665 Gastric Sensitivity and Emptying Interact With Gastric Accommodation in Functional Dyspepsia

Introduction: According to Rome IV, functional dyspepsia is diagnosed with presence of dyspepsia in the absence of organic or metabolic causes. FD caused by several factors such as impaired gastric accommodation and hypersensitivity to gastric distention. Several studies have reported effectiveness of herbal medicine on FD. This article, thus, reviews Persian herbal medicine in FD. Method: Electronic databases including Pubmed, Scopus, Cochrain, Embase, Web of science and Ovid were searched so as to find clinical articles related to dyspepsia and herbal medicine by July 2019. Our search strategies were traditional medicine, complementary and alternative medicine, herb, plant, and dyspepsia. We excluded all articles except Persian clinical trials. Results: We found 34 clinical trials with 15 herbs and 4 compound herbal remedies like Asparagus racemosus, Brassica oleracea, Cynara scolymus, Ocimum basilicum, Mentha longifolia, Mentha pulegium, Mentha piperata, Pimpinella anisum, Nigella sativa, Mastic gum, Curcuma longa, Pistatio atlantica, Glycyrrhiza glabra, Solanum tuberosum and Zingiber officinale and compound remedies of Rosa damascene & Crocus sativus, Trachyspermum copticom & Apium graveolence, Carum carvi & Mentha pipperata, Gingiber officinalis & Cynara scolymus are effective in functional dyspepsia. Conclusion: Many people use herbal and traditional remedies for treatment of disorders such as gastrointestinal disordersو , especially in Asian countries. Several studies reported the efficacy of herbal medicine in functional dyspepsia. Although their mechanisms are not fully understood, it seems they can modulate GI motility and improve symptoms of FD.

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Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia

Gut ◽

10.1136/gut.52.9.1271 ◽

2003 ◽

Vol 52 (9) ◽

pp. 1271-1277 ◽

Cited By ~ 167

Author(s):

J Tack

Keyword(s):

Functional Dyspepsia ◽

Gastric Accommodation ◽

Drinking Test

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Gastric accommodation and gastric emptying in patients with functional dyspepsia

The American Journal of Gastroenterology ◽

10.1016/s0002-9270(03)00879-7 ◽

2003 ◽

Vol 98 (9) ◽

pp. S38-S39

Author(s):

M ALAGHBAR

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Gastric Accommodation

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Gastric Accommodation in Functional Dyspepsia

Scandinavian Journal of Gastroenterology ◽

10.3109/00365529709000193 ◽

1997 ◽

Vol 32 (3) ◽

pp. 193-197 ◽

Cited By ~ 21

Author(s):

Arnold Berstad ◽

Trygve Hauksen ◽

Odd Helge Gilja ◽

Kristian Hveem ◽

Karl Anton Undeland ◽

...

Keyword(s):

Functional Dyspepsia ◽

Gastric Accommodation

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Relationship of Motor Mechanisms to Gastroparesis Symptoms: Towards Individualized Treatment

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00006.2021 ◽

2021 ◽

Author(s):

Michael Camilleri

Keyword(s):

Animal Studies ◽

Gastrointestinal Symptoms ◽

Feedback Regulation ◽

Individualized Treatment ◽

Control Mechanisms ◽

Gastric Accommodation ◽

Billroth I ◽

Gastric Sensitivity

Following a classical paper by Dr. Keith A. Kelly published in this journal, and over the past 40 years, there has been increased understanding of the functions of different regions of the stomach, specifically the fundus, antrum, and pylorus. Several of the important physiological principles were based on in vivo animal studies that led to the appreciation of regional function and control mechanisms. These include the roles of the extrinsic parasympathetic vagal innervation, the gastric enteric nervous system and electrical syncytium consisting of pacemaker cells and smooth muscle cells, and duodenogastric reflexes providing feedback regulation following the arrival of food and hydrogen ions stimulating the release of hormones and vagal afferent mechanisms that inhibit gastric motility and stimulate pyloric contractility. Further insights on the role of regional motor functions in gastric emptying were obtained from observations in patients following diverse gastric surgeries or bariatric procedures, including fundoplication, Billroth I and sleeve gastrectomy, and sleeve gastroplasty. Antropyloroduodenal manometry as well as measurements of pyloric diameter and distensibility index provided important assessments of the role of antral hypomotility and pylorospasm, and these constitute specific targets for individualized treatment of patients with gastroparesis. Moreover, in patients with upper gastrointestinal symptoms suggestive of gastroparesis, the availability of measurements of gastric accommodation as well as pharmacological agents to reduced gastric sensitivity or enhance gastric accommodation provide additional specific targets for individualized treatment. It is anticipated that, in the future, such physiological measurements will be applied in patients to optimize choice of therapy, possibly including identifying the best candidate for pyloric interventions.

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Secretin effects on gastric functions, hormones and symptoms in functional dyspepsia and health: randomized crossover trial

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00371.2019 ◽

2020 ◽

Vol 318 (4) ◽

pp. G635-G645 ◽

Cited By ~ 2

Author(s):

Justin Brandler ◽

Laurence J. Miller ◽

Xiao Jing Wang ◽

Duane Burton ◽

Irene Busciglio ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Animal Studies ◽

Delayed Gastric Emptying ◽

Gastrointestinal Hormones ◽

Receptor Activation ◽

Gastric Accommodation ◽

Double Blind ◽

Secretin Receptor ◽

Therapeutic Mechanism

Abnormal gastric accommodation (GA) and gastric emptying contribute to pathophysiology in functional dyspepsia (FD). Secretin is a key regulator of GA in animal studies. Our aim was to study the effects of secretin on gastric motility, satiation, postprandial symptoms, and key hormones. We performed two double-blind, randomized, saline-controlled crossover trials in 10 healthy volunteers and 10 patients with FD by Rome IV criteria. We used measured GA (by validated SPECT method) after a 111In radiolabeled Ensure 300-mL meal and quantified gastric emptying for 30 min by scintigraphy. Satiation was measured by volume to fullness (VTF) and maximum tolerated volume (MTV) on an Ensure nutrient drink test and postprandial symptoms 30 min post-MTV. Fasting and postprandial GLP-1, GIP, and HPP were measured. The ages and sex distribution of healthy controls and patients with FD were similar. Compared with placebo, secretin delayed gastric emptying at 30 min in both health [−11% (−16, −4), P = 0.004]; and FD [−8% (−9, 0), P = 0.03]. Satiation (VTF and MTV), GA, and plasma levels of GLP-1, GIP, and HPP did not differ between treatment arms in health or FD. On ANCOVA analysis (adjusting for age and sex), secretin did not consistently increase postprandial symptoms in health or FD. Secretin delayed gastric emptying in both health and FD without significantly altering GA, VTF, or MTV or selected hormones. Thus, secretin receptor activation may provide a novel therapeutic mechanism for patients with FD and rapid gastric emptying. NEW & NOTEWORTHY The naturally occurring hormone secretin retards gastric emptying of solids without deleteriously affecting gastric accommodation, satiation, other upper gastrointestinal hormones, or postprandial symptoms. Given these findings, a subset of patients with rapid gastric emptying (e.g., the estimated 20% of patients with functional dyspepsia) could be candidates for treatments that stimulate a secretin receptor such as sacubitril, which inhibits neprilysin, an enzyme that degrades secretin.

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Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography

Neurogastroenterology & Motility ◽

10.1111/j.1365-2982.2012.01897.x ◽

2012 ◽

Vol 24 (6) ◽

pp. 540-e251 ◽

Cited By ~ 80

Author(s):

H. Kusunoki ◽

K. Haruma ◽

N. Manabe ◽

H. Imamura ◽

T. Kamada ◽

...

Keyword(s):

Real Time ◽

Functional Dyspepsia ◽

Therapeutic Efficacy ◽

Randomized Controlled Study ◽

Controlled Study ◽

Gastric Accommodation ◽

Randomized Controlled ◽

Study Evaluation ◽

Real Time Ultrasonography

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An Alternative to Current Therapies of Functional Dyspepsia: Self-Administrated Transcutaneous Electroacupuncture Improves Dyspeptic Symptoms

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/832523 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 26

Author(s):

Ting Ji ◽

Xueliang Li ◽

Lin Lin ◽

Liuqin Jiang ◽

Meifeng Wang ◽

...

Keyword(s):

Quality Of Life ◽

Gastric Emptying ◽

Functional Dyspepsia ◽

Therapeutic Potential ◽

Treatment Options ◽

Treatment Method ◽

Gastric Accommodation ◽

Dyspeptic Symptoms ◽

New Treatment

Functional dyspepsia is of high prevalence with little treatment options. The aim of this study was to develop a new treatment method using self-management transcutaneous electroacupuncture (TEA) for functional dyspepsia (FD). Twenty-eight patients with FD were enrolled and underwent a crossover clinical trial with 2-week TEA at ST36 and PC6 and 2-week sham-TEA at nonacupuncture sham-points. Questionnaires were used to assess symptoms of dyspepsia and quality of life. Physiological testing included gastric emptying and electrogastrography. It was found that (1) TEA but not sham-TEA significantly improved dyspeptic symptoms and 4 domains in quality of life; improvement was also noted in self-rated anxiety and depression scores; (2) gastric emptying was significantly and substantially increased with 2-week TEA but not sham-TEA; and (3) gastric accommodation was also improved with TEA but not sham-TEA, reflected as increased ingested nutrient volumes at the levels of satiety and maximum tolerance. These findings suggest a therapeutic potential of self-administrated TEA method for functional dyspepsia, possibly attributed to improvement in gastric motility.

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