Functional Dyspepsia (functional + dyspepsia)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Functional Dyspepsia

  • functional dyspepsia patient

  • Selected Abstracts


    H. PYLORI ERADICATION IN FUNCTIONAL DYSPEPSIA

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
    Colin W. Howden
    [source]


    Pain versus discomfort,is differentiation clinically useful?

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001
    V. Stanghellini
    Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub-groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history-taking will be of pivotal importance in management strategies for functional dyspepsia. [source]


    The herbal preparation STW5 (lberogast®) has potent and region-specific effects on gastric motility

    NEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2004
    B. Hohenester
    Abstract, Functional dyspepsia (FD) is amongst the most common functional gastrointestinal disorders. Symptomatic treatment includes the use of herbal preparations whose effects on gastric motility are unclear. The present study aimed at investigating the effects of STW 5 (Iberogast®), a fixed combination of hydroethanolic herbal extracts, on gastric motility in vitro. Muscle strips from guinea-pig gastric fundus, corpus and antrum were set up in organ baths either in circular or longitudinal orientation. Addition of ethanol-free STW 5 to the organ baths (32,512 ,g mL,1) dose-dependently evoked a sustained and reversible relaxation of circular and longitudinal fundus and corpus muscle strips without changes in phasic activity. In contrast, antral muscle strips responded to STW 5 with a significant increase in the contractile force of phasic contractions without changes in tone. All effects were resistant to tetrodotoxin (0.5 ,mol L,1), atropine (1 ,mol L,1), , -conotoxin GVIA (0.5 ,mol L,1), capsaicin (1 ,mol L,1) or l -NAME (100 ,mol L,1), suggesting that neither nerves nor nitric oxide pathways were involved. These data demonstrate that STW 5 profoundly alters gastric motility in a region-specific but not layer-specific manner and thus implicates Iberogast® in the treatment of FD patients suffering from motility disorders with impaired fundus accommodation and/or antral hypomotility. [source]


    Excessive belching and aerophagia: two different disorders

    DISEASES OF THE ESOPHAGUS, Issue 4 2010
    Albert J. Bredenoord
    SUMMARY Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders. [source]


    Gastric inflammatory markers and interleukins in patients with functional dyspepsia, with and without Helicobacter pylori infection

    FEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 2 2005
    Leif P. Andersen
    Abstract Helicobacter pylori is the most important cause of gastritis, peptic ulcers and the development of gastric cancer. The chronic active inflammation is dominated by neutrophils, macrophages, lymphocytes and plasma cells. Several interleukins (IL-8, IL-10 and IFN-,) are involved in the inflammatory process in the gastric mucosa. The aim of this study was to investigate the gastric inflammation in patients with functional dyspepsia. Fifty-three consecutive patients were included and antral biopsies were obtained for histology, culture and immunohistochemistry. The sections were examined for the interleukins IL-4, IL-6, IL-8, IL-10 and IFN-, as well as for the cell markers CD4, CD8, CD14, Cd19, CD25 and CD30. Only CD4 and CD19 were significantly increased in patients with increased gastric inflammation and increased density of H. pylori. However, several of the examined markers (IFN-,, IL-8, IL-10 and CD14) showed a non-significant trend to be increased in patients with extensive gastric inflammation and high density of H. pylori. Therefore, an arbitrary index (IM11) for all the 11 immunological markers was made as an average value for each of the four morphological groups. For the four morphologically different groups of patients the values were 0.49, 0.77, 0.86 and 1.25, respectively. Significant increases in the index from none to moderate antral inflammation as well as the density of H. pylori were found (p < 0.001). By using an index of inflammatory markers trends can be summarized and thereby significant which may be of importance when gastric inflammation is investigated in children and patients with functional dyspepsia. [source]


    Prevalence of Duodenal Ulcer-Promoting Gene (dupA) of Helicobacter pylori in Patients with Duodenal Ulcer in North Indian Population

    HELICOBACTER, Issue 6 2007
    H. S. Jayasinghe Arachchi
    Abstract Background: , The duodenal ulcer (DU)-promoting gene (dupA) of Helicobacter pylori has been identified as a novel virulent marker associated with an increased risk for DU. The presence or absence of dupA gene of H. pylori present in patients with DU and functional dyspepsia in North Indian population was studied by polymerase chain reaction (PCR) and hybridization analysis. Materials and Methods: , One hundred and sixty-six patients (96 DU and 70 functional dyspepsia) were included in this study. In addition, sequence diversity of dupA gene of H. pylori found in these patients was analyzed by sequencing the PCR products jhp0917 and jhp0918 on both strands with appropriate primers. Results: , PCR and hybridization analyses indicated that dupA gene was present in 37.5% (36/96) of H. pylori strains isolated from DU patients and 22.86% (16/70) of functional dyspepsia patients (p .05). Of these, 35 patients with DU (97.2%) and 14 patients with functional dyspepsia (81.25%) were infected by H. pylori positive for cagA genotype. Furthermore, the presence of dupA was significantly associated with the cagA -positive genotype (p .02). Conclusion: , Results of our study have shown that significant association of dupA gene with DU in this population. The dupA gene can be considered as a novel virulent marker for DU in this population. [source]


    ,Rescue' Therapy with Rifabutin after Multiple Helicobacter pylori Treatment Failures

    HELICOBACTER, Issue 2 2003
    Javier P. Gisbert
    abstract Aim. Eradication therapy with proton pump inhibitor, clarithromycin and amoxicillin is extensively used, although it fails in a considerable number of cases. A ,rescue' therapy with a quadruple combination of omeprazole, bismuth, tetracycline and metronidazole (or ranitidine bismuth citrate with these same antibiotics) has been recommended, but it still fails in approximately 20% of cases. Our aim was to evaluate the efficacy and tolerability of a rifabutin-based regimen in patients with two consecutive H. pylori eradication failures. Patients and Methods. Design: Prospective multicenter study. Patients: Consecutive patients in whom a first eradication trial with omeprazole, clarithromycin and amoxicillin and a second trial with omeprazole, bismuth, tetracycline and metronidazole (three patients) or ranitidine bismuth citrate with these same antibiotics (11 patients) had failed were included. Intervention: A third eradication regimen with rifabutin (150 mg bid), amoxicillin (1 g bid) and omeprazole (20 mg bid) was prescribed for 14 days. All drugs were administered together after breakfast and dinner. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. Outcome: H. pylori eradication was defined as a negative 13C-urea breath test 8 weeks after completing therapy. Results. Fourteen patients have been included. Mean age ± SD was 42 ± 11 years, 41% males, peptic ulcer (57%), functional dyspepsia (43%). All patients took all the medications and completed the study protocol. Per-protocol and intention-to-treat eradication was achieved in 11/14 patients (79%; 95% confidence interval = 49,95%). Adverse effects were reported in five patients (36%), and included: abdominal pain (three patients), nausea and vomiting (one patient), and oral candidiasis (one patient); no patient abandoned the treatment due to adverse effects. Conclusion. Rifabutin-based rescue therapy constitutes an encouraging strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole and tetracycline. [source]


    High Efficacy of Ranitidine Bismuth Citrate, Amoxicillin, Clarithromycin and Metronidazole Twice Daily for Only Five Days in Helicobacter pylori Eradication

    HELICOBACTER, Issue 2 2001
    Javier P. Gisbert
    ABSTRACT Aim. The combination of a proton pump inhibitor (PPI) or ranitidine-bismuth-citrate (Rbc) and two antibiotics for 7,10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication. Methods. We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C-urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. Results. In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow-up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84,96%) and in 72/80 (90%; 81,95%) by intention-to-treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87,100%) vs. 85% (73,92%) by intention-to-treat; p < .05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients). Conclusion. The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance. [source]


    Functional gastrointestinal disorders and visceral hypersensitivity in children and adolescents suffering from Crohn's disease

    INFLAMMATORY BOWEL DISEASES, Issue 11 2008
    Christophe Faure MD
    Abstract Background: Symptoms of abdominal pain are reported by children with active Crohn's disease (CD). During remissions abdominal pain improves in most children but some of them continue to experience pain. We hypothesized that these patients may suffer from protracted abdominal pain related to functional gastrointestinal disorders (FGID) and visceral hypersensitivity. The objective was to characterize the symptoms and to measure the rectal sensory threshold for pain (RSTP) by barostat in CD children and adolescents suffering from abdominal pain despite remission. Methods: Eight patients (median age 14.5 years; range 9.8,17) with quiescent CD but suffering from chronic abdominal pain were studied by rectal barostat. At the same time they completed validated questionnaires to assess FGID, anxiety, and depression. They were compared to 10 control children and 8 children with FGID also investigated in our laboratory. Results: All patients fulfilled Rome II criteria for irritable bowel syndrome (n = 5), functional abdominal pain (n = 2), and functional dyspepsia (n = 1). RSTP was significantly lower in CD patients compared to the normal controls: median (range) 25 mmHg (15,29) versus 40 mmHg (30,48) (P < 0.01). RSTP was similar in patients and children with FGID. Rectal compliance was similar in patients, children with FGID, and controls. Seven of the 8 patients had scores indicating an anxiety problem. Conclusions: Protracted abdominal pain that affects children and adolescents with quiescent CD is related to FGID associated with visceral hypersensitivity and anxiety. The incidence of FGID in children suffering from CD requires further investigation. (Inflamm Bowel Dis 2008) [source]


    Non-erosive reflux disease, functional heartburn and gastroesophageal reflux disease; insights into pathophysiology and clinical presentation

    JOURNAL OF DIGESTIVE DISEASES, Issue 4 2006
    Eamonn MM QUIGLEY
    Non-erosive reflux disease (NERD) has emerged as a real entity in the spectrum of gastroesophageal reflux disease (GERD) and may, indeed, represent the most common manifestation of reflux disease. Recent information indicates NERD can be further subclassified based on the results of pH studies and suggests that functional heartburn needs to be differentiated as that subgroup of patients in which there appears to be no relationship between symptoms, however ,typical' of GERD, and acid exposure. Other aspects of NERD need to be appreciated, including overlap with functional dyspepsia and the potential variations in response to such therapeutic interventions as acid-suppressive therapy and fundoplication. It seems quite possible that our failure to separate functional heartburn from NERD, in general, has contributed, in large measure, to diagnostic difficulties and therapeutic disappointment in GERD. An appreciation of the range of entities, of different etiology and pathology, within NERD will foster the development of effective approaches to the assessment and therapy of this challenging disorder. [source]


    Analysis of clinical characteristics of dyspeptic symptoms in Shanghai patients

    JOURNAL OF DIGESTIVE DISEASES, Issue 2 2005
    Xiao Bo LI
    OBJECTIVE: To improve the management of dyspepsia by analyzing the clinical characteristics of dyspeptic symptoms in patients from Shanghai. METHODS: 782 patients with functional dyspepsia (FD) or organic dyspepsia (OD) completed a questionnaire about dyspepsia. The questionnaire asked participants to score 12 previously validated common upper abdominal symptoms. The clinical characteristics of dyspepsia including severe symptoms; and the relationship between symptoms and meals were then analyzed. RESULTS: Among the 782 dyspeptic patients, 543 cases (69.4%) were classed as FD and 239 (30.6%) OD. The proportion of males was significantly higher in the OD group. There was no difference in average dyspepsia scores between the 2 dyspeptic groups (21.5 vs 20.4, P > 0.05), but the scores of ,stomach' pain and ,stomach' pain before meals were higher in OD patients than in FD patients (2.65 ± 1.11 vs 2.16 ± 0.92, 2.26 ± 1.26 vs 1.79 ± 0.92, P < 0.05). In 45.2% of the OD patients and 47.7% of the FD patients, respectively, the severity of symptoms was not related to meals. In subgroups of ulcer-like, dysmotility-like and unspecified dyspepsia, the proportion of patients with symptoms not related to meals was 59.6%, 50.9% and 35.2%, respectively. 2.5% (6/239) of OD patients presented with progressive dysphagia, compared with 2.8% (15/543) of FD patients who presented with intermittent dysphagia. Approximately 8.8% (21/239) of OD patients reported dramatic weight loss accompanied with other severe symptoms, compared with 5.9% (32/543) of FD patients who had no other severe symptoms. A shift in symptom subtypes during the follow-up period was found in 13.8% of FD patients. The infection rate of Helicobacter pylori was higher in the OD group than in the FD group (53.1%vs 42.2%, P < 0.01), but no difference was found among the three subgroups of FD patients (P > 0.05). Halitosis was more often found in dyspeptic patients with H. pylori infection (44.9%vs 17.0% in OD, 47.3%vs 25.4% in FD, P < 0.01). CONCLUSIONS: When dyspepsia patients present with ,stomach' pain or ,stomach' pain before meals, a diagnosis of OD should be considered. Intermittent dysphagia, weight loss not accompanied with other severe symptoms, and halitosis (more often seen in patients with H. pylori infection) might be regarded as the relatively unique symptoms of dyspepsia in some FD patients. In FD, we found that the severity of dyspepsia symptoms was not related to meals in half of the patients, and symptom subtypes might shift over time, this adds difficulty to the management of FD. [source]


    Effect of a gastro-protective agent, rebamipide, on symptom improvement in patients with functional dyspepsia: A double-blind placebo-controlled study in Japan

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2006
    Hiroto Miwa
    Abstract Background and Aim:, Although mucosal protective agents have been used frequently for treatment of symptomatic gastritis, there has been no well-controlled study of functional dyspepsia. The aim of this study was to assess the efficacy of a 4-week treatment with rebamipide for the relief of overall dyspeptic symptoms and the improvement in quality of life from an untreated baseline in Japanese patients with functional dyspepsia. Methods:, In a double-blinded, randomized, placebo-controlled, single-center study, 81 patients with functional dyspepsia were recruited and treated with rebamipide (100 mg, t.i.d.) or placebo for 4 weeks. Symptoms were assessed at baseline and at the end of the study period by a symptom questionnaire. Quality of life was evaluated by the QPD 32. Results:, Data was analyzed for symptoms from 38 patients who received rebamipide and 33 patients who received placebo treatment. Overall symptoms were significantly improved in both the rebamipide and placebo treatment groups from the untreated baseline after 4 weeks of treatment, and the mean changes in overall symptoms were not significantly different between the groups. However, the improvement in symptom score was significantly greater in the treatment arm than in the placebo arm for three items, which were bloating, belching, and pain or discomfort that was relieved after a meal. Regarding quality of life, social restriction and pain intensity were significantly improved in the rebamipide treatment group in per-protocol analysis (P = 0.048 and P = 0.031, respectively). Conclusions:, Although rebamipide was not significantly better than placebo in reducing overall symptoms by 4 weeks' treatment, it may partially improve the symptoms. It may also be beneficial in improvement of quality of life in Japanese patients with functional dyspepsia. [source]


    CORRELATION OF GASTRIC INTESTINAL METAPLASIA AND HELICOBACTER PYLORI INFECTION AMONG FUNCTIONAL DYSPEPTIC PATIENTS

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
    Murdani Abdullah
    Background: It is generally accepted that intestinal metaplasia (IM) is a pre cursor of gastric cancer and is associated with Helicobacter pylori (Hp) infection. But still little data available about association of IM and Hp in different clinical groups of patients, especially in areas with high Hp prevalence. Aim: to evaluate the IM and itís correlation with Hp infection in consecutive patients with functional dyspepsia (FD). Methods: a retrospective review of our endoscopy database and histological data from January 1997 to December 1999 was made. In this period we performed 3083 upper intestinal endoscopy in patients with FD. Endoscopy procedure was done without any specific preparation for Hp evaluation. Biopsy specimen were taken from antrum and corpus and were stained with Giemsa, H&E and Alcian Blue. Histological data was evaluated by pathologist from Department of Pathology, Medical Faculty, University of Indonesia according to the Sydney System. IM was evaluated as present or absent. One hundred and fourteen consecutive data were eligible for statistical analysis. Results: Histological data of 114 patients with FD was analyzed. Average age was 45.47 years (SD 14.32), male 62.3 % (71/114), and female 37.7 % (43/114). Forty-eight (42.11%) patients with FD were Hp positive on histology and were significantly older than Hp negative. (48.74 +12.65/43.25+15.04; p < 0.05). IM was present in 13 ( 11.4%) patients with FD. They were significantly older than the patients without IM (mean age 55.08+11.98/44.23+14.18; p <0.05) Frequency of IM was similar both in Hp positive and Hp negative patients with FD (12.5%/10.6%; p>0.05). Conclusions: IM among patients with FD was 11.4%. IM was significantly more frequent found in older age but our data suggest that IM is not related to Hp status in FD patients. [source]


    A long way toward understanding the pathogenesis of functional dyspepsia, but we should go forward with the accumulation of clinical evidence

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2000
    Hiroto Miwa
    No abstract is available for this article. [source]


    Stability of the irritable bowel syndrome and subgroups as measured by three diagnostic criteria , a 10-year follow-up study

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010
    L. B. Olafsdottir
    Aliment Pharmacol Ther 2010; 32: 670,680 Summary Background, The irritable bowel syndrome (IBS) is a common disorder, but information on its natural history is limited. Aim, To study the performance of four IBS criteria in detecting incidence and stability of categories over a 10-year period. Method, This study was a population-based postal study. Questionnaire was mailed to the same age- and gender-stratified random sample of the Icelandic population aged 18,75 years in 1996 and again in 2006. IBS was estimated by the Manning criteria, Rome II, Rome III, subgroups and self-report. Results, Prevalence of IBS varied according to criteria: Manning showed the highest (32%) and Rome II the lowest (5%). Younger subjects and females were more likely to have IBS. Prevalence was stable over 10 years for all criteria except Rome III. There was a turnover in all IBS subgroups and a strong correlation among IBS, functional dyspepsia and heartburn. Conclusions, The prevalence of the IBS remained stable over a 10-year period with a turnover in symptoms. The study suggests that IBS is a cluster of symptoms that float in time between different IBS categories, functional dyspepsia and heartburn. The irritable bowel syndrome in Iceland is very common and indicates a chronic condition, which poses a heavy burden on the health care system. [source]


    Effects of transcutaneous electrical acu-stimulation in patients with functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010
    Y. Beyazit
    No abstract is available for this article. [source]


    Effects of transcutaneous electrical acu-stimulation in patients with functional dyspepsia: authors' reply

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010
    S. Köklü
    No abstract is available for this article. [source]


    Implications of eosinophilia in the normal duodenal biopsy , an association with allergy and functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010
    M. M. WALKER
    Aliment Pharmacol Ther,31, 1229,1236 Summary Background, Allergy and functional gastrointestinal disorders have been associated with eosinophilia in duodenal mucosa. Aim, To assess the prevalence of eosinophilia in duodenal biopsies of patients attending for oesophogastroduodenoscopy and delineate associated clinical conditions. Methods, A total of 155 patients (mean age 55 years, 59% women) with normal duodenal biopsies were randomly selected for audit from histopathology files. Eosinophil counts in five high power fields (HPFs) were assessed. Records were analysed for symptoms, diagnosis and medications; patients were divided into five groups based on upper gastrointestinal (UGI) symptom profiles, including a control group of those without predominant UGI symptoms. The prevalence of duodenal eosinophilia (defined as >22/5HPFs a priori) was calculated. Results, In the control group, the mean duodenal eosinophil count was 15/5HPFs; prevalence of duodenal eosinophilia was 22.5%. In postprandial distress syndrome (PDS), both mean eosinophil counts (20.2/5HPF, P < 0.04) and prevalence of duodenal eosinophilia (47.3%, P < 0.04) were significantly higher. Duodenal eosinophilia was significantly associated with allergy (OR 5.04, 95% CI 2.12,11.95, P < 0.001). There was no association with irritable bowel syndrome or medications. Conclusions, Subtle duodenal eosinophilia is relatively common in routine oesophogastroduodenoscopy and previously overlooked; it is associated with allergy and may indicate a hypersensitivity mechanism in some patients with PDS including early satiety. [source]


    Endocannabinoid control of gastric sensorimotor function in man

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2010
    K. AMELOOT
    Aliment Pharmacol Ther,31, 1123,1131 Summary Background, Little is known about the physiological role of the endocannabinoid system in the regulation of the motility and the sensitivity of the stomach. Endocannabinoid system dysfunction has been hypothesized to contribute to the control of food intake and the pathogenesis of functional dyspepsia. Aim, To study the influence of rimonabant, the endocannabinoid 1 (CB1) receptor antagonist, on gastric sensorimotor function in healthy controls. Methods, After 4 days of pre-treatment with rimonabant 20 mg/day or placebo, 12 healthy volunteers (mean age 34 ± 12 years, six men) participated in a placebo-controlled, double-blind, randomized, crossover study with a gastric barostat assessment of gastric sensitivity to distension, gastric compliance, gastric accommodation and phasic motility on day 3 and a liquid nutrient challenge test on day 4. Results, Rimonabant did not influence gastric compliance and sensitivity to distension. The meal-induced gastric accommodation reflex was significantly inhibited by rimonabant (154.3 ± 30.9 vs. 64.3 ± 32.4 mL, P = 0.02). Rimonabant did not affect maximal nutrient tolerance or meal-related symptoms during the satiety drinking test. Conclusion, Endocannabinoids acting on the CB1 receptor are involved in the control of gastric accommodation in man. [source]


    Clinical trial: interferential electric stimulation in functional dyspepsia patients , a prospective randomized study

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2010
    S. KÖKLÜ
    Aliment Pharmacol Ther,31, 961,968 Summary Background, There are several studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with gastroparesis and chronic constipation. Aim, To analyse whether transcutaneous electrical stimulation is an effective procedure in functional dyspepsia patients. Methods, Functional dyspepsia patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Upper gastrointestinal system symptoms were documented at the beginning, during and after the treatment sessions. Results, Patients in therapy (23 cases) and placebo (21 cases) groups were homogeneous with respect to demographic data and upper gastrointestinal system symptoms. In the therapy group, all symptoms other than early satiation improved significantly during and after the treatment sessions, whereas in the placebo group, symptoms including heartburn and vomiting did not change significantly. IFC therapy was superior to placebo with respect to epigastric discomfort, pyrosis, bloating, early satiation and postprandial fullness during the treatment sessions. One month after the treatment sessions, vacuum IFC proved to be superior to placebo with regard to early satiation and heartburn. Conclusions, Vacuum IFC is a non-invasive and effective therapy for functional dyspepsia. Transcutaneous electrical stimulation may represent a new treatment modality for drug-refractory functional dyspepsia patients. [source]


    Relative importance of abnormalities of CCK and 5-HT (serotonin) in Giardia -induced post-infectious irritable bowel syndrome and functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010
    V. DIZDAR
    Aliment Pharmacol Ther,31, 883,891 Summary Background, Post-infectious irritable bowel syndrome (PI-IBS) and functional dyspepsia (FD) have been described after both Campylobacter jejuni gastroenteritis and Giardia infection. After C. jejuni, there is increased rectal serotonin (5-HT)-containing EC cells and postprandial plasma 5-HT, while a pilot study suggested increased plasma cholecystokinin (CCK) after Giardia infection. Aim, To determine changes in plasma and duodenal mucosal 5-HT and CCK in Giardia -induced PI-IBS. Methods, A total of 32 patients previously infected with Giardia and 19 who had recovered fully (controls) completed symptom questionnaires. Endoscopic duodenal biopsies were obtained from all subjects and immunohistochemically stained for CCK, 5-HT and CgA containing entero-endocrine cells and mast cells. 5-HT content was also assessed. Twenty-one of 32 patients and 19 controls consumed a high-carbohydrate meal, while fasting and postprandial plasma CCK and 5-HIAA were measured. Results, Post-infectious irritable bowel syndrome patients had increased numbers of CCK cells (P = 0.02), but lower numbers of EC cells (P = 0.009). Plasma CCK did not differ significantly between the groups, but correlated significantly with postprandial dyspepsia scores (r = 0.5, P = 0.05). PI-IBS patients had significantly lower plasma 5-HIAA, before and after meal (P = 0.05) as well as more dyspepsia (P < 0.0001) compared with recovered subjects. Conclusions, Post-infectious bowel dysfunction following Giardia infection is associated with increased duodenal mucosal CCK. Postprandial dyspeptic symptoms correlate better with CCK than measures of 5-HT metabolism. [source]


    Duodenal mastocytosis, eosinophilia and intraepithelial lymphocytosis as possible disease markers in the irritable bowel syndrome and functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
    M. M. WALKER
    Summary Background, Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common functional disorders without defined pathology. Mast cells and eosinophils interact with T lymphocytes and may alter enteric nerve and smooth muscle function. Aim, To examine mast cell, eosinophil and intraepithelial lymphocyte populations in duodenal biopsies of subjects with IBS and FD. Methods, A random sample of an adult Swedish population (n = 1001; mean age 54 years; 51% female) underwent upper endoscopy and biopsy; 51 cases with FD and 41 cases with IBS were compared with 48 randomly selected controls. Eosinophils were identified by light microscopy; mast cells by immunocytochemistry (CD117). Intraepithelial lymphocytes were counted per 100 enterocytes. Cell counts were quantified by counting the number per high power field (HPF) in 5HPFs in the bulb (D1) and second part of duodenum (D2), summed over 5HPFs at each site. Results, Cases and controls showed similar demographics. Compared to controls, IELs in IBS-constipation were significantly increased (P = 0.005). Mast cells were significantly increased in IBS in D2 (P < 0.001), while eosinophils were significantly increased in FD in D1 and D2 (P < 0.001). Conclusion, Duodenal mast cell hyperplasia is linked to IBS and eosinophilia to FD, and duodenal biopsy may identify subsets of these disorders. [source]


    Review article: a critical view on impaired accommodation as therapeutic target for functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2006
    B. D. J. VAN DEN ELZEN
    Summary Several important pathophysiological mechanisms have been identified in functional dyspepsia, however a complete understanding of these mechanisms and beneficial therapeutic strategies are still lacking. Based on the currently available literature we aimed at providing a critical view on one of these pathophysiological mechanisms, impaired accommodation. Although impaired gastric accommodation is identified as a major pathophysiological mechanism, the clinical evidence supporting its role as an important therapeutic target is currently still lacking. Treatment with fundic relaxant drugs has shown conflicting results and has been rather disappointing in general. These negative findings could be explained by the fact that impaired fundic accommodation is part of a more complex disorder involving other regions of the proximal gut or by the increasing insight that central mechanisms may play an important role. Future studies of impaired accommodation should take these considerations into account. [source]


    Predictors of the placebo response in functional dyspepsia

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2006
    N. J. TALLEY
    Summary Background, Trials in functional dyspepsia report placebo response rates of 30% to 40%. Aim, We aimed to identify predictors of the placebo response. Methods, Patients from primary, secondary and tertiary practices with functional dyspepsia defined by Rome II criteria were enrolled into one of four clinical trials; 220 patients were randomized to receive placebo. Scintigraphic assessment of gastric emptying at baseline was repeated at the end of the treatment in those with delayed emptying. After a 2 week run-in period, patients were followed for 8 weeks on placebo. Response was assessed on a weekly basis and a responder was defined as satisfactory relief of meal-related symptoms on at least 50% of weeks. Results, The mean age was 44 years (range 18,82) and 74% were female; 76 (35%) were placebo responders. The predominant symptom was an unstable measure over the trial. Independent predictors of a lower placebo response were lower body mass index and a more consistent predominant symptom pattern (both P < 0.05). No association was seen with age, gender, centre type, baseline symptom score, baseline or change in gastric emptying, or baseline quality of life. Conclusion, In functional dyspepsia, a consistent predominant symptom pattern and lower body mass index may be associated with a lower placebo response rate. [source]


    Pre-operative fasting guidelines: an update

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2005
    E. Sřreide
    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast- or formula milk feeding up to 4 h before anaesthesia. Recently, the concept of pre-operative oral nutrition using a special carbohydrate-rich beverage has also gained support and been shown not to increase gastric fluid volume or acidity. Based on the available literature, our Task Force has produced new consensus-based Scandinavian guidelines for pre-operative fasting. What is still not clear is to what extent the new liberal fasting routines should apply to patients with functional dyspepsia or systematic diseases such as diabetes mellitus. Other still controversial areas include the need for and effect of fasting in emergency patients, women in labour and in association with procedures done under ,deep sedation'. We think more research on the effect of various fasting regimes in subpopulations of patients is needed before we can move one step further towards completely evidence-based pre-operative fasting guidelines. [source]


    Mental distress in patients with functional or organic dyspepsia: a comparative study with a sample of the general population

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2005
    M. Pajala
    Summary Background :,It has been argued that patients with functional gastrointestinal disorders have mental disorders more often than healthy controls and patients with organic disease. Most studies surveying psychological factors at the population level have relied on symptom questionnaires to diagnose functional dyspepsia. However, the symptom patterns alone are unable to adequately discriminate organic from functional dyspepsia. Aim :,To evaluate the frequency of mental distress in primary care patients with organic or functional dyspepsia and compare the findings with a sample of the Finnish general population. Methods :,Four-hundred consecutive, unselected dyspeptic patients were referred for upper gastrointestinal endoscopy and other diagnostic examinations. All patients compiled a self-administered questionnaire including the 12-item General Health Questionnaire to detect cases of recent mental disorders. Results :,The prevalence of mental distress among patients with functional and organic dyspepsia was 38 and 36.4% respectively. The sex- and age-adjusted risk of having mental distress was nearly fourfold higher among patients with dyspepsia than in the general population. Conclusion :,Mental distress is common among patients with functional or organic dyspepsia. Nevertheless, there is no difference between patients with functional or organic dyspepsia in the prevalence or risk of mental distress. [source]


    Current concepts in the management of Helicobacter pylori infection,The Maastricht 2-2000 Consensus Report

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2002
    P. Malfertheiner
    Significant progress and new insights have been gained in the 4 years since the first Maastricht Consensus Report, necessitating an update of the original guidelines. To achieve this, the European Helicobacter Pylori Study Group organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies and general practitioners from Europe to establish updated guidelines on the current management of Helicobacter pylori infection. The meeting took place on 21,22 September 2000. A ,test and treat' approach is recommended in adult patients under the age of 45 years (the age cut-off may vary locally) presenting in primary care with persistent dyspepsia, having excluded those with predominantly gastro-oesophageal reflux disease symptoms, non-steroidal anti-inflammatory drug users and those with alarm symptoms. Diagnosis of infection should be by urea breath test or stool antigen test. As in the previous guidelines, the eradication of H. pylori is strongly recommended in all patients with peptic ulcer, including those with complications, in those with low-grade gastric mucosa-associated lymphoid tissue lymphoma, in those with atrophic gastritis and following gastric cancer resection. It is also strongly recommended in patients who are first-degree relatives of gastric cancer patients and according to patients' wishes after full consultation. It is advised that H. pylori eradication is considered to be an appropriate option in infected patients with functional dyspepsia, as it leads to long-term symptom improvement in a subset of patients. There was consensus that the eradication of H. pylori is not associated with the development of gastro-oesophageal reflux disease in most cases, and does not exacerbate existing gastro-oesophageal reflux disease. It was agreed that the eradication of H. pylori prior to the use of non-steroidal anti-inflammatory drugs reduces the incidence of peptic ulcer, but does not enhance the healing of gastric or duodenal ulcer in patients receiving antisecretory therapy who continue to take non-steroidal anti-inflammatory drugs. Treatment should be thought of as a package which considers first- and second-line eradication therapies together. First-line therapy should be with triple therapy using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole. Second-line therapy should use quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline. Where bismuth is not available, second-line therapy should be with proton pump inhibitor-based triple therapy. If second-line quadruple therapy fails in primary care, patients should be referred to a specialist. Subsequent failures should be handled on a case-by-case basis by the specialist. In patients with uncomplicated duodenal ulcer, eradication therapy does not need to be followed by further antisecretory treatment. Successful eradica- tion should always be confirmed by urea breath test or an endoscopy-based test if endoscopy is clinically indicated. Stool antigen test is the alternative if urea breath test is not available. [source]


    Pain versus discomfort,is differentiation clinically useful?

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001
    V. Stanghellini
    Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub-groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history-taking will be of pivotal importance in management strategies for functional dyspepsia. [source]


    Quality of life in functional dyspepsia: responsiveness of the Nepean Dyspepsia Index and development of a new 10-item short form

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001
    N. J. Talley
    Background: The Nepean Dyspepsia Index is a reliable and valid measure of quality of life in functional dyspepsia, but responsiveness has been little studied. The Nepean Dyspepsia Index originally contained 42 items designed to measure impairment of a subject's ability to engage in relevant aspects of their life because of dyspepsia, and their enjoyment of these aspects; in addition, the individual importance of areas was assessed. It was subsequently shortened to 25 items, yielding five sub-scales. Aim: To test the Nepean Dyspepsia Index's responsiveness and develop a responsive, very short form. Methods: A randomized, double-blind controlled trial was performed in 589 patients with documented functional dyspepsia. Symptoms and quality of life were measured at baseline, 2 and 4 weeks. Responsiveness of the Nepean Dyspepsia Index quality-of-life section was evaluated by correlation with symptom scores and calculation of standardized changes in scores. Two items from each sub-scale which best represented the area of life (by factor loadings) were selected to create the 10-item short form (SF; short form-Nepean Dyspepsia Index). Internal consistency was assessed by Cronbach's alpha and responsiveness was assessed as above. Results: The Nepean Dyspepsia Index quality-of-life scales demonstrated excellent responsiveness to change in both the active and placebo arms (standardized response means all > 1.0). The Nepean Dyspepsia Index accounted for only 8% of the variance in percentage change in symptoms (by visual analogue scales), indicating that it was evaluating areas of life not covered by symptoms. The 10-item short form had adequate internal consistency (all scales , 0.70) and all strongly (and significantly) correlated with the long form sub-scales; it was also highly responsive. Conclusion: The Nepean Dyspepsia Index is a responsive disease-specific quality-of-life measure; the 10-item short form can be applied in clinical trials of functional dyspepsia. [source]


    Comparative effects of levosulpiride and cisapride on gastric emptying and symptoms in patients with functional dyspepsia and gastroparesis

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2000
    C. Mansi
    Background: The efficacy of several prokinetic drugs on dyspeptic symptoms and on gastric emptying rates are well-established in patients with functional dyspepsia, but formal studies comparing different prokinetic drugs are lacking. Aim: To compare the effects of chronic oral administration of cisapride and levosulpiride in patients with functional dyspepsia and delayed gastric emptying. Methods: In a double-blind crossover comparison, the effects of a 4-week administration of levosulpiride (25 mg t.d.s.) and cisapride (10 mg t.d.s.) on the gastric emptying rate and on symptoms were evaluated in 30 dyspeptic patients with functional gastroparesis. At the beginning of the study and after levosulpiride or cisapride treatment, the gastric emptying time of a standard meal was measured by 13C-octanoic acid breath test. Gastrointestinal symptom scores were also evaluated. Results: The efficacy of levosulpiride was similar to that of cisapride in significantly shortening (P < 0.001) the t1/2 of gastric emptying. No significant differences were observed between the two treatments with regards to improvements in total symptom scores. However, levosulpiride was significantly more effective (P < 0.01) than cisapride in improving the impact of symptoms on the patients' every-day activities and in improving individual symptoms such as nausea, vomiting and early postprandial satiety. Conclusion: The efficacy of levosulpiride and cisapride in reducing gastric emptying times with no relevant side-effects is similar. The impact of symptoms on patients' everyday activities and the improvement of some symptoms such as nausea, vomiting and early satiety was more evident with levosulpiride than cisapride. [source]