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

2017 ◽  
Vol 9 (1) ◽  
pp. 23-32 ◽  
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.

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

Cephalalgia ◽  
2019 ◽  
Vol 39 (12) ◽  
pp. 1560-1568
Author(s):  
Michele Di Stefano ◽  
Ennio Pucci ◽  
Emanuela Miceli ◽  
Elisabetta Pagani ◽  
Natascia Brondino ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Distress Syndrome ◽  
Epigastric Pain ◽  
Pain Syndrome ◽  
Gastric Accommodation ◽  
Postprandial Distress Syndrome ◽  
Epigastric Pain Syndrome ◽  
Gastric Emptying Time ◽  
Early Satiation ◽  
Severe Migraine

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.

Temperature Can Influence Gastric Accommodation and Sensitivity in Functional Dyspepsia with Epigastric Pain Syndrome

2012 ◽  
Vol 58 (9) ◽  
pp. 2550-2555 ◽  
Author(s):  
Rui-Feng Wang ◽  
Zhi-Feng Wang ◽  
Mei-Yun Ke ◽  
Xiu-Cai Fang ◽  
Xiao-Hong Sun ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Epigastric Pain ◽  
Pain Syndrome ◽  
Gastric Accommodation ◽  
Epigastric Pain Syndrome

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

2020 ◽  
Vol 318 (4) ◽  
pp. G635-G645 ◽  
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.

Fasting and Postprandial Gastric Sensorimotor Activity in Functional Dyspepsia: Postprandial Distress Vs. Epigastric Pain Syndrome

2014 ◽  
Vol 109 (10) ◽  
pp. 1631-1639 ◽  
Author(s):  
Michele Di Stefano ◽  
Emanuela Miceli ◽  
Paola Tana ◽  
Caterina Mengoli ◽  
Manuela Bergonzi ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Epigastric Pain ◽  
Pain Syndrome ◽  
Epigastric Pain Syndrome ◽  
Sensorimotor Activity

scholarly journals The effect of acotiamide on epigastric pain syndrome and postprandial distress syndrome in patients with functional dyspepsia

2016 ◽  
Vol 63 (3.4) ◽  
pp. 230-235 ◽  
Author(s):  
Satoshi Shinozaki ◽  
Hiroyuki Osawa ◽  
Hirotsugu Sakamoto ◽  
Yoshikazu Hayashi ◽  
Alan Kawarai Lefor ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Distress Syndrome ◽  
Epigastric Pain ◽  
Pain Syndrome ◽  
Postprandial Distress Syndrome ◽  
Epigastric Pain Syndrome

scholarly journals Level of proinflammatory cytokines in children with various clinical forms of functional dyspepsia

2019 ◽  
Keyword(s):  
Gastric Mucosa ◽  
Functional Dyspepsia ◽  
Epigastric Pain ◽  
Pain Syndrome ◽  
Endoscopic Examination ◽  
Control Group ◽  
Total Group ◽  
Tnf Α ◽  
Epigastric Pain Syndrome ◽  
Pro Inflammatory Cytokines

Objective was to study the level of tumor necrosis factor α (TNF-α) and interleukin 1α (IL-1α) in the blood of children with various forms of functional dyspepsia in accordance with various endoscopic changes of the gastric mucosa. Materials and methods. 79 school age children with functional dyspepsia were examined. The diagnosis was made in accordance with the recommendations of the Rome Criteria IV (2016). All patients underwent endoscopic examination of the esophagus, stomach and duodenum to exclude destructive changes of the mucous membrane. The level of TNF-α and IL-1α in the blood serum was determined by enzyme immunoassay. Statistical processing of the results obtained was performed using Microsoft Excel 2010. Results. The average level of TNF-α in the total group was 463.22±27.4 pg/ml, which statistically significantly exceeded this indicator in the control group (26.76±1.10 pg/ml; p<0.01). The IL-1α value in the total group was 148.6±6.06 pg/ml and was significantly higher in comparison with the control group (53.29±3.28 pg/ml; p<0.01). The level of proinflammatory cytokines in the group of children with epigastric pain syndrome was significantly higher than in the group of children with postprandial distress syndrome. Endoscopic examination showed the presence of unchanged mucous membrane in only 25.3% of children. Erythematous gastroduodenopathy was observed in 74.7% of children and was typical mainly for patients with epigastric pain syndrome (97.7%; p<0.05). Conclusions. The level of pro-inflammatory cytokines in children with functional dyspepsia is increased. When comparing the clinical variants of the disease, a significant increase in the level of TNFα, and IL-1α in children with epigastric pain syndrome was found. In the same group of children, endoscopic changes in the gastric mucosa were more pronounced. Further study of changes in the level of pro-inflammatory cytokines in children with functional dyspepsia may allow this to be used as one of the methods for the differential diagnosis of functional dyspepsia and chronic gastritis.

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