients meeting Rome IV criteria for FD and evaluated the effect of the G-protein beta 3 (GNB3) subunit polymorphism (C825T) on therapeutic response.
METHODS
This multicenter, placebo-controlled, double-blind study included 272 FD patients meeting Rome II criteria in the intention-to-treat cohort and 266 meeting Rome IV criteria. We used the validated Gastrointestinal Symptom Score (GIS) to assess GI symptoms, defining response rate as the proportion of patients with ≥50% GIS improvement in at least three of four assessments.
RESULTS
After 8 weeks, the response rate was significantly higher in the STW 5-II group placebo (61.2% 45.1%, = 0.008). Mean GIS non-significantly improved with STW 5-II treatment (7.9 ± 4.41 6.7 ± 4.91 with placebo; = 0.07). In the Rome IV subgroup analysis, STW 5-II yielded a better response rate ( = 0.01) placebo and greater postprandial distress symptom improvement ( = 0.04) placebo. Safety parameters did not differ between groups, and GNB3 status was not linked with therapeutic response.
CONCLUSION
STW 5-II is efficacious, with no observed safety signals at up to 8 weeks of treatment in patients with FD meeting Rome II or IV criteria.
PubMed: 38699471
DOI: 10.1002/jgh3.13054 -
Turkish Journal of Surgery Dec 2023Biliary cysts are biliary duct dilatations, with 20% of the cysts being diagnosed in adulthood. Abdominal pain, jaundice and palpable abdominal mass are defined as the...
OBJECTIVES
Biliary cysts are biliary duct dilatations, with 20% of the cysts being diagnosed in adulthood. Abdominal pain, jaundice and palpable abdominal mass are defined as the classical triad. However, nausea, vomiting, fever, itching and weight loss are frequent complaints. There are several treatment options depending on the type of the cyst. This study aimed to share our experience with biliary cysts and contribute to the literature on this subject.
MATERIAL AND METHODS
Thirty patients, who received treatment for biliary cyst from January 1981 to December 2018 at our clinic, were studied retrospectively. The patients were analyzed based on age, sex, type of the cyst, diagnosis and treatment methods, post-op follow up and complications.
RESULTS
Twenty-seven of the patients were females, and three were males. The patients were aged between 16 and 76 years, and the median age was 41.9 years. All patients presented with abdominal pain, which was accompanied by cholangitis in nine patients, nausea and vomiting in four patients, dyspepsia in three patients and palpable mass in one patient. According to the Todani classification, biliary cyst findings were consistent with Type I in 23 patients, Type V in three patients, Type IV in two patients, Type II in one patient and Type III in one patient.
CONCLUSION
Diagnosis and treatment are complex in biliary cysts due to anatomical proximity and variations. Therefore, it would be beneficial to refer them to referral centers. Choice of treatment should be based on the type of the cyst.
PubMed: 38694518
DOI: 10.47717/turkjsurg.2023.6285 -
Cleveland Clinic Journal of Medicine May 2024Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper... (Review)
Review
Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.
Topics: Humans; Dyspepsia; Abdominal Pain; Postprandial Period
PubMed: 38692696
DOI: 10.3949/ccjm.91a.23062 -
JAMA Psychiatry May 2024A significant need exists for new antipsychotic medications with different mechanisms of action, greater efficacy, and better tolerability than existing agents....
IMPORTANCE
A significant need exists for new antipsychotic medications with different mechanisms of action, greater efficacy, and better tolerability than existing agents. Xanomeline is a dual M1/M4 preferring muscarinic receptor agonist with no direct D2 dopamine receptor blocking activity. KarXT combines xanomeline with the peripheral muscarinic receptor antagonist trospium chloride with the goal of reducing adverse events due to xanomeline-related peripheral muscarinic receptor activation. In prior trials, xanomeline-trospium chloride was effective in reducing symptoms of psychosis and generally well tolerated in people with schizophrenia.
OBJECTIVE
To evaluate the efficacy and safety of xanomeline-trospium vs placebo in adults with schizophrenia.
DESIGN, SETTING, AND PARTICIPANTS
EMERGENT-3 (NCT04738123) was a phase 3, multicenter, randomized, double-blind, placebo-controlled, 5-week trial of xanomeline-trospium in people with schizophrenia experiencing acute psychosis, conducted between April 1, 2021, and December 7, 2022, at 30 inpatient sites in the US and Ukraine. Data were analyzed from February to June 2023.
INTERVENTIONS
Participants were randomized 1:1 to receive xanomeline-trospium chloride (maximum dose xanomeline 125 mg/trospium 30 mg) or placebo for 5 weeks.
MAIN OUTCOMES AND MEASURES
The prespecified primary end point was change from baseline to week 5 in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcome measures were change from baseline to week 5 in PANSS positive subscale score, PANSS negative subscale score, PANSS Marder negative factor score, Clinical Global Impression-Severity score, and proportion of participants with at least a 30% reduction in PANSS total score. Safety and tolerability were also evaluated.
RESULTS
A total of 256 participants (mean [SD] age, 43.1 [11.8] years; 191 men [74.6%]; 156 of 256 participants [60.9%] were Black or African American, 98 [38.3%] were White, and 1 [0.4%] was Asian) were randomized (125 in xanomeline-trospium group and 131 in placebo group). At week 5, xanomeline-trospium significantly reduced PANSS total score compared with placebo (xanomeline-trospium , -20.6; placebo, -12.2; least squares mean difference, -8.4; 95% CI, -12.4 to -4.3; P < .001; Cohen d effect size, 0.60). Discontinuation rates due to treatment-emergent adverse events (TEAEs) were similar between the xanomeline-trospium (8 participants [6.4%]) and placebo (7 participants [5.5%]) groups. The most common TEAEs in the xanomeline-trospium vs placebo group were nausea (24 participants [19.2%] vs 2 participants [1.6%]), dyspepsia (20 participants [16.0%] vs 2 participants [1.6%]), vomiting (20 participants [16.0%] vs 1 participant [0.8%]), and constipation (16 participants [12.8%] vs 5 participants [3.9%]). Measures of extrapyramidal symptoms, weight gain, and somnolence were similar between treatment groups.
CONCLUSIONS AND RELEVANCE
Xanomeline-trospium was efficacious and well tolerated in people with schizophrenia experiencing acute psychosis. These findings, together with the previously reported and consistent results from the EMERGENT-1 and EMERGENT-2 trials, support the potential of xanomeline-trospium to be the first in a putative new class of antipsychotic medications without D2 dopamine receptor blocking activity.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04738123.
PubMed: 38691387
DOI: 10.1001/jamapsychiatry.2024.0785