Diffi culties of diff erential diagnosis in functional dyspepsia

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.

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

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]

Correlation between sleep impairment and functional dyspepsia

Objective Sleeping habits may greatly impact the prevalence of functional dyspepsia (FD). This study examined relationships between aspects of sleep impairment and FD. Methods This prospective study included university student volunteers. Following enrolment, FD was diagnosed based on the Rome IV criteria, dividing participants into an FD group or controls. The FD group was further subdivided into long-term (disease course >6 months) and short-term (disease course 3–6 months) FD groups. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Rome IV Diagnostic Questionnaire for Gastrointestinal Disorders in Adults, and a visual analogue scale (VAS). Results Out of 418 participants in total, sleep quality, latency, and duration, habitual sleep efficiency, sleep disturbances, sleep medication use, daytime dysfunction, and PSQI scores were higher in the FD groups versus controls. Components of PSQI scores emerged as risk factors, and were higher in the long-term versus short-term dyspepsia group. Moreover, these components were positively correlated with frequency/severity of postprandial distress syndrome and early satiation. Total PSQI scores were positively correlated with VAS scores. Conclusion Several PSQI components are associated with FD occurrence, symptom frequency, and symptom severity.

The association between eating rate and functional dyspepsia in Iranian adults

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.

Treatment of Patients with Refractory Functional Dyspepsia Using Nardostachys jatamansi (D.Don) DC. Hydroalcoholic Extract: A Case Series

Functional dyspepsia (FD) is a highly prevalent condition with high impact on healthcare costs. Considering the complimentary therapies options like phytotherapy, this study aimed to investigate the efficacy and safety of Nardostachys jatamansi (D.Don) DC. extract in sixteen FD patients. The subjects received capsules of 500 mg N. Jatamansi, 3 times daily before meals for 30 days. The severity of early satiation and postprandial fullness were assessed by self-report of improvement at least 50% of symptoms and other FD symptoms assessed by Gastrointestinal Symptom Rating Scale (GSRS) before intervention and at end of treatment. The mean GSRS score level decreased significantly after intervention among study population. Five patients had chief complaint of early satiety and post prandial fullness who all of them reported 50% improvement. According to the results N. jatamansi seems to be effective in patients with refractory FD. Randomized clinical studies seem to be required.

Nerve growth factor and Tropomyosin receptor kinase A are increased in the gastric mucosa of patients with functional dyspepsia

Background Nerve growth factor (NGF) and enteric glial cells (EGCs) are associated with visceral hypersensitivity and gastrointestinal motility disorder, which may represent the pathogenesis of functional dyspepsia (FD). This study aimed to investigate the expression of NGF, its high affinity receptor tropomyosin receptor kinase A (TrkA) and the EGC activation marker glial fibrillary acidic protein (GFAP) in the gastric mucosa of patients with FD and the association of these proteins with dyspeptic symptoms. Methods Gastric mucosal biopsies taken from 27 FD patients (9 epigastric pain syndrome (EPS) patients, 7 postprandial distress syndrome (PDS) patients and 11 EPS overlap PDS patients) and 26 control subjects were used for analysis. The expression of NGF, TrkA and GFAP was examined, and the association of these proteins with dyspeptic symptoms, including epigastric pain, postprandial fullness, early satiation and epigastric burning, was analysed. Results The expression levels of NGF, TrkA, and GFAP in the gastric mucosa were significantly higher in the EPS group, the PDS group, and the EPS overlap PDS group than in the healthy control group. There was no significant difference between the FD subgroups. TrkA colocalized with GFAP, which indicated that TrkA was localized to EGCs, and the expression of TrkA in EGCs was significantly higher in the FD group than in the control group. Changes in the expression of NGF, TrkA, and GFAP were positively correlated with epigastric pain, postprandial fullness and early satiation but had no significant relationship with epigastric burning. Conclusions The increased expression of gastric NGF, TrkA and GFAP might be involved in FD pathophysiology and symptom perception.

Prevalence and pathophysiology of post-prandial migraine in patients with functional dyspepsia

Background Migraine is a condition frequently associated with gastrointestinal disorders. Previous reports have shown the relationship between irritable bowel syndrome and migraine, but no data are yet available in patients with functional dyspepsia. We therefore evaluated whether alteration of gastric sensorimotor activity may be related to migraine. Methods Sixty patients affected by functional dyspepsia, 38 with postprandial distress syndrome and 22 with epigastric pain syndrome were enrolled in a cohort study. Presence and severity of dyspeptic symptoms, migraine presence and severity, gastric sensitivity thresholds during fasting and postprandial period, gastric accommodation and gastric emptying time were evaluated. Results In epigastric pain syndrome, 12/22 (54%) patients suffered from migraine and this condition was never correlated with meal ingestion. In postprandial distress syndrome patients, 29/38 (76%) suffered from migraine, in 26/29 (89%) its onset was considered as meal-related, and migraine severity was significantly correlated with postprandial modification of the gastric discomfort threshold (r = −0.73; p < 0.001). In patients with postprandial distress syndrome, in the subgroup with moderate to severe migraine, the severity of fullness and early satiation was significantly higher than in patients with mild or absent migraine. In patients with moderate to severe migraine, gastric accommodation, sensitivity thresholds and gastric emptying time were similar to patients with mild or no migraine. Conclusions In patients with functional dyspepsia and postprandial symptoms, migraine is a very frequent comorbidity. On clinical grounds, it is associated with an increased severity of fullness and early satiation and, on pathophysiological grounds, it seems correlated with postprandial hypersensitivity.

Gambaran Klinis dan Endoskopi Saluran Cerna Bagian Atas Pasien Dispepsia di Bagian RSUP Dr. M. Djamil Padang

AbstrakDispepsia ialah suatu sindrom yang terdiri dari nyeri atau rasa tidak nyaman di ulu hati, kembung, mual, muntah, sendawa, rasa cepat kenyang, perut rasa penuh/begah. Salah satu alat diagnostik untuk dispepsia adalah endoskopi. Alat ini dapat menentukan jenis lesi dan lokasi lesi pada saluran cerna atas pasien dispepsia. Tujuan penelitian ini adalah mementukan frekuensi keluhan, derajat keluhan, insiden pasien dispepsia yang mengalami tanda bahaya berdasarkan jenis kelamin, faktor risiko dispepsia, diagnosis endoskopi dan lokasi lesi saluran cerna atas pasien dispepsia. Desain penelitian ini adalah deskriptif observasional. Subjek penelitian terdiri dari 54 orang pasien dispepsia yang dilakukan pemeriksaan esofagogastroduodenoskopi (EGD) di RSUP Dr. M. Djamil dari Mei hingga Juni 2014. Data dikumpulkan dengan cara pengisian kuisioner melalui wawancara, pencatatan hasil pemeriksaan endoskopi. Hasil penelitian didapatkan bahwa keluhan terbanyak dari pasien dispepsia adalah nyeri ulu hati (98,15%), derajat keluhan terbanyak adalah derajat sedang (38,89%), insiden tanda bahaya lebih banyak pada pria, faktor risiko terbanyak adalah konsumsi makanan berlemak (92,59%), diagnosis endoskopi dispepsia terbanyak adalah gastritis (61,11%), lokasi lesi saluran cerna atas terbanyak adalah gaster (85,19%). Kata kunci: dispepsia, gambaran klinis, endoskopi AbstractDyspepsia is a syndrome that consist of pain or discomfort in upper abdominal, bloating, nausea, vomiting, bletching, early satiation and post-prandial fullness. One of the diagnostic tool for dyspepsia was endoscopy. It can be determined the type and the location of upper gastrointestinal’s lesions in patient with dyspepsia. The objective of this study was to determined the frequency of dyspepsia’s complaints, the degree of dyspepsia’s complaints, the incident of alarm sign based on gender, the frequency of risk factors of dyspepsia, endoscopic diagnosis and the location of upper-gastrointestinal’s lesions in patient with dyspepsia. The design of this research was an observational descriptive study. The subject of this study are consist of 54 patients with dyspepsia who have performed esophagogastro- duodenoscopy (EGD) examination in Integrated Diagnostics Installation of Dr. M. Djamil Hospital Padang from May to June 2014. Data were collected by filling the questionnaire through an interview, recording the results of endoscopic examination. The results showed that the majority of dyspepsia patients’ complaints were heartburn (98.15%), the degree of complains is moderate (38.89%), the incidence of alarm sign most experienced by male, the most risk factor of dyspepsia was the consumption of fatty foods (92.59%), the most endoscopic diagnosis of dyspepsia was gastritis (61.11%), and the most upper gastrointestinal lesion of dyspepsia was located in gastric (85.19%)Keywords: dyspepsia, clinical findings, endoscopy