Eradication of intestinal bacterial overgrowth as a treatment method for functional dyspepsia

2021 ◽  
Author(s):  
S. M. Tkach ◽  
N. V. Kharchenko ◽  
A. E. Dorofeev
Keyword(s):  
Functional Dyspepsia ◽  
Epigastric Pain ◽  
Bacterial Overgrowth ◽  
Intestinal Microbiome ◽  
Control Group ◽  
Gastrointestinal Infections ◽  
Intestinal Bacterial Overgrowth ◽  
Epigastric Pain Syndrome ◽  
H Pylori

Functional dyspepsia (FD) is one of the most common gastrointestinal functional diseases, occurring in an average of 10 % of the adult population. Recently, much attention is being paid to the infectious factor in FD pathophysiology. In addition to H. pylori infection and acute gastrointestinal infections, consideration is given to the syndrome of intestinal bacterial overgrowth (SIBO), in which the number of bacteria in the small intestine increases significantly. Objective — to establish the SIBO prevalence in patients with different FD subtypes and to establish the clinical and microbiological efficacy of rifaximin‑a (Alpha Normix®) at this pathology. Materials and methods. To refine the SIBO prevalence, 118 patients with FD were examined in three gastroenterological centers, including 45 men, 73 women aged 22 to 45 years (mean age — 35 ± 10 years). The control group consisted of 30 clinically healthy people with the mean age 33 ± 12 years. The diagnosis of FD and establishment of its subtype was performed according to Rome IV criteria. All patients underwent upper endoscopy with biopsy and H. pylori testing, which did not show any structural abnormalities. To diagnose SIBO, all patients underwent H2‑breath test with lactulose (H2‑LBT). All patients, depending on the FD subtype, received basic therapy with either a proton pump inhibitor (Omeprazole 20 mg once a day) at FD with epigastric pain syndrome (EPS) (group 1, n = 37), or prokinetic (Itopride in a dose of 50 mg three times a day) at FD with postprandial distress syndrome (PDS) (group 2, n = 36) for two weeks. Patients with positive H2‑LBT result, which predicted SIBO presence, were administered monotherapy with rifaximin‑a  (Alpha Normix®) in a dose of 1200 mg/day for 10 days. The effectiveness of the treatment was assessed after 2 and 4 weeks based on the dynamics of the scores of SAGIS (Structured Assessment of Gastrointestinal Symptom) scale. Results. According to the positive H2‑LBT results, SIBO presence was recorded in 45 of 118 patients with FD (38.1 %) and 2 (6.6 %) subjects from the control group. Positive H2‑LBT result was significantly more often recorded in patients with FD‑PDS (45.4 %) compared with patients with FD‑EPS (28.8 %, p < 0.01) and all patients with FD (38.1 %). Moreover, SIBO was significantly more common in patients with postinfectious FD (50 % of patients, p < 0.01). The use of rifaximin in a dose of 1200 mg/day for 10 days was accompanied by the clinical improvement in 28 of 45 patients (62.2 %) after 4 weeks of treatment. The clinical efficacy of rifaximin in FD patients on the SAGIS scale did not differ significantly from the efficacy of PPIs and prokinetics used in FD‑EPS and FD‑PDS, respectively. After 4 weeks, in 36 of 45 patients, repeated H2‑LBT was negative, which indirectly indicated the SIBO eradication and high antibacterial efficacy of rifaximin. Rifaximin treatment was safe, and minor side effects were observed in only 3 patients (6.6 %). Conclusions. SIBO is quite often associated with FD and is observed in more than every third patient. In patients with FD‑PDS, SIBO was found significantly more often than in patients with FD‑EPS, which emphasizes the important role of slowing gastric emptying in the development of SIBO. Also, SIBO is significantly more common in patients with postinfectious FD, which emphasizes the important role of the intestinal microbiome in maintaining the stability of the structural and functional state of the gastrointestinal tract. The obtained data allow to consider SIBO as a possible pathogenetic factor of FD, at least in some patients. This requires timely diagnosis and correction of SIBO in patients with FD, in particular with the use of rifaximin‑a.

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.

scholarly journals Rabeprazole in the treatment of duodenal ulcer desease and functional dyspepsia

2018 ◽  
pp. 70-76
Author(s):  
V. Yu. Rusyaev ◽  
D. A. Sheptulin ◽  
N. V. Shulpekova ◽  
Yu. O. Shulpekova
Keyword(s):  
Duodenal Ulcer ◽  
Mucous Membrane ◽  
Functional Dyspepsia ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Epigastric Pain ◽  
Intraepithelial Lymphocytes ◽  
Gastric Accommodation ◽  
Epigastric Pain Syndrome ◽  
H Pylori

The review aims to provide a contemporary view of the pathogenesis and treatment of the most common duodenum diseases – duodenal ulcer disease (DUD) and functional dyspepsia (FD). Due to its unique structure and functions, the duodenum that anatomically represents the initial section of the small intestine differentiates itself from others. The prevalence of DUD is declining in many Western countries due to the widespread introduction of effective anti-Helicobacter therapy and a significant decrease in the prevalence of H pylori infection. However, the ideas about the poly-biological nature of DUD persists and additional risk factors continue to be studied. DUD is manifested by pain/burning feeling in the epigastric region, as well as by symptoms such as early satiety, epigastric filling after eating in the absence of obvious organic changes in the digestive system. The diagnosis of FD is based on the Rome IV criteria. The duodenum plays an important role in its pathogenesis (disorders of gastric accommodation, motor and visceral hypersensitivity). Most patients with FD have microscopic signs of inflammation of the mucous membrane of the postbulbar part of the duodenum - an increased amount of intraepithelial lymphocytes, eosinophils, and signs of increased permeability of the mucous membrane. In all likelihood, these changes are provoked by infection and / or nutritional factors, as well as by exposure to hydrochloric acid. Proton pump inhibitors (prokinetics in postprandial distress syndrome) form the basis of treatment of peptic ulcer and epigastric pain syndrome; all patients with DUD and dyspepsia syndrome infected with H. pylori receive antihelicobacter therapy. Rabeprazole that is characterized by a long and powerful effect and minimal interaction with the cytochrome 2C19 system stands out from the proton pump inhibitors. Conclusion: acid aggression plays a very important role in the pathogenesis of duodenal ulcers diseases and FD; proton pump inhibitors form the basis for the treatment of such patients both in the form of monotherapy and as part of eradication regimens. 

scholarly journals Immune Responses to Differentiated Forms of Helicobacter pylori in Children with Epigastric Pain

2003 ◽  
Vol 10 (5) ◽  
pp. 866-869 ◽  
Author(s):  
Bee Ling Ng ◽  
Seng Hock Quak ◽  
Marion Aw ◽  
Kee Tai Goh ◽  
Bow Ho
Keyword(s):  
Helicobacter Pylori ◽  
Pediatric Patients ◽  
Epigastric Pain ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Human Populations ◽  
Coccoid Form ◽  
Spiral Form ◽  
H Pylori

ABSTRACT Helicobacter pylori infection affects human populations of all ages. This gastric bacterium exists in spiral form and the reported viable but nonculturable coccoid form. The present study aims to examine the probable role of the coccoid form in H. pylori infection by comparing the seroprevalences of the spiral and the coccoid forms in children with epigastric pain. Four hundred eighty-nine children (mean age, 8.5 years) with epigastric pain formed the basis of this study. Five hundred ninety-nine schoolchildren of comparable ages and with no record of dyspepsia served as controls. The seroprevalence of antigens prepared from both morphological forms was examined by enzyme-linked immunosorbent assay. The results showed that 65 (13.3%) and 273 (55.8%) of 489 symptomatic children were seropositive for antigens of the H. pylori spiral and coccoid forms, respectively. In contrast, only 7.0% of the control group had elevated levels of immunoglobulin G antibodies against the spiral form, while 26.5% were positive for antibodies against the coccoid form. There were no significant differences between genders or among ethnic groups. The study showed a rise in seroprevalence corresponding with age: 7.1% for those ≤5 years to 21.4% for those ≥11 years. The seroprevalence of antigens of the H. pylori spiral and coccoid forms in children with epigastric pain was twofold higher than that in the control subjects. Interestingly, there was a fourfold increase in seropositivity for coccoid-form antigen compared to that for the spiral-form antigen among the symptomatic pediatric patients as well as the control group, indicating a possible infective role of the coccoid form of H. pylori in the pediatric patients with epigastric pain.

Establishment of Multi-Dimensional Detection Series (MDS) For the Assessments of Gastric Motility Alterations in Patients With Functional Dyspepsia

2020 ◽  
Author(s):  
Jun Yu ◽  
Yi Yang ◽  
Mingxin Lin ◽  
Xiaoyan Wang ◽  
Lixia Wang ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Gastric Motility ◽  
Epigastric Pain ◽  
Low Frequency ◽  
Pain Syndrome ◽  
Control Group ◽  
Clinical Value ◽  
Gastric Emptying Rate ◽  
Non Invasive ◽  
Epigastric Pain Syndrome

Abstract Background: Functional dyspepsia (FD) is sub-categorized into postprandial distress syndrome (FD-PDS) and epigastric pain syndrome (FD-EPS). It is a necessary to determine a series of safe, feasible, non-invasive, and economical assessment methods, which may detect more pathophysiological alterations to guide corresponding treatment. Aim: To establish a multi-dimensional detection series (MDS) comprehensively evaluating the gastric motility of FD patients and verify the clinical value of MDS. Methods: FD-PDS patients (meeting Rome IV criteria) were recruited, among which 35 patients were enrolled in FD group. 30 healthy volunteers were recruited into the Control group (C group). After the assessment of psychology and symptom scales, the following tests (measuring gastric motility from different latitude) were conducted in both groups. Then, the differential indexes between the two groups were determined and a multi-dimensional detection series for FD was combined according to the statistical principle. Finally, the MDS was used to test another group for verifying its validity and feasibility. Results: The differential indexes could be detected (P<0.05), including Maximum gastric tolerance, 10 min, 20min and 30 min Sufficiency score, Postprandial slow wave ratio, Post-meal/pre-meal power ratio, 20 min and 30 min Gastric emptying rate, and Low frequency/High frequency of HRV. A formula was constructed it was proved that MDS could give evidences of normal or abnormal gastric motility. Conclusions: MDS may help clinicians to discover more pathophysiological alterations of gastric motility in FD patient, and potentially provide a basis for corresponding treatments.

scholarly journals DO H. PYLORI STATUS AND SMALL INTESTINAL BACTERIAL OVERGROWTH DETERMINE THE CLINICAL COURSE OF CHRONIC ACTIVE GASTRITIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS?

2020 ◽  
Vol 73 (6) ◽  
pp. 1223-1228
Author(s):  
Tetiana O. Radionova ◽  
Igor M. Skrypnyk ◽  
Ganna S. Maslova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Epigastric Pain ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Postprandial Fullness ◽  
Chronic Active Gastritis ◽  
Intestinal Bacterial Overgrowth ◽  
Small Intestinal

The aim: To define clinical peculiarities of chronic active gastritis in patients with type 2 diabetes mellitus (T2DM) considering Helicobacter pylori (HP) status and small intestinal bacterial overgrowth (SIBO). Materials and methods: 172 patients with chronic active gastritis were enrolled in the study, 92 out of them had concomitant T2DM. Symptoms were collected with the questionnaire, HP infection was diagnosed with stool antigen test, SIBO was assessed with glucose hydrogen breath test. Results: 87.5% (n=70) patients with chronic gastritis without DM had epigastric pain, however those with T2DM reported pain only in 41.3% (n=38) cases. Other symptoms included: nausea, bloating, early satiety, postprandial fullness, heartburn, belching and vomiting. HP infection in patients with chronic gastritis and concomitant T2DM is significantly associated with symptoms of epigastric pain (OR=2.78, 95%CI 0.92-8.41), bloating (OR=3.92, 95%CI 1.40-10.99), nausea (OR=2.32, 95%CI 0.85-0.6.30), postprandial fullness (OR=1.45, 95%CI 0.54-3.87) and belching (OR=1.01, 95%CI 0.32-3.16), whereas SIBO – with bloating (OR=8.82, 95%CI 2.88-27.01), nausea (OR=5.15, 95%CI 1.88-14.10) and belching (OR=2.53, 95%CI 0.67-9.52). Conclusions: Patients with T2DM and chronic active gastritis report epigastric pain significantly less than non-diabetics. HP infection probably plays a prominent role in development of epigastric pain in patients with T2DM. Additionally, HP is linked to SIBO, which may lead to bloating, belching and nausea onset.

scholarly journals Role of Bacterial Overgrowth in the Stomach as an Additional Risk Factor for Gastritis

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 13B-17B ◽  
Author(s):  
Gregory Naylor ◽  
Anthony Axon
Keyword(s):  
Gastric Cancer ◽  
Cell Mass ◽  
Bacterial Overgrowth ◽  
Nitroso Compounds ◽  
Current Evidence ◽  
Additional Risk Factor ◽  
Proximal Small Bowel ◽  
Increased Risk ◽  
H Pylori

Gastric bacteria can either be ingested or ascend from the distal bowel; however, their survival is usually limited by gastric acidity and motility. A reduction in gastric acid can result in bacterial overgrowth in the stomach and proximal small bowel, and the number of organisms rises as the intragastric pH rises.The increased risk of noncardia gastric cancer seen in patients with hypochlorhydria may be explained by an excess of nitrites and N-nitroso compounds (NOCs). These compounds are found in the diet of populations with a high gastric cancer risk, but can also be produced by the organisms that exist in the hypochlorhydria stomach. It has long been hypothsized that nitrites and NOCs act as one of the triggers in the atrophy-metaplasia-dysplasia-carcinoma path. However, although indirect data have linked the premalignant changes of metaplasia and dysplasia to NOCs, direct measurement of gastric nitrites and NOCs has not confirmed such a link.The role ofHelicobacter pyloriin bacterial overgrowth is mainly as a cause of hypochlorhydria resulting from atrophic gastritis, leading to a reduction in the parietal cell mass.Acid-suppressing drugs can result in bacterial overgrowth and increased nitrites and NOCs, although there is no current evidence for an increased risk of gastric cancer in patients taking them. One explanation is that the stomach appears to be colonized by different organisms than those in patients with hypochlorhydria for other reasons. There is some evidence that bacterial overgrowth per se can cause gastric inflammation in mice; however, although in humans the degree of gastric inflammation is greater when overgrowth is more prominant this may simply reflect the greater degree of hypochlorhydria in patients with a more severe H pylori-induced inflammation.

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