Dispepsia funcional y gastroparesia: ¿dos entidades superpuestas? De la fisiopatología a la terapéutica

Functional dyspepsia and gastroparesis represent the most common sensory-motor disorders of the upper gastrointestinal tract. Scientific advances in the last decade have shown that there is significant overlap between them. This review aims to address current knowledge about their pathophysiology, diagnosis and treatment. Functional dyspepsia is a medical condition that is characterized by one or more of the following symptoms: early satiety, postprandial fullness, and epigastric pain or burning. The pathophysiological mechanisms involved are: the gastroduodenal motility and sensory abnormalities, the immune dysfunction, the duodenal inflammation, the gastrointestinal infections, the alterations in the gastrointestinal microbiota and the dysfunction of the gut-brain axis. The Rome IV criteria make possible to establish a presumptive diagnosis of functional dyspepsia in most patients, although it continues to be a diagnosis of exclusion that requires the performance of an upper digestive video endoscopy to confirm it. The recommended therapeutic options are: the eradication of Helicobacter pylori, the proton pump inhibitors, the tricyclic antidepressants and prokinetics. Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of a mechanical obstruction. The pathophysiology is caused by neuromuscular abnormalities of gastric motor function. Gastric emptying scan is the current gold standard for diagnosis. The mainstays of treatment are restoration of hydration and nutrition, and pharmacological treatment with prokinetics and antiemetics.

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The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2021-0003 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Mirjana Cvetković ◽

Igor Jovanović ◽

Slobodanka Crevar-Marinović ◽

Marija Branković ◽

Olga Mandić ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Test Meal ◽

Healthy Subjects ◽

Metabolic Diseases ◽

Epigastric Pain ◽

Postprandial Fullness ◽

Epigastric Pain Syndrome ◽

Significant Difference ◽

Antral Area

Abstract Background: Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p<0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p <0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p <0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p <0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.

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DA-9701 (Motilitone): A Multi-Targeting Botanical Drug for the Treatment of Functional Dyspepsia

International Journal of Molecular Sciences ◽

10.3390/ijms19124035 ◽

2018 ◽

Vol 19 (12) ◽

pp. 4035 ◽

Cited By ~ 3

Author(s):

Mirim Jin ◽

Miwon Son

Keyword(s):

Functional Dyspepsia ◽

Serotonin Receptors ◽

Epigastric Pain ◽

Herbal Medicines ◽

Gastrointestinal Disorder ◽

Clinical Results ◽

Promising Alternative ◽

Postprandial Fullness ◽

Botanical Drug ◽

Upper Abdomen

Functional dyspepsia (FD) is the most common functional gastrointestinal disorder (FGID). FD is characterized by bothersome symptoms such as postprandial fullness, early satiety, and epigastric pain or burning sensations in the upper abdomen. The complexity and heterogeneity of FD pathophysiology, which involves multiple mechanisms, make both treatment and new drug development for FD difficult. Current medicines for FD targeting a single pathway have failed to show satisfactory efficacy and safety. On the other hand, multicomponent herbal medicines that act on multiple targets may be a promising alternative treatment for FD. DA-9701 (Motilitone), a botanical drug consisting of Corydalis Tuber and Pharbitidis Semen, has been prescribed for FD since it was launched in Korea in 2011. It has multiple mechanisms of action such as prokinetic effects, fundus relaxation, and visceral analgesia, which are mediated by dopamine D2 and several serotonin receptors involved in gastrointestinal (GI) functions. In clinical studies, DA-9701 has been found to be beneficial for improvement of FD symptoms and GI functions in FD patients, while showing better safety compared to that associated with conventional medicines. In this review, we provide updated information on the pharmacological effects, safety, and clinical results of DA-9701 for the treatment of FGIDs.

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A Randomized Controlled Study of Efficacy and Safety Profile of Levosulpiride and Itopride in Functional Dyspepsia

Journal of Mahatma Gandhi University of Medical Sciences and Technology ◽

10.5005/jp-journals-10057-0131 ◽

2020 ◽

Vol 5 (2) ◽

pp. 50-56

Author(s):

Ganesh Narain Saxena ◽

Saumya Mathur

Keyword(s):

Functional Dyspepsia ◽

Safety Profile ◽

Epigastric Pain ◽

Randomized Controlled Study ◽

Controlled Study ◽

Efficacy And Safety ◽

Early Satiety ◽

Postprandial Fullness ◽

Presenting Symptoms ◽

Randomized Controlled

ABSTRACT Introduction Dyspepsia is a clinical problem of considerable magnitude for the healthcare system due to the high prevalence and chronic and recurrent nature of symptoms. Earlier dyspepsia was referred to as a heterogeneous group of symptoms in the upper abdomen and retrosternal which are related to ingestion of meals and include heartburn, regurgitation, epigastric pain, epigastric burning, postprandial fullness/distension, early satiety, bloating, belching, anorexia, nausea, and vomiting. This has prompted the search for newer agents with equal efficacy but lower side effect potential such as levosulpiride and itopride. Aim and objectives To evaluate and compare the efficacy of the newer drugs like levosulpiride and itopride in functional dyspepsia. Observations and results The most common presenting symptoms in the present study were epigastric fullness (81%), upper abdominal pain (55%), early satiety (52%), and epigastric burning (45%). Less common symptoms were bloating (27%), belching (11%), heartburn (10%), and nausea (8%). Conclusion Drugs, itopride and levosulpiride, were equally effective in ameliorating different symptoms of functional dyspepsia at the end of 4 weeks of treatment. There was a significant reduction in mean global symptom score (GSS) and mean duration score and mean score of severity in follow-up visits at the 2nd and 4th week from the day of presentation (p value < 0.05). How to cite this article Saxena GN, Mathur S. A Randomized Controlled Study of Efficacy and Safety Profile of Levosulpiride and Itopride in Functional Dyspepsia. J Mahatma Gandhi Univ Med Sci Tech 2020;5(2):50–56.

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Topical Mastic Oil for Treatment of Functional Dyspepsia: A Randomized Triple-Blind Controlled Trial

Galen Medical Journal ◽

10.31661/gmj.v10i0.1965 ◽

2021 ◽

Vol 10 ◽

pp. 1965

Author(s):

Mahsa Baradaran Sattarzadeh ◽

Asie Shojaii ◽

Mohssen Nassiri Toosi ◽

Mehri Abdollahi-Fard ◽

Foroogh Alborzi Avanaki ◽

...

Keyword(s):

Functional Dyspepsia ◽

Epigastric Pain ◽

Controlled Trial ◽

Study Groups ◽

Control Group ◽

Test Results ◽

Postprandial Fullness ◽

Friedman's Test ◽

Early Satiation ◽

Better Than

Background: The main goal of the present study was to evaluate the effect of topical mastic oil, compared to placebo on treatment of functional dyspepsia (FD). Materials and Methods: Sixty-three patients with FD were included. Thirty-two subjects received the topical mastic oil (10 drops/TDS after meal) with massage and 31 patients received topical sesame oil with massage. Both groups received pantoprazole (40 mg daily) along with oil and massage. The severity of early satiation, postprandial fullness, epigastric pain and epigastric burning was assessed after 4 weeks using the Visual Analogue Scale (VAS) as well as frequency of symptoms. Satisfaction with the treatment was also assessed using a researcher-made questionnaire. Changes in the severity of symptoms were evaluated by Friedman’s test. Results: Mean and standard deviation of age of the subjects were equal to 36.95±13.64 and 50 (79.4%) patients were female. Both groups experienced a significant decrease in the severity of all the four symptoms (P<0.001). The percentage of decrease in the severity of early satiation was significantly higher in the mastic group than the control group (76.03±34.91% vs. 37.24±38.86%, P=0.003). No significant differences were found in the percentage of decrease in the severity of postprandial fullness, epigastric pain and burning between the study groups (P=0.05, 0.06, and 0.13, respectively). The frequency of symptoms was decreased similarly in both groups. Satisfaction with the treatment was reported to be significantly higher in the mastic group than the sesame group (P=0.01). There were no intolerable side effects in both groups. Conclusion: Mastic oil reduced early satiation better than the placebo. In addition, satisfaction with the treatment was higher in the mastic group than the sesame group. [GMJ.2021;10:e1965]

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The association between eating rate and functional dyspepsia in Iranian adults

10.21203/rs.2.23971/v1 ◽

2020 ◽

Author(s):

Parvane Saneei ◽

Ammar Hassanzadeh Keshteli ◽

Hamid Rasad ◽

Hamed Daghaghzadeh ◽

Awat Feizi ◽

...

Keyword(s):

Functional Dyspepsia ◽

Epigastric Pain ◽

Large Population ◽

Cross Sectional Study ◽

Dietary Habit ◽

Eating Rate ◽

Cross Sectional ◽

Postprandial Fullness ◽

Gastrointestinal Health ◽

Early Satiation

Abstract Objective: This study aimed to investigate the association between eating rate and functional dyspepsia (FD) in a large population of Iranian adults.Methods: In this cross-sectional study, we assessed eating rate of 4763 Iranian adults using a dietary habit questionnaire. We used a modified validated version of the Rome III questionnaire to assess gastrointestinal health. FD was defined as having one or more of the following characteristics: bothersome postprandial fullness, early satiation and/or epigastric pain or epigastric burning. Needed information on meal frequency, meal regularity, intra-meal fluid drinking as well as on other potential confounders was obtained by using a pre-tested questionnaire.Results: Functional dyspepsia was prevalent in 15.2% (n=703) of the studied population. Lunch and total eating rate was associated with greater odds of having FD(OR: 1.37; 95% CI: 1.04-1.8) and (OR: 1.45; 95% CI: 1-2.11), respectively). However, this relationship weakened after adjusting for confounding factors. No significant relationship was found between dinner eating rate and FD in both crude and adjusted models (OR: 1.23; 95% CI: 0.83-1.51). There was no significant relation between lunch, dinner or total eating rate and risk of postprandial fullness, early satiation or epigastric pain either in crude or adjusted models. Eating rate was not related to severity or frequency of FD components.Conclusions: Fast eating was associated with greater odds of FD. However, there was no association between fast eating with postprandial fullness and epigastria pain. Further studies, particularly prospective ones, are required to confirm these relations.

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Efficacy of Trimebutine Maleate in the Treatment of Functional Dyspepsia in Childhood

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v33i2.7229 ◽

2013 ◽

Vol 33 (2) ◽

pp. 158-162

Author(s):

Alexander A Nijevitch ◽

Elsa N Akhmadeeva ◽

Valery U Sataev ◽

Bulat Idrisov

Keyword(s):

Functional Dyspepsia ◽

Epigastric Pain ◽

Functional Gastrointestinal Disorders ◽

Therapeutic Interventions ◽

Therapeutic Drug ◽

Limited Data ◽

Opioid Agonist ◽

Postprandial Fullness ◽

Trimebutine Maleate ◽

Increasing Demand

Peripheral μ-, k- and δ-opioid agonist trimebutine maleate is considered to be an effective therapeutic drug for the treatment of functional gastrointestinal disorders. Ninety-two paediatric outpatients (12- 17 year-old) suffering from functional dyspepsia (epigastric pain and meal-induced dyspeptic symptoms) were enrolled in a prospective openlabel study. For ethical reasons, no placebo group was included. Patients were treated with trimebutine maleate (200 mg three times daily). After a 3-week treatment there was a significant decrease in scores of epigastric pain (p<0.05), postprandial fullness (p<0.05), early satiety (p<0.05), nausea (p<0.05) and belching (p<0.05). The treatment regimen was well tolerated and demonstrated a good compliance. In conclusion, we postulate that trimebutine maleate is an effective medication for relief of main symptoms associated with functional dyspepsia syndrome in childhood. Because of the limited data on therapeutic interventions in functional dyspepsia in childhood and increasing demand for therapies to treat this disorder, further evaluation of the efficacy of trimebutine treatment for children is certain. DOI: http://dx.doi.org/10.3126/jnps.v33i2.7229 J Nepal Paediatr Soc. 2013; 33(2):158-162

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Functional Dyspepsia and Gastroparesis

Digestive Diseases ◽

10.1159/000445226 ◽

2016 ◽

Vol 34 (5) ◽

pp. 491-499 ◽

Cited By ~ 33

Author(s):

Michael Camilleri

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Delayed Gastric Emptying ◽

Gastrointestinal Symptoms ◽

Psychological Disorder ◽

Mechanical Obstruction ◽

Gastric Accommodation ◽

Postprandial Fullness ◽

Rumination Syndrome ◽

Upper Gastrointestinal

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.

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Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-09 ◽

2017 ◽

Vol 54 (1) ◽

pp. 46-50 ◽

Cited By ~ 3

Author(s):

Alessandra Maciel ALMEIDA ◽

Luísa Alvarenga Guerra MARTINS ◽

Patrícia Liz Terenzi CUNHA ◽

Viviane Willig BRASIL ◽

Lucas Galuppo Fernandes FÉLIX ◽

...

Keyword(s):

Functional Dyspepsia ◽

Eating Habits ◽

Epigastric Pain ◽

Pain Syndrome ◽

Postprandial Fullness ◽

Epigastric Pain Syndrome ◽

Dyspeptic Symptoms ◽

Rome Iii ◽

Belo Horizonte ◽

Social Demographic

ABSTRACT BACKGROUND Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

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Management of functional dyspepsia: state of the art and emerging therapies

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622317725479 ◽

2017 ◽

Vol 9 (1) ◽

pp. 23-32 ◽

Cited By ~ 15

Author(s):

Hiroshi Yamawaki ◽

Seiji Futagami ◽

Mako Wakabayashi ◽

Noriko Sakasegawa ◽

Shuhei Agawa ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Clinical Symptoms ◽

Epigastric Pain ◽

Pain Syndrome ◽

Multicenter Studies ◽

Gastric Accommodation ◽

Double Blind ◽

Epigastric Pain Syndrome ◽

Rome Iv

Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. Several etiologies have been associated with the disorder. In the Rome IV criteria, the brain–gut axis was acknowledged as an important factor in the etiology of functional gastrointestinal (GI) disorders. The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. A previous study has reported that proton pump inhibitors (PPIs) and H2-blockers were equally effective in functional dyspepsia. A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. The pharmacological mechanisms of acotiamide remain unknown; whether acotiamide alters gastric emptying and gastric accommodation in patients with functional dyspepsia remains an open question. Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs). Different drugs are needed to accommodate the clinical symptoms and etiology in individual patients.

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Diffi culties of diff erential diagnosis in functional dyspepsia

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2021-99-3-208-212 ◽

2021 ◽

Vol 99 (3) ◽

pp. 208-212

Author(s):

A. A. Sheptulin ◽

S. S. Kardasheva ◽

A. A. Kurbatova

Keyword(s):

Functional Dyspepsia ◽

Epigastric Pain ◽

Diagnostic Errors ◽

Postprandial Fullness ◽

Comprehensive Examination ◽

Early Satiation ◽

Rome Iv

Dyspepsia syndrome is understood as a complex of symptoms, including epigastric pain and epigastric burning, postprandial fullness and early satiation. In cases when organic diseases cannot be detected in patients as the cause of these symptoms, the term functional dyspepsia (FD) should be used. Rome IV criteria of FD in the absence of “alarm symptoms” consider it possible to make a diagnosis of FD without instrumental examination (fi rst of all, without esophagogastroduodenoscopy). The recommendations of the Russian Gastroenterological Association emphasize that this approach leads to serious diagnostic errors, and therefore the diagnosis of PD should be considered as a diagnosis of exclusion, which can be made only after a comprehensive examination of patients.

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