Functional dyspepsia leads to more healthcare utilization in secondary care compared with other functional gastrointestinal disorders

Acupuncture and moxibustion intervention in functional dyspepsia: Gastric and duodenal regulation

Functional dyspepsia (FD) is a brain-gut interaction disorder located in the stomach and duodenum, which has complex pathophysiological mechanisms, and there is no effective treatment for FD. Acupuncture and moxibustion have been proven to have definite and significant efficacy on FD. Focusing on the affected area and combined with the potential pathophysiology of FD, here we discuss the possible mechanisms of acupuncture and moxibustion in treating FD to guide future clinical and experimental research. We argue that the pathological causes of FD can be roughly divided into gastrointestinal dysfunction, duodenal low-grade inflammation, visceral hypersensitivity, and duodenal intestinal barrier and microbial imbalance. Correspondingly, the possible mechanisms of acupuncture and moxibustion in treating FD are elucidated from the perspective of how they improve gastric accommodation, regulate gastrointestinal motility, reduce gastric visceral sensitivity, regulate eosinophil-mast cell axis, inhibit low-grade inflammatory responses, and possibly regulate intestinal microbial homeostasis and duodenal barrier function through the microbiota-gut-brain axis. Although some evidence is still lacking, acupuncture remains a promising treatment for FD. In the future, it is necessary to conduct additional clinical and experimental research on acupuncture and moxibustion in treating FD to further explore their effects and mechanisms.

Efficacy of antidepressants in functional dyspepsia: Systematic review and meta-analysis with trial sequential analysis of randomized controlled trials

INTRODUCTION

The beneficial effects of using antidepressants in improving functional dyspepsia (FD) symptoms have been reported in previous meta-analyses; however, the results have not been conclusive. The aim was to perform an updated meta-analysis coupled with trial sequential analysis (TSA) to assess the efficacy of the use of any antidepressants in the treatment of FD in adults.

METHODS

Electronic databases were searched up to March 2024 for randomized controlled trials (RCTs) recruiting adults with FD. Data of overall symptoms improved between the antidepressants and placebo groups was pooled to obtain risk ratio (RR) employing the random-effects model. The effect of random errors was evaluated with TSA. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. Analyses were performed using STATA version 16.0.

RESULTS

Nine RCTs with 924 patients met the eligible criteria. The RRs of FD symptoms improving with any antidepressants, tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors were (n = 9, RR = 1.30 [95% CI, 1.02-1.67]), (n = 5, RR = 1.41 [95% CI, 1.07-1.85]) and (n = 2, RR = 0.97 [95% CI, 0.72-1.29]), respectively. TSA demonstrated conclusive evidence for the beneficial effect of TCAs. The number needed to treat (NNT) with any depressants and TCAs were 11 (95% CI, 7-36) and 6 (95% CI, 4-15), respectively. The certainty of the evidence for an effect of TCAs was that of moderate GRADE quality. The benefit, however, was limited to the western population (n = 3, RR = 1.43 [95% CI, 1.04-1.96]) and did not extend to the Asian population (n = 2, RR = 1.32 [95% CI, 0.75-2.32]). Conversely, antidepressant-using patients experienced adverse events more frequently. However, no statistically significant association was found between TCAs and any adverse events (n = 3; RR = 1.36 [95% CI, 0.91-2.04]).

CONCLUSION

Evidence was obtained suggesting TCAs can be an effective alternative in the treatment of FD, but more evidence from high-quality large trials is required to support their use, especially in the Asian population.

Evaluating the accuracy and reproducibility of ChatGPT-4 in answering patient questions related to small intestinal bacterial overgrowth

BACKGROUND

Small intestinal bacterial overgrowth (SIBO) poses diagnostic and treatment challenges due to its complex management and evolving guidelines. Patients often seek online information related to their health, prompting interest in large language models, like GPT-4, as potential sources of patient education.

AIM

To investigate ChatGPT-4's accuracy and reproducibility in responding to patient questions related to SIBO.

METHODS

A total of 27 patient questions related to SIBO were curated from professional societies, Facebook groups, and Reddit threads. Each question was entered into GPT-4 twice on separate days to examine reproducibility of accuracy on separate occasions. GPT-4 generated responses were independently evaluated for accuracy and reproducibility by two motility fellowship-trained gastroenterologists. A third senior fellowship-trained gastroenterologist resolved disagreements. Accuracy of responses were graded using the scale: (1) Comprehensive; (2) Correct but inadequate; (3) Some correct and some incorrect; or (4) Completely incorrect. Two responses were generated for every question to evaluate reproducibility in accuracy.

RESULTS

In evaluating GPT-4's effectiveness at answering SIBO-related questions, it provided responses with correct information to 18/27 (66.7%) of questions, with 16/27 (59.3%) of responses graded as comprehensive and 2/27 (7.4%) responses graded as correct but inadequate. The model provided responses with incorrect information to 9/27 (33.3%) of questions, with 4/27 (14.8%) of responses graded as completely incorrect and 5/27 (18.5%) of responses graded as mixed correct and incorrect data. Accuracy varied by question category, with questions related to “basic knowledge” achieving the highest proportion of comprehensive responses (90%) and no incorrect responses. On the other hand, the “treatment” related questions yielded the lowest proportion of comprehensive responses (33.3%) and highest percent of completely incorrect responses (33.3%). A total of 77.8% of questions yielded reproducible responses.

CONCLUSION

Though GPT-4 shows promise as a supplementary tool for SIBO-related patient education, the model requires further refinement and validation in subsequent iterations prior to its integration into patient care.

Application and value of anxiety and depression scale in patients with functional dyspepsia

BACKGROUND

Patients with functional dyspepsia (FD) cannot be assessed for their mental health using a suitable and practical measure. The purpose of the study is to investigate the usefulness of several anxiety and depression scales in patients with FD, offering recommendations for clinical identification and therapy.

METHODS

From September 2021 to September 2022, patients were sought and selected. The psychological symptoms were assessed using ten depression or anxiety questionnaires. The receiver operating characteristic (ROC) curve, Spearman analysis, Pearson correlation analysis, and single factor analysis were applied.

RESULTS

Prospective analysis was performed on 142 healthy individuals and 113 patients with FD. In the case group, anxiety and depression symptoms were more common than in the control group, and the 10 scales showed strong validity and reliability. HAMD had the strongest connection with the PHQ-9 score on the depression scale (0.83). The score correlation between SAS and HAMA on the anxiety analysis scale was the greatest at 0.77. The PHQ-9, SAS, HAMD, and HAMA measures performed exceptionally well in detecting FD with anxiety or depression symptoms (AUC = 0.72, 0.70, 0.70, 0.77, and 0.77, respectively).

CONCLUSIONS

PHQ-9, SAS, HAMD, and HAMA scales have good application performance in FD patients. They can assist gastroenterologists in evaluating anxiety and depression symptoms, and provide reference and guidance for subsequent treatment.

Global prevalence of functional dyspepsia according to Rome criteria, 1990-2020: a systematic review and meta-analysis

Although functional dyspepsia (FD) is a common functional gastroduodenal disorder with a high socioeconomic burden, little is known about its global prevalence. Thus, we performed a comprehensive study to estimate long-term trends in the prevalence of FD. We searched PubMed/MEDLINE, Embase, and Google Scholar from 1990 to 2022 for population-based studies that reported the prevalence of FD in adults (≥ 18 years old) according to Rome I, II, III, or IV criteria. The prevalence of FD was extracted from included studies to obtain pooled prevalence with 95% confidence intervals (CI) and 95% prediction intervals. Subgroup analysis was performed according to certain characteristics, including geographic region. A total of 44 studies met the eligibility criteria, including 256,915 participants from 40 countries across six continents. The overall global pooled prevalence of FD was 8.4% (95% CI 7.4-.9.5). The prevalence was the highest in Rome I (11.9%; 95% CI 5.1-25.4) and lowest in Rome IV (6.8%; 95% CI 5.8-7.9). Developing countries showed a higher prevalence than developed countries (9.1% versus 8.0%), and prevalence was higher in women, irrespective of the definition used (9.0% versus 7.0%). The pooled prevalence gradually decreased from 1990 to 2020 (12.4% [8.2-18.3] in 1990-2002 versus 7.3% [6.1-8.7] in 2013-2020). The prevalence of FD differs by country, economic status, geographical region, and sex, and the global prevalence has been gradually declining. Despite the heterogeneity of sample population, our study estimates the current global burden of FD and provides information to heath care policy decisions.

Curricular representation of neurogastroenterology: A survey among medical students in Germany

BACKGROUND

Neurogastroenterological disorders (NGDs) are highly prevalent and substantially impact patients' quality of life. Effective treatment of NGDs depends on the competence and training of medical caregivers. Students' perceived competence in neurogastroenterology and its place in medical school curricula are assessed in this study.

METHODS

A multi-center digital survey among medical students was conducted at five universities. Self-ratings of competence regarding basic mechanisms, diagnosis, and treatment of six chronic medical conditions were assessed. These included irritable bowel syndrome (IBS), gastroesophageal reflux disease, and achalasia. Ulcerative colitis, hypertension, and migraine were included as references.

KEY RESULTS

Of 231 participants, 38% remembered that neurogastroenterology was covered in their curriculum. Highest competence ratings were stated for hypertension and the lowest for IBS. These findings were identical for all institutions irrespective of their curricular model and demographic parameters. Students who remembered neurogastroenterology as a part of their curriculum reported higher competence ratings. According to 72% of students, NGDs should be highlighted more prominently in the curriculum.

CONCLUSIONS & INFERENCES

Despite its epidemiological relevance, neurogastroenterology is only weakly represented in medical curricula. Students report low levels of subjective competence in handling NGDs. In general, assessing the learners' perspective on an empirical basis may enrichen the process of national standardization of medical school curricula.

It's a helluva journey: a qualitative study of patient and clinician experiences of nausea and vomiting syndromes

Background

Chronic gastroduodenal disorders including, chronic nausea and vomiting syndrome, gastroparesis, and functional dyspepsia, are challenging to diagnose and manage. The diagnostic and treatment pathways for these disorders are complex, costly and overlap substantially; however, experiences of this pathway have not been thoroughly investigated. This study therefore aimed to explore clinician and patient perspectives on the current clinical pathway.

Methods

Semi-structured interviews were conducted between June 2020 and June 2022 with 11 patients with chronic nausea and vomiting syndrome alone (based on Rome IV criteria) and nine gastroenterologists who treat these conditions. Interviews were recorded, transcribed, and thematically analyzed using a reflexive, iterative, inductive approach. Five key patient themes were identified: (1) the impacts of their chronic gastroduodenal symptoms, (2) the complexity of the clinical journey, (3) their interactions with healthcare providers, (4) the need for advocacy, and (5) their experience of treatments. Five key clinician themes were also identified: (1) these conditions were seen as clinically complex, (2) there is an uncertain and variable clinical pathway, (3) the nuance of investigations, (4) these conditions were difficult to therapeutically manage, and (5) there are barriers to developing a therapeutic relationship.

Conclusion

Findings indicate that both patients and clinicians are dissatisfied with the current clinical care pathways for nausea and vomiting syndromes. Recommendations included the development of more clinically relevant and discriminant tests, standardization of the diagnostic journey, and the adoption of a multidisciplinary approach to diagnosis and treatment.

Clinical outcome of disorders of gut-brain interaction in secondary care: A longitudinal study

BACKGROUND

Real-world data on the outcome of routine treatment for disorders of gut-brain interaction (DGBI) in secondary care are lacking.

METHOD

A longitudinal study of consecutive adult patients with various DGBI attending this institution's gastroenterology clinic was conducted. Following 2 years of treatment, the proportion of patients with symptom improvement, details of clinical therapy, factors associated with and the impact of 'no symptom improvement' were determined.

RESULTS

A total of 289 patients (median age 68 years; 64.7% females; 28.4% irritable bowel syndrome (IBS), 20.1% functional dyspepsia (FD), 8.7% functional constipation (FC), 42.9% overlap syndrome) were recruited. After 2 years, 66.1% patients reported symptom improvement. Patients with overlap syndrome were less likely to have symptomatic improvement compared to those with a single DGBI (Overlap 55.6% vs IBS 74.4% vs FD 72.4% vs FC 76.0%, p = 0.014). Reassurance was associated with symptom improvement (p < 0.001). On multivariate analysis, overlap syndrome remained significantly associated with a poorer outcome (OR 2.27, 95% CI 1.22-4.25, p = 0.010), while providing reassurance was associated with a positive outcome (OR 0.30, 95% CI 0.16-0.56, p < 0.001). Only 25.6% and 14.9% of patients were referred for a low FODMAP diet and psychiatric intervention respectively. DGBI patients who had 'no improvement' were more likely to seek further GI consultations and had more work absenteeism.

CONCLUSION

Two-thirds of DGBI patients in secondary care showed symptom improvement. Patients who were reassured had better symptom improvement, while those with an overlap syndrome were associated with a poorer outcome, resulting in greater healthcare consultation and work absenteeism.

Functional gastrointestinal disorders among healthcare professionals at a tertiary Australian hospital

Background and Aim

The aim of this study was to determine the frequency, characteristics, and associations of functional gastrointestinal disorders (FGIDs) among healthcare professionals.

Methods

A qualitative survey was conducted among the staff at a tertiary Australian hospital between January 2017 and June 2018. Rome III criteria (excluding endoscopic) were used to define FGID. Multivariable logistic regression was used to explore associations.

Results

Of the 274 respondents (17% doctors, 66% nurses, 17% others; 77% female), 54% had experienced GI symptoms ≥3 times per week and 23% were diagnosed with FGIDs (2% IBS, 19% FD, 2% both). GI symptoms were more common in females (58% vs. 38%), Caucasians versus Asians (59% vs. 35%), respondents who were easily (67% vs. 40%) or often stressed (58% vs. 37%), and had irregular working hours (62% vs. 46%, each P < 0.05). Independent predictors of GI symptoms included being easily stressed (OR 2.7) and female sex (OR 2.4), while Asian ethnicity was protective (OR 0.42, each P < 0.05). FGIDs were more prevalent in respondents who often felt stressed (27% vs. 10%), felt easily stressed (29% vs. 17%), and in nurses compared to others (27% vs. 16%; each P < 0.05). The only independent predictor of FGID was being often stressed (OR 4.1, P = 0.011).

Conclusions

FGIDs and GI symptoms are prevalent among hospital workers. Stress, female sex, irregular working hours, and non-Asian ethnicity appeared to be associated with GI symptoms and FGIDs.

The epidemiology and impact of disorders of gut-brain interaction in Canada: Results from the Rome Foundation Global Epidemiologic Study

BACKGROUND

Using data from the Rome Foundation Global Epidemiology Study examining prevalence of disorders of gut-brain interaction (DGBI) in 33 countries, this study explored the prevalence of all 22 disorders in Canada. It examined differences related to geography and sociodemographic factors, health impact and compared these findings to other countries.

METHODS

The Rome Foundation survey was conducted through the Internet, targeting 2000 Canadian participants. The survey used the validated ROME IV diagnostic questionnaire to identify the 22 DGBI and an in-depth supplemental questionnaire that included quality assurance techniques.

KEY RESULTS

There were 2029 respondents with a mean age of 48 years and 50% females. Diagnostic criteria for at least one of the 22 DGBI were met by 41.3%, similar to other countries. Functional constipation, functional diarrhea, and unspecified functional bowel disorders were most common. Irritable bowel syndrome prevalence was 4.2% using Rome IV and 10.1% using ROME III criteria. DGBI were associated with poorer quality of life and increased psychological symptom scores. Prevalence of DGBI ranged from 48% in Quebec to 36% in British Columbia. Prescription pain medication was reported by 17% with DGBI compared to 9% without DGBI and correlated negatively with mental health and physical well-being. Quebecers and francophones were in limited number but reported higher DGBI prevalence and symptom severity compared to others.

CONCLUSIONS & INFERENCES

A large proportion of Canadians suffer from DGBI which seriously impact their well-being. Findings highlight the need for further research and education, including understanding whether significant regional and cultural differences contribute to DGBI.

Comparing diagnostic performance of Cantonese-Chinese version of Rome IV criteria and a short Reference Standard for functional dyspepsia in China

INTRODUCTION

Functional dyspepsia (FD) is diagnosed based on self-reported symptoms and negative upper gastrointestinal endoscopic findings. The Rome criteria were not adopted as a diagnostic instrument in clinical guidelines due to their complexity. Different guidelines used relatively simple symptom assessment schemes with contents that vary significantly. A previously evaluated short Reference Standard may serve as a more standardised tool for guidelines. We evaluated its diagnostic accuracy against the Rome IV criteria in a cross-sectional study in Hong Kong.

METHODS

A total of 220 dyspeptic patients sampled consecutively from a tertiary hospital and the community completed the Rome IV diagnostic questionnaire, which was translated into Cantonese-Chinese, and the Reference Standard. Sensitivity, specificity, positive and negative likelihood ratios (LRs), and area under the receiver operating characteristics curve (AUC), with 95% confidence intervals (CIs), were calculated.

RESULTS

Among the participants, 160 (72.7%) fulfilled the Reference Standard with negative upper gastrointestinal endoscopic results. The Reference Standard identified patients with Rome IV-defined FD with 91.1% (95% CI 82.6%-96.4%) sensitivity and 37.6% (95% CI 29.6%-46.1%) specificity. The positive and negative LRs were 1.46 (95% CI 1.26-1.69) and 0.24 (95% CI 0.11-0.49), respectively. The AUC value was 0.64 (95% CI 0.59-0.69).

CONCLUSIONS

The Reference Standard can rule out patients without Rome IV-defined FD. It may be used as an initial screening tool for FD in settings where the use of the Rome IV criteria is impractical. It may also provide a uniform definition and diagnostic rule for future updates of clinical guidelines.

Epidemiological trends of gastrointestinal and liver diseases in Malaysia: A single-center observational study

BACKGROUND AND AIM

The spectrum of gastrointestinal (GI) and liver diseases is recognized to have a geographical variation, which may be due to environmental or genetic differences. We aimed to explore this further in a specialist clinic serving a multi-ethnic Asian urban population.

METHODS

A retrospective analysis of outpatient data from this institution's electronic medical records was conducted between January and June 2019. Clinical diagnoses of GI and liver diseases and associated demographic information were collected.

RESULTS

Data from 3676 adult patients (median age 62 years, female 51.1%) were available for analysis. The frequency of luminal GI, liver and pancreato-biliary diseases were 34.2%, 63.2%, and 2.6%, respectively. Among luminal GI diseases, 38.6% were functional gastrointestinal disorders and 61.4% had an organic cause. A higher proportion of patients of Indian ethnicity were diagnosed with IBD compared with other ethnic groups (India 21.9%, Malay 16.5%, Chinese 12.2%, P = 0.001). Among liver diseases, the most common etiologies were HBV (44.4%) and NAFLD (39.3%). Cirrhosis and/or hepatocellular carcinoma were present in 18% of liver diseases, with NAFLD as the most frequent etiology. Among patients with NAFLD, a higher proportion of ethnic Malays and Indians were evident (Malay 53.8% vs Chinese 28.7% vs Indian 61.1%, P < 0.001). In contrast, a greater proportion of ethnic Chinese were diagnosed with HBV compared with other ethnic groups (Malay 30.9% vs Chinese 57.5% vs Indian 8.4%, P < 0.001).

CONCLUSION

The spectrum of GI and liver diseases has a peculiar epidemiology, particularly with reference to the ethnic predilection of certain diseases.

Do Socio-Demographics Play a Role in the Prevalence of Red Flags and Pursuant Colonoscopies in Patients With Irritable Bowel Syndrome?

Background

Irritable bowel syndrome (IBS) is a “brain-gut disorder” that lacks laboratory, radiologic, or physical exam findings. Colonoscopies are not routinely performed unless “red flag” symptoms, such as bleeding or abnormal weight loss, are present. Socio-demographics have been implicated as sources of potential disparities in appropriate care.

Aims

We hypothesize that the incidence of red flag symptoms and pursuant colonoscopies differ by socio-demographic status in patients with IBS.

Methods

Patients diagnosed with IBS were extracted from the National Inpatient Sample 2001-2013 using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Gastrointestinal bleed, blood in stool, weight loss, and anemia were pooled into red flag symptoms. Colonoscopies during the admission were identified using ICD-9 procedural codes. Chi-square analysis and binomial logistic regression were used to evaluate potential disparities with α<0.01.

Results

Patients with Medicaid or Medicare or those without insurance had higher odds of presenting with red flag symptoms compared to those with private insurance. Medicaid patients and uninsured patients had higher odds of undergoing colonoscopies. All patients that were not Caucasian had higher odds of presenting with red flags and subsequently undergoing colonoscopies. Older patients had higher odds of presenting with concerning red flag symptoms but lower odds of undergoing colonoscopies.

Conclusions

The incidence of red flag symptoms and performance of colonoscopies differed by socio-demographics in patients with IBS. Patients with non-private or those without insurance were more likely to have red flags and undergo a colonoscopy. Age and race also increased rates of red flag symptoms while having a mixed effect on pursuant colonoscopies. This may represent discrepancies in healthcare utilization in a vulnerable population.