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Arnaout AY, Alhejazi TJ, Nerabani Y, Hamdan O, Arnaout K, Arnaout I, aljarad Z. The prevalence and risk factors of functional dyspepsia among adults in low- and middle-income countries: An international cross-sectional study. Medicine (Baltimore) 2023; 102:e35437. [PMID: 37800762 PMCID: PMC10553146 DOI: 10.1097/md.0000000000035437] [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: 03/02/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Dyspepsia is one of the most common chronic digestive diseases, which is due to underlying organic causes that can be detected, or causes that cannot be detected called functional dyspepsia (FD). There is no epidemiological study to date that measures the prevalence and risk factors of the FD in low- and middle-income countries, so this international cross-sectional study was conducted in 15 low- and middle-income countries from data previously published its protocol NCT05340400. Participants were recruited in the period from 22/April/2022 to 14/June/2022. The diagnosis of the FD was according to clinical manifestations. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias. Our study concluded that the prevalence of FD is much higher in low- and middle-income countries 37.9% [6.2%-44.2%], compared to high-income countries 10% [8%-12%], with a higher rate among the Afro-Caribbean race 47.9%. Sudan obtained the highest prevalence 44.3%, then Egypt 41.4%, while the lowest prevalence was in Algeria 25.7%. Moreover, there are many risk factors, including modifiable ones, such as severe stress, chronic fatigue, smoking, abnormal BMI, insufficient or too many hours of sleep, and previous infection with Covid-19, and non-modifiable ones such as advanced age, chronic diseases, and female sex. Highlighting the prevalence and increasing risk factors of FD in low- and middle-income countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.
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Affiliation(s)
| | | | - Yaman Nerabani
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ola Hamdan
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Khaled Arnaout
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ibrahim Arnaout
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ziad aljarad
- MD, MSc, PhD Gastroenterologist, University of Aleppo, Aleppo, Syrian Arab Republic
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Ha NY, Ko SJ, Park JW, Kim J. Efficacy and safety of the herbal formula Naesohwajung-tang for functional dyspepsia: a randomized, double-blind, placebo-controlled, multi-center trial. Front Pharmacol 2023; 14:1157535. [PMID: 37251334 PMCID: PMC10213234 DOI: 10.3389/fphar.2023.1157535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Current treatment and management options for functional dyspepsia (FD) often fail to alleviate symptoms. Naesohwajung-tang (NHT) is a herbal formula frequently used to treat functional dyspepsia in traditional Korean medicine. However, few animal and case reports on the use of Naesohwajung-tang for functional dyspepsia treatment exist, and the clinical evidence remains deficient. Objectives: This study aimed to evaluate the efficacy of Naesohwajung-tang in patients with functional dyspepsia. Methods: We enrolled 116 patients with functional dyspepsia at two study sites in this 4 weeks, randomized, double-blind, placebo-controlled trial and randomly assigned them to either the Naesohwajung-tang or placebo group. To evaluate the efficacy of Naesohwajung-tang, the primary endpoint was a score on the total dyspepsia symptom (TDS) scale after treatment. The overall treatment effect (OTE), single dyspepsia symptom (SDS) scale, food retention questionnaire (FRQ), Damum questionnaire (DQ), functional dyspepsia-related quality of life (FD-QoL) questionnaire, and gastric myoelectrical activity measured using electrogastrography were evaluated as secondary outcomes. Laboratory tests were performed to confirm the safety of the intervention. Results: The 4 weeks administration of Naesohwajung-tang granules demonstrated a significantly higher reduction in the total dyspepsia symptom (p < 0.05) and a higher degree of improvement in the total dyspepsia symptom (p < 0.01) than the placebo group. Patients who underwent Naesohwajung-tang had a significantly higher overall treatment effect and a greater increase in the degree of improvement in scores such as epigastric burning, postprandial fullness, early satiation, functional dyspepsia-related quality of life, and Damum questionnaire (p < 0.05). Additionally, the Naesohwajung-tang group showed a greater effect in preventing a decrease in the percentage of normal gastric slow waves after meals than the placebo group. As a result of subgroup analyses using the degree of improvement in total dyspepsia symptom, Naesohwajung-tang was found to be more effective than placebo in female, younger patients (<65 years), with a high body-mass index (≥22), overlap type, food retention type, and Dampness and heat in the spleen and stomach systems pattern. There was no significant difference in the incidence of adverse events between the two groups. Conclusion: This is the first randomized clinical trial to verify that Naesohwajung-tang leads on symptom relief in patients with functional dyspepsia. Clinical Trial Registration: https://cris.nih.go.kr/cris/search/detailSearch.do/17613, identifier KCT0003405.
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Affiliation(s)
- Na-Yeon Ha
- Division of Digestive Diseases, Department of Internal Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seok-Jae Ko
- Department of Gastroenterology, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Gastroenterology, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Gastroenterology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Setia G, Ramanathan M, Bhavanani AB, Prabu BSM, B V, N A. Adjuvant yoga therapy for symptom management of functional dyspepsia: A case series. J Ayurveda Integr Med 2023; 14:100715. [PMID: 37216873 PMCID: PMC10213372 DOI: 10.1016/j.jaim.2023.100715] [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: 09/22/2022] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 05/24/2023] Open
Abstract
Functional Dyspepsia (FD), commonly called chronic indigestion, comes under the umbrella of 'Disorders of Gut-Brain Axis'. It manifests as a cluster of upper gastrointestinal symptoms including epigastric pain or burning, postprandial fullness and early satiety. Since the pathophysiology is complex, it is often difficult to effectively manage and significantly impacts the patient's quality of life. This case series aims to elucidate the role of Yoga as an adjuvant therapy to modern medicine in providing relief of dyspeptic symptoms in such patients. Yoga is an ancient Indian mind-body practise that has the potential to be used for various brain-gut disorders. Apart from treating the gut disorders from top down (mind-gut) pathway, it may have more direct physiological effects as well. Researches on IBS and one research on abdominal pain related FGID have shown Yoga therapy to be effective in ameliorating the symptoms. In this study, we present three such cases (1 male and 2 female) having a clinical diagnosis of FD in detail. These patients were initially non-responsive to medications but later showed remarkable improvement in symptoms within one month of added Yoga therapy intervention. This study was conducted as a part of a larger study conducted at a tertiary hospital in Pondicherry in collaboration between its Yoga department and Medical Gastroenterology Department. Yoga therapy protocol was given along with their regular medical management for a month. Gastrointestinal Symptom Rating Scale (GSRS) and Dyspepsia Symptom Score questionnaires were used to assess symptoms before and after the intervention period. All three patients showed marked reductions in symptom scores both in the GSRS and Dyspepsia Questionnaire. The present case series suggests effect of adjuvant Yoga therapy in reducing symptoms of functional dyspepsia. Future studies may clarify the psycho-physiological basis of the same.
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Affiliation(s)
- Garima Setia
- Institute of Salutogenesis & Complementary Medicine (ISCM), Sri Balaji Vidyapeeth (SBV) Deemed-to-be University, Pondicherry, India
| | - Meena Ramanathan
- School of Yoga Therapy, ISCM, SBV Deemed-to-be University, Pondicherry, India.
| | | | - B Sajeeth Manikanda Prabu
- Medical Gastroenterology, Mahatma Gandhi Medical College & Research Institute (MGMCRI), SBV Deemed-to-be University, Pondicherry, India
| | - Vinoth B
- Department of Gastroenterology, Aarupadai Veedu Medical College & Hospital, Pondicherry, India
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Soboka M, Gudina EK, Gashaw M, Amare H, Berhane M, Desalegn H, Tewolde D, Jebena MG, Ali S, Wieser A, Froeschl G, Tesfaye M. Depression among people with dyspepsia and H. pylori infection: A community based cross-sectional study in Ethiopia. PLoS One 2022; 17:e0275424. [PMID: 36201454 PMCID: PMC9536533 DOI: 10.1371/journal.pone.0275424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression is the most common mental health problem, and frequently associated with physical illnesses. A link between depression, dyspepsia and Helicobacter pylori (H. pylori) infection has previously been reported. However, there is limited data regarding the association between these conditions from sub-Saharan Africa where they are highly prevalent. OBJECTIVE This study aimed at elucidating the potential associations between depression, dyspepsia and H. pylori infection in Ethiopia. METHODS We conducted a community based cross-sectional study involving urban and rural residents aged 13 years or older in Jimma Zone, southwest Ethiopia. A total of 871 participants were evaluated using a structured case reporting format for symptoms of dyspepsia and the patient health questionnaire (PHQ-9) for depression. Additionally, participants were assessed for H. pylori infection using stool antigen and serology tests. A multivariate logistic regression was used to identify the association between depression, dyspepsia and H. pylori infection after controlling for potential confounders. RESULTS The prevalence of PHQ-9 scores indicative of probable case of depression among all participants was 10.9%. The prevalence of probable case of depression among patients who had at least one symptom of dyspepsia was 13.3% (X2 = 15.1 = p-value<0.001), while it was 11.9% (X2 = 1.23, p-value = 0.26) among patients who had H. pylori infection. Out of patients who took medications for their heartburn in the past 30 days, 14.9% (X2 = 3.6, p-value = 0.06) had probable case of depression. Dyspepsia symptoms such as epigastric discomfort (aOR = 2.59, 95%CI = 1.14, 5.87), postprandial fullness (aOR = 1.70, 95%CI = 1.48, 5.51), nausea (aOR = 1.71, 95%CI = 1.04, 2.82) excessive belching (aOR = 0.53, 95%CI = 0.31, 0.92) were associated with probable case of depression. However, being H. pylori test positive, gender, and age were not associated with probable case of depression. CONCLUSIONS There was an increased prevalence of probable case of depression among patients who had dyspepsia symptoms and H. pylori infection. Longitudinal studies are needed to examine possible further determinants of association between symptoms of dyspepsia and probable case of depression.
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Affiliation(s)
- Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
- * E-mail:
| | | | - Mulatu Gashaw
- School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Hiwot Amare
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Hailemichale Desalegn
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dagimawi Tewolde
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Mulusew Gerbababa Jebena
- Faculty of Public Health, Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Solomon Ali
- Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Wang J, Duan G, Zhan T, Dong Z, Zhang Y, Chen Y, Sun H, Xu S. Upregulation of Netrin-1 in the hippocampus mediates the formation of visceral hypersensitivity induced by maternal separation. Front Mol Neurosci 2022; 15:908911. [PMID: 35966013 PMCID: PMC9366914 DOI: 10.3389/fnmol.2022.908911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Early adverse life events (EALs), such as maternal separation (MS), can cause visceral hypersensitivity, which is thought to be a key pathophysiological mechanism of irritable bowel syndrome (IBS). Previous studies mainly focused on EALs-induced visceral hypersensitivity in adulthood but did not consider that it may have occurred in the preadult period. We previously found that rats who experienced MS suffered from visceral hypersensitivity starting from the post-weaning period. Moreover, the hippocampus is considered to be critical in regulating the formation of visceral hypersensitivity induced by MS. But the underlying mechanisms throughout different life periods are unclear. In this study, behavioral tests, RNA-seq, lentiviral interference, and molecular biology techniques were applied to investigate the molecular mechanism in the hippocampus underlying MS-induced long-lasting visceral hypersensitivity. It was found that both visceral sensitivity and anxiety-like behaviors were significantly increased in MS rats in post-weaning, prepubertal, and adult periods, especially in the prepubertal period. Subsequently, RNA-seq targeting the hippocampus identified that the expression level of Netrin-1 was significantly increased in all periods, which was further confirmed by quantitative real-time PCR and Western blot. Knocking-down hippocampal Netrin-1 in the post-weaning period by lentivirus interference alleviated visceral hypersensitivity and anxiety-like behaviors of MS rats in the later phase of life. In addition, deleted in colorectal cancer (DCC), instead of neogenin-1(Neo-1) or uncoordinated (UNC5), was proved to be the specific functional receptor of Netrin-1 in regulating visceral hypersensitivity, whose upregulation may result in the most severe symptoms in the prepubertal period. Furthermore, the activation of the Netrin-1/DCC pathway could enhance long-term potentiation (LTP) in the hippocampus, probably via recruitment of the AMPA receptor subunit GluA1, which finally resulted in the formation of visceral hypersensitivity. These novel findings suggest that long-lasting over-expression of Netrin-1 can mediate visceral hypersensitivity and anxiety disorder from the post-weaning period to adulthood by activating DCC/GluA1 pathway in the hippocampus. Moreover, early intervention of Netrin-1 in the post-weaning period could lead to significant symptom relief afterward, which provides evidence that the Netrin-1/DCC/GluA1 signaling pathway may be a potential therapeutic target for the treatment of visceral hypersensitivity in clinics.
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Shi X, Luo H, Wang X, Ren G, Zhang L, Tao Q, Liang S, Liu N, Huang X, Zhang X, Deng H, Qin W, Kang X, Pan Y, Fan D. Functional dyspepsia symptom diary is correlated with other questionnaires and associated with severity in patients with functional dyspepsia: a multicenter, prospective observational study. J Gastroenterol Hepatol 2022; 37:1298-1306. [PMID: 35434810 DOI: 10.1111/jgh.15854] [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: 01/13/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Functional dyspepsia symptom diary (FDSD) is a newly designed questionnaire of functional dyspepsia (FD). The relationships between FDSD and other FD-related questionnaires and patient-reported severity remain unclear. This study aims to investigate the correlations between FDSD and other questionnaires and to determine the relationships between FDSD and FD severity. METHODS Consecutive outpatients with FD were prospectively enrolled in four tertiary hospitals. All patients were evaluated by six FD-related questionnaires, including FDSD, Dyspepsia Symptom Severity Index (DSSI), Gastrointestinal Symptom Rating Scale, Short-Form Nepean Dyspepsia Index, and Hamilton Depression and Anxiety Scale (HAMD and HAMA). The severity of FD was also graded as mild, moderate, and severe by patients themselves. Correlations between different scores were assessed by Spearman correlation coefficient (ρ), and risk factors for patient-reported severity were identified. RESULTS For 512 enrolled FD patients, the overall median FDSD score was 19 (2-42). FDSD was well correlated with DSSI (ρ = 0.64) and fairly correlated with the other four scores (ρ = 0.32-0.55) (all P < 0.001). Mild, moderate, and severe FD were reported by 18.5%, 55.9%, and 25.6% of patients, respectively. There were seven factors associated with the severe FD, including education level, duration, and subtypes of FD, prior treatment, FDSD, HAMD, and HAMA scores (all P < 0.10). FDSD ≥ 20 (odds ratio [OR] 3.3, 95% confidence interval [CI]: 2.0-5.2, P < 0.001) and HAMD ≥ 13 (OR 2.9, 95% CI: 1.8-4.6, P < 0.001) were independently associated with patient-reported severe FD. CONCLUSIONS This study firstly revealed that the newly developed FDSD correlated with other FD-related questionnaires. FDSD ≥ 20 and HAMD ≥ 13 were independently associated with severe FD reported by patients (clinicaltrials.gov number: NCT04953975).
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Affiliation(s)
- Xin Shi
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Hui Luo
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Xiangping Wang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Gui Ren
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Linhui Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Qin Tao
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Shuhui Liang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaojun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaoyin Zhang
- Department of Gastroenterology, National Clinical Research Center of Infectious Disease, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hui Deng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wei Qin
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiaoyu Kang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
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Singh P, Ballou S, Rangan V, Katon J, Hassan R, Iturrino J, Lembo A, Nee J. Clinical and Psychological Factors Predict Outcome in Patients With Functional Dyspepsia: A Prospective Study. Clin Gastroenterol Hepatol 2022; 20:1251-1258.e1. [PMID: 34339874 DOI: 10.1016/j.cgh.2021.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Symptoms of functional dyspepsia (FD) fluctuate over time but there are limited data on the impact of factors on change in dyspepsia symptom severity over time. We aimed to evaluate the demographic, clinical, and psychological factors associated with change in dyspepsia symptom severity. METHODS Consecutive patients with FD presenting to a tertiary care center completed questionnaires assessing clinical and psychological symptoms at the time of the initial visit (baseline) and 3- to 6-month follow-up evaluations. FD and irritable bowel syndrome (IBS) were diagnosed using Rome IV criteria. FD severity was measured using patient assessment of gastrointestinal symptom severity. Patient-reported outcome measures information scales were used to assess the severity of anxiety, depression, and sleep disturbance. RESULTS Of 128 FD patients, 64 (50%) also met Rome IV criteria for IBS. In the final multivariable model, lower baseline sleep disturbance, improvement in anxiety scores, absence of IBS, and a lower number of medications taken for gastrointestinal symptoms were associated with improvement in dyspepsia scores (P < .05 for all). Conversely, higher baseline dyspepsia severity was associated with greater improvement in dyspepsia severity at follow-up evaluation (P < .001). CONCLUSIONS Improvement in FD symptom severity over 3 to 6 months was associated with improvement of anxiety, lower sleep disturbance at baseline, absence of IBS, and higher baseline dyspepsia severity.
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Affiliation(s)
- Prashant Singh
- Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Sarah Ballou
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jesse Katon
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rafla Hassan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Johanna Iturrino
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anthony Lembo
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Ho L, Zhong CC, Wong CH, Wu JC, Chan KK, Wu IX, Leung TH, Chung VC. Herbal medicine for functional dyspepsia: Network meta-analysis of placebo-controlled randomised trials. JOURNAL OF ETHNOPHARMACOLOGY 2022; 283:114665. [PMID: 34592339 DOI: 10.1016/j.jep.2021.114665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/06/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Conventional treatments for functional dyspepsia (FD) are limited. Herbal medicine (HM) use is prevalent despite unclear comparative effectiveness among different formulae. AIM OF THE STUDY This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of HM formulae for FD against placebo. MATERIALS AND METHODS Seven international and Chinese databases were searched for randomised controlled trials (RCTs) on HM versus placebo. Risk of bias among RCTs was assessed using Cochrane Risk-of-Bias Tool 2. Data from RCTs were extracted for random-effect pairwise meta-analyses. NMAs were performed to evaluate the comparative effectiveness of HM formulae. GRADE partially contextualised framework was adopted to facilitate NMA result interpretation. RESULTS Twelve different HM formulae were identified from fifteen RCTs of mediocre quality. At 8-week follow-up, pairwise meta-analyses indicated that HM was superior to placebo in alleviating global symptoms (pooled risk difference (RD): 0.20; 95% confidence interval (CI): 0.11-0.29), with effect size larger than the minimally clinically important difference of 0.20 RD. Sensitivity analysis showed no significant impact on results attributable to risk of bias. NMAs demonstrated that Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction probably have a large beneficial effect on alleviating global symptoms (RD: 0.37; 95% CI: 0.03-0.99) and postprandial fullness (standardised mean difference: -0.93; 95% credible interval: -1.61 to -0.06), respectively. No serious adverse events were reported. CONCLUSIONS Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction may be considered as an alternative among patients unresponsive to conventional treatments. The comparative effectiveness of these two formulae should be evaluated in future trials.
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Affiliation(s)
- Leonard Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Claire Cw Zhong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Charlene Hl Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Justin Cy Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Karina Kh Chan
- United Christian Nethersole Community Health Service - The Chinese University of Hong Kong Chinese Medicine Clinic Cum Training and Research Centre (Tai Po District), Hong Kong.
| | - Irene Xy Wu
- Xiangya School of Public Health, Central South University, Hunan, China.
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Vincent Ch Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Irani MZ, Jones MP, Halland M, Herrick L, Choung RS, Loftus YAS, Walker MM, Murray JA, Talley NJ. Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population-based study. Aliment Pharmacol Ther 2021; 54:1416-1431. [PMID: 34626489 PMCID: PMC10835603 DOI: 10.1111/apt.16630] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rumination syndrome is a functional gastroduodenal disorder characterised by effortless regurgitation of recently ingested food. Emerging evidence reports duodenal eosinophilic inflammation in a subset, suggesting a shared pathophysiology with functional dyspepsia (FD). AIM To assess the clinical features of rumination syndrome and FD in a community-based study. METHODS We mailed a survey assessing gastrointestinal symptoms, diet and psychological symptoms to 9835 residents of Olmsted County, MN, USA in 2017-2018; diagnostic codes were obtained from linked clinical records. The two disorders were assessed as mutually exclusive in 'pure' forms with a separate overlap group, all compared to a control group not meeting criteria for either. Prevalence of associations, and univariate and independent associations with predictors were assessed by logistic regression. RESULTS Prevalence of rumination syndrome and FD were 5.8% and 7.1%, respectively; the overlap was 3.83-times more likely than expected by chance. Independent predictors for rumination (odds ratio (OR), 95% confidence interval (CI)) were female gender (1.79, 1.21-2.63), smoking (1.89, 1.28-2.78), gluten-free diet (1.58, 1.14-2.19), allergic rhinitis (1.45, 1.01-2.08) and depression (1.10, 1.05-1.16). FD was independently associated with female gender, depression, non-coeliac wheat sensitivity, migraine, irritable bowel syndrome and somatic symptoms. A similar reported efficacy (≥54%) of low fat or dairy-free diets was found with both disorders (P = 0.53 and P = 1.00, respectively). The strongest independent associations with overlapping FD and rumination syndrome were a history of rheumatoid arthritis (3.93, 1.28-12.06) and asthma (3.02, 1.44-6.34). CONCLUSION Rumination syndrome overlaps with FD with a shared risk factor profile, suggesting a common pathophysiology.
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Affiliation(s)
- Mudar Zand Irani
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michael P. Jones
- NHMRC Centre of Research Excellence in Digestive Health
- School of Psychological Sciences, Macquarie University, North Ryde, Australia
| | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Linda Herrick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Marjorie M. Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
| | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas J. Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health
- Hunter Medical Research Institute, New Lambton Heights, Australia
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10
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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: 13] [Impact Index Per Article: 4.3] [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.
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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
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11
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Kao KL, Sung FC, Huang HC, Lin CJ, Chen SC, Lin CL, Huang YP, Wu SI, Chen YS, Stewart R. Functional dyspepsia in depression: A population-based cohort study. Eur J Clin Invest 2021; 51:e13506. [PMID: 33529347 DOI: 10.1111/eci.13506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with functional dyspepsia (FD) are more likely to have persistent depression, yet whether depression and antidepressant treatments are associated with subsequent risk of FD remain unclear. METHODS Using population-based insurance administrative data of Taiwan, an 11-year historic cohort study was assembled, comparing cases aged 18 and above with the diagnosis of depressive disorder, to a propensity score-matched sample of adults without depression. Incident FD as a primary diagnosis was ascertained. Hazard ratios of FD were calculated using Cox regression models by age, gender, other comorbidities, nonsteroidal anti-inflammatory medications, antidepressants and antidiabetic agents. RESULTS A total of 20,197 people with depressive disorder and 20,197 propensity score-matched comparisons without depression were followed up. The incidence of FD was 1.7-fold greater in the depressive cohort than in comparisons (12.9 versus 7.57 per 1000 person-years), with an adjusted hazard ratio (aHR) of 2.16 (95% confidence interval (CI) 1.93~2.41). Increased risks were significant regardless of comorbidities or medication uses, the highest in the untreated depression group compared to the group without depression, with an aHR of 2.51(95% CI 2.15~2.93). CONCLUSIONS This population-based study showed that patients with depressive disorder are at elevated risk of FD. Antidepressant treatment could reduce the risk of FD.
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Affiliation(s)
- Kai-Liang Kao
- Department of Pediatrics, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chen-Ju Lin
- Section of Psychiatry and Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Chin Chen
- Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Shu-I Wu
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.,Section of Psychiatry and Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yi-Shin Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Robert Stewart
- Service and Population Research Department, King's College, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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12
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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.
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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
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13
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Huang I, Pranata R, Pangestu W, Kosasih FN, Raffaello WM, Yanto TA, Lugito NPH. The prevalence of uninvestigated dyspepsia and the association of physical exercise with quality of life of uninvestigated dyspepsia patients in Indonesia: An internet-based survey. Indian J Gastroenterol 2021; 40:176-182. [PMID: 33219984 DOI: 10.1007/s12664-020-01113-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Epidemiological data on the prevalence of uninvestigated dyspepsia (UD) and its impact on the health-related quality of life (HRQOL) in Indonesian population are still lacking. There is no study investigating the association between exercise and the HRQOL in UD patients. We aimed to investigate the prevalence of UD and its association with physical exercise, and its impact on HRQOL in Indonesian patients with UD. METHODS This was a population-based, cross-sectional study, conducted using an internet-based questionnaire which was randomly distributed throughout Indonesia using the social media. The questionnaire contained socio-demographic details, exercise levels, Rome III criteria for dyspepsia, and SF-NDI (Short Form-Nepean Dyspepsia Index). The frequency, duration, the intensity of exercise, and the classification of exercise according to ACSM (American College of Sports Medicine) were included in the assessment. The screening for UD was conducted using the Rome III criteria and the SF-NDI score was calculated to assess the HRQOL in patients with UD. RESULTS A total of 2725 valid responses were collected. The overall prevalence of UD in the study was 49.75%. Multiple logistic regression analysis showed that gender (female) and lack of exercise were independently associated with UD (OR 2.07, 95% CI 1.74-2.47, p < 0.001 and OR 1.72, 95% CI 1.42-2.07, p < 0.001). The median SF-NDI score among 1295 UD subjects in non-exercising and exercising groups was 21.00 and 18.00 (p < 0.001), respectively. CONCLUSION This study demonstrated the prevalence of UD and the association between exercise and HRQOL among UD patients in Indonesia.
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Affiliation(s)
- Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia.
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
| | - Winfrey Pangestu
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
| | | | | | - Theo Audi Yanto
- Internal Medicine Department, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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14
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Cordner ZA, Li Q, Liu L, Tamashiro KL, Bhargava A, Moran TH, Pasricha PJ. Vagal gut-brain signaling mediates amygdaloid plasticity, affect, and pain in a functional dyspepsia model. JCI Insight 2021; 6:144046. [PMID: 33591956 PMCID: PMC8026195 DOI: 10.1172/jci.insight.144046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
Functional dyspepsia (FD) is associated with chronic gastrointestinal distress and with anxiety and depression. Here, we hypothesized that aberrant gastric signals, transmitted by the vagus nerve, may alter key brain regions modulating affective and pain behavior. Using a previously validated rat model of FD characterized by gastric hypersensitivity, depression-like behavior, and anxiety-like behavior, we found that vagal activity - in response to gastric distention - was increased in FD rats. The FD phenotype was associated with gastric mast cell hyperplasia and increased expression of corticotrophin-releasing factor (Crh) and decreased brain-derived neurotrophic factor genes in the central amygdala. Subdiaphragmatic vagotomy reversed these changes and restored affective behavior to that of controls. Vagotomy partially attenuated pain responses to gastric distention, which may be mediated by central reflexes in the periaqueductal gray, as determined by local injection of lidocaine. Ketotifen, a mast cell stabilizer, reduced vagal hypersensitivity, normalized affective behavior, and attenuated gastric hyperalgesia. In conclusion, vagal activity, partially driven by gastric mast cells, induces long-lasting changes in Crh signaling in the amygdala that may be responsible for enhanced pain and enhanced anxiety- and depression-like behaviors. Together, these results support a "bottom-up" pathway involving the gut-brain axis in the pathogenesis of both gastric pain and psychiatric comorbidity in FD.
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Affiliation(s)
| | - Qian Li
- Center for Neurogastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liansheng Liu
- Center for Neurogastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Aditi Bhargava
- Department of Obstetrics and Gynecology and The Center for Reproductive Sciences, UCSF, San Francisco, California, USA
| | | | - Pankaj Jay Pasricha
- Center for Neurogastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Huang MH, Wang YP, Wu PS, Chan YLE, Cheng CM, Yang CH, Tsai SJ, Lu CL, Tsai CF. Association between gastrointestinal symptoms and depression among older adults in Taiwan: A cross-sectional study. J Chin Med Assoc 2021; 84:331-335. [PMID: 33186213 DOI: 10.1097/jcma.0000000000000460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Older adults with depression more frequently experience somatic and gastrointestinal (GI) problems compared with people without depression and younger adults with depression. However, whether GI symptoms are predictive of elevated rates of depression among older adults is unclear. METHODS We enrolled 106 older adults (>60 years old); 69 had late-life depression (LLD), and 37 were controls. All participants gave ratings on the Gastrointestinal Symptom Rating Scale (GSRS) and Hamilton Depression Rating Scale. Food consumption was assessed using a food frequency questionnaire, and a Mediterranean diet score was used as a covariate. RESULTS Compared with the controls, patients with LLD reported higher levels of depressive and GI symptoms and reported more reflux, abdominal pain, and dyspepsia symptoms, and these symptoms were correlated with Hamilton Depression Rating Scale scores (GSRS total: β = 0.47; reflux: β = 1.47; abdominal pain: β = 1.98; dyspepsia: β = 1.02; all p < 0.01). After demographic variables and Mediterranean diet score were controlled for, a logistic regression analysis indicated that total GSRS score was an independent determinant of LLD (odds ratio: 1.20, 95% CI: 1.04-1.38). Moreover, a stratified analysis by depression severity indicated that higher total GSRS score may contribute to greater depression severity (odds ratio: 1.25, 95% CI: 1.04-1.52). CONCLUSION We provide evidence that GI symptoms are associated with depressive symptoms among patients with LLD. Older people with more specific GI symptoms, such as reflux, abdominal pain, and dyspepsia, are potentially at greater risk of having LLD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Hualien, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
| | - Yen-Po Wang
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Hualien, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Endoscopic Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Cheng Hsin Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Shan Wu
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yee-Lam E Chan
- Department of Psychiatry, Cheng Hsin Hospital, Taipei, Taiwan, ROC
| | - Chih-Ming Cheng
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hung Yang
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Tsai
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Liang Lu
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Hualien, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Endoscopic Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Cheng Hsin Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Fen Tsai
- Faculty of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Park JK, Huh KC, Kwon JG, Jung KW, Oh JH, Song KH, Jung K, Bang KB, Lee JY, Tae CH, Shin CM, Kim JW, Lee H. Sleep disorders in patients with functional dyspepsia: A multicenter study from the Korean Society of Neurogastroenterology and Motility. J Gastroenterol Hepatol 2021; 36:687-693. [PMID: 32720319 DOI: 10.1111/jgh.15198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The few studies concerning the association between sleep disorders and functional dyspepsia (FD) have yielded inconsistent results. We compared the prevalence of sleep disorders in patients with FD and healthy controls, and evaluated whether FD was independently associated with sleep disorders, and the risk factors for sleep disorders in patients with FD. METHODS This prospective, multicenter, cross-sectional study was conducted from August 2014 to December 2017 at 12 hospitals in South Korea. The inclusion criterion was the presence of FD (for ≥18 years) according to the Rome III criteria. Healthy controls were recruited from among patients who visited the Health Examination Center for check-ups. RESULTS In total, 526 subjects were prospectively enrolled in this study (201 with FD and 325 healthy controls). The prevalence of sleep disorders was significantly higher among the patients with FD than among the healthy controls (41.8% vs 18.8%, P = 0.000). In a multivariate analysis, FD (odds ratio [OR] = 1.851; 95% confidence interval [CI] 1.194-2.870; P = 0.006), female sex (OR = 1.672; 95% CI 1.063-2.628; P = 0.026), and anxiety (OR = 3.325; 95% CI 2.140-5.166; P = 0.000) were independent risk factors for sleep disorders in the overall cohorts. In patients with FD only, low body mass index, heartburn, and anxiety were independent risk factors for sleep disorders in a further multivariate analysis. CONCLUSION Sleep disorders were common in patients with FD. FD was significantly associated with sleep disorders in our patient population, irrespective of the presence of heartburn or psychiatric disorders.
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Affiliation(s)
- Jong Kyu Park
- Department of Gastroenterology, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Kyu Chan Huh
- Department of Gastroenterology, Konyang University Hospital, Daejeon, South Korea
| | - Joong Goo Kwon
- Department of Gastroenterology, College of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Ulsan University College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jung Hwan Oh
- Department of Gastroenterology, College of Medicine, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Kyung Ho Song
- Department of Gastroenterology, Konyang University Hospital, Daejeon, South Korea
| | - Kyoungwon Jung
- Department of Gastroenterology, College of Medicine, Kosin University, Pusan, South Korea
| | - Ki Bae Bang
- Department of Gastroenterology, College of Medicine, Dankook University, Cheonan, South Korea
| | - Ju Yup Lee
- Department of Gastroenterology, College of Medicine, Keimyung University, Daegu, South Korea
| | - Chung Hyun Tae
- Department of Gastroenterology, College of Medicine, Ewha Woman's University, Seoul, South Korea
| | - Cheol Min Shin
- Department of Gastroenterology, Seoul National University, Bundang Seoul University Hospital, Seongnam, South Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hyuk Lee
- Department of Gastroenterology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
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Ha NY, Jeong HI, Lee HN, Ko SJ, Park JW, Kim J. Herbal medicine Siho-sogan-san for functional dyspepsia: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22358. [PMID: 32991452 PMCID: PMC7523762 DOI: 10.1097/md.0000000000022358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is characterized by persistent and recurrent dyspeptic symptoms, such as postprandial fullness and epigastric pain. Although it is rarely severe or life-threatening, it can degrade the quality of life and cause social and economic issues. As symptoms often persist despite the treatment with conventional Western medicine, herbal medicine can be considered as an alternative for treating FD. Siho-sogan-san (SHS) is a traditional herbal formula prescribed for dyspepsia for hundreds of years. This protocol for a systematic review was designed to evaluate the safety and efficacy of SHS for the treatment of FD through a meta-analysis. METHODS Studies will be searched from the following electronic databases up to March 2020: Embase, MEDLINE (via PubMED), Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Korean Medical Database, KoreaMed, Korean Studies Information Service System, National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, China National Knowledge Infrastructure Database, and Citation Information by Nii. Randomized controlled trials of SHS and herb-added SHS for treating FD will be selected in this review. The control groups of no-treatment, placebo, and conventional Western medicine will be compared with SHS for its efficacy. The synergetic effect of SHS with Western medicine will also be analyzed in comparison with conventional Western medicine alone. Two independent reviewers will collect the data and assess the risk of bias in individual studies. The total clinical effectiveness rate will be synthesized and evaluated as primary outcome. RESULTS This systematic review will present an adequate clinical evidence of SHS for the treatment of FD based on specific parameters, including dyspepsia-related symptoms, gastric emptying, and adverse events. CONCLUSION This study will provide evidence for the safety and efficacy of SHS for the treatment of patients with FD. REVIEW REGISTRY UNIQUE IDENTIFYING NUMBER:: reviewregistry952.
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Barberio B, Mahadeva S, Black CJ, Savarino EV, Ford AC. Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria. Aliment Pharmacol Ther 2020; 52:762-773. [PMID: 32852839 DOI: 10.1111/apt.16006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prevalence of uninvestigated dyspepsia varies across cross-sectional surveys. This may be due to differences in definitions used or study methodology, rather than global variability. AIM To determine the global prevalence of uninvestigated dyspepsia according to Rome criteria. METHODS MEDLINE and EMBASE were searched to identify population-based studies reporting prevalence of uninvestigated dyspepsia in adults (≥18 years old) according to Rome I, II, III or IV criteria. Prevalence of uninvestigated dyspepsia was extracted, according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (OR), and 95% confidence intervals (CIs) were calculated. RESULTS Of 2133 citations evaluated, 67 studies fulfilled eligibility criteria, representing 98 separate populations, comprising 338 383 subjects. Pooled prevalence ranged from 17.6% (95% CI 9.8%-27.1%) in studies defining uninvestigated dyspepsia according to Rome I criteria, to 6.9% (95% CI 5.7%-8.2%) in those using Rome IV criteria. Postprandial distress syndrome was the commonest subtype, occurring in 46.2% of participants using Rome III criteria, and 62.8% with Rome IV. Prevalence of uninvestigated dyspepsia was up to 1.5-fold higher in women, irrespective of the definition used. There was significant heterogeneity between studies in all our analyses, which persisted even when the same criteria were applied and similar methodology was used. CONCLUSIONS Even when uniform symptom-based criteria are used to define the presence of uninvestigated dyspepsia, prevalence varies between countries. This suggests that there are environmental, cultural, ethnic, dietary or genetic influences determining symptoms.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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19
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Mind and gut: Associations between mood and gastrointestinal distress in children exposed to adversity. Dev Psychopathol 2020; 32:309-328. [PMID: 30919798 DOI: 10.1017/s0954579419000087] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal and mental disorders are highly comorbid, and animal models have shown that both can be caused by early adversity (e.g., parental deprivation). Interactions between the brain and bacteria that live within the gastrointestinal system (the microbiome) underlie adversity-gastrointestinal-anxiety interactions, but these links have not been investigated during human development. In this study, we utilized data from a population of 344 youth (3-18 years old) who were raised with their biological parents or were exposed to early adverse caregiving experiences (i.e., institutional or foster care followed by international adoption) to explore adversity-gastrointestinal-anxiety associations. In Study 1, we demonstrated that previous adverse care experiences were associated with increased incidence of gastrointestinal symptoms in youth. Gastrointestinal symptoms were also associated with concurrent and future anxiety (measured across 5 years), and those gastrointestinal symptoms mediated the adversity-anxiety association at Time 1. In a subsample of children who provided both stool samples and functional magnetic resonance imaging of the brain (Study 2, which was a "proof-of-principle"), adversity was associated with changes in diversity (both alpha and beta) of microbial communities, and bacteria levels (adversity-associated and adversity-independent) were correlated with prefrontal cortex activation to emotional faces. Implications of these data for supporting youth mental health are discussed.
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20
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Kim YS, Kim N. Functional Dyspepsia: A Narrative Review With a Focus on Sex-Gender Differences. J Neurogastroenterol Motil 2020; 26:322-334. [PMID: 32606255 PMCID: PMC7329152 DOI: 10.5056/jnm20026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/11/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Functional dyspepsia (FD) is among the most common gastrointestinal disorders affecting quality of life (QoL). As it frequently occurs in women than in men the comparison of various aspects including prevalence, clinical manifestations, and QoL in FD between women and men is very important for understanding the disease distribution and burden, evaluating treatment options, developing new drugs, and allocating medical resources. However, little is known about sex or gender differences among patients with FD. In spite of limited studies, consistent points are that FD occurs more often in women than in men and there are several symptom differences between men and women with FD. In addition, women with FD tend to have lower QoL than men with FD. Similarly, the pathophysiology of FD likely to vary depending on gender. Furthermore, a sex-gender-oriented approach in healthcare system could enhance understanding heterogeneous patients suffering from FD. Due to the sex-gender differences in physiological and psychological factors, treatment strategies should differ between women and men with FD. In conclusion, an individualized and multicomponent approach that considers sex and gender issues might improve FD treatment and improve patient Qol, especially for women.
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Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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21
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Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most frequent functional gastrointestinal disorders and is defined using the Rome IV criteria as any combination of the following symptoms: postprandial fullness, early satiety, epigastric pain, and epigastric burning that are severe enough to interfere with the usual activities and occur at least 3 days per week over the past 3 months with an onset of at least 6 months before the presentation. The purpose of this systematic review is to analyze all the relevant studies in the literature that investigate the efficiency of hypnotherapy in FD. AREAS OF UNCERTAINTY FD refractory to conservative treatment is a therapeutic challenge, and alternative treatment options are needed. Gut-oriented hypnotherapy has been reported an effective treatment for irritable bowel syndrome, but poorly tested in FD. DATA SOURCES We performed a search in 6 bibliographic databases (PubMed, Embase, Cochrane Library, Web of Science, Scopus, and LILACS) using customized search strategies for each engine. The search strategy included the following terms: (hypnosis, hypnotherapy, hypnotherapies, hypnogenesis, hypnotism, hypnotist, hypnotical suggestion, suggestion, and mesmerism) and {[functional and (dyspepsia or dyspeptic)] or FD}. RESULTS Taking the aforementioned criteria into account, the result was a review of 4 articles analyzing the efficacy of hypnotherapy in the treatment of FD, published in the past 20 years. The initial search identified 398 articles, of which 37 potentially appropriate articles were reviewed. Of these 37 articles, 4 articles were included in the review. The benefits observed by numerous studies go beyond the field of digestive pathology, patients describing a general improvement in physical and mental health. CONCLUSIONS Current studies analyzing the efficacy of hypnotherapy in FD provide encouraging data, but additional randomized controlled trials are needed before a firm position on the effectiveness of hypnosis in FD.
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22
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Mak ADP, Ho YM, Leung ONW, Chou IWY, Lui R, Wong S, Yeung DKW, Chu WCW, Edden R, Chan S, Lam L, Wu J. Unaltered Brain GABA Concentrations and Resting fMRI Activity in Functional Dyspepsia With and Without Comorbid Depression. Front Psychiatry 2020; 11:549749. [PMID: 33061916 PMCID: PMC7518235 DOI: 10.3389/fpsyt.2020.549749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND GABA-deficit characterizes depression (MDD), which is highly comorbid with Functional Dyspepsia (FD). We examined brain GABA concentrations and resting activities in post-prandial distress subtype FD (FD-PDS) patients with and without MDD. METHODS 24 female age/education-matched FD-PDS with comorbid MDD (FD-PDS-MDD), non-depressed FD-PDS, and healthy controls each were compared on GABA concentrations, resting fMRI (fALFF) in bilateral pregenual anterior cingulate (pgACC), left dorsolateral prefrontal cortex (DLPFC), insula, and somatosensory cortex (SSC). RESULTS FD-PDS-MDD patients had mild though elevated depressive symptoms. FD-PDS patients had generally mild dyspeptic symptoms. No significant between-group differences in GABA or fALFF were found. No significant correlations were found between GABA and depressive/dyspeptic symptoms after Bonferroni correction. In patients, GABA correlated positively with left insula fALFF (r = 0.38, Bonferroni-corrected p = .03). CONCLUSION We did not find altered GABA concentrations or brain resting activity in FD-PDS or its MDD comorbidity. The neurochemical link between MDD and FD remains elusive.
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Affiliation(s)
- Arthur D P Mak
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yuen Man Ho
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Owen N W Leung
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Idy Wing Yi Chou
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Richard Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Sandra Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linda Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Justin Wu
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Tshabalala SJ, Tomita A, Ramlall S. Depression, anxiety and stress symptoms in patients presenting with dyspepsia at a regional hospital in KwaZulu-Natal province. S Afr J Psychiatr 2019; 25:1382. [PMID: 31745439 PMCID: PMC6852706 DOI: 10.4102/sajpsychiatry.v25i0.1382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background Depression, anxiety and stress (DAS) have been shown to be co-morbid with dyspepsia. Local data on the factors associated with these co-morbidities could inform the role of psychiatric intervention in affected patients. Aim The aim of this study was to describe the frequency of undiagnosed DAS and their associated protective and risk correlates in a sample of patients undergoing endoscopies for dyspepsia. Setting The study was conducted at a regional hospital’s gastro-intestinal unit in KwaZulu-Natal province. Method A cross-sectional survey was conducted on 201 in- and outpatients with symptoms of dyspepsia awaiting endoscopy. Information on DAS symptomatology (using the DASS-21 screening questionnaire, as well as socio-demographic and clinical data) were collected. Analyses Following a descriptive analysis of the participants’ socio-demographic and clinical details, linear regression models were fitted to identify potential risk and protective correlates linked to DAS symptomatology. Results The mean age of participants (N = 201) was 48.89 years, of whom approximately two-thirds (n = 133; 66.17%) were women, 97% (n = 195) were African and 64.68% (n = 130) resided in rural areas. Anxiety was the most prevalent symptom category (n = 149; 74.13%) versus depression (n = 96; 47.76%) and stress (n = 68; 33.83%) in each category of symptom (mild to extremely) severity. In the severe and extremely severe range, anxiety existed without co-morbid depression or stress in 61.19% of anxious patients. Alcohol use was significantly associated with all three symptom categories (p < 0.01). Conclusions Given high frequencies of depression and anxiety in patients undergoing endoscopies for dyspepsia, screening for common mental disorders is essential.
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Affiliation(s)
- Sijabulisiwe J Tshabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Suvira Ramlall
- Department of Psychiatry, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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24
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Mak ADP, Chung VCH, Yuen SY, Tse YK, Wong SYS, Ju Y, Hung SS, Leung KC, You JHS, Lui R, Wong SH, Leung ONW, Lam LCW, Lee S, Wu JCY. Noneffectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome. J Gastroenterol Hepatol 2019; 34:1736-1742. [PMID: 30891824 DOI: 10.1111/jgh.14667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Comorbid generalized anxiety disorder and irritable bowel syndrome are common and therapeutically challenging. We aimed to assess the effectiveness of electroacupuncture in relieving anxiety and bowel symptoms in Chinese adults with this form of comorbidity. METHODS In a single-blind randomized sham-controlled trial, subjects with comorbid generalized anxiety disorder and irritable bowel syndrome were randomly assigned to receive 10 weekly sessions of electroacupuncture or sham electroacupuncture. Patients were assessed at baseline, immediately after intervention and at 6-week follow-up. Primary outcome was anxiety (7-item Patient Health Questionnaire section for anxiety). Secondary outcomes included bowel symptoms (bowel symptoms questionnaire), depressive symptoms (9-item Patient Health Questionnaire), somatic symptoms (15-item Patient Health Questionnaire), and health-related quality of life (EuroQol-5 Dimensions). RESULTS Eighty subjects, 40 in each arm, were randomized. All but two in the sham group completed 10 weekly sessions. There was no significant difference in the proportion of patients experiencing significant (≥ 50%) reduction of anxiety symptoms between the two groups immediately after intervention (32.4% vs 21.6%, P = 0.06) and at 6-week follow-up (25.7% in electroacupuncture vs 27% in sham, P = 0.65). Anxiety, depressive symptom, and bowel symptom severity did not differ significantly between electroacupuncture and sham groups. CONCLUSIONS Findings failed to support the effectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome. Further studies are needed to identify effective acupuncture treatment protocols for such comorbidity.
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Affiliation(s)
- Arthur Dun-Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Ying Yuen
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yee Kit Tse
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Yeung Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yanli Ju
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sheung Sheung Hung
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Chun Leung
- Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joyce Hoi Sze You
- Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rashid Lui
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sunny Hei Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Owen Ngo Wang Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin Che Yuen Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
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Luo L, Du L, Shen J, Cen M, Dai N. Benefit of small dose antidepressants for functional dyspepsia: Experience from a tertiary center in eastern China. Medicine (Baltimore) 2019; 98:e17501. [PMID: 31593119 PMCID: PMC6799471 DOI: 10.1097/md.0000000000017501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Traditional treatment of functional dyspepsia (FD) is unsatisfactory in a subgroup of patients with FD, and the potential role of antidepressant medications also has not been definitely clarified. To provide more evidence for future optimal practice recommendations, we reviewed a 1-year clinical database of antidepressant agents applied in outpatients with FD. METHODS Clinical presentations, treatment course, and outcomes were determined by chart review of patients referring to the functional gastrointestinal disorders specialist clinic. One hundred thirty patients with FD were included for further analysis. RESULTS Patients were treated with different antidepressant drugs according to individual symptoms. The most commonly used drugs were flupenthixol melitracen and fluoxetine. Improvement and complete remission occurred in 93.8% and 54.6% of patients, respectively. There was a trend toward superior outcome for citalopram compared to sulpiride and mirtazapine in overall analysis. Meanwhile, regimens containing fluoxetine had significant increased remission rate compared to any other antidepressant regimens in postprandial distress syndrome subgroup analysis. Furthermore, older patients were more likely to achieve remission. However, sex and symptom duration were not associated with symptom remission. Finally, 11.5% of patients experienced adverse events. CONCLUSIONS This retrospective cohort study indicated that small dose antidepressant therapy, especially citalopram and fluoxetine, is an effective and well tolerated treatment option for refractory FD.
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Affiliation(s)
- Liang Luo
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lijun Du
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jinhua Shen
- Department of Gastroenterology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Mengsha Cen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Ning Dai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
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Tahir NSM, Zakaria R, Draman N. Gastro Oesophageal Reflux Disease Shadowing Anxiety Disorder Causing Prolonged Exposure to Proton Pump Inhibitor. Korean J Fam Med 2019; 40:348-350. [PMID: 30477049 PMCID: PMC6768841 DOI: 10.4082/kjfm.18.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/02/2018] [Indexed: 11/03/2022] Open
Abstract
Anxiety disorders are the most prevalent psychiatric disorders in the general population. The relationship between dyspepsia and particularly gastroesophageal reflux disease (GERD) and psychiatric comorbidity such as anxiety is poorly defined. However, GERD was noted to be strongly associated and often coincident in onset with generalized anxiety disorder in the community. In this paper, we report the case of an adult man who presented with severe weight loss and underlying GERD, and was later found to have an anxiety disorder as the cause of both.
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Affiliation(s)
| | - Rosnani Zakaria
- Department of Family Medicine, School of Medical Science, Universiti Sains Malaysia Health Campus, Kubang Kerian, Malaysia
- Corresponding Author: Rosnani Zakaria https://orcid.org/0000-0002-7093-8278 Tel: +60-9-7676927, Fax: +60-9-7673370, E-mail:
| | - Nani Draman
- Department of Family Medicine, School of Medical Science, Universiti Sains Malaysia Health Campus, Kubang Kerian, Malaysia
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The association between functional dyspepsia and depression: a meta-analysis of observational studies. Eur J Gastroenterol Hepatol 2019; 31:911-918. [PMID: 31162150 DOI: 10.1097/meg.0000000000001451] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Concomitant functional dyspepsia (FD) and psychosocial stressors have been reported; however, the association between FD and depression remains controversial and no quantitative meta-analysis exists. Published articles were identified through a comprehensive review of PubMed, Embase, and Web of Science from inception to the 8 July 2018. The pooled odds ratios (ORs) with 95% confidence intervals and subgroup analyses were calculated using a random-effects model. Findings for a total of 59 029 individuals were pooled across 23 studies and examined. Our analyses showed a positive association between FD and depression, with an OR of 2.28 (95% confidence interval: 2.02-3.81; I=100%). In the subgroup analysis, FD patients in Europe (OR=6.19) were more likely to have depression compared with Asians (OR=2.47); the overall significance results decreased the most in subgroup which the overall significance of the subgroup analyses results decreased the most in studies that adjusted for BMI (OR=1.42). Our meta-analysis showed a positive association between FD and depression. Further large-scale prospective cohort studies are needed to investigate the causality between FD and depression.
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28
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Dong Y, Li S, Yin J, Chen JDZ. Ameliorating effects of optimized gastric electrical stimulation and mechanisms involving nerve growth factor and opioids in a rodent model of gastric hypersensitivity. Neurogastroenterol Motil 2019; 31:e13551. [PMID: 30790401 DOI: 10.1111/nmo.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been applied to treat gastric motility disorders for decades. This study was designed to investigate the effects and mechanisms of GES for visceral hypersensitivity in a rodent model of functional dyspepsia (FD). METHODS Male Sprague-Dawley rat pups at 10-days old received 0.1% iodoacetamide (IA) daily for 6 days. The experiments were performed when the rats reached 8-11 weeks of age, and visceral hypersensitivity was established. Then, GES parameters were optimized and the chronic effects of GES on gastric hypersensitivity were assessed by electromyogram (EMG). Naloxone (3 mg/kg), D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP, 1 mg/kg), and anti-NGF (16 μg/kg) were individually intraperitoneally injected to investigate opioid and nerve growth factor (NGF) mechanisms. Tissues were analyzed for NGF expression. KEY RESULTS In the IA-treated rats, the visceromotor response to gastric distension was significantly increased, and both acute GES with optimized stimulation parameters (0.25 seconds on, 0.25 seconds off, 100 Hz, 0.25 ms, 6 mA) and chronic GES (7 days, 2 hours/day) normalized gastric hypersensitivity. The inhibitory effect of GES on gastric hypersensitivity was blocked by naloxone and CTOP. Anti-NGF normalized EMG responses in IA-treated rats. The expressions of NGF in the tissues of IA-treated rats were dramatically increased, and these increases were suppressed with GES. CONCLUSIONS AND INFERENCES GES with optimized parameters improves gastric hypersensitivity induced by neonatal treatment of IA mediated peripherally by suppressing NGF and via the opioid mechanism involving the µ receptor. GES as a potential therapy for treating visceral pain may be explored in clinical studies.
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Affiliation(s)
- Yan Dong
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, Oklahoma.,Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shiying Li
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jieyun Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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29
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Smeets FGM, Keszthelyi D, Vork L, Tack J, Talley NJ, Simren M, Aziz Q, Ford AC, Conchillo JM, Kruimel JW, Van Os J, Masclee AAM. Development of a real-time patient-reported outcome measure for symptom assessment in patients with functional dyspepsia using the experience sampling method. Neurogastroenterol Motil 2019; 31:e13496. [PMID: 30393939 DOI: 10.1111/nmo.13496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are used to assess symptoms in patients with functional dyspepsia (FD). Current end-of-day questionnaires have several limitations including sensitivity to recall and ecological bias. The experience sampling method (ESM) is characterized by random and repeated assessments across momentary states in daily life and therefore less sensitive to these limitations. This study describes the development of a novel PROM based on ESM technology. METHODS An initial draft of the PROM was developed based on literature. Focus group interviews with FD patients according to Rome IV criteria, and an expert meeting with international opinion leaders in the field of functional gastrointestinal disorders were conducted in order to select items for the PROM. Cognitive interviews were performed to evaluate patients' understanding of the selected items and to create the definitive PROM. KEY RESULTS A systematic literature search revealed 59 items across four domains (ie, physical status; mood and psychological factors; context and environment; and nutrition, medication, and substance use). After patient focus group interviews and an international expert meeting, the number of items was reduced to 33. Cognitive interviews resulted in some minor linguistic changes in order to improve patients' understanding. CONCLUSIONS AND INFERENCES A novel digital ESM-based PROM for real-time symptom assessment in patients with functional dyspepsia was developed. This novel PROM has the potential to identify individual symptom patterns and specific triggers for dyspeptic symptoms, and optimize treatment strategies.
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Affiliation(s)
- Fabiënne G M Smeets
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Lisa Vork
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jan Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Magnus Simren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Qasim Aziz
- Centre for Neuroscience and Trauma, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - José M Conchillo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Joanna W Kruimel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jim Van Os
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Psychiatry, Utrecht University Medical Centre, Utrecht, The Netherlands.,King's Health Partners Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - Ad A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Neznanov NG, Kibitov AO, Rukavishnikov GV, Mazo GE. The prognostic role of depression as a predictor of chronic somatic diseases manifestation. TERAPEVT ARKH 2018; 90:122-132. [DOI: 10.26442/00403660.2018.12.000019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The negative impact of depression on the course and outcome of somatic disorders is well-known and has a solid theoretical basis. The analyses of prospective studies confirm the role of depression as an independent and significant risk factor for widespread chronic somatic disorders including such severe and life-threatening conditions as cardiovascular diseases, diabetes and oncological pathology. The majority of somatic disorders and depression are the part of the big class of hereditary diseases with multifactorial character and polygenic nature. It is likely, that the genetic risk diversity of these diseases in population is close. There is also a high probability of genetic risks levels overlap (or of common «cluster») of two or more diseases in one individual, with one disorder being major depression. In that case such diseases could be considered «genetically comorbid» and manifestation of one disease could alter the risks of other. Precise and informative diagnostic tools could detect subsyndromal depression that could be the prognostic sign of the high risk and rapid manifestation of somatic diseases. Thus, patients with depressive disorder could be considered as a group with high risks of diverse range of somatic pathology. The coalescence of fundamental biomedical scientists and internists (psychiatrists and other physicians) could lead to the elaboration of specific complex preventative measures including social ones.
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31
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Cheong PK, Ford AC, Cheung CKY, Ching JYL, Chan Y, Sung JJY, Chan FKL, Wu JCY. Low-dose imipramine for refractory functional dyspepsia: a randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2018; 3:837-844. [DOI: 10.1016/s2468-1253(18)30303-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
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32
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Nam Y, Kwon SC, Lee YJ, Jang EC, Ahn SH. Relationship between job stress and functional dyspepsia in display manufacturing sector workers: a cross-sectional study. Ann Occup Environ Med 2018; 30:62. [PMID: 30364417 PMCID: PMC6194695 DOI: 10.1186/s40557-018-0274-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Job stress has been reported as a risk factor of psychological changes, which have been shown to be related to gastrointestinal diseases and symptoms such as functional dyspepsia. However, few studies have assessed the relationship between job stress and functional dyspepsia. Therefore, we investigated the relationship between job stress and functional dyspepsia in South Korea. Methods This study was conducted between May 23 and July 6, 2016 and included 901 workers in the display manufacturing sector. Subjects completed self-reported questionnaires, regarding Korean Occupational Stress Scale (KOSS), functional dyspepsia, Insomnia Severity Index-K, and health-related behaviors and job characteristics. Subjects were divided into functional dyspepsia-positive and -negative groups based on the Rome III criteria. The KOSS high-risk group was defined as subjects with KOSS score above the 75 percentile of KOSS reference value. Multiple logistic regression analysis was performed to investigate the association between job stress and functional dyspepsia. Results In women, the risk of functional dyspepsia was significantly higher in the high-risk groups of the following KOSS subcategories in unadjusted model: job demand (OR 3.282, 95% CI 1.181–9.126), and occupational climate (OR 2.665, 95% CI 1.041–6.823). Even in adjusted model, the risk was significantly higher in the high-risk groups of the following KOSS subcategories: job demand (OR 3.123, 95% CI 1.036–9.416) and occupational climate (OR 3.304, 95% CI 1.198–9.115). In men, the risk of functional dyspepsia was not significant in all KOSS subcategories. Conclusions This study showed that job demand and occupational climates were associated with functional dyspepsia in female display manufacturing sector workers. Therefore, both clinical and mental health approaches should be used in the management of functional dyspepsia in women.
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Affiliation(s)
- Younghyeon Nam
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Soon-Chan Kwon
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Yong-Jin Lee
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea.,2Environmental Health Center for Asbestos, Soonchunhyang University Cheonan Hospital, 67, Suncheonhyang 3-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Eun-Chul Jang
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Seung-Hwan Ahn
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
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Addula M, Wilson VED, Reddymasu S, Agrawal DK. Immunopathological and molecular basis of functional dyspepsia and current therapeutic approaches. Expert Rev Clin Immunol 2018; 14:831-840. [PMID: 30235962 PMCID: PMC6287908 DOI: 10.1080/1744666x.2018.1524756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Functional dyspepsia (FD) is widespread with 20% prevalence worldwide and a significant economic burden due to health care cost and constraints on daily activities of patients. Despite extensive investigation, the underlying causes of dyspepsia in a majority of patients remain unknown. Common complaints include abdominal discomfort, pain, burning, nausea, early satiety, and bloating. Motor dysfunction of the gut was long considered a major cause, but recent investigations suggest immune-based pathophysiological and molecular events in the duodenum are more probable contributing factors. Areas Covered: Inflammatory mediators and immune cells including duodenal eosinophils, intraepithelial lymphocytes, and T-cells have been implicated in the underlying cause of disease process, as have genetic factors. In this article, we critically reviewed findings, identified gaps in knowledge and suggested future directions for further investigation to identify targets and develop better therapeutic approaches. Expert commentary: Impaired gastric accommodation, slow gastric emptying, and increased visceral sensitivity have long been thought of as main causal factors of FD. However, more recent identification of eosinophilic degranulation and recruitment of T cells that induce mild duodenal inflammation are giving rise to new insights into immune-mediated pathophysiology. These insights offer promising avenues to explore for immune-mediated therapy in the future.
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Affiliation(s)
- Mounika Addula
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Victoria E. D. Wilson
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Savio Reddymasu
- Departments of Clinical & Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Devendra K. Agrawal
- Departments of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
- Departments of Clinical & Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, USA
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Chung VCH, Wong CHL, Ching JYL, Sun WZ, Ju YL, Hung SS, Lin WL, Leung KC, Wong SYS, Wu JCY. Electroacupuncture plus standard of care for managing refractory functional dyspepsia: protocol of a pragmatic trial with economic evaluation. BMJ Open 2018; 8:e018430. [PMID: 29593017 PMCID: PMC5875645 DOI: 10.1136/bmjopen-2017-018430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION This trial proposes to compare the effectiveness and cost-effectiveness of electroacupuncture (EA) plus on-demand gastrocaine with waiting list for EA plus on-demand gastrocaine in providing symptom relief and quality-of-life improvement among patients with functional dyspepsia (FD). METHODS AND ANALYSIS This is a single-centre, pragmatic, randomised parallel-group, superiority trial comparing the outcomes of (1) EA plus on-demand gastrocaine group and (2) waiting list to EA plus on-demand gastrocaine group. 132 (66/arm) endoscopically confirmed, Helicobacter pylori-negative patients with FD will be recruited. Enrolled patients will respectively be receiving (1) 20 sessions of EA over 10 weeks plus on-demand gastrocaine; or (2) on-demand gastrocaine and being nominated on to a waiting list for EA, which entitles them 20 sessions of EA over 10 weeks after 12 weeks of waiting. The primary outcome will be the between-group difference in proportion of patients achieving adequate relief of symptoms over 12 weeks. The secondary outcomes will include patient-reported change in global symptoms and individual symptoms, Nepean Dyspepsia Index, Nutrient Drink Test, 9-item Patient Health Questionnaire (PHQ9), and 7-item Generalised Anxiety Disorder Scale (GAD7). Adverse events will be assessed formally. Results on direct medical costs and on the EuroQol (EQ-5D) questionnaire will also be used to assess cost-effectiveness. Analysis will follow the intention-to-treat principle using appropriate univariate and multivariate methods. A mixed model analysis taking into account missing data of these outcomes will be performed. Cost-effectiveness analysis will be performed using established approach. ETHICS AND DISSEMINATION The study is supported by the Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region of China. It has been approved by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee. Results will be published in peer-reviewed journals and be disseminated in international conference. TRIAL REGISTRATION NUMBER ChiCTR-IPC-15007109; Pre-result.
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Affiliation(s)
- Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Charlene H L Wong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Zhu Sun
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yan Li Ju
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sheung Sheung Hung
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Ling Lin
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ka Chun Leung
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Justin C Y Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
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Smeets FGM, Masclee AAM, Conchillo JM, Keszthelyi D. Systematic review: Disease-specific instruments to assess gastrointestinal symptoms in functional dyspepsia. Neurogastroenterol Motil 2018; 30. [PMID: 29520918 DOI: 10.1111/nmo.13327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a common functional gastrointestinal disorder with incompletely understood pathophysiology and heterogeneous symptom presentation. Assessment of treatment efficacy in FD is a methodological challenge as response to treatment must be assessed primarily by measuring subjective symptoms. Therefore, the use of patient-reported outcome measures (PROMs) is recommended by regulatory authorities to assess gastrointestinal symptoms in clinical trials for FD. In the last decades, a multitude of outcome measures has been developed. However, currently no PROM has been approved by the regulatory authorities, and no consensus has been reached with regard to the most relevant outcome measure in FD. PURPOSE This systematic review discusses the available disease-specific outcome measures for assessment of FD symptoms with psychometric validation properties, strengths, and limitations. Moreover, recommendations for use of current available outcome measures are provided, and potential areas of future research are discussed.
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Affiliation(s)
- F G M Smeets
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J M Conchillo
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - D Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Xu JH, Lai Y, Zhuang LP, Huang CZ, Li CQ, Chen QK, Yu T. Certain Dietary Habits Contribute to the Functional Dyspepsia in South China Rural Area. Med Sci Monit 2017; 23:3942-3951. [PMID: 28809820 PMCID: PMC5567766 DOI: 10.12659/msm.902705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Functional dyspepsia (FD) refers to a group of upper gastrointestinal syndromes, subdivided into two types: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The etiology of FD remains unclear; however, unhealthy dietary habit is one potential underlying cause. We aim to explore the association of poor dietary habits with FD and its subtypes. MATERIAL AND METHODS A validated epidemiological questionnaire was designed to investigate dietary habits and gastrointestinal syndromes. Citizens in the Baotun community of Dongguan were invited to complete the study questionnaire. All participants were asked to undergo a physical examination and a blinded physician interview. The study was conducted from June 2015 to June 2016. FD was diagnosed using ROME III criteria. The association between investigated dietary habits and dyspeptic symptoms were explored. RESULTS There were 1,304 adult residents recruited for the study survey; 165 residents had existing organic dyspepsia (OD), 203 residents were diagnosed with FD, and the other 936 participants, who were without dyspeptic symptoms or functional gastrointestinal diseases, were regarded as the control group. Subtype diagnosis indicated 61 participants had EPS, 66 participants had PDS, and 76 participants had coexisting EPS and PDS. Unhealthy dietary habits were more prevalent in the FD group than in the control groups (75.86% versus 37.50%; p<0.001). FD was found to be associated with irregular mealtime, dining out, fatty food, sweet food, and coffee (p<0.05). The impact of each dietary factor varied with FD subtypes. CONCLUSIONS Certain types of dietary habits were positively correlated with the prevalence of FD. FD subtypes showed relatively different associations with dietary factors.
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Affiliation(s)
- Ji-Hao Xu
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yu Lai
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Li-Ping Zhuang
- Department of Internal Medicine, Baotun Community Health Station, Houjie Township, Dongguan, Guangdong, P.R. China
| | - Can-Ze Huang
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Chu-Qiang Li
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Qi-Kui Chen
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
- Corresponding Authors: Tao Yu, e-mail: ; Qikui Chen, e-mail:
| | - Tao Yu
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
- Corresponding Authors: Tao Yu, e-mail: ; Qikui Chen, e-mail:
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Asano H, Tomita T, Nakamura K, Yamasaki T, Okugawa T, Kondo T, Kono T, Tozawa K, Ohda Y, Oshima T, Fukui H, Fukushima K, Hirota S, Watari J, Miwa H. Prevalence of Gastric Motility Disorders in Patients with Functional Dyspepsia. J Neurogastroenterol Motil 2017; 23:392-399. [PMID: 28423481 PMCID: PMC5503289 DOI: 10.5056/jnm16173] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/14/2017] [Accepted: 02/08/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Gastric motility abnormalities have been considered to be pathophysiological features of functional dyspepsia (FD) that are closely related to dyspepsia symptoms, especially postprandial distress syndrome (PDS). The aims of this study are to (1) investigate the prevalence of gastric motility disorders and (2) evaluate the association between gastric motility abnormalities and dyspeptic symptoms using gastric scintigraphy in the PDS type of FD. Methods Forty healthy subjects and 94 PDS type FD patients were enrolled in the study. The volunteers and patients ingested a radiolabeled (technetium-99m) solid test meal, and scintigraphic images were recorded. Gastric accommodation and emptying were assessed by scintigraphic imaging. The patients’ dyspeptic symptoms were also explored using self-completed symptom questionnaires with 10 variables (4 scales, 0–3 points) at the same time. Results In 94 Japanese FD patients, the prevalence of impaired gastric accommodation and delayed emptying were 14.9% (14/94) and 10.6% (10/94), respectively. Gastric motility abnormalities were seen in 25.5% (24/94) of FD patients. There was no association between gastric motility abnormalities and dyspeptic symptoms. Conclusions Gastric motility abnormalities were seen in 25.5% of Japanese PDS type FD patients. However, there was no association between gastric motility abnormalities and dyspeptic symptoms on gastric scintigraphy.
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Affiliation(s)
- Haruki Asano
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kumiko Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahisa Yamasaki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takuya Okugawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoaki Kono
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Ohda
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhito Fukushima
- Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Abstract
Functional Dyspepsia-Post-prandial Distress Syndrome (FD-PDS) was associated with mood-related increases in resting activity and lowered activation threshold in the somatosensory cortex (SSC), insula and perigenual anterior cingulate cortex(pgACC) in functional imaging studies. The underlying cortical neurochemical changes are unknown. We performed proton Magnetic Resonance Spectroscopy (1H-MRS) on 17 consecutive tertiary clinic-recruited psychotropic-naïve Rome III FD-PDS female and 17 age-sex matched healthy controls. Voxels were placed on bilateral pgACC, left insula and SSC. Water-suppressed spectra were acquired using PRESS with short echo time (TE) (T = 24 ms) to separately quantify glutamate (Glu) and glutamine (Gln). Main outcome measure was regional Glu/Cr + PCr. Severity of depression, anxiety, somatization, and dyspepsia were also assessed. We found significantly increased SSC Glu/Cr + PCr in FD-PDS subjects compared to controls. SSC Glu/Cr + PCr correlated significantly with postprandial distress chronicity, dyspeptic symptoms severity and anxiety. The SSC Glu/Cr + PCr - dyspepsia correlations became insignificant after controlling for anxiety but were independent of depression. Gln/Glu ratio, which indicates glial Glu cycling failure, was unchanged. No between-group differences were noted in other regional metabolite concentrations. Our findings suggested enhanced SSC glutamate transmission in FD-PDS that was linked to post-prandial distress chronicity and severity and anxiety.
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Triantafyllou K, Kourikou A, Gazouli M, Karamanolis GP, Dimitriadis GD. Functional dyspepsia susceptibility is related to CD14, GNB3, MIF, and TRPV1 gene polymorphisms in the Greek population. Neurogastroenterol Motil 2017; 29. [PMID: 27430937 DOI: 10.1111/nmo.12913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) susceptibility might be influenced by polymorphisms of genes related to inflammation (CD14, macrophage migration inhibitory factor [MIF]), motor (GNB3), and sensory dysfunction (GNB3, TRPV1). We examined the association between CD14 rs2569190, GNB3 rs5443, MIF rs222747, and TRPV1 rs755622 gene polymorphisms with FD (Rome III criteria) in the Greek population. METHODS We genotyped 174 dyspeptics (115 with epigastric pain syndrome; 41% Helicobacter pylori positive) and 181 controls using polymerase chain reaction-based methods and we measured disease symptoms' burden with a modified Gastrointestinal Symptoms Related Scale. KEY RESULTS Homozygous for the TT genotype and the T allele of the CD14 gene were significantly associated (OR [95% CI]) with FD (2.65 [1.42-4.94] and 1.67 [1.23-2.26], respectively). The CT, TT genotypes, and T allele frequencies of GNB3 showed also significant association with FD (2.18 [1.35-3.54], 3.46 [1.30-9.23], and 2.18 [1.48-3.19]). While heterozygous GC MIF genotype was more common in dyspeptics (1.67 [1.07-2.60]), homozygous CC genotype and the C allele of TRPV1 gene were more prevalent in controls (0.47 [0.25-0.87] and 0.69 [0.51-0.92], respectively). None of the gene polymorphism was related either to dyspepsia clinical syndrome type or to the H. pylori infection. Among dyspeptics, CD14 TT genotype was related to lower epigastric pain burden score (p<.011); CD14 CT genotype was related to higher epigastric burning and nausea burden scores (p<.04) while belching score was lower (p=.027) in MIF CG dyspeptics. CONCLUSION & INFERENCES Functional dyspepsia susceptibility is related to CD14, GNB3, MIF, and TRPV1 gene polymorphisms, while CD14 and MIF gene variants are also associated with dyspepsia symptoms burden.
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Affiliation(s)
- K Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - A Kourikou
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - M Gazouli
- Laboratory of Biology, Medical School, National and Kapodistrian University, Athens, Greece
| | - G P Karamanolis
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - G D Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Research institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University, Athens, Greece
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Fabrizio AC, Alimi Y, Kumar AS. Methods of Evaluation of Anorectal Causes of Obstructed Defecation. Clin Colon Rectal Surg 2016; 30:46-56. [PMID: 28144212 DOI: 10.1055/s-0036-1593427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obstructed defecation is a complex disorder that results in impaired propagation of stool from the rectum. It is one of the major subtypes of functional constipation and can be secondary to either functional or anatomic etiologies. Patients with obstructed defecation typically present with symptoms of abdominal discomfort, a sensation of incomplete evacuation and rectal obstruction, passage of hard stools, the need for rectal or vaginal digitation, excessive straining, and reduced stool frequency. Evaluation of obstructed defecation is multimodal, starting with a thorough history and physical examination with focus on the abdominal, perineal, and rectal examination. Additional modalities to elicit the diagnosis of obstructed defecation include proctoscopy, colonic transit time studies, anorectal manometry, a rectal balloon expulsion test, defecography, electromyography, and ultrasound. The results from these studies should be taken in the context of each patient's clinical situation, as there is no single criterion standard for the diagnosis of obstructed defecation. Surgery is typically a last resort for these patients and the majority of patients will have good symptomatic management with diet and lifestyle changes. Patients who are found to have functional mechanisms behind their obstructed defecation also benefit from pelvic floor exercises and biofeedback therapy.
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Affiliation(s)
- Anne C Fabrizio
- Department of Surgery, Medstar Georgetown University Hospital, District of Columbia, Washington
| | - Yewande Alimi
- Department of Surgery, Medstar Georgetown University Hospital, District of Columbia, Washington
| | - Anjali S Kumar
- Colorectal Surgery Program, Virginia Mason Medical Center, Seattle, Washington
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Motavasselian M, Saghebi SA, Nademi MR, Tavakkoli-Kakhki M. Depression and Dyspepsia: An Implication of Islamic Resources. JOURNAL OF RELIGION AND HEALTH 2016; 55:1864-1868. [PMID: 26359048 DOI: 10.1007/s10943-015-0115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Depression is a common mental disorder and the leading cause of disability in the worldwide. Based on Islamic resources, indigestion and dyspepsia can lead to depression. In modern medicine, though many somatic diseases have been named as possible causes of depression, the effect of gastrointestinal disorders on depression is still an enigma. Therefore, the focus of this study is to explore the available scientific literature of modern medicine in order to find the footprint of effect of indigestion on depression. In this study, related articles were retrieved from PubMed, Ovid, Proquest and Magiran databases by using the Medical Subject Heading keywords "depression," "psychology," "dyspepsia" and "gastrointestinal diseases." In the next step, studies, which are exactly confirm the Islamic viewpoint, were selected from the retrieved articles. Only one prospective study in 2012 has stated that people with functional gastrointestinal disorders and without elevated levels of anxiety and depression at baseline had significantly higher levels of anxiety and depression at 12-year follow-up. Based on Islamic viewpoint, indigestion can lead to depression, but this aspect approved by only one 12-year prospective population-based study in our review. It seems that it is necessary to conduct complementary studies investigating this hypothesis.
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Affiliation(s)
- Malihe Motavasselian
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Seyyd-Ahamd Saghebi
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Mandana Tavakkoli-Kakhki
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Science, Mashhad, Iran.
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Abdalla SM, Kalra G, Moshiree B. Motility Evaluation in the Patient with Inflammatory Bowel Disease. Gastrointest Endosc Clin N Am 2016; 26:719-38. [PMID: 27633599 DOI: 10.1016/j.giec.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients with inflammatory bowel disease (IBD) suffer frequently from functional bowel diseases (FBD) and motility disorders. Management of FBD and motility disorders in IBD combined with continued treatment of a patient's IBD symptoms will likely lead to better clinical outcomes and improve the patient's quality of life. The goals of this review were to summarize the most recent literature on motility disturbances in patients with IBD and to give a brief overview of the ranges of motility disturbances, from reflux disease to anorectal disorders, and discuss their diagnosis and specific management.
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Affiliation(s)
- Sherine M Abdalla
- Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Central Building, 600D, Miami, FL 33136, USA
| | - Gorav Kalra
- Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, CRB, 11th Floor, Miami, FL 33136, USA
| | - Baha Moshiree
- Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, CRB Suite 971, Miami, FL 33136, USA.
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Dibaise JK, Islam RS, Dueck AC, Roarke MC, Crowell MD. Psychological distress in Rome III functional dyspepsia patients presenting for testing of gastric emptying. Neurogastroenterol Motil 2016; 28:196-205. [PMID: 26511077 DOI: 10.1111/nmo.12709] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/22/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND There have been conflicting results from studies that have evaluated psychological disturbances in functional dyspepsia (FD). We conducted a comprehensive survey of psychological measures in patients undergoing gastric emptying testing (GET) in order to determine the relationship among psychological distress, gastric emptying, and dyspeptic symptoms. METHODS Consecutive patients referred for GET were prospectively enrolled. Details regarding patient characteristics, health care utilization, dyspeptic symptoms, quality of life, and psychological dysfunction were obtained. Depression, anxiety, somatization, stress, positive and negative affect, and alexithymia were queried using validated questionnaires. We compared those dyspeptic patients who met Rome III criteria for FD to those who did not meet these criteria. KEY RESULTS Two hundred and nine patients (160 female; mean age 46.6 years ± 17.3 years) participated. Around 151 patients (72%) met Rome III criteria for FD. In the entire group, a high level of depression, anxiety, somatization, and perceived stress was present compared to population norms. Health care seeking behavior and symptom severity were greater in those with FD and quality of life was lower compared to non-FD. Gastric emptying did not differentiate the two groups and similar degrees of psychological distress were present whether emptying was delayed or normal. CONCLUSIONS & INFERENCES In patients referred for GET, substantial psychological distress is present. The degree of distress was similar regardless of whether the patient met Rome III FD criteria or not. Further evaluation of psychological dysfunction in FD patients may lead to improved diagnosis and determination of the most appropriate treatment.
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Affiliation(s)
- J K Dibaise
- Division of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - R S Islam
- Division of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - A C Dueck
- Department of Biostatistics, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - M C Roarke
- Department of Radiology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - M D Crowell
- Division of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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Oshima T, Tomita T, Ohda Y, Fukui H, Watari J, Miwa H. Epidemiology of Uninvestigated Dyspepsia and Functional Dyspepsia in Asia. J Gen Fam Med 2015. [DOI: 10.14442/jgfm.16.4_235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kourikou A, Karamanolis GP, Dimitriadis GD, Triantafyllou K. Gene polymorphisms associated with functional dyspepsia. World J Gastroenterol 2015; 21:7672-7682. [PMID: 26167069 PMCID: PMC4491956 DOI: 10.3748/wjg.v21.i25.7672] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/07/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
Functional dyspepsia (FD) is a constellation of functional upper abdominal complaints with poorly elucidated pathophysiology. However, there is increasing evidence that susceptibility to FD is influenced by hereditary factors. Genetic association studies in FD have examined genotypes related to gastrointestinal motility or sensation, as well as those related to inflammation or immune response. G-protein b3 subunit gene polymorphisms were first reported as being associated with FD. Thereafter, several gene polymorphisms including serotonin transporter promoter, interlukin-17F, migration inhibitory factor, cholecystocynine-1 intron 1, cyclooxygenase-1, catechol-o-methyltransferase, transient receptor potential vanilloid 1 receptor, regulated upon activation normal T cell expressed and secreted, p22PHOX, Toll like receptor 2, SCN10A, CD14 and adrenoreceptors have been investigated in relation to FD; however, the results are contradictory. Several limitations underscore the value of current studies. Among others, inconsistencies in the definitions of FD and controls, subject composition differences regarding FD subtypes, inadequate samples, geographical and ethnical differences, as well as unadjusted environmental factors. Further well-designed studies are necessary to determine how targeted genes polymorphisms, influence the clinical manifestations and potentially the therapeutic response in FD.
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Kim MT, Kim KB, Han HR, Huh B, Nguyen T, Lee HB. Prevalence and Predictors of Depression in Korean American Elderly: Findings from the Memory and Aging Study of Koreans (MASK). Am J Geriatr Psychiatry 2015; 23:671-83. [PMID: 25554484 PMCID: PMC4442756 DOI: 10.1016/j.jagp.2014.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To estimate the prevalence and identify the predictors of depression among community-dwelling Korean American elderly (KAE). DESIGN A cross-sectional descriptive epidemiological survey using a two-step sampling strategy to obtain a representative community sample. SETTING The authors recruited study participants at religious, service, and business establishments in the KA community (26 churches, 6 senior centers, 2 medical daycare centers, 1 supermarket). PARTICIPANTS Community-dwelling first-generation KAE (N = 1,118; mean age ± SD: 70.5 ± 7.0 years; female: 67.2%). MEASUREMENTS Trained bilingual nurses and community health workers interviewed participants face-to-face for demographic information, chronic conditions, and depression using the Korean versions of the Patient Health Questionnaire (PHQ-9K). RESULTS 30.3% of KAEs were classified as having either mild (PHQ-9K score 5-9; N = 218, 19.5%) or clinical depression (PHQ-9K score ≥10; N = 120, 10.8%), respectively. One of seven KAE (N = 164, 14.7%) endorsed thoughts of death or self-injury, but only 63 (5.7%) reported utilizing mental health services. The authors also identified several predictors of depression, including living arrangement (living alone versus living with family/spouse); having chronic conditions such as diabetes, arthritis, digestive disorders, or chronic bronchitis; years of education; and cognitive impairment. CONCLUSIONS The authors' findings reveal a high prevalence of depression among KAE and a low level of mental health service utilization. Because there are urgent needs for culturally and contextually relevant interventions, the authors also discuss the feasibility of community-based interventions to reduce the burden of depression, which should be incorporated into a management system for multiple chronic conditions.
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Affiliation(s)
- Miyong T. Kim
- School of Nursing, University of Texas at Austin, Austin, Texas
| | - Kim B. Kim
- Korean Resource Center, Ellicott City, Maryland
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Boyun Huh
- School of Nursing, University of California at San Francisco, San Francisco, California
| | - Tam Nguyen
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
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Ford AC, Marwaha A, Sood R, Moayyedi P. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut 2015; 64:1049-57. [PMID: 25147201 DOI: 10.1136/gutjnl-2014-307843] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/22/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Many cross-sectional surveys have reported the prevalence of uninvestigated dyspepsia, but there has been no recent systematic review of data from all studies to determine its global prevalence and risk factors. DESIGN MEDLINE, EMBASE and EMBASE Classic were searched (until January 2014) to identify population-based studies that reported the prevalence of uninvestigated dyspepsia in adults (≥ 15 years old); dyspepsia was defined using symptom-based criteria or questionnaires. The prevalence of dyspepsia was extracted for all studies and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, ORs and 95% CIs were calculated. RESULTS Of the 306 citations evaluated, 103 reported the prevalence of uninvestigated dyspepsia in 100 separate study populations, containing 312,415 subjects. Overall pooled prevalence in all studies was 20.8% (95% CI 17.8% to 23.9%). The prevalence varied according to country (from 1.8% to 57.0%) and criteria used to define dyspepsia. The greatest prevalence values were found when a broad definition of dyspepsia (29.5%; 95% CI 25.3% to 33.8%) or upper abdominal or epigastric pain or discomfort (20.4%; 95% CI 16.3% to 24.8%) were used. The prevalence was higher in women (OR 1.24; 95% CI 1.13 to 1.36), smokers (OR 1.25; 95% CI 1.12 to 1.40), non-steroidal anti-inflammatory drug (NSAID) users (OR 1.59; 95% CI 1.27 to 1.99) and Helicobacter pylori-positive individuals (OR 1.18; 95% CI 1.04 to 1.33). CONCLUSIONS The overall pooled prevalence of uninvestigated dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori-positive individuals, although these associations were modest.
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Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Avantika Marwaha
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Ruchit Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Paul Moayyedi
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
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Oshima T, Miwa H. Epidemiology of Functional Gastrointestinal Disorders in Japan and in the World. J Neurogastroenterol Motil 2015; 21:320-9. [PMID: 26095436 PMCID: PMC4496905 DOI: 10.5056/jnm14165] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 01/25/2015] [Accepted: 01/25/2015] [Indexed: 12/15/2022] Open
Abstract
Functional gastrointestinal disorders (FGIDs), represented by functional dyspepsia (FD) and irritable bowel syndrome (IBS), are a group of disorders that include variable combinations of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. FGIDs account for a significant percentage of patients seen in primary care settings with abdominal symptoms. Although the definition of FGIDs can easily affect the prevalence, the prevalences of dyspepsia/FD and IBS diagnosed by the Rome III criteria in the general population are 5.3–20.4% and 1.1–29.2%, respectively. Recent reports of FD and IBS defined by the Rome III criteria indicated a female predominance. Regarding the subtype prevalence of FD, postprandial distress syndrome was more prevalent than epigastric pain syndrome (5.6–13.9% vs 0.9–9.5%). The subtype prevalence of IBS is characterized by male predominance for IBS with diarrhea and female predominance for IBS with constipation. Factors affecting the development of FGIDs such as epidemiological factors including genetic and environmental factors, are important. Gene polymorphisms are involved in the development of FGIDs. The prevalence differs among races and geographic areas. Foods may affect the development of FGIDs, but the causal relationships between food and FGIDs are not conclusive. The symptoms often regress and appear in the course of these entities. Building a favorable patient-doctor relationship is effective for controlling symptoms of FGIDs. Physicians should explain that FGIDs are highly prevalent conditions, impair the patients’ quality of life even without evident underlying organic causes and are not life-threatening conditions to ensure patients’ understanding.
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Affiliation(s)
- Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Yan XJ, Li WT, Chen X, Wang EM, Liu Q, Qiu HY, Cao ZJ, Chen SL. Effect of clinician-patient communication on compliance with flupentixol-melitracen in functional dyspepsia patients. World J Gastroenterol 2015; 21:4652-4659. [PMID: 25914475 PMCID: PMC4402313 DOI: 10.3748/wjg.v21.i15.4652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/10/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia (FD) patients with psychological symptoms.
METHODS: A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen (FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal (GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3.
RESULTS: After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3 (Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantly higher compliance rate than Groups 2 and 3 (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia (Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores (anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were greater than those in Groups 2-4. The compliance indices were positively correlated with the reduction in symptom scores in Groups 1-3.
CONCLUSION: Appropriate clinician-patient communication regarding the reasons for prescribing psychoactive drugs that emphasizes both the psychological and GI mechanisms might improve adherence to FM in patients with FD.
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Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. The effect of emotional stress and depression on the prevalence of digestive diseases. J Neurogastroenterol Motil 2015; 21:273-82. [PMID: 25779692 PMCID: PMC4398234 DOI: 10.5056/jnm14116] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Epidemiological data indicate that emotional stress and depression might influence the development of gastrointestianl disorders and cancers, but the relationship between the two is still unclear. The aim was to investigate the effect of stress/depression on the prevalence of digestive diseases. In addition, we tried to identify whether stress and depression are risk factors for these diseases. Methods A total of 23 698 subjects who underwent a medical check-up including upper and lower endoscopy were enrolled. By review -ing the subject’s self-reporting questionnaire and endoscopic findings, we investigated the digestive diseases, including functional dyspepsia (FD), irritable bowel syndrome (IBS), reflux esophagitis, peptic ulcer disease, and adenoma and carcinoma of the stomach and colon. Stress and depression scores were measured by the Brief Encounter Psychosocial Instrument and Beck’s Depression Inventory, respectively (Korean version). Results Stress and depression were related to FD, IBS, and reflux esophagitis. Depression was also linked to peptic ulcer disease and adenoma/carcinoma of the colon and stomach. Multivariate analysis revealed that stress and depression were independent risk factors for FD (OR, 1.713 and 1.984; P < 0.001) and IBS (OR, 1.730 and 3.508; P < 0.001). In addition, depression was an independent risk factor for gastric adenoma/carcinoma (OR, 4.543; P < 0.001). Conclusions Stress and depression are related to various digestive diseases, and they may be predisposing factors for FD and IBS. Depression may also be a cause of gastric cancer. Psychological evaluation of gastroenterology patients may be necessary, but more study is needed.
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chan Sup Shim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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