1
|
Chiodi D, Ishihara Y. The role of the methoxy group in approved drugs. Eur J Med Chem 2024; 273:116364. [PMID: 38781921 DOI: 10.1016/j.ejmech.2024.116364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024]
Abstract
The methoxy substituent is prevalent in natural products and, consequently, is present in many natural product-derived drugs. It has also been installed in modern drug molecules with no remnant of natural product features because medicinal chemists have been taking advantage of the benefits that this small functional group can bestow on ligand-target binding, physicochemical properties, and ADME parameters. Herein, over 230 methoxy-containing small-molecule drugs, as well as several fluoromethoxy-containing drugs, are presented from the vantage point of the methoxy group. Biochemical mechanisms of action, medicinal chemistry SAR studies, and numerous X-ray cocrystal structures are analyzed to identify the precise role of the methoxy group for many of the drugs and drug classes. Although the methoxy substituent can be considered as the hybridization of a hydroxy and a methyl group, the combination of these functionalities often results in unique effects that can amount to more than the sum of the individual parts.
Collapse
Affiliation(s)
- Debora Chiodi
- Department of Chemistry, Takeda Pharmaceuticals, 9625 Towne Centre Drive, San Diego, CA, 92121, USA
| | - Yoshihiro Ishihara
- Department of Chemistry, Vividion Therapeutics, 5820 Nancy Ridge Drive, San Diego, CA, 92121, USA.
| |
Collapse
|
2
|
Bor S, Kalkan İH, Savarino E, Rao S, Tack J, Pasricha J, Cangemi D, Schol J, Karunaratne T, Ghisa M, Ahuja NK, Lacy B. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36:e14774. [PMID: 38462678 DOI: 10.1111/nmo.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects. PURPOSE Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.
Collapse
Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, School of Medicine & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - İsmail H Kalkan
- Department of Gastroenterology, School of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
| | - Satish Rao
- Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Augusta, Georgia, USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jay Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Tennekon Karunaratne
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Division of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nitin K Ahuja
- Division of Gastroenterology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
3
|
Fangxu L, Wenbin L, Pan Z, Dan C, Xi W, Xue X, Jihua S, Qingfeng L, Le X, Songbai Z. Chinese expert consensus on diagnosis and management of gastroesophageal reflux disease in the elderly (2023). Aging Med (Milton) 2024; 7:143-157. [PMID: 38725699 PMCID: PMC11077342 DOI: 10.1002/agm2.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 05/12/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) in the elderly is characterized by atypical symptoms, relatively severe esophageal injury, and more complications, and when GERD is treated, it is also necessary to fully consider the general health condition of the elderly patients. This consensus summarized the epidemiology, pathogenesis, clinical manifestations, and diagnosis and treatment characteristics of GERD in the elderly, and provided relevant recommendations, providing guidance for medical personnel to correctly understand and standardize the diagnosis and treatment of GERD in the elderly.
Collapse
Affiliation(s)
- Liu Fangxu
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Li Wenbin
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zhang Pan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Chen Dan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Wu Xi
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Xue
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Shi Jihua
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Luo Qingfeng
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Le
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zheng Songbai
- Department of GeriatricsHuadong Hospital Affiliated to Fudan UniversityShanghaiChina
| |
Collapse
|
4
|
Lakhtakia S, Singh AP, Singla N, Memon SF, Reddy DN. Efficacy and safety of pantoprazole and itopride in patients with overlap of gastroesophageal reflux disease and dyspepsia: A prospective, open-label, single-arm pilot study. JGH Open 2024; 8:e12988. [PMID: 38344252 PMCID: PMC10854202 DOI: 10.1002/jgh3.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 08/15/2024]
Abstract
BACKGROUND AND AIM Combining proton pump inhibitors (PPIs) with prokinetics can provide synergistic action in patients with gastroesophageal reflux disease (GERD) and overlapping dyspepsia, but data regarding this is lacking. METHODS This single-center, prospective study evaluated the efficacy and safety of 6-week treatment with fixed-drug combination (FDC) of pantoprazole (PPI) and itopride (prokinetic) in 50 patients with ≥3 month history of GERD and overlapping dyspepsia refractory to pantoprazole. Efficacy was assessed as reduction in GERD symptom assessment scale (GSAS) distress score for 15 symptoms from baseline to week 6. Adverse events (AEs) were monitored up to week 6. RESULTS Although heartburn was the most common symptom at week 6 (26.8%), its frequency significantly decreased from baseline (84.0%; P <0.01). A similar trend was observed for other symptoms: pressure/discomfort inside chest (19.5%), belching (14.6%), regurgitation (12.2%), bloating (9.8%), flatulence (9.8%), early satiety (7.3%), acidic/sour taste in mouth (7.3%), nausea (7.3%), frequent gurgling in stomach/belly (4.9%), and pressure/lump in throat (2.4%). Mean distress scores of all symptoms markedly decreased at week 6. Three AEs (n = 2) of moderate intensity were reported. CONCLUSION The FDC of pantoprazole and itopride showed favorable efficacy and safety in patients with GERD and overlapping dyspepsia refractory to pantoprazole monotherapy. Nevertheless, further studies are warranted.
Collapse
Affiliation(s)
| | | | - Neeraj Singla
- Department of Medical GastroenterologyAIG HospitalsHyderabadIndia
| | | | - Duvvur N Reddy
- Department of Medical GastroenterologyAIG HospitalsHyderabadIndia
| |
Collapse
|
5
|
Ullah H, Di Minno A, Piccinocchi R, Buccato DG, De Lellis LF, Baldi A, El-Seedi HR, Khalifa SAM, Piccinocchi G, Xiao X, Sacchi R, Daglia M. Efficacy of digestive enzyme supplementation in functional dyspepsia: A monocentric, randomized, double-blind, placebo-controlled, clinical trial. Biomed Pharmacother 2023; 169:115858. [PMID: 37976892 DOI: 10.1016/j.biopha.2023.115858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
Functional dyspepsia is a form of dyspepsia lacking in clear causes following clinical assessment. Dyspepsia is characterized by episodic or persistent abdominal pain or discomfort of the upper gastrointestinal (GI) tract. Its onset has been linked with a deficiency or dysfunction of digestive enzymes. Thus, consumption of digestive multi-enzymatic preparations may be effectively used for the reduction of symptoms. The aim of this study is to assess the effectiveness and tolerability of the supplementation of a normal diet with a multi-enzyme blend obtained from fungal fermentation, in a randomized, placebo-controlled, double-blind, clinical trial. Enrolled subjects (n = 120, male: 63, female: 57), aged 18-59 years, were randomized (allocation ratio 1:1) to receive either 2 capsules per day of the food supplement (containing 200 mg of the multi-enzyme blend/capsule) or placebo, for 2 months. The primary outcome of the study (i.e., improvements in quality of life) was evaluated by the Nepean Dyspepsia Index-SF (NDI-SF) questionnaire, while the secondary outcomes (i.e., severity of pain and the quality of sleep) were assessed through the Visual Analogue Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) questionnaire. The results showed an improvement in NDI-SF1, NDI-SF2-5, VAS, and PSQI scores in subjects treated with the multi-enzyme blend, indicating an improvement in quality of life and of sleep, and a decreased severity of pain, following the supplementation with digestive enzymes, without side effects. In conclusion, treatment with digestive enzymes was found to be effective in the reduction of functional dyspepsia symptoms and in the improvement of sleep quality, and is well-tolerated.
Collapse
Affiliation(s)
- Hammad Ullah
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | - Alessandro Di Minno
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy; CEINGE-Biotecnologie Avanzate, Via Gaetano Salvatore 486, 80145 Naples, Italy
| | - Roberto Piccinocchi
- Level 1 Medical Director Anaesthesia and Resuscitation A. U. O. Luigi Vanvitelli, Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Daniele Giuseppe Buccato
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | | | - Alessandra Baldi
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | - Hesham R El-Seedi
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China; Department of Chemistry, Faculty of Science, Islamic University of Madinah, Madinah 42351, Saudi Arabia
| | - Shaden A M Khalifa
- Psychiatry and Psychology Department, Capio Saint Göran's Hospital, Sankt Göransplan 1, 112 19 Stockholm, Sweden
| | - Gaetano Piccinocchi
- Comegen S.c.S., Società Cooperativa Sociale di Medici di Medicina Generale, Viale Maria Bakunin 41, 80125 Naples, Italy
| | - Xiang Xiao
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Roberto Sacchi
- Applied Statistic Unit, Department of Earth and Environmental Sciences, University of Pavia, Viale Taramelli 24, 27100 Pavia, Italy
| | - Maria Daglia
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China.
| |
Collapse
|
6
|
Qi Q, Wang N, Liu H, Li Y. Prokinetics for the treatment of functional dyspepsia: an updated systematic review and network meta-analysis. BMC Gastroenterol 2023; 23:370. [PMID: 37907846 PMCID: PMC10617220 DOI: 10.1186/s12876-023-03014-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Since the previous network meta-analysis assessing the efficacy of prokinetics for functional dyspepsia (FD), there have been a number of new studies and cinitapride is a new prokinetic agent for FD. This updated meta-analysis aimed to explore the efficacy and safety of prokinetics for FD. METHODS An updated study search in Pubmed, EMBASE, Cochrane Library and Web of Science was conducted in literatures published from July 2015 to March 2023. Randomized controlled trials investigating the use of prokinetics in adult FD patients were included. The primary outcome was the total efficacy rate and the secondary outcome was adverse events. A Bayesian network meta-analysis was performed using R software. RESULTS A total of 28 studies were included. Network meta-analysis showed that metoclopramide had a higher total efficacy rate than mosapride (OR: 3.53, 95%CI: 1.70-7.47), domperidone (OR: 2.29, 95%CI: 1.16-4.63), itopride(OR: 2.77, 95%CI: 1.41-5.59), acotiamide(OR: 2.63, OR: 1.33-5.36), and placebo(OR: 5.68, 95%CI: 2.98-11.10), however similar to cinitapride (OR: 1.62, 95%CI: 0.75-3.53). Cinitapride had a higher total efficacy rate than mosapride (OR: 2.18, 95%CI: 1.16-4.14) and placebo (OR: 3.52, 95%CI: 2.01-6.24). Cinitapride had lower risk of total adverse events than domperidone. There was no difference in the risk of drug-related adverse events between the prokinetics. CONCLUSIONS Metoclopramide and cinitapride may have a better efficacy than other prokinetics in the treatment of FD, and cinitapride may have a lower risk of total adverse events. Further studies using uniform definitions or validated tools to measure the total efficacy rate are needed.
Collapse
Affiliation(s)
- Qingqing Qi
- Department of Gastroenterology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, Shandong Province, 250012, People's Republic of China
| | - Nana Wang
- Department of Radiation Oncology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, Shandong Province, 250012, People's Republic of China
| | - Han Liu
- Department of Gastroenterology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, Shandong Province, 250012, People's Republic of China
| | - Yanqing Li
- Department of Gastroenterology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, Shandong Province, 250012, People's Republic of China.
| |
Collapse
|
7
|
Bordin DS, Livzan MА, Kucheryavyy YА, Mozgovoi SI. Gastritis and dyspepsia: differentiation as the cornerstone of pharmacotherapy. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2023:77-86. [DOI: https:/doi.org/10.21518/ms2023-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Chronic gastritis is a complex, polyetiological pathology with no clear clinical presentation. The most significant etiological factor of gastritis to date is H. pylori infection. A common clinical manifestation is the dyspepsia syndrome, which is caused by impaired motility. Symptoms can significantly affect a patient’s quality of life, necessitating rapid and effective pharmacotherapy. This paper discusses the algorithm of the physician actions in the case of a patient with uninvestigated dyspepsia. PPI has significant negative impact on the accuracy of H. pylori diagnostic test results. In this regard, it is proposed to use empirical therapy with prokinetics before diagnostic test would be performed. Among the prokinetics available on the Russian market, itopride hydrochloride stands out due to its high safety profile and proven efficacy. Current evidence supports the use of the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis. Due to its dual mechanism of action, itopride hydrochloride alleviates dyspeptic symptoms by improving gastric evacuation and can be used for an extended period. Several studies have shown the superiority of itopride in treating functional dyspepsia compared to other prokinetics, including metoclopramide and domperidone. Thus, prescribing the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis, is a pathogenetically justified approach aimed at improving the patient’s condition in the short term before establishing a final clinical diagnosis.
Collapse
Affiliation(s)
- D. S. Bordin
- Loginov Moscow Clinical Scientific Center;
Yevdokimov Moscow State University of Medicine and Dentistry;
Tver State Medical University
| | | | | | | |
Collapse
|
8
|
Bordin DS, Livzan MА, Kucheryavyy YА, Mozgovoi SI. Gastritis and dyspepsia: differentiation as the cornerstone of pharmacotherapy. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2023:77-86. [DOI: 10.21518/ms2023-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Chronic gastritis is a complex, polyetiological pathology with no clear clinical presentation. The most significant etiological factor of gastritis to date is H. pylori infection. A common clinical manifestation is the dyspepsia syndrome, which is caused by impaired motility. Symptoms can significantly affect a patient’s quality of life, necessitating rapid and effective pharmacotherapy. This paper discusses the algorithm of the physician actions in the case of a patient with uninvestigated dyspepsia. PPI has significant negative impact on the accuracy of H. pylori diagnostic test results. In this regard, it is proposed to use empirical therapy with prokinetics before diagnostic test would be performed. Among the prokinetics available on the Russian market, itopride hydrochloride stands out due to its high safety profile and proven efficacy. Current evidence supports the use of the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis. Due to its dual mechanism of action, itopride hydrochloride alleviates dyspeptic symptoms by improving gastric evacuation and can be used for an extended period. Several studies have shown the superiority of itopride in treating functional dyspepsia compared to other prokinetics, including metoclopramide and domperidone. Thus, prescribing the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis, is a pathogenetically justified approach aimed at improving the patient’s condition in the short term before establishing a final clinical diagnosis.
Collapse
Affiliation(s)
- D. S. Bordin
- Loginov Moscow Clinical Scientific Center;
Yevdokimov Moscow State University of Medicine and Dentistry;
Tver State Medical University
| | | | | | | |
Collapse
|
9
|
Bosman M, Smeets F, Elsenbruch S, Tack J, Simrén M, Talley N, Winkens B, Masclee A, Keszthelyi D. Placebo response in pharmacological trials in patients with functional dyspepsia-A systematic review and meta-analysis. Neurogastroenterol Motil 2023; 35:e14474. [PMID: 36168188 PMCID: PMC10078497 DOI: 10.1111/nmo.14474] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/18/2022] [Accepted: 09/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pharmacological trials in functional dyspepsia (FD) are associated with high placebo response rates. We aimed to identify the magnitude and contributing factors to the placebo response. METHODS We conducted a systematic review and meta-analysis including randomized controlled trials (RCTs) with a dichotomous outcome in adult patients with FD that compared an active pharmacotherapeutic treatment with placebo. Our main outcome was identification of the magnitude of the pooled placebo response rate for the following endpoints: symptom responder, symptom-free responder, adequate relief responder, and combined endpoint responder (i.e., the primary endpoint of each specific trial regarding treatment response). Several putative moderators (i.e., patient, disease, and trial characteristics) were examined. KEY RESULTS We included 26 RCTs in our analysis. The pooled placebo response rate was 39.6% (95% CI 30.1-50.0) using the symptom responder definition, 20.5% (12.8-31.0) using the symptom-free responder definition, 38.5% (33.8-43.6) using the adequate relief responder definition, and 35.5% (31.6-39.7) using the combined endpoint responder definition. A lower overall baseline symptom score was significantly associated with a higher placebo response rate. No other moderators were found to significantly impact the placebo response rate. Due to the lack of data, no analyses could be performed according to individual FD subtypes or symptoms. CONCLUSIONS AND INFERENCES The pooled placebo response rate in pharmacological trials in FD is about 39%, depending on which responder definitions is used. Future trials should consider applying an entry criterion based on minimal level of symptom severity to decrease the placebo response. We also suggest separate reporting of core FD symptoms pending more concrete harmonization efforts in FD trials.
Collapse
Affiliation(s)
- Michelle Bosman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Fabiënne Smeets
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Catholic University of Leuven, Leuven, Belgium.,Division of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicholas Talley
- NHMRC Center of research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
10
|
Elwood JL, Henry MC, Lopez-Fernandez JD, Mowat JM, Boyle M, Buist B, Livingstone K, Jamieson C. Functionalized Tetrazoles as Latent Active Esters in the Synthesis of Amide Bonds. Org Lett 2022; 24:9491-9496. [PMID: 36524745 PMCID: PMC9806851 DOI: 10.1021/acs.orglett.2c03971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We report the use of N-2,4-dinitrophenyltetrazoles as latent active esters (LAEs) in the synthesis of amide bonds. Activating the tetrazole generates an HOBt-type active ester without the requirement for exogenous coupling agents. The methodology was widely applicable to a range of substrates, with up to quantitative yields obtained. The versatility and functional group tolerance were exemplified with the one-step synthesis of various pharmaceutical agents and the N-acylation of resin-bound peptides.
Collapse
|
11
|
Shah A, Kang S, Talley NJ, Do A, Walker MM, Shanahan ER, Koloski NA, Jones MP, Keely S, Morrison M, Holtmann GJ. The duodenal mucosa associated microbiome, visceral sensory function, immune activation and psychological comorbidities in functional gastrointestinal disorders with and without self-reported non-celiac wheat sensitivity. Gut Microbes 2022; 14:2132078. [PMID: 36303431 PMCID: PMC9621048 DOI: 10.1080/19490976.2022.2132078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Frequently, patients with functional gastrointestinal disorders (FGIDs) report intolerance of wheat products. We compared gastrointestinal symptoms, sensory function, psychiatric comorbidities, gut-homing immune cells, and duodenal mucosa-associated microbiome (d-MAM) in FGID patients and controls with and without self-reported wheat sensitivity (SR-NCWS). We recruited 40 FGID patients and 20 controls referred by GPs for treatment. Gastrointestinal/extraintestinal symptoms, visceral sensory function, psychological comorbidities, and SR-NCWS were assessed in a standardized approach. Peripheral gut homing T-cells (CD4+α4+β7+CCR9+/CD8+α4+β7+CCR9+) were quantified, and the d-MAM was assessed by DNA sequencing for 46 subjects. Factors of bacterial genera were extracted utilizing factor analysis with varimax rotation and factors univariately associated with FGID or SR-NCWS included in a subsequent multivariate analysis of variance to identify statistically independent discriminators. Anxiety scores (p < .05) and increased symptom responses to a nutrient challenge (p < .05) were univariately associated with FGID. Gut homing T-cells were increased in FGID patients with SR-NCWS compared to other groups (p all <0.05). MANOVA revealed that anxiety (p = .03), visceral sensory function (p = 0.007), and a d-MAM factor comprise members of the Alloprevotella, Prevotella, Peptostreptococcus, Leptotrichia, and Veillonella lineages were significantly (p = .001) associated with FGID, while gut homing CD4+α4+ β7+CCR9+ T-cells were associated (p = .002) with SR-NCWS. Compared to controls, patients with and without SR-NCWS show that there are shifts in the amplicon sequence variants within specific bacterial genera between the FGID subgroups (particularly Prevotella and Streptococcus) as well as distinct bacterial taxa discriminatory for the two different FGID subtypes. Compared to controls, both FGID patients with and without SR-NCWS have an increased symptom response to a standardized nutrient challenge and increased anxiety scores. The FGID patients with SR-NCWS - as compared to FGID without SR-NCWS (and controls without SR-NCWS) - have increased gut homing T-cells. The d-MAM profiles suggest species and strain-based variations between the two FGID subtypes and in comparison to controls.
Collapse
Affiliation(s)
- Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Seungha Kang
- Faculty of Medicine, University of Queensland, Brisbane, Australia,University of Queensland Diamantina Institute, Woolloongabba, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Anh Do
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Marjorie M Walker
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Erin R Shanahan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia
| | - Natasha A Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michael P Jones
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, and Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Mark Morrison
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,University of Queensland Diamantina Institute, Woolloongabba, Australia,CONTACT Mark Morrison
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Australia,Gerald J Holtmann Princess Alexandra Hospital, Brisbane Department of Gastroenterology and Hepatology & University of Queensland 199 Ipswich Road, Woolloongabba, Queensland, Australia
| |
Collapse
|
12
|
Carbone F, Vandenberghe A, Holvoet L, Piessevaux H, Arts J, Caenepeel P, Staessen D, Vergauwe P, Maldague P, De Ronde T, Wuestenberghs F, Lamy V, Lefebvre V, Latour P, Vanuytsel T, Jones M, Tack J. A double-blind randomized, multicenter, placebo-controlled study of itopride in functional dyspepsia postprandial distress syndrome. Neurogastroenterol Motil 2022; 34:e14337. [PMID: 35357058 DOI: 10.1111/nmo.14337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 12/13/2021] [Accepted: 01/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itopride, a mixed D2 antagonist and cholinesterase inhibitor, has prokinetic effects on gastric motility. The Leuven Postprandial Distress Scale is a validated patient-reported outcome instrument for functional dyspepsia (FD) postprandial distress syndrome (PDS). We aimed to use the LPDS to assess treatment outcome in PDS and PDS/EPS (epigastric pain syndrome). METHODS Patients with PDS, with or without non-predominant EPS symptoms, were enrolled in an 8-week double-blind placebo-controlled multi-center trial with itopride (100 mg t.i.d.). Patients completed LPDS diaries and questionnaires to assess treatment response. Mann-Whitney test and mixed models were used. RESULTS One hundred patients (79% females, 39.1 ± 1.5 yo) were included. No significant difference was observed between treatment arms (p = 0.6). Compared to baseline, itopride treatment significantly improved the LPDS score (p = 0.001) and all individual symptoms (p < 0.0001). In the placebo arm, this was only the case for belching and epigastric pain (p < 0.05). In an exploratory analysis, outcomes in "pure" PDS (n = 45) and overlapping PDS/EPS (n = 55) patients were assessed and showed that the latter subgroup has the largest benefit with itopride compared to placebo (p = 0.03). CONCLUSION Using the LPDS score in a pilot controlled trial in FD, itopride shows no therapeutic benefit over placebo after 8 weeks of treatment. In an exploratory post hoc analysis, itopride but not placebo was associated with improvement of symptoms compared to baseline, and this was most prominent in patients with overlapping PDS/EPS. The efficacy of itopride in this subgroup needs to be evaluated in a large study using the same outcome measure. (clinialtrials.org ref.: NCT04647955).
Collapse
Affiliation(s)
- Florencia Carbone
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium
| | | | - Lieselot Holvoet
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium
| | | | - Joris Arts
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium.,AZ St Lucas, Bruges, Belgium
| | - Philippe Caenepeel
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium.,AZ St Jan Limburg, Genk, Belgium
| | | | | | | | - Thierry De Ronde
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Godinne University Hospital, UCLouvain, Yvoir, Belgium
| | - Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Godinne University Hospital, UCLouvain, Yvoir, Belgium
| | | | | | - Pascale Latour
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium
| | - Michael Jones
- Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Jan Tack
- Department of Gastroenterology, Neurogastroenterology & Motility, University of Leuven, TARGID, Leuven, Belgium
| |
Collapse
|
13
|
Song HY, Jung SW, Kim YS. Prokinetic Agents. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2022. [DOI: 10.7704/kjhugr.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Gastrointestinal (GI) prokinetic agents are drugs that increase GI motility and promote the movement of contents in the GI tract by amplifying and controlling the contraction of GI smooth muscle. Currently used prokinetics increase GI motility by acting as a dopamine D<sub>2</sub> receptor antagonist (e.g., metoclopramide, domperidone, levosulpiride) and 5-HT<sub>4</sub> receptor agonist (e.g., mosapride, prucalopride). Some prokinetics also have a cholinesterase inhibitory property (e.g., itopride), and herb-derived prokinetics (e.g., motilitone) affect multiple receptors. Depending on the type and distribution of receptors on which the prokinetics bind, the effect(s) may be regional or throughout the GI tract. Most prokinetics have been used for functional dyspepsia and gastroparesis because they mainly affect upper GI motility. However, prucalopride, a highly selective 5-HT<sub>4</sub> receptor agonist, is used primarily to treat chronic constipation and pseudo-obstruction. Dopamine D<sub>2</sub> receptor antagonists also inhibit the D<sub>2</sub> receptor in the medulla oblongata chemoreceptor trigger zone; therefore, they can treat nausea and vomiting. However, short term use of dopamine D<sub>2</sub> antagonists at an appropriate dose is recommended because of their potential for central nervous system side effects by penetrating the blood-brain barrier. It is necessary to know the mechanism of action, each clinical trial’s characteristics, and the side effects of prokinetics to obtain the best clinical outcomes. This article aims to summarize the results of clinical studies related to the impact of currently available prokinetic agents in Korea on GI motility.
Collapse
|
14
|
Comparative Efficacy of Various Pharmacological Interventions in the Treatment of Functional Dyspepsia: A Network Meta-Analysis. Dig Dis Sci 2022; 67:187-207. [PMID: 33590403 DOI: 10.1007/s10620-021-06846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/10/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Patients with functional dyspepsia often select different pharmacological treatments. We aimed to compare and rank the efficacy of different pharmacological interventions in treating functional dyspepsia. METHODS We searched EMBASE, PubMed, Cochrane, Web of Science and MEDLINE from the date of database inception to March 28, 2019. A random-effects model was selected to conduct traditional meta-analysis to directly examine the efficacy of different pharmacological interventions. The consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probability of different pharmacological interventions. RESULTS We included 58 trials (15,629 participants and 21 pharmacological treatments). Network meta-analysis showed that cisapride, domperidone, itopride, and levosulpiride were better than placebo, especially in short term (< 4 weeks). And levosulpiride was significantly more effective than 15 other drugs and placebo (ORs ranging between 0.05 and 0.15). Cisapride was significantly more effective than lansoprazole (OR 0.30, 95% CrI 0.09-0.99) and tegaserod (OR 0.26, 95% CrI 0.07-0.98). The rank probability showed that levosulpiride was most likely to be rank 1 (77%), cinitapride rank 2 (17%), and cisapride rank 3 (23%). CONCLUSIONS Our study confirmed the effectiveness of several pharmacological treatments for ameliorating functional dyspepsia. Furthermore, levosulpiride relatively ranked the best in managing FD. Physicians should be encouraged to apply promising pharmacological interventions (e.g., levosulpiride and cisapride). However, the results should be interpreted with caution due to small study effects.
Collapse
|
15
|
Ivashkin VT, Maev IV, Lapina TL, Fedorov ED, Sheptulin AA, Trukhmanov AS, Kononov AV, Abdulkhakov RA, Alexeeva OP, Alekseenko SA, Andreev DN, Baranskaya EK, Dekhnich NN, Klyaritskaya IL, Kozlov RS, Kogan EA, Korolev MP, Korochanskaya NV, Kurilovich SA, Livsan MA, Osipenko MF, Pavlov PV, Pirogov SS, Sarsenbaeva AS, Simanenkov VI, Tertychny AS, Tkachev AV, Uspensky YP, Khlynov IB, Tsukanov VV. Clinical Recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on Diagnosis and Treatment of Gastritis and Duodenitis. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2021; 31:70-99. [DOI: 10.22416/1382-4376-2021-31-4-70-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Aim.The clinical guidelines are intended to supplement specialty decision-making for improved aid quality in patients with gastritis and duodenitis though acknowledging the latest clinical evidence and principles of evidencebased medicine.Key points.Gastritis is an inflammatory disease of stomach mucosa, with a separate definition of acute and chronic gastritis. Chronic gastritis is a cohort of chronic diseases uniting a typical morphology of persistent inflammatory infiltration, impaired cellular renewal with emergent intestinal metaplasia, atrophy and epithelial dysplasia of gastric mucosa. Oesophagogastroduodenoscopy (OGDS) or high-resolution OGDS with magnified or non-magnified virtual chromoendoscopy, including targeted biopsy for atrophy and intestinal metaplasia grading and neoplasia detection, are recommended to verify gastritis and duodenitis, precancer states and/or gastric mucosal changes. All chronic gastritis patients positive for H. рylori should undergo eradication therapy as aetiological and subsidiary for gastric cancer prevention. Chronic gastritis patients with symptoms of dyspepsia (epigastric pain, burning and congestion, early satiety), also combined with functional dyspepsia, are recommended proton pump inhibitors, prokinetics, rebamipide and bismuth tripotassium dicitrate in symptomatic treatment. With focal restricted intestinal metaplasia, follow-up is not required in most cases, mainly when advanced atrophic gastritis is ruled out in high-quality endoscopy with biopsy. However, a familial history of gastric cancer, incomplete intestinal metaplasia and persistent H. pylori infection render endoscopy monitoring with chromoendoscopy and targeted biopsy desirable once in three years. Patients with advanced atrophic gastritis should have high-quality endoscopy every 3 years, and once in 1–2 years if complicated with a familial history of gastric cancer.Conclusion.The recommendations condense current knowledge on the aetiology and pathogenesis of gastritis and duodenitis, as well as laboratory and instrumental diagnostic techniques, main approaches to aetiological H. pylori eradication and treatment of dyspeptic states.
Collapse
Affiliation(s)
- V. T. Ivashkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - T. L. Lapina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E. D. Fedorov
- Pirogov Russian National Research Medical University
| | - A. A. Sheptulin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | | | - D. N. Andreev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - E. K. Baranskaya
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | - E. A. Kogan
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | - S. A. Kurilovich
- Research Institute of Therapy and Preventive Medicine — branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | | | - M. F. Osipenko
- Research Institute of Therapy and Preventive Medicine — branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - P. V. Pavlov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - S. S. Pirogov
- Hertsen Moscow Oncology Research Center — Branch of the National Medical Research Radiology Center
| | | | | | - A. S. Tertychny
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | - V. V. Tsukanov
- Research Institute for Medical Problems in the North — Division of Krasnoyarsk Scientific Centre of Siberian Branch of the RAS
| |
Collapse
|
16
|
A comprehensive review of functional dyspepsia in pediatrics. Clin J Gastroenterol 2021; 15:30-40. [PMID: 34854065 DOI: 10.1007/s12328-021-01561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Functional gastrointestinal disorders have been known as a diagnosis of exclusion since the Rome Foundation first created these criteria in 1990. Since that time, a large amount of research and clinical data has better clarified the mechanisms and treatment options for these. Functional dyspepsia is caused by physiologic, genetic, environmental, and psychological factors, as well as various functional abnormalities, such as increased sensitivity to acid, increased sensitivity to duodenal lipids and low-grade inflammation. This disorder has significant symptom overlap between other functional disorders, such as irritable bowel syndrome and gastroparesis, but has differential criteria and two new subclasses: postprandial distress syndrome and epigastric pain syndrome. Diagnosis of functional dyspepsia should be based upon appropriate clinical evaluation in tandem with Rome IV criteria. In recent years, many treatment measures for functional dyspepsia have been studied, such as pharmacologic intervention, behavioral therapy, or alternative therapy, an example being hypnotherapy. These treatment measures have proven to be effective in symptom reduction in pediatrics. Though this disorder is functional, it has been shown to cause a significant impact on pediatric patients' quality of life continuing into adulthood.
Collapse
|
17
|
Lazebnik LB, Golovanova EV, Volel BA, Korochanskaya NV, Lyalyukova EA, Mokshina MV, Mekhtiev SN, Mekhtieva OA, Metsaeva ZV, Petelin DS, Simanenkov VI, Sitkin SI, Cheremushkin SV, Chernogorova MV, Khavkin АI. Functional gastrointestinal disorders. Overlap syndrome Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine and Gastroenterological Scientific Society of Russia. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:5-117. [DOI: 10.31146/1682-8658-ecg-192-8-5-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- L. B. Lazebnik
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - E. V. Golovanova
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - B. A. Volel
- I. M. Sechenov First Moscow Medical State University
| | - N. V. Korochanskaya
- Federal State Budgetary Educational Institution of Higher Education “Kuban State Medical University” Health Ministry of Russian Federation; State Budgetary Institution of Health Care “Region Clinic Hospital Nr 2” Health Ministry of Krasnodar Region
| | - E. A. Lyalyukova
- FSBEI VO “Omsk State Medical University” of the Ministry of Health
| | - M. V. Mokshina
- Institute of therapy a. instrumental diagnostics of FSBEI VO “Pacifi c State Medical Unuversity”
| | | | | | - Z. V. Metsaeva
- Republican clinical hospital of Health Care Ministry of Northen Ossetia- Alania Republic
| | - D. S. Petelin
- I. M. Sechenov First Moscow Medical State University
| | - V. I. Simanenkov
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - S. I. Sitkin
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - S. V. Cheremushkin
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - M. V. Chernogorova
- Moscow regional research and clinical Institute of M. F. Vladimirsky; GBUZ MO “Podolsk City Clinical Hospital No. 3”
| | - А. I. Khavkin
- FSBAI HPE “N. I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
| |
Collapse
|
18
|
Meta-Analysis: Placebo Response and Its Determinants in Functional Dyspepsia. Am J Gastroenterol 2021; 116:2184-2196. [PMID: 34404084 DOI: 10.14309/ajg.0000000000001397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Placebo response rates are relatively higher in clinical trials of disorders of brain-gut interaction. However, placebo response in functional dyspepsia (FD) has not been well described. Minimizing placebo response is important in drug development. We therefore conducted a meta-analysis to determine placebo response in trials for FD and to identify factors affecting placebo response rates. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify double-blinded randomized controlled trials (RCTs) comparing medication with placebo in patients with FD. Both symptom improvement and complete relief were considered as separate primary endpoints in the analysis. Proportions of placebo patients experiencing any symptom improvement or complete relief were calculated. Dropouts after randomization for any reason were assumed to represent treatment failure for data extraction and analysis. Placebo response was pooled by a random-effects model, and effects of trial characteristics on the magnitude of placebo response were evaluated. RESULTS In 58 eligible placebo-controlled RCTs of FD from 52 selected citations, 6,732 of 17,890 participants in all trials received placebo. Pooled placebo response rates for symptom improvement and complete relief were 44.3% and 15.6%, respectively. The placebo response rate was lower when improvements were assessed for ≥8 weeks. Trials assessing complete symptom relief showed lower placebo response rates even in trials for <8 weeks. DISCUSSION Our systematic review and meta-analysis showed that pooled placebo response rates in double-blinded RCTs of FD depended on efficacy criteria. Trials assessing complete symptom relief showed stable low placebo response rates in short-term trials.
Collapse
|
19
|
Orduña JM, Domínguez G, Pérez-Castells J. Cobalt catalysed aminocarbonylation of thiols in batch and flow for the preparation of amides. RSC Adv 2021; 11:30398-30406. [PMID: 35480268 PMCID: PMC9041104 DOI: 10.1039/d1ra04736a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022] Open
Abstract
The synthesis of amides from thiols through a cobalt-catalyzed aminocarbonylation is shown. After optimizing all the reaction parameters, the methodology makes possible the obtention of amides with variable yields, while competing reactions such as the formation of disulfides and ureas can be limited. The process works well with aromatic thiols with electron donating groups (EDG) whereas other thiols give reaction with lower yields. The previous process has been transferred and optimized into flow equipment, thus allowing using less CO in a safer way, and permitting the scaling up of the synthesis. Two drugs, moclobemide and itopride were prepared with this methodology, albeit only in the second case with good results. A mechanistic pathway is proposed.
Collapse
Affiliation(s)
- Jose Maria Orduña
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe 28660 Boadilla del Monte Madrid Spain
| | - Gema Domínguez
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe 28660 Boadilla del Monte Madrid Spain
| | - Javier Pérez-Castells
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe 28660 Boadilla del Monte Madrid Spain
| |
Collapse
|
20
|
Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. Neurogastroenterol Motil 2021; 33:e14238. [PMID: 34586707 DOI: 10.1111/nmo.14238] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. METHODS A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. RESULTS The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable. CONCLUSIONS AND INFERENCES A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
Collapse
Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Center of Endoscopy, Starnberg, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
| |
Collapse
|
21
|
Handattu MS, Thirumaleshwar S, Prakash GM, Somareddy HK, Veerabhadrappa GH. A Comprehensive Review on Pellets as a Dosage Form in Pharmaceuticals. Curr Drug Targets 2021; 22:1183-1195. [PMID: 33475056 DOI: 10.2174/1389450122999210120204248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
Oral route of administration is widely accepted and desired because of its versatility, convenience, and, most importantly, patient compliance. Multiparticulate systems like granules and pellets are more advantageous when compared to single-unit dosage forms, as they are capable of distributing the drug more evenly in the gastrointestinal tract. The current paper focuses on pellets, the merits and demerits associated, various pelletization techniques, and their characterization. It also focuses on how pellets can be employed for drug delivery is controlled and sustained release formulations. It gives a complete emphasis on the drug and excipients that can be used in pellet formation, the marketed formulations, and the research pertaining to pellets.
Collapse
Affiliation(s)
- Maithri S Handattu
- Department of Pharmaceutics, Industrial Pharmacy, JSS College of Pharmacy, Sri Shivarathreeshwara Nagara, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru-570015, Karnataka, India
| | - Shailesh Thirumaleshwar
- Department of Pharmaceutics, Industrial Pharmacy, JSS College of Pharmacy, Sri Shivarathreeshwara Nagara, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru-570015, Karnataka, India
| | - Gowrav M Prakash
- Department of Pharmaceutics, Industrial Pharmacy, JSS College of Pharmacy, Sri Shivarathreeshwara Nagara, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru-570015, Karnataka, India
| | - Hemanth K Somareddy
- Department of Pharmaceutics, Industrial Pharmacy, JSS College of Pharmacy, Sri Shivarathreeshwara Nagara, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru-570015, Karnataka, India
| | - Gangadharappa H Veerabhadrappa
- Department of Pharmaceutics, Industrial Pharmacy, JSS College of Pharmacy, Sri Shivarathreeshwara Nagara, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru-570015, Karnataka, India
| |
Collapse
|
22
|
Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J 2021; 9:307-331. [PMID: 33939891 PMCID: PMC8259261 DOI: 10.1002/ueg2.12061] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. Methods A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. Results The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long‐term prognosis and life expectancy are favorable. Conclusions and Inferences A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
Current knowledge
Functional dyspepsia is one of the most common conditions encountered in clinical practice. There is a lack of guidance for clinicians in guiding diagnosis and treatment of this prevalent condition. No treatments are currently approved for the treatment of functional dyspepsia in Europe.
What is new here
A Delphi panel consisting of 41 experts from 22 European countries established the level of consensus on 87 statements regarding functional dyspepsia. The statements reaching consensus serve to guide clinicians in recognizing, diagnosing and treating FD in clinical practice. Endoscopy is mandatory for establishing a firm diagnosis of functional dyspepsia D, but in primary care patients without alarm symptoms or risk factors can be managed without endoscopy. Helicobacter pylori status should be determined in every patient with dyspeptic symptoms and H. Pylori positive patients should receive eradication therapy. Proton pump inhibitor‐therapy is considered an effective therapy for FD, but no other treatment approach reached consensus support.
Collapse
Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Center of Endoscopy, Starnberg, Germany.,Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
| |
Collapse
|
23
|
Wang Y, Liu B, Fu X, Tong T, Yu Z. Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials. BMC Complement Med Ther 2021; 21:11. [PMID: 33407405 PMCID: PMC7788807 DOI: 10.1186/s12906-020-03176-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. METHODS Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. RESULTS A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. CONCLUSION SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. TRIAL REGISTRATION Systematic review registration: [PROSPERO registration: CRD42019139136 ].
Collapse
Affiliation(s)
- Yaping Wang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Bin Liu
- Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiuqiong Fu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Tiejun Tong
- Department of Mathematics, Hong Kong Baptist University, Hong Kong, China
| | - Zhiling Yu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China. .,Consun Chinese Medicines Research Centre for Renal Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
| |
Collapse
|
24
|
Ford AC, Moayyedi P, Black CJ, Yuan Y, Veettil SK, Mahadeva S, Kengkla K, Chaiyakunapruk N, Lee YY. Systematic review and network meta-analysis: efficacy of drugs for functional dyspepsia. Aliment Pharmacol Ther 2021; 53:8-21. [PMID: 32936964 DOI: 10.1111/apt.16072] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Functional dyspepsia (FD) is a relapsing and remitting condition affecting between 5% and 10% of people. Efficacious therapies are available, but their relative efficacy is unknown. AIM To perform a systematic review with network meta-analysis to resolve this uncertainty. METHODS We searched the medical literature through July 2020 for randomised controlled trials (RCTs) assessing efficacy of drugs for adults with FD, compared with each other, or placebo. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic with a 95% confidence interval (CI) to summarise efficacy of each comparison tested. Relative ranking was assessed with surface under the cumulative ranking curve (SUCRA) probabilities. RESULTS We identified 71 eligible RCTs (19 243 participants). Tricyclic antidepressants (TCAs) were ranked second for efficacy (RR of remaining symptomatic = 0.71; 95% CI 0.58-0.87, SUCRA 0.87), and first when only low risk of bias trials were included. Most RCTs that used TCAs recruited patients who were refractory to other drugs included in the network. Although sulpiride or levosulpiride were ranked first for efficacy (RR = 0.49; 95% CI 0.36-0.69, SUCRA 0.99), trial quality was low and only 86 patients received active therapy. TCAs were more likely to cause adverse events than placebo. CONCLUSIONS TCAs, histamine-2 receptor antagonists, standard- and low-dose proton pump inhibitors, sulpiride or levosulpiride, itopride and acotiamide were all more efficacious than placebo for FD.
Collapse
Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Paul Moayyedi
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Yuhong Yuan
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirati Kengkla
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
25
|
Wei Z, Yang Q, Yang Q, Yang J, Tantai X, Xing X, Xiao C, Pan Y, Liu N, Wang J. Rome III, Rome IV, and Potential Asia Symptom Criteria for Functional Dyspepsia Do Not Reliably Distinguish Functional From Organic Disease. Clin Transl Gastroenterol 2020; 11:e00278. [PMID: 33512804 PMCID: PMC7721216 DOI: 10.14309/ctg.0000000000000278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Although the Rome criteria were created primarily for research purposes, it was an important question whether the Rome criteria can distinguish organic dyspepsia from functional dyspepsia (FD). We evaluated the accuracy of the Rome IV criteria in identifying patients with FD and compared the differences between the Rome IV, Rome III, and potential Asia criteria in identifying patients with FD. METHODS In this cross-sectional study, we analyzed data from patients who met the inclusion and exclusion criteria from March 2018 to January 2019 at 2 tertiary hospitals. RESULTS A total of 600 patients were enrolled in this study, including 381 individuals met the Rome IV criteria for FD, 438 individuals met the Rome III criteria for FD, and 525 individuals met the potential Asia criteria for FD. The Rome IV criteria identified patients with FD with 67.3% sensitivity and 38.4% specificity, and the positive and negative likelihood ratios of FD identified by Rome IV criteria were 1.09 (95% confidence interval 0.97-1.24) and 0.85 (95% confidence interval 0.67-1.08), respectively. There was no significant difference in the area under Rome IV, Rome III, or potential Asia criteria receiver operating characteristic curves in identifying FD (P > 0.05). DISCUSSION The Rome IV criteria were no better than the Rome III or potential Asia criteria in identifying FD and were not helpful in identifying patients with FD. Hence, although the Rome criteria remain useful for defining patients with FD for inclusion into clinical treatment trials, they should not be used for diagnosing FD.
Collapse
Affiliation(s)
- Zhongcao Wei
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Qian Yang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Qi Yang
- Department of Gastroenterology, Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Juan Yang
- Department of Gastroenterology, Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Xinxing Tantai
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Xin Xing
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Cailan Xiao
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, China
| |
Collapse
|
26
|
Wei ZC, Yang Q, Yang Q, Yang J, Tantai XX, Xing X, Xiao CL, Pan YL, Wang JH, Liu N. Predictive value of alarm symptoms in patients with Rome IV dyspepsia: A cross-sectional study. World J Gastroenterol 2020; 26:4523-4536. [PMID: 32874062 PMCID: PMC7438198 DOI: 10.3748/wjg.v26.i30.4523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND No studies have evaluated the predictive value of alarm symptoms for organic dyspepsia and organic upper gastrointestinal (GI) diseases based on Rome IV criteria in the Chinese population.
AIM To evaluate the predictive value of alarm symptoms for dyspeptic patients based on Rome IV criteria.
METHODS We performed a cross-sectional study of dyspepsia patients who met the inclusion and exclusion criteria at two academic urban tertiary-care centers from March 2018 to January 2019. Basic demographic data, dyspeptic information, alarm symptoms, lifestyle, examination results, family history and outpatient cost information were collected. Dyspepsia patients with normal findings on upper GI endoscopy, epigastric ultrasound and laboratory examination and without Helicobacter pylori-associated dyspepsia were classified as functional dyspepsia.
RESULTS A total of 381 patients were enrolled in the study, including 266 functional dyspepsia patients and 115 organic dyspepsia patients. There were 24 patients with organic upper GI disease among patients with organic dyspepsia. We found that based on the Rome IV criteria, alarm symptoms were of limited value in differentiating organic dyspepsia and organic upper GI diseases from functional dyspepsia. Age (odds ratio (OR) = 1.056, P = 0.012), smoking (OR = 4.714, P = 0.006) and anemia (OR = 88.270, P < 0.001) were independent predictors for organic upper GI diseases. For the comparison of epigastric pain syndrome, postprandial distress syndrome and epigastric pain syndrome combined with postprandial distress syndrome, the results showed that there were statistically significant differences in anorexia (P = 0.021) and previous visits (P = 0.012). The ClinicalTrials.gov number is NCT 03479528.
CONCLUSION Most alarm symptoms had poor predictive value for organic dyspepsia and organic upper GI diseases based on Rome IV criteria. Gastroscopic screening should not be based solely on alarm symptoms.
Collapse
Affiliation(s)
- Zhong-Cao Wei
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Qian Yang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Qi Yang
- Department of Gastroenterology, Xi’an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi’an 710018, Shaanxi Province, China
| | - Juan Yang
- Department of Gastroenterology, Xi’an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi’an 710018, Shaanxi Province, China
| | - Xin-Xing Tantai
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Xin Xing
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Cai-Lan Xiao
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Yang-Lin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Jin-Hai Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| |
Collapse
|
27
|
Isshi K, Furuhashi H, Nakada K. Therapeutic strategy for the patients with coexisting gastroesophageal reflux disease and postprandial distress syndrome of functional dyspepsia. JGH Open 2020; 4:582-588. [PMID: 32782942 PMCID: PMC7411656 DOI: 10.1002/jgh3.12299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022]
Abstract
Background and Aim Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) frequently overlap. However, no accepted treatment has yet been established for such patients. This study was conducted to identify an adequate initial treatment for patients with GERD accompanied by the postprandial distress syndrome type of FD (FD‐PDS). Methods Of the 150 patients newly diagnosed with GERD who visited our clinic, 53 patients with the typical symptoms of both GERD and FD‐PDS were assessed using the modified frequency scale for the symptoms of GERD and the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaires. Of those, 42 patients who completed 4 weeks of treatment were analyzed. We compared the treatment responses between the 21 patients who received proton pump inhibitor (PPI) monotherapy and 21 patients who received a PPI in combination with the prokinetic drug acotiamide. Results Assessment of the two questionnaires revealed a marked improvement of both GERD and FD symptom scores after 4 weeks of treatment in both groups. However, there were no significant differences in any GERD or FD symptom scores at baseline, after 4 weeks of treatment and in the symptom score change between the two different treatment groups. Conclusion The results of this retrospective study suggest no benefit of PPI‐prokinetic combination versus PPI monotherapy in adult patients with FD‐GERD overlap; therefore, PPI monotherapy could be an adequate initial treatment for such patients.
Collapse
Affiliation(s)
- Kimio Isshi
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Endoscopy Jikei University School of Medicine Tokyo Japan
| | - Hiroto Furuhashi
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Endoscopy Jikei University School of Medicine Tokyo Japan
| | - Koji Nakada
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Laboratory Medicine The Jikei University Daisan Hospital Tokyo Japan
| |
Collapse
|
28
|
Tu JF, Yang JW, Wang LQ, Zheng Y, Zhang LW, Li YT, Zhang X, Shi GX, Wang J, Zhao JJ, Du Y, Chen SS, Cheng L, Liu CZ. Acupuncture for postprandial distress syndrome: a randomized controlled pilot trial. Acupunct Med 2020; 38:301-309. [PMID: 32028783 DOI: 10.1177/0964528419900911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence for treating postprandial distress syndrome with acupuncture is limited. AIM We aimed to evaluate the feasibility of verum acupuncture versus sham acupuncture in patients with postprandial distress syndrome. METHODS A total of 42 eligible patients were randomly allocated to either verum acupuncture or sham acupuncture groups in a 1:1 ratio. Each patient received 12 sessions over 4 weeks. The primary outcome was the response rate based on the overall treatment effect (OTE) 4 weeks after randomization. Secondary outcomes included dyspepsia symptom severity and adverse events. RESULTS In each group, 19 patients (91.5%) completed the study. Thirteen patients receiving verum acupuncture and seven patients receiving sham acupuncture were classified as responders according to OTE (61.9% vs 33.3%; rate difference 28.6%; p = 0.06). Dyspepsia symptom severity at the end of treatment also differed significantly between verum acupuncture and sham acupuncture groups (5.9 units vs 3.7 units; between-group difference 2.2 (95% CI, 0.2-4.2); p = 0.04). No serious adverse events occurred. CONCLUSION Four weeks of acupuncture may represent a potential treatment for postprandial distress syndrome. The treatment protocol and outcome measures used in this trial were feasible. Since this was a pilot study, the efficacy of acupuncture still needs to be determined by a larger, adequately powered trial.
Collapse
Affiliation(s)
- Jian-Feng Tu
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China.,School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Zheng
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Li-Wen Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Yong-Ting Li
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China
| | - Xin Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Guang-Xia Shi
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China
| | - Jun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Jie Zhao
- Department of Traditional Chinese Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Du
- Department of Traditional Chinese Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - San-San Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lu Cheng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China.,School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
29
|
Park MS, Kang CN, Lee WS, Kim HJ, Lee S, Kim JH, Shin SJ, Moon SH. A comparative study of the efficacy of NAXOZOL compared to celecoxib in patients with osteoarthritis. PLoS One 2020; 15:e0226184. [PMID: 31986170 PMCID: PMC6984721 DOI: 10.1371/journal.pone.0226184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Selective cyclooxygenase-2 inhibitors (celecoxib) can minimize the gastrointestinal complications related to non-steroidal anti-inflammatory drug (NSAID) use. NAXOZOL is a new combination formulation designed to provide sequential delivery of a non-enteric-coated, immediate-release esomeprazole strontium tetrahydrate 20 mg mantle followed by an enteric-coated naproxen 500 mg core. However, there have been no studies comparing NAXOZOL to celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis. This study was undertaken to compare the effects of NAXOZOL and celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis. Methods The randomized enrolled patients were divided into two treatment groups: a NAXOZOL group and a celecoxib group. All participants received treatments (NAXOZOL, 500/20 mg (naproxen 500 mg, esomeprazole strontium tetrahydrate 20 mg) twice per day versus celecoxib, 200 mg daily) on a 1:1 allocation basis for 12 weeks. The primary outcome was the Leeds Dyspepsia Questionnaire (LDQ) score used for non-inferiority testing. Secondary outcome measures included the Gastrointestinal Symptom Rating Scale (GSRS) score, Visual Analogue Scale (VAS) score, European Quality of Life-5 dimensions (EQ-5D) scale and the EQ-5D Visual Analogue Scale (EQ VAS). Other outcome measures included the use of supplementary or rescue drugs, and the incidence of adverse events. Results The baseline-adjusted LDQ scores immediately after 12 weeks of treatment in NAXOZOL group were not inferior to those in celecoxib group. The overall change in the baseline-adjusted GSRS score, VAS score, EQ-5D, and EQ VAS was not different between the two groups. The usage of supplementary drugs and the drug-related incidence of adverse events were not different. However, the days to use rescue drug were longer in celecoxib group than in NAXOZOL group. Conclusion NAXOZOL was not inferior to celecoxib in protecting the gastrointestinal tract and providing pain relief in patients with osteoarthritis.
Collapse
Affiliation(s)
- Moon Soo Park
- Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Chang-Nam Kang
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sahnghoon Lee
- Department of Orthopaedic Surgery, Seoul National University, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Kim
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
30
|
Vandenberghe A, Schol J, Van den Houte K, Masuy I, Carbone F, Tack J. Current and emerging therapeutic options for the management of functional dyspepsia. Expert Opin Pharmacother 2020; 21:365-376. [PMID: 31899982 DOI: 10.1080/14656566.2019.1707805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Functional Dyspepsia (FD), defined as chronic symptoms originating from the gastroduodenal region in absence of readily identifiable organic disease, is one of the most common gastrointestinal disorders. FD is divided into two subgroups: Post-Prandial Distress Syndrome (PDS) or meal-related FD, characterized by postprandial fullness and early satiation, and Epigastric Pain Syndrome (EPS) or meal-unrelated FD, characterized by epigastric pain and burning.Areas covered: This review summarizes the existing and off-label therapeutic options for FD.Expert opinion: The identification of mechanisms, the Rome IV classification, the reduction of PDS/EPS overlap and pictograms for symptom identification allow a better diagnosis and a more targeted treatment choice. Acotiamide, a first-in-class prokinetic agent available only in Japan and India, is the only agent of proven efficacy for FD, but clinicians use acid-suppressive therapy, prokinetics, neuromodulators and herbal therapies for treating FD symptoms. New emerging targets are duodenal low-grade inflammation with eosinophils and duodenal or other modified luminal microbiota.
Collapse
Affiliation(s)
- A Vandenberghe
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - J Schol
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - K Van den Houte
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - I Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - F Carbone
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - J Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| |
Collapse
|
31
|
Madisch A, Andresen V, Enck P, Labenz J, Frieling T, Schemann M. The Diagnosis and Treatment of Functional Dyspepsia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:222-232. [PMID: 29669681 DOI: 10.3238/arztebl.2018.0222] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/04/2017] [Accepted: 02/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the more common functional disorders, with a prevalence of 10-20%. It affectsthe gastrointestinal tract. METHODS This article is based on publications retrieved by a selective search of PubMed, with special attention to controlled trials, guidelines, and reviews. RESULTS Typical dyspeptic symptoms in functional dyspepsia include epigastric pain, sensations of pressure and fullness, nausea, and early subjective satiety. The etiology of the disorder is heterogeneous and multifactorial. Contributory causes include motility disturbances, visceral hypersensitivity, elevated mucosal permeability, and disturbances of the autonomic and enteric nervous system. There is as yet no causally directed treatment for functional dyspepsia. Its treatment should begin with intensive patient education regarding the benign nature of the disorder and with the establishment of a therapeutic pact for long-term care. Given the absence of a causally directed treatment, drugs to treat functional dyspepsia should be given for no more than 8-12 weeks. Proton-pump inhibitors, phytotherapeutic drugs, and Helicobacter pylori eradication are evidence-based interventions. For intractable cases, tricyclic antidepressants and psychotherapy are further effective treatment options. CONCLUSION The impaired quality of life of patients with functional dyspepsia implies the need for definitive establishment of the diagnosis, followed by symptom-oriented treatment for the duration of the symptomatic interval.
Collapse
Affiliation(s)
- Ahmed Madisch
- Department of Gastroenterology, Interventional Endoscopy, Diabetology, and Acute Geriatrics, KRH Hospital Siloah, Hanover
| | | | - Paul Enck
- Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen
| | - Joachim Labenz
- Department of Medicine, Diakonie Hospital Jung- Stilling, Siegen
| | - Thomas Frieling
- Department of Gastroenterology, Helios Hospital Krefeld, Krefeld
| | | |
Collapse
|
32
|
Basnayake C, Kamm MA, Salzberg M, Khera A, Liew D, Burrell K, Wilson-O'Brien A, Stanley A, Talley NJ, Thompson AJ. Defining Optimal Care for Functional Gut Disorders - Multi-Disciplinary Versus Standard Care: A Randomized Controlled Trial Protocol. Contemp Clin Trials 2019; 84:105828. [PMID: 31437539 DOI: 10.1016/j.cct.2019.105828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are the commonest reason for gastroenterological consultation, with patients usually seen by a specialist working in isolation. There is a wealth of evidence testifying to the benefit provided by dieticians, behavioral therapists, hypnotherapists and psychotherapists in treating these conditions, yet they rarely form a part of the therapeutic team, and these treatment modalities are rarely offered as part of the therapeutic management. There has been little examination of different models of care for FGIDs. We hypothesize that multi-disciplinary integrated care is superior to standard specialist-based care in the treatment of functional gut disorders. METHODS The "MANTRA" (Multidisciplinary Treatment for Functional Gut Disorders) study compares comprehensive multi-disciplinary outpatient care with standard hospital outpatient care. Consecutive new referrals to the gastroenterology and colorectal outpatient clinics of a single secondary and tertiary care hospital of patients with an FGID, defined by the Rome IV criteria, will be included. Patients will be prospectively randomized 2:1 to multi-disciplinary (gastroenterologist, gut-hypnotherapist, psychiatrist, behavioral therapist ('biofeedback') and dietician) or standard care (gastroenterologist or colorectal surgeon). Patients are assessed up to 12 months after completing treatment. The primary outcome is an improvement on a global assessment scale at the end of treatment. Symptoms, quality of life, psychological well-being, and healthcare costs are secondary outcome measures. DISCUSSION There have been few studies examining how best to deliver care for functional gut disorders. The MANTRA study will define the clinical and cost benefits of two different models of care for these highly prevalent disorders. TRIAL REGISTRATION NUMBER Clinicaltrials.govNCT03078634 Registered on Clinicaltrials.gov, completed recruitment, registered on March 13th 2017. Ethics and Dissemination: Ethical approval has been received by the St Vincent's Hospital Melbourne human research ethics committee (HREC-A 138/16). The results will be disseminated in peer-reviewed journals and presented at international conferences. Protocol version 1.2.
Collapse
Affiliation(s)
- Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | | | - Angela Khera
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Danny Liew
- Monash University, Melbourne, Australia.
| | - Kathryn Burrell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.
| | - Amy Wilson-O'Brien
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.
| | | | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| |
Collapse
|
33
|
Ora M, Nazar AH, Parashar A, Kheruka S, Gambhir S. Gastric Emptying Scintigraphy: Beyond Numbers - An Observational Study to Differentiate between Various Etiologies and a Step toward Personalized Management. Indian J Nucl Med 2019; 34:194-200. [PMID: 31293297 PMCID: PMC6593947 DOI: 10.4103/ijnm.ijnm_55_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: Gastric emptying (GE) scintigraphy is commonly used as a standard diagnostic procedure for the assessment of functional dyspepsia (FD). Results of the study are often reported as either normal or delayed GE times. The aim of this study was to recognize various patterns of scintigraphy among both normal and abnormal emptying times. Materials and Methods: Fifty patients with suspected FD were included in the study. GE study was performed with a standardized vegetarian solid meal. Results: Out of 50 patients, 33 patients had deranged GE. Thirty patients had delayed GE. Three patients demonstrated gastric hurrying. Five different patterns were demonstrated in patients having similar emptying and retention times such as reduced fundus compliance, decreased fundic accommodation, antral dysmotility, gastric hurrying, and gastroesophageal reflux. Conclusion: According to our findings, it may be suggested that visual assessment of GE and identification of various pattern is a very important aspect of the GE study. It not only subcategorized patients but also decreases the number of “normal” studies. This finding may have an impact on patient management in the era of personalized medicine.
Collapse
Affiliation(s)
- Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aftab Hasan Nazar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Parashar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subhash Kheruka
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
34
|
Illuri R, Venkataramana SH, Daguet D, Kodimule S. Sub-acute and acute toxicity of Ferula asafoetida and Silybum marianum formulation and effect of the formulation on delaying gastric emptying. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:159. [PMID: 31277639 PMCID: PMC6612090 DOI: 10.1186/s12906-019-2576-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Delayed gastric emptying play an important role in the pathology of functional dyspepsia. Owing to their functional attributes in alleviating the gastrointestinal disorders, single or polyherbal formulations have gained attention to treat the symptoms of functional dyspepsia. We have investigated the safety and efficacy of a novel formulation of Ferula asafoetida oleo resin and standardized Silybum marianum extract (Asdamarin). METHODS The effect of asdamarin on delayed gastric emptying was investigated in Sprague Dawley rats using phenol red method. The acute and sub-acute oral toxicity was evaluated in wistar rats following OECD guidelines 425 and 407 respectively. The data were analyzed by one-way ANOVA using GraphPad Prism 5.0 software. RESULTS Oral administration of Asdamarin dose-dependently improved the delay in gastric emptying as evident from the significant increase in the gastrointestinal transit time (p < 0.001). The LD50 of asdamarin was estimated to be more than 2000 mg/kg. Further, in the 28-day sub-acute toxicity study, the administration of 250, 500 and 1000 mg/kg of Asdamarin did not significantly altered the feed and water consuption, body weight change, biochemical and haematological parameters compared to control animals. Macroscopic and histopathological examination of vital organs revealed no toxic signs. CONCLUSION The preliminary data from the present study provides the first evidence on the possible effectiveness of novel formulation of F. Asafoatida and S. marianum extracts in alleviating the associated symptoms of functional dyspepsia. The toxicity data indicated that Asdamarin can be considered safe up to 1000 mg/kg dose.
Collapse
Affiliation(s)
- Ramanaiah Illuri
- Preclinical Research Laboratory, R&D Center for Excellence, Vidya Herbs Pvt. Ltd, AnekalTaluk, Jigani Industrial Area, #14A, KIADB, Jigani I phase, Bangalore, Karnataka 560 105 India
| | - Sudeep Heggar Venkataramana
- Preclinical Research Laboratory, R&D Center for Excellence, Vidya Herbs Pvt. Ltd, AnekalTaluk, Jigani Industrial Area, #14A, KIADB, Jigani I phase, Bangalore, Karnataka 560 105 India
| | - David Daguet
- Vidya Europe SAS, 7 avenue de Norvège, 91140 Villebon sur Yvette, France
| | - Shyamprasad Kodimule
- Preclinical Research Laboratory, R&D Center for Excellence, Vidya Herbs Pvt. Ltd, AnekalTaluk, Jigani Industrial Area, #14A, KIADB, Jigani I phase, Bangalore, Karnataka 560 105 India
| |
Collapse
|
35
|
Loganathan P, Gajendran M, McCallum R. Current and future treatment management strategies for gastroparesis. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1617694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Priyadarshini Loganathan
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Richard McCallum
- Division of Gastroenterology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX, USA
| |
Collapse
|
36
|
Matsuzaki J, Tsugawa H, Kashiwazaki Y, Mori H, Yamamoto Y, Kameyama H, Masaoka T, Kanai T, Suzuki H. Neutrophil-activating Protein Polymorphism of Helicobacter pylori Determines the Host Risk of Dyspepsia. Cell Mol Gastroenterol Hepatol 2019; 8:295-297.e6. [PMID: 31108232 PMCID: PMC6718361 DOI: 10.1016/j.jcmgh.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Juntaro Matsuzaki
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Tsugawa
- Department of Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Kashiwazaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Mori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan,Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuta Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hisako Kameyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa, Japan,Corresponding author.
| |
Collapse
|
37
|
Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther 2019; 49:1134-1172. [PMID: 30924176 DOI: 10.1111/apt.15191] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional dyspepsia, consisting of epigastric pain syndrome and postprandial distress syndrome, is a prevalent functional gastrointestinal disorder. To date, only limited treatment options are available and conflicting results in terms of efficacy have been reported. Consequently, nonpharmacological treatment options are increasingly being explored for functional dyspepsia. AIM To provide an overview of current pharmacological and nonpharmacological treatment options for functional dyspepsia. METHODS A literature search was conducted on Pubmed and other sources to identify relevant studies. RESULTS Acid suppressive therapy reduced symptoms in 30%-70% of the patients, with higher benefit in epigastric pain syndrome and superior effectiveness for proton pump inhibitors compared to H2 -antagonists. Prokinetic agents, primarily used to treat postprandial distress syndrome, showed variable efficiency: 59%-81% responder rate for dopamine receptor antagonists, 32%-91% for serotonin-4-receptor agonists and 31%-80% for muscarinic receptor antagonists. H Pylori eradication, recommended in infected patients, was effective in 24%-82%. Refractory symptoms are addressed with neuromodulators. However, their efficacy in functional dyspepsia remains incompletely elucidated, available data showing symptom reduction in 27%-71% of the patients. Regarding herbal agents, peppermint oil reduced symptoms in 66%-91%, rikkunshito in 29%-34% and iberogast in 20%-95%. Lastly, acupuncture, cognitive behavioural therapy and hypnotherapy may help to provide symptom control, but research on their efficacy remains sparse. CONCLUSIONS None of the available therapies is effective in the majority of patients without being associated with major side effects. Developing new treatment options is challenging due to the heterogeneity of functional dyspepsia, the lack of readily identified target mechanisms and the poor association between pathophysiological disturbances and symptoms.
Collapse
Affiliation(s)
- Imke Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| |
Collapse
|
38
|
Van den Houte K, Carbone F, Pauwels A, Vos R, Vanuytsel T, Tack J. Influence of itopride and domperidone on gastric tone and on the perception of gastric distention in healthy subjects. Neurogastroenterol Motil 2019; 31:e13544. [PMID: 30706652 DOI: 10.1111/nmo.13544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Itopride, a prokinetic with dopamine D2-antagonistic and cholinesterase inhibitor properties, is used for treating functional dyspepsia (FD) patients. However, the effects of itopride on sensitivity to gastric distention and impaired gastric accommodation, major pathophysiological mechanisms of FD, are unknown. Our aim was to evaluate the effect of itopride on gastric distention and on gastric accommodation in healthy volunteers, compared to placebo and domperidone. METHODS Fifteen healthy volunteers (6 male, mean age 28.3 ± 5.8) were studied after pretreatment for 2 days tid with placebo (P), itopride 50 mg (I50), itopride 100 mg (I100), or domperidone 10 mg (D10) in a placebo-controlled, double-blind cross-over design. A gastric barostat study was performed to assess gastric compliance, sensitivity to gastric distention, and gastric accommodation. Symptoms were evaluated by visual analogue scales and perception scores. RESULTS I50, I100, and D10 did not influence gastric compliance and sensitivity compared to placebo. No significant differences in accommodation were observed after I100 compared to P. Preprandial intragastric volumes were similar with D10, I50, or placebo (respectively, 244 ± 21, 225 ± 23, and 261 ± 36 mL, NS). However, postprandial gastric volumes were lower after I50 compared to placebo (303 ± 34 vs. 448 ± 50 mL, P < 0.01). Gastric accommodation was significantly reduced after D10 (90 ± 26 mL) and I50 (78 ± 25 mL) compared to placebo (186 ± 37 mL, P < 0.05, and P < 0.01). CONCLUSION In healthy subjects, itopride and domperidone do not alter gastric compliance or sensitivity. I50 and D10 three times daily, but not I100, decrease meal-related gastric accommodation.
Collapse
Affiliation(s)
- Karen Van den Houte
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Florencia Carbone
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Ans Pauwels
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Rita Vos
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| |
Collapse
|
39
|
Xiao Y, Li Y, Shu J, Li Y, Xu J, Ren J, Liu D, Wang J, Zhou L, Li Y, Tang G, Tian D, Zhang S, Hou X, Wang H, Li Z, Lv N, Chen M. The efficacy of oral Zhizhu Kuanzhong, a traditional Chinese medicine, in patients with postprandial distress syndrome. J Gastroenterol Hepatol 2019; 34:526-531. [PMID: 30207000 DOI: 10.1111/jgh.14467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The treatment of patients with functional dyspepsia (FD) remains unsatisfactory. We assessed the efficacy of Zhizhu Kuanzhong (ZZKZ) capsule, a traditional Chinese medicine formula, in patients with postprandial distress syndrome (PDS) of FD. METHODS The study was designed as a multicenter, randomized, double-blinded, controlled clinical trial. Three-hundred ninety-two patients with PDS defined by Rome III criteria from 16 centers in China were randomly assigned to receive either ZZKZ or placebo. The proportion of the responders at 4 weeks after randomization was considered primary endpoint. Secondary endpoint was the symptom score reduction of each dyspeptic symptom relative to the baseline at 4 weeks after randomization in all subjects. RESULTS In terms of the primary endpoint, the proportion of the responders concerning the composite PDS symptom score was 38.8% and 54.7% in placebo group and ZZKZ group, respectively (P = 0.003), in per protocol analysis at 4 weeks after randomization. Concerning the individual evaluated upper gastrointestinal symptoms, only postprandial fullness and early satiety showed significant difference in symptom score reduction at 4 weeks after randomization between placebo and ZZKZ groups. CONCLUSIONS Zhizhu Kuanzhong is superior to placebo in the treatment of PDS with FD. The exact mechanisms by which ZZKZ improves symptoms remain to be established (http://www.chictr.org.cn/ChinCTR-TRC-14004714).
Collapse
Affiliation(s)
- Yinglian Xiao
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yuwen Li
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jianchang Shu
- Guangzhou Red Cross Hospital Affiliated to Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Yan Li
- The Second Affiliated Hospital of Chinese Medical University, Shenyang, Liaoning Province, China
| | - Jianming Xu
- The First Affiliated Hospital of Anhui University, Hefei, Anhui Province, China
| | - Jianlin Ren
- Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Deliang Liu
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jiangbin Wang
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Liya Zhou
- The Third Hospital of Peking University, Beijing, China
| | - Yanqing Li
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Guodou Tang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - De'an Tian
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shutian Zhang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Hou
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huahong Wang
- The First Hospital of Peking University, Beijing, China
| | - Zhaoshen Li
- Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Nonghua Lv
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Minhu Chen
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| |
Collapse
|
40
|
Prokinetics for Functional Dyspepsia: A Systematic Review and Meta-Analysis of Randomized Control Trials. Am J Gastroenterol 2019; 114:233-243. [PMID: 30337705 DOI: 10.1038/s41395-018-0258-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Prokinetics are recommended for the treatment of functional dyspepsia (FD) but systematic reviews give conflicting results on the efficacy of these agents. We have therefore conducted an updated systematic review to support the 2017 joint ACG/CAG dyspepsia guidelines. METHODS Electronic databases, including MEDLINE, EMBASE, and CENTRAL, were searched until September 2017 for randomized controlled trials (RCTs) comparing either prokinetics and placebo or two types of prokinetics to improve FD symptoms. The primary outcome was absence or improvement of dyspeptic symptoms at the end of treatment. Double-blind eligibility assessment and data extraction was performed. Pooled risk ratios of symptoms persisting or adverse events occurring, and standardized mean difference of quality-of-life (QoL) scores with 95% CI, using a random effects model, were calculated. Quality of evidence was assessed using GRADE. RESULTS The search identified 1388 citations; 38 studies in 35 papers were included. Of these, 29 trials comparing prokinetics with placebo were found. There was a statistically significant effect of prokinetic treatment in reducing global symptoms of FD (RR 0.81, 95% CI 0.74 to 0.89; I2 91%; NNT 7), regardless of FD subtype or ethnicity. When comparing two types of prokinetic, the most commonly used comparator was domperidone. There was no difference in reducing global symptoms (RR 0.94, 95% CI 0.83 to 1.07). QoL was not improved with prokinetic treatment. The adverse events with individual prokinetics were not different from placebo, except for cisapride. The GRADE assessment rated the quality of the evidence in each outcome as very low. CONCLUSIONS From the current evidence, prokinetics may be effective for the treatment in all subtypes of FD, with very low quality of evidence. There was no difference between prokinetics for dyspeptic symptom improvement. High-quality RCTs with large sample sizes of FD patients are needed to verify the efficacy of prokinetics.
Collapse
|
41
|
Hou YQ, Zhang X, Tu JF, Zheng Y, Yang JW, Kim M, Hu H, Wang LQ, Zhao JJ, Zhou W, Wang J, Zou X, Wang Y, Shi GX, Liu CZ. Efficacy of acupuncture versus sham acupuncture for postprandial distress syndrome: study protocol for a randomized controlled trial. Trials 2019; 20:65. [PMID: 30658669 PMCID: PMC6339308 DOI: 10.1186/s13063-018-3051-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
Background Postprandial distress syndrome (PDS) has a considerable impact on quality of life. Our previous pilot trial suggested that acupuncture might be a potential treatment option for PDS. We will conduct this large trial to determine the efficacy of acupuncture versus sham acupuncture for PDS. Methods/design A total of 280 eligible patients who meet the Rome IV criteria for PDS will be randomly allocated to either the acupuncture group or the sham acupuncture group. Each patient will receive 12 sessions over four weeks. The primary outcomes will be the response rate of overall treatment effect (OTE) and the elimination rate of all three cardinal symptoms (postprandial fullness, upper abdominal bloating, and early satiation) at four weeks after randomization. Secondary outcomes will include assessments of the severity of dyspepsia symptoms and disease-specific quality of life at weeks 4, 8, and 16 after randomization. All patients who receive randomization will be included in the intent-to-treat analysis. Discussion The finding of this trial will provide high-quality evidence on the efficacy of acupuncture for treatment of PDS. Results of this research will be published in peer-reviewed journals. Trial registration ISRCTN Registry, ISRCTN12511434. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3051-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ya-Quan Hou
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Xin Zhang
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Jian-Feng Tu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Yang Zheng
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Jing-Wen Yang
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Mirim Kim
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Hui Hu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Li-Qiong Wang
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Jing-Jie Zhao
- Department of Traditional Chinese Medicine, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Wei Zhou
- Department of Traditional Chinese Medicine, Huguosi Hospital of Chinese Medicine, Beijing University of Chinese Medicine, Xicheng District, Beijing, China
| | - Jun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Dongcheng District, Beijing, China
| | - Xuan Zou
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China
| | - Yu Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Guang-Xia Shi
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Cun-Zhi Liu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Fengtai District, Beijing, China.
| |
Collapse
|
42
|
Czerwiński PJ, Furman B. Overcoming inaccessibility of fluorinated imines - synthesis of functionalized amines from readily available fluoroacetamides. Chem Commun (Camb) 2019; 55:9436-9439. [PMID: 31304490 DOI: 10.1039/c9cc04111g] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although imines are convenient substrates for the synthesis of functionalized amines, they may be hard to obtain, as in the case of fluorinated imines. To aid in overcoming this issue, we propose a protocol of corresponding amine synthesis from simple fluoroacetic acid-derived amides using Schwartz's reagent.
Collapse
Affiliation(s)
- Paweł J Czerwiński
- Institute of Organic Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland.
| | | |
Collapse
|
43
|
Holtmann GJ, Talley NJ. Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning? Gut 2018; 67:1911-1915. [PMID: 29921653 DOI: 10.1136/gutjnl-2017-314775] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/06/2018] [Accepted: 05/12/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Faculties of Medicine and Health and Behavioural Sciences, University of Queensland and Translational Research Institute (TRI), Brisbane, Queensland, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
44
|
Pittayanon R, Yuan Y, Bollegala NP, Khanna R, Leontiadis GI, Moayyedi P. Prokinetics for functional dyspepsia. Cochrane Database Syst Rev 2018; 10:CD009431. [PMID: 30335201 PMCID: PMC6516965 DOI: 10.1002/14651858.cd009431.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dyspepsia is a common condition associated with gastrointestinal (GI) disease. Prokinetics are the treatment of choice for functional dyspepsia (FD). However, the role of prokinetics in FD treatment is still controversial. OBJECTIVES We conducted a systematic review and meta-analysis of randomised control trials (RCTs) examining the efficacy of prokinetics in the treatment of FD. The primary outcome was overall absence of or improvement of symptoms and symptom scores at the end of treatment. We also evaluated quality of life (QoL) and adverse events as secondary outcomes. SEARCH METHODS We performed a systematic search of MEDLINE, Embase, the Cochrane Library, and CINAHL, from 1946 until September 2017. RevMan 5.3 was used to calculate pooled risk ratios (RR) of symptoms persisting or without improved QoL or adverse events, mean difference (MD) or standardised mean difference (SMD) of post-treatment symptoms scores, changes of symptom scores, and QoL, when appropriate with 95% confidence intervals (CI), using a random-effects model. Quality of evidence was evaluated using GRADE methodology. SELECTION CRITERIA We included studies that were parallel group RCTs comparing one prokinetic with either placebo or another prokinetic of the same or different class for the treatment of FD. Studies involved adults who presented with dyspepsia symptoms and who had negative or insignificant findings on endoscopy as well as no other organic and metabolic disorders. Studies only including participants with primarily reflux or heartburn symptoms were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, study quality and performed data extraction. MAIN RESULTS From an initial 1388 citations, we identified 43 studies in 40 papers. Of those, 29 studies with 10,044 participants compared six prokinetics with placebo for the outcome of absence of symptoms or symptom improvement. There was a statistically significant effect of prokinetic treatment in reducing global symptoms of FD (RR of remaining dyspeptic = 0.81, 95% CI 0.74 to 0.89; number needed to treat for an additional beneficial outcome (NNTB) =7, very low-quality evidence) with considerable heterogeneity; I2 = 91% (P < 0.00001). After removing cisapride from the analysis, the effect of prokinetics in global symptom improvement still persisted, compared to placebo (RR 0.87, 95% CI 0.80 to 0.94), but was still based on very low-quality evidence. The result showed persistence of significant improvement in subgroups of studies at unclear or at low risk of bias (RR 0.86, 95% CI 0.80-0.92), and in subgroups by molecules of cisapride (RR 0.71, 95% CI 0.54 to 0.93; NNTB = 4), acotiamide (RR 0.94, 95% CI 0.91 to 0.98; NNTB = 20) and tegaserod(RR 0.89, 95% CI 0.82 to 0.96; NNTB = 14).Ten studies compared different types of prokinetics with each other and the most commonly used comparator was domperidone, 10 mg three times a day (eight of the 10 studies). There was a significantly better post-treatment symptom score in other prokinetics, compared to domperidone (SMD -0.19, 95% CI -0.35 to -0.03, very low-quality evidence), but no difference in reducing global symptom (RR 0.94, 95% CI 0.83 to 1.07), and mean difference symptom scores (SMD -0.13, 95% CI -0.31 to 0.05). We found five studies that assessed quality of life, but there was no benefit in improving quality of life with prokinetic treatment (SMD 0.11, 95% CI -0.10 to 0.33; participants = 1774). The adverse events in individual prokinetics was not different from placebo (RR 1.09, 95% CI 0.95 to 1.25; participants = 3811; studies = 17). However, when we looked at the adverse effects by each prokinetic, there were overall greater adverse effects in the active treatment group with cisapride (RR 1.31, 95% CI 1.03 to 1.65; P = 0.03). The most common side effects were diarrhoea, abdominal discomfort and nausea. The funnel plot was asymmetric (Egger's test, P = 0.02) implying reporting bias or other small-study effects may be, in part, driving the benefit of prokinetics compared to placebo in this meta-analysis. The GRADE assessment of the quality of the evidence in each outcome are mostly low or very low due to concerns around risk of bias in study design, unexplained heterogeneity and possible publication bias. AUTHORS' CONCLUSIONS Due to low, or very low, quality of evidence, we are unable to say whether prokinetics are effective for the treatment of functional dyspepsia . We are uncertain which of the individual prokinetic drugs is the most effective as well as whether prokinetics can improve quality of life. Apart from cisapride, prokinetics are well-tolerated. Good quality RCTs are needed to verify the efficacy of prokinetics.
Collapse
Affiliation(s)
- Rapat Pittayanon
- McMaster UniversityDepartment of Medicine, Division of GastroenterologyHamiltonONCanada
- Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red CrossDivision of Gastroenterology, Department of Medicine, Faculty of Medicine1873 Rama 4 RoadPatumwanBangkokThailand10330
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of GastroenterologyHamiltonONCanada
| | | | - Reena Khanna
- University of Western OntarioDepartment of MedicineLondonONCanada
| | | | - Paul Moayyedi
- McMaster UniversityDepartment of Medicine, Division of GastroenterologyHamiltonONCanada
| | | |
Collapse
|
45
|
Majeed M, Majeed S, Nagabhushanam K, Arumugam S, Pande A, Paschapur M, Ali F. Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. J Med Food 2018; 21:1120-1128. [PMID: 30156436 PMCID: PMC6249666 DOI: 10.1089/jmf.2017.4172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Functional dyspepsia (FD) is a highly prevalent disorder having nonspecific symptoms and varied pathophysiology. Its treatment remains a challenge as therapeutic options are limited, unsatisfactory, and elusive. Thus, safety and efficacy of DigeZyme®, a proprietary multienzyme complex (MEC), was evaluated as a dietary supplement in FD patients. In this randomized, double-blind, placebo-controlled, parallel-group study, 40 patients were randomly assigned (1:1 ratio) to receive either MEC (50 mg, TID; n = 20) or placebo (n = 20) for 60 days. Reports of adverse or serious adverse events (AEs), abnormal results of vital signs, abnormal findings during physical examination, and abnormal laboratory investigations were monitored closely. Efficacy measures were change in Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Nepean Dyspepsia Index-Short Form (NDI-SF), Visual Analog Scale (VAS), Clinical Global Impression Severity Rating Scale (CGI-S), and Glasgow Dyspepsia Severity Score (GDSS) at baseline and follow-up visits on day 15, 30, and 60. Supplementation with MEC was associated with statistically significant differences (P value ranging from .0401 to .0033) in all efficacy parameters compared with placebo. The between-group comparison also revealed that MEC supplement had a significantly greater effect (P < .001) versus placebo. No investigation product-related AEs were reported. There were no clinically significant abnormalities in physical findings and no statistically significant changes in biochemical and hematological parameters, vital signs, body weight, and body mass index observed between the two groups at baseline and follow-up visits. MEC supplementation represents an effective and safe alternative to manage dyspepsia symptoms in FD patients.
Collapse
Affiliation(s)
- Muhammed Majeed
- 1 Sami Labs Limited , Bangalore, Karnataka, India .,2 Sabinsa Corporation , East Windsor, New Jersey, USA.,3 Sabinsa Corporation , Payson, Utah, USA.,4 ClinWorld Private Limited , Bangalore, Karnataka, India
| | - Shaheen Majeed
- 1 Sami Labs Limited , Bangalore, Karnataka, India .,2 Sabinsa Corporation , East Windsor, New Jersey, USA.,3 Sabinsa Corporation , Payson, Utah, USA
| | | | | | - Anurag Pande
- 2 Sabinsa Corporation , East Windsor, New Jersey, USA
| | | | - Furqan Ali
- 1 Sami Labs Limited , Bangalore, Karnataka, India
| |
Collapse
|
46
|
Su Q, Chen SL, Wang HH, Liang LX, Dai N, Lyu B, Zhang J, Wang RQ, Zhang YL, Yu Y, Liu JS, Hou XH. A Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial of Qi-Zhi-Wei-Tong Granules on Postprandial Distress Syndrome-Predominant Functional Dyspepsia. Chin Med J (Engl) 2018; 131:1549-1556. [PMID: 29941708 PMCID: PMC6032672 DOI: 10.4103/0366-6999.235118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Functional dyspepsia (FD) is a common upper gastrointestinal disorder worldwide, but the current treatments for FD are still unsatisfactory. The aims of this study were to investigate the efficacy and safety of Qi-Zhi-Wei-Tong granules in patients with postprandial distress syndrome (PDS)-predominant FD. Methods: The study was conducted as a randomized, double-blinded, multicenter, placebo-controlled design in 197 patients with PDS. All participants received placebo treatment for 1 week. Patients whose total symptom score decreased by <50% after the placebo treatment were recruited into the 4-week treatment period, in which they were randomly assigned to be treated with either Qi-Zhi-Wei-Tong granules or placebo. The patients were then followed for 2 weeks without any treatment. Dyspeptic symptoms were scored at weeks 2 and 4 during the random treatment period and 2 weeks after the treatment. Anxiety and depression symptoms were also scored and compared. Results: (1) The total effective rates in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 during the random treatment period and 2 weeks after treatment were all significantly higher than those in the placebo group (38.82% vs. 8.75%, P < 0.001; 69.14% vs. 16.25%, P < 0.001; 77.65% vs. 21.25%, P < 0.001). (2) The total dyspeptic symptoms scores in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 and 2 weeks after treatment were significantly lower than those in the placebo group. (3) The severity and frequency of each dyspeptic symptom at weeks 2 and 4 and the follow-up period were all significantly lower than those in the placebo group. (4) The anxiety scores in the Qi-Zhi-Wei-Tong granules group were significantly lower than those in the placebo group. (5) Qi-Zhi-Wei-Tong granules did not have more adverse effects than the placebo. Conclusion: Qi-Zhi-Wei-Tong granules offer significant symptomatic improvement in PDS with no more adverse effects than placebo. Trial Registration: https://clinicaltrials.gov/, NCT02460601.
Collapse
Affiliation(s)
- Qing Su
- Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Sheng-Liang Chen
- Department of Gastroenterology, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Hua-Hong Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Lie-Xin Liang
- Department of Gastroenterology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Ning Dai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Bin Lyu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, China
| | - Jun Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Rong-Quan Wang
- Department of Gastroenterology, The Southwest Hospital of Third Military Medical University, Chongqing 400038, China
| | - Ya-Li Zhang
- Department of Gastroenterology, The Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yue Yu
- Department of Gastroenterology, Anhui Provincial Hospital, Hefei, Anhui 230001, China
| | - Jin-Song Liu
- Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Xiao-Hua Hou
- Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| |
Collapse
|
47
|
Wang H, Lu Z, Liu YH, Sun Y, Tu L, Ngan MP, Yeung CK, Rudd JA. Establishment of a radiotelemetric recording technique in mice to investigate gastric slow waves: Modulatory role of putative neurotransmitter systems. Exp Physiol 2018; 103:827-837. [PMID: 29667248 DOI: 10.1113/ep086815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
NEW FINDINGS What is the central question of this study? Gastric slow waves originating from the interstitial cells of Cajal-smooth muscle syncytium are usually studied in culture or in tissue segments, but nobody has described recordings of slow waves from awake, freely moving mice. Can radiotelemetry be used to record slow waves, and do they respond predictably to drug treatment? What is the main finding and its importance? Radiotelemetry can be used to record slow waves from awake, freely moving mice, permitting an examination of drug actions in vivo, which is crucial to drug discovery projects for characterizing the effects of drugs and metabolites on gastrointestinal function. ABSTRACT The mouse is the most commonly used species in preclinical research, and isolated tissues are used to study slow waves from the interstitial cells of Cajal-smooth muscle syncytium of the gastrointestinal tract. The aim of this study was to establish a radiotelemetric technique in awake mice to record gastric myoelectric activity from the antrum to gain insight into the effects of endogenous modulatory systems on slow waves. Under general anaesthesia, two biopotential wires from a telemetry transmitter were sutured into the antrum of male ICR (imprinting control region) mice. The animals were allowed 1 week to recover from surgery before the i.p. administration of drugs to stimulate or inhibit slow waves. The basal dominant frequency of slow waves was 6.96 ± 0.43 c.p.m., and the percentages of power in the bradygastric, normogastric and tachygastric ranges were 6.89 ± 0.98, 37.32 ± 1.72 and 34.38 ± 0.77%, respectively (n = 74). Nicotine at 1 mg kg-1 increased normogastric power, but at 3 mg kg-1 it increased bradygastric power (P < 0.05). Metoclopramide at 10 mg kg-1 increased normogastric power; sodium nitroprusside at 10 mg kg-1 had latent effects on tachygastric power (P < 0.05); and l-NAME at 10 mg kg-1 had no effect (P > 0.05). Nicotine and bethanechol also caused varying degrees of hypothermia (>1°C reductions; P < 0.05). In conclusion, radiotelemetry can be used to record slow waves from awake, freely moving mice. In light of our findings, we recommend that studies assessing slow waves should also assess body temperature simultaneously.
Collapse
Affiliation(s)
- Huichuan Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Zengbing Lu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Yuen Hang Liu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Yayi Sun
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Longlong Tu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Man P Ngan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Chi-Kong Yeung
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - John A Rudd
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China.,Brain and Mind Institute, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| |
Collapse
|
48
|
Fang JY, Du YQ, Liu WZ, Ren JL, Li YQ, Chen XY, Lv NH, Chen YX, Lv B. Chinese consensus on chronic gastritis (2017, Shanghai). J Dig Dis 2018; 19:182-203. [PMID: 29573173 DOI: 10.1111/1751-2980.12593] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
49
|
Koduru P, Irani M, Quigley EMM. Definition, Pathogenesis, and Management of That Cursed Dyspepsia. Clin Gastroenterol Hepatol 2018; 16:467-479. [PMID: 28899670 DOI: 10.1016/j.cgh.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Abstract
Dyspepsia is an umbrella term used to encompass a number of symptoms thought to originate from the upper gastrointestinal tract. These symptoms are relatively nonspecific; not surprisingly, therefore, a myriad of conditions may present with any one or a combination of these symptoms. Therein lays the clinician's first challenge: detecting the minority who may have a potentially life-threatening disorder, such as gastric cancer, from a population whose symptoms are, for the most part, considered functional in origin. The second challenge lies in the definition and management of those individuals with functional dyspepsia (FD); the major focus of this review. The Rome process has addressed the issue of FD definition and a look back at the evolution of Rome criteria for this disorder illustrates the complexities that have so frustrated us. There has been no shortage of hypotheses to explain symptom pathogenesis in FD; initially focused on gastric sensorimotor dysfunction, these have now strayed well into the duodenum and have come to entertain such factors as immune responses and the microbiome. FD has proven to be an equally challenging area for therapeutics; while the staple approaches of acid suppression and eradication of Helicobacter pylori have some limited efficacy in select populations, strategies to ameliorate symptoms in the majority of sufferers based on presumed pathophysiology have largely foundered. Lacking a validated biomarker(s) FD continues to be an elusive target and is likely to remain so until we can better define the various phenotypes that it must surely contain.
Collapse
Affiliation(s)
- Pramoda Koduru
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Malcolm Irani
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Eamonn M M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
| |
Collapse
|
50
|
Talley NJ. Functional Dyspepsia: Advances in Diagnosis and Therapy. Gut Liver 2018; 11:349-357. [PMID: 28452210 PMCID: PMC5417776 DOI: 10.5009/gnl16055] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/19/2016] [Indexed: 12/13/2022] Open
Abstract
Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pre-test probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD–Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation.
Collapse
Affiliation(s)
- Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| |
Collapse
|