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Huang Q, Yuan H, Li Q, Li Y, Geng S, Zhu Y, Liao M, Jiang H. Global trends in research related to functional dyspepsia and anxiety or depression over the past two decades: a bibliometric analysis. Front Neurosci 2023; 17:1218001. [PMID: 38027507 PMCID: PMC10651763 DOI: 10.3389/fnins.2023.1218001] [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: 05/06/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Functional dyspepsia (FD) is a prevalent global disorder of the upper digestive tract characterized by functional impairment. It often coexists with anxiety/depression, significantly impairing occupational productivity and overall quality of life. This study aimed to identify emerging patterns and prominent themes within FD and anxiety/depression research through bibliometric analysis to help explore new innovative avenues for investigating this type of FD. Methods A comprehensive review of literature encompassing FD and anxiety/depression was conducted using the Science Citation Index Extension of the Web of Science Core Collection from 2003 to 2023. Information extracted comprised "Full Record and Cited References." Bibliometric analysis of relevant publications, including country, institution, author, journal, citations, and keywords, was conducted using CiteSpace, VOSviewer, and Bibliometrix package in R and Excel. Results Studies related to FD and anxiety/depression have demonstrated an ascending trajectory since 2003. Our bibliometric analysis identified 338 studies published by 2023. NEUROGASTROENTEROLOGY AND MOTILITY emerged as the most prolific journal, while GASTROENTEROLOGY retained pre-eminence within the top 10 published journals. China emerged as the most prolific country, with two institutions within the top 10 in terms of volume of publications. The Mayo Clinic stood as the foremost institution in terms of publication volume, with the Chengdu University of Traditional Chinese Medicine exhibiting robust collaborative engagement. Eminent author influence was attributed to Talley NJ of Newcastle University, Australia. Clusters of extensively cited papers and prevalent keywords delineate the status and trend of FD and anxiety/depression research. This encompasses FD, anxiety, depression, sleep disorders, and functional gastrointestinal disorders. Furthermore, the timeline view map or trend-term analysis suggested that duodenal low-grade inflammation ("duodenal eosinophilia" and "mast cells") might be a new concern associated with FD and anxiety/depression. Conclusion Employing bibliometric analysis, this study revealed prevalent focal areas and new trends within FD and anxiety/depression research. These insights serve as valuable guidance for scholars seeking to delve into new research avenues.
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Affiliation(s)
- Qian Huang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huixiao Yuan
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingqing Li
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Li
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shasha Geng
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingqian Zhu
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Liao
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Du H, Lin R, Xiao S, Zhao Y, Wu M, Chen W, Cai W, Wei N, Gong G, Huang K, Zhang F, Chen H. Improved Sleep Affects Epigastric Pain in Functional Dyspepsia by Reducing the Levels of Inflammatory Mediators. Dig Dis 2023; 41:835-844. [PMID: 37607491 DOI: 10.1159/000531748] [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: 01/05/2023] [Accepted: 06/20/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION The pathogenesis of epigastric pain in functional dyspepsia (FD) is complex. The study aims to explore the effect of sleep improvement on this symptom. METHODS In total, 120 patients with FD-associated epigastric pain and insomnia were randomly divided into experimental and control groups using the envelope method. After applying the exclusion criteria, 107 patients were enrolled in the experimental (56 patients) and control (51 patients) groups. Insomnia was graded according to the Pittsburgh Sleep Quality Index (PSQI). In the experimental group, eszopiclone 3 mg, eszopiclone 3 mg + estazolam 1 mg, and eszopiclone 3 mg + estazolam 2 mg were given to patients with mild, moderate, and severe insomnia, respectively. In the control group, patients were given 1, 2, or 3 tablets of vitamin B complex. Patient sleep quality was monitored with Sleepthing. Epigastric pain was evaluated with a Numeric Rating Scale. The serum levels of IL-1β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. Pain scores, sleep parameters, and serum levels of inflammatory mediators were compared before and after treatment. RESULTS After treatment, the pain scores, sleep parameters, and TNF-α and IL-6 levels in the experimental group were significantly lower than those in the control group (p < 0.05). PSQI insomnia scores were significantly associated with pain scores, IL-6, and TNF-α (p < 0.05) but not in IL-8 and IL-1β levels (p > 0.05) among the three groups. CONCLUSIONS Improving sleep with eszopiclone and/or estazolam alleviates FD-associated epigastric pain, possibly by inhibiting related downstream transmission pathways and reducing the release of inflammatory mediators.
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Affiliation(s)
- Huang Du
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Rongpan Lin
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Shuping Xiao
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Yu Zhao
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Mingxia Wu
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Wenhua Chen
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Wangfeng Cai
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Nating Wei
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Guohua Gong
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Kangming Huang
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Fajing Zhang
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
| | - Hongbin Chen
- Department of Gastroenterology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming City, China
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Yan L, Zhang X, Li Y, Liu C, Yang H, Yang C. The role of psychological factors in functional gastrointestinal disorders: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:65. [PMID: 36894717 DOI: 10.1007/s00384-023-04333-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To systematically reevaluate the role of psychological factors in functional gastrointestinal disorders (FGIDs) and thus provide a scientific basis for the psychological treatment of FGIDs. METHODS A literature search was conducted using the PubMed, Embase, Web of Science, and Cochrane Library databases from January 2018 to August 2022 for researches on psychological factors affecting patients with functional gastrointestinal disorders. Meta-analysis was carried out with Stata17.0 after the screening, extraction, and evaluation of article quality. RESULTS The search included 22 articles with 2430 patients in the FGIDs group and 12,397 patients in the healthy controls. Meta-analysis showed anxiety [(pooled SMD = 0.74, 95%CI: 0.62 ~ 0.86, p < 0.000) (pooled OR = 3.14, 95%CI: 2.47 ~ 4.00, p < 0.000)], depression [(pooled SMD = 0.79, 95%CI: 0.63 ~ 0.95, p < 0.000) (pooled OR = 3.09, 95%CI: 2.12 ~ 4.52, p < 0.000)], mental disorders (pooled MD = -5.53, 95%CI: -7.12 ~ -3.95, p < 0.05), somatization (pooled SMD = 0.92, 95%CI: 0.61 ~ 1.23, p < 0.000), and sleep disorders (pooled SMD = 0.69, 95%CI: 0.04 ~ 1.34, p < 0.05) are risk factors for functional gastrointestinal disorders. CONCLUSION There is a significant association between psychological factors and FGIDs. Interventions such as anti-anxiety drugs, antidepressants, and behavioral therapy are of great clinical significance in reducing FGIDs risk and improving prognosis.
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Affiliation(s)
- Liyanran Yan
- School of Public Health, Hebei Medical University, Hebei, China
| | - Xueli Zhang
- Department of Gastroenterology, The First Hospital of Hebei Medical University, Donggang Road 89, Shijiazhuang, 050031, Hebei, China
| | - Yan Li
- Student Career Center, Peking University, Beijing, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anhui, China
| | - Hua Yang
- Department of Pulmonary and Critical Care Medicine, Henan Province People's Hospital, Henan, China
| | - Chunchun Yang
- Department of Gastroenterology, The First Hospital of Hebei Medical University, Donggang Road 89, Shijiazhuang, 050031, Hebei, China.
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Yamamoto Y, Furukawa S, Watanabe J, Kato A, Kusumoto K, Miyake T, Takeshita E, Ikeda Y, Yamamoto N, Okada K, Kohara K, Saheki S, Saeki Y, Hiasa Y. Positive Association Between Sleep Disturbance and Prevalence of Functional Dyspepsia in Japanese Young People. Dig Dis Sci 2022; 67:3929-3937. [PMID: 34618281 DOI: 10.1007/s10620-021-07260-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence regarding the association between sleep disturbance and functional dyspepsia (FD) remains limited in the young population. AIMS This study aimed to investigate the association between sleep disturbance and FD including subgroups among Japanese young people. METHODS Study subjects were 8923 university students. FD was defined according to the Rome III criteria. Subjects with FD were further categorized as having postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS). Subjects completed a self-reported questionnaire assessing self-reported sleep duration, sleep disturbance, difficulty falling asleep, deep sleep disorder, nocturnal awakening, early awakening, and daytime sleepiness. RESULTS The prevalence of FD was 1.9%. After adjustment, all types of sleep disturbances were independently positively associated with FD (total sleep disturbance: OR 4.11 [95% CI: 2.89-5.78], difficulty falling asleep: OR 3.97 [95% CI: 2.53-6.01], deep sleep disorder: OR 4.85 [95% CI: 3.06-7.40], nocturnal awakening: OR 4.35 [95% CI: 1.90-8.67], early awakening: OR 4.50 [95% CI: 1.97-8.97], and daytime sleepiness: OR 2.83 [95% CI: 1.25-5.56]). While nocturnal awakening and daytime sleepiness were not associated with EPS, the other types of sleep disturbance were independently positively associated with EPS and PDS. No association between self-reported sleep duration and FD was found. CONCLUSIONS Sleep disturbance may be independently positively associated with the prevalence of FD among Japanese young people. Nocturnal awakening and daytime sleepiness were not associated with EPS; the other types of sleep disturbance were independently positively associated with EPS and PDS.
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Affiliation(s)
| | - Shinya Furukawa
- Health Services Center, Ehime University, Matsuyama, Ehime, 790-8577, Japan.
| | - Junichi Watanabe
- Department of Rehabilitation, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Aki Kato
- Health Services Center, Ehime University, Matsuyama, Ehime, 790-8577, Japan
| | - Katsunori Kusumoto
- Health Services Center, Ehime University, Matsuyama, Ehime, 790-8577, Japan
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Toon, Ehime, Japan
| | - Naofumi Yamamoto
- Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Ehime, Japan
| | | | - Katsuhiko Kohara
- Department of Internal Medicine, Ibusuki Kozenkai Hospital, Ibusuki, Kagoshima, Japan
| | - Syuichi Saheki
- Health Services Center, Ehime University, Matsuyama, Ehime, 790-8577, Japan
| | - Yuka Saeki
- Health Services Center, Ehime University, Matsuyama, Ehime, 790-8577, Japan
- Community Health Systems for Nursing, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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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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Wuestenberghs F, Melchior C, Desprez C, Leroi AM, Netchitailo M, Gourcerol G. Sleep Quality and Insomnia Are Associated With Quality of Life in Functional Dyspepsia. Front Neurosci 2022; 16:829916. [PMID: 35210990 PMCID: PMC8861511 DOI: 10.3389/fnins.2022.829916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Sleep disturbances are common in patients with functional dyspepsia. Our aim was to assess the relationship between subjective sleep and quality of life and to identify factors associated with impaired sleep in functional dyspepsia. Methods One thousand two hundred and twenty patients referred for functional gastrointestinal disorders at a single tertiary care center between end 2017 and June 2019 were studied using a self-administered questionnaire. 355 patients with Rome IV-based functional dyspepsia were identified. Sleep was assessed using both the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). The severity of dyspeptic symptoms was assessed using the Total Symptom Score (TSS). Quality of life was assessed by the GastroIntestinal Quality of Life Index (GIQLI). Anxiety and depression levels were evaluated using the Hospital Anxiety and Depression (HAD) scale. Key Results Among the 355 patients with functional dyspepsia, 66 (18.6%) patients displayed normal sleep quality whereas 289 (81.4%) patients had altered sleep quality. Functional dyspepsia patients with sleep disturbances were older (48.1 ± 15.4 vs. 41.4 ± 16.0, p = 0.0009), had decreased quality of life (GIQLI: 75.3 ± 18.5 vs. 92.1 ± 15.4, p < 0.0001), greater severity of their symptoms (TSS: 18.9 ± 3.6 vs. 17.2 ± 3.9, p = 0.0007), and higher anxiety and depression scores (HADS: 17.7 ± 7.2 vs. 11.9 ± 5.1, p < 0.0001). A correlation was found between sleep quality and quality of life [r = −0.43 (95% CI: −0.51 to −0.34), p < 0.0001]. Independent factors predicting poor sleep quality were age [OR 1.03 (95% CI = 1.01–1.05), p = 0.006], depression level [OR 1.27 (95% CI = 1.16–1.39); p < 0.0001], and the severity of dyspeptic symptoms [OR 1.13 (95% CI = 1.04–1.22); p = 0.004]. Conclusion and Inferences A high prevalence of sleep disturbances was found in patients suffering from functional dyspepsia, with 81% of them having altered sleep quality and 61% having insomnia based on subjective assessment. Altered sleep quality and insomnia were associated with altered quality of life, higher severity of symptoms, and higher anxiety and depression scores in this disorder.
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Affiliation(s)
- Fabien Wuestenberghs
- Department of Physiology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- INSERM Unit 1073, UNIROUEN, Normandy University, Rouen, France
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Chloé Melchior
- INSERM Unit 1073, UNIROUEN, Normandy University, Rouen, France
- Department of Gastroenterology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- INSERM CIC-CRB 1404, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Desprez
- Department of Physiology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- INSERM Unit 1073, UNIROUEN, Normandy University, Rouen, France
| | - Anne-Marie Leroi
- Department of Physiology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- INSERM Unit 1073, UNIROUEN, Normandy University, Rouen, France
- INSERM CIC-CRB 1404, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
| | - Marie Netchitailo
- Department of Physiology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
| | - Guillaume Gourcerol
- Department of Physiology, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- INSERM Unit 1073, UNIROUEN, Normandy University, Rouen, France
- INSERM CIC-CRB 1404, Rouen University Hospital, UNIROUEN, Normandy University, Rouen, France
- *Correspondence: Guillaume Gourcerol,
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Teimouri A, Amra B. Association between Sleep Quality and Gastroesophageal Reflux in Medical Students. Middle East J Dig Dis 2021; 13:139-144. [PMID: 34712452 PMCID: PMC8531919 DOI: 10.34172/mejdd.2021.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Due to stressful occupational conditions, irregular dietary and sleep schedules, medical students are at increased risk of developing gastrointestinal disorders, gastroesophageal reflux (GERD) in particular, as well as sleep disturbances. Therefore, for the first time, we aimed to assess the correlation between GERD and sleep disturbances among medical students. METHODS The current cross-sectional study was done on 290 medical students at different study periods in Iran during 2018-2019. Age, sex, stage of studying, residence, and body mass index were gathered. The frequency scale for the symptoms of gastroesophageal reflux (FSSG) was utilized to assess gastrointestinal symptoms among them and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Eventually, the association of sleep disturbances with demographic factors and gastrointestinal symptoms was evaluated. RESULTS Living in the dormitory (p = 0.048; OR: 1.73; 95%CI: 1.01-2.99) and being overweight (p < 0.001; OR: 3.09; 95%CI: 1.58-6.06) were independently correlated with impaired sleep quality. GERD presented either by heartburn (p < 0.001) or regurgitation (p < 0.001) was associated with a lower quality of life. CONCLUSION GERD was correlated with poor sleep quality among medical students. In addition, residence in dormitory and being overweight were correlated with poor sleep quality.
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Affiliation(s)
- Azam Teimouri
- Assistant Professor of Gastroenterology, Department of Gasteroenterology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Amra
- Professor of Pulmonology, Department of Pulmonology, Bamdad Respiratory Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Fujiwara Y, Okuyama M, Nagami Y, Taira K, Ishizu H, Takaishi O, Sato H, Watanabe T. Heartburn, Functional Dyspepsia, Anxiety/Depression, and Sleep Disturbances Are Associated With Clinically Significant Belching. J Neurogastroenterol Motil 2021; 27:581-587. [PMID: 34642278 PMCID: PMC8521483 DOI: 10.5056/jnm20225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/29/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background/Aims Belching is the act of expelling gas from the stomach or esophagus noisily through the oral cavity. Although it is a physiological phenomenon, belching may also be a symptom of upper gastrointestinal diseases such as reflux esophagitis and functional dyspepsia (FD). A detailed epidemiology of belching has not yet been reported. The aim of this study is to examine the prevalence and clinical characteristics of clinically significant belching (CSB) in adults. Methods We analyzed 1998 subjects who visited the hospital for annual health checkups. Belching was evaluated by a simple question “Do you burp a lot?” and scored as 0 (never), 1 (occasionally), 2 (sometimes), 3 (often), or 4 (always). Subjects with CSB were defined as having scores ≥ 3. We also collected the clinical parameters, endoscopic findings, and data according to the Athens Insomnia Scale, Rome IV questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results Of the 1998 subjects, 121 (6.1%) had CSB. Subjects with CSB had FD more commonly than reflux esophagitis, but presence of heartburn was high (10.7% vs 3.1%). In addition, the HADS and Athens Insomnia Scale scores in subjects with CSB were significantly higher than those in subjects without CSB. Presence of heartburn (OR, 2.07; 95% CI, 1.05-4.09), presence of FD (OR, 2.12; 95% CI, 1.33-3.36), anxiety/depression (OR, 2.29; 95% CI 1.51-3.45), and sleep disturbances (OR, 1.73; 95% CI, 1.14-2.61) were significantly associated with CSB. Conclusion The detailed epidemiology of belching in the general adult population was clarified.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsugu Okuyama
- Department of Gastroenterology, Kashiwara Municipal Hospital, Kashiwara, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirotaka Ishizu
- Department of Gastroenterology, Kashiwara Municipal Hospital, Kashiwara, Japan
| | - Osamu Takaishi
- Department of Gastroenterology, Kashiwara Municipal Hospital, Kashiwara, Japan
| | - Hiroshi Sato
- Department of Gastroenterology, Kashiwara Municipal Hospital, Kashiwara, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Kawada T. Epigastric Pain Syndrome, Functional Dyspepsia, and Sleep Disturbance. Dig Dis Sci 2021; 66:2466-2467. [PMID: 34046823 DOI: 10.1007/s10620-021-07036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
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Goyal O, Nohria S, Dhaliwal AS, Goyal P, Soni RK, Chhina RS, Sood A. Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India. Indian J Gastroenterol 2021; 40:144-153. [PMID: 33226570 DOI: 10.1007/s12664-020-01106-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE There is scarcity of data on prevalence, overlap, and risk factors for functional gastrointestinal disorders (FGID) by Rome IV criteria. We evaluated these factors among medical, nursing, and humanities students. METHODS Rome IV Diagnostic Questionnaire (for all FGIDs), Rome III questionnaire (for irritable bowel syndrome [IBS], functional diarrhea [FDr], and functional constipation [FC]), and questionnaires assessing demography, physical activity, anxiety, and depression were used. RESULTS A total of 1309 college students were included (medical 425, nursing 390, humanities 494; mean age 20.5 ± 2.1 years; 36.5% males). Prevalence of Rome IV FGIDs was 26.9% (n = 352), significantly higher among females compared with males (32.3% vs. 17.6%; p < 0.001) and significantly higher among medical (34.4%) and nursing students (29.2%) compared with humanities students (18.6%) (p < 0.05). Most common FGIDs were functional dyspepsia (FD) (15.2%), IBS (6.2%), reflux hypersensitivity (3.5%), FDr (2.9%), FC (2.1%), and unspecified functional bowel disorder (2.1%). FGID overlap was present in 9.3%, most common being FD-IBS overlap (4.4%). With Rome III criteria, prevalence of IBS was higher (9.5%), while that of FDr (0.92%) and of FC (1.3%) were lower. On multivariate analysis, independent predictors for FGIDs were female gender, medical student, non-vegetarian diet, junk food, tea/coffee, poor physical activity, anxiety, and insomnia. CONCLUSION Rome IV FGIDs were present among one-fourth of college students with preponderance among females and medical students. FD, IBS, and reflux hypersensitivity were the most common FGIDs. Rome IV criteria led to a reduction in IBS prevalence and increase in FDr and FC prevalence. Dietary factors, physical activity, anxiety, and insomnia affected FGID prevalence.
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Affiliation(s)
- Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
| | - Sahil Nohria
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Armaan Singh Dhaliwal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Prerna Goyal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ravinder Kumar Soni
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Rajoo Singh Chhina
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
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11
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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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12
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Nakamura F, Kuribayashi S, Tanaka F, Kawami N, Fujiwara Y, Iwakiri K, Kusano M, Uraoka T. Impact of improvement of sleep disturbance on symptoms and quality of life in patients with functional dyspepsia. BMC Gastroenterol 2021; 21:78. [PMID: 33602148 PMCID: PMC7890897 DOI: 10.1186/s12876-021-01659-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS Functional dyspepsia (FD) is often comorbid with sleep disturbance. However, it is not fully understood how sleep disturbance affects the pathophysiology of FD. We aimed to investigate the relationship between FD and sleep disturbance. METHODS We prospectively enrolled 20 FD patients with sleep disturbance between December 2018 and July 2019. Patients took sleep aids for 4 weeks and filled out questionnaires before and after taking sleep aids. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Athens Insomnia Scale (AIS) were used to evaluate the severity of their sleep disturbance. Modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (mFSSG), Gastrointestinal Symptom Rating Scale (GSRS), and the Japanese version of Patient Assessment of Constipation Quality of Life (JPAC-QOL) were used to evaluate the severity of GI symptoms. Short-Form 36-Item Health Survey (SF-36) was used to evaluate QOL. Pre- and post-sleep medication values of questionnaires were compared. RESULTS Among 20 enrolled patients, 16 completed the study protocol. Zolpidem, eszopiclone, and suvorexant were administered to six, nine, and one patient, respectively. Each median total score of questionnaires (pre-/post-sleep medication, respectively) was as follows: PSQI, 10.0/8.5; ESS, 12.5/5.0; AIS, 10.0/4.0; mFSSG, 21.0/16.0; GSRS, 44.0/31.0 (Pain in GSRS, 11.0/5.0); JPAC-QOL, 26.0/15.5; SF-36, 63.9/71.9. All of these results showed statistically significant differences between pre- and post-sleep medication (p < 0.05). CONCLUSIONS Improvement of sleep disturbance by administration of sleep aids resulted in improvement of GI symptoms and QOL in patients with FD. This effect may be related to pain modification.
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Affiliation(s)
- Fumihiko Nakamura
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.,Digestive Disease Center, Kohseichuo General Hospital, 1-11-7 Mita, Meguro-ku, Tokyo, 153-8581, Japan
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-5-7 Asahi-cho, Abeno-ku, Osaka, 545-8586, Japan
| | - Noriyuki Kawami
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-5-7 Asahi-cho, Abeno-ku, Osaka, 545-8586, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Motoyasu Kusano
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan
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13
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Andreev DN, Kucheryavy YA, Mayev IV. [The prevalence and risk of sleep disorders in patients with functional dyspepsia: a meta-analysis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:26-30. [PMID: 33580757 DOI: 10.17116/jnevro202112101126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Systematization of data on the incidence and risk of sleep disorders in patients with functional dyspepsia (FD). MATERIAL AND METHODS Studies were searched in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane until October 2020. Publications with detailed descriptive statistics (sample size, number of patients with sleep disorders) were selected for the final analysis, allowing the resulting data to be included in the meta-analysis. RESULTS The final analysis included 10 studies with 7739 people (2354 patients with FD, 5385 controls). The generalized incidence of sleep disturbances in patients with FD was 53.23% (95% CI: 37.738-68.419). There was significant heterogeneity between the results (p<0.0001; I2=98.05%). An association was found between FD and sleep disorders (OR 2.884; 95% CI 2.518-3.304; I2=28.35%) compared with controls. In patients with epigastric pain syndrome (EPS), the generalized incidence of sleep disorders was 40.6% (95% CI 34.267-47.181; I2=0%), with postprandial distress syndrome (PDS) - 51.82% (95% CI 26.479-76.666; I2=94.76%), and at the intersection of EPS and PDS - 51.67% (95% CI 23.497-79.270; I2=95.34%). CONCLUSION The meta-analysis has demonstrated that sleep disorders are often associated with FD and are observed in about every second patient with this functional gastrointestinal disease. Further research is needed to investigate possible causal relationships between sleep disorders and FD.
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Affiliation(s)
- D N Andreev
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - Yu A Kucheryavy
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia.,Ilya Hospital, Krasnogorsk, Russia
| | - I V Mayev
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
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14
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Matsuzaki J, Suzuki H, Togawa K, Yamane T, Mori H, Komori T, Masaoka T, Kanai T. Burden of impaired sleep quality on work productivity in functional dyspepsia. United European Gastroenterol J 2017; 6:398-406. [PMID: 29774153 DOI: 10.1177/2050640617726466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022] Open
Abstract
Background Impaired sleep quality is common, and can reduce work productivity in patients with functional dyspepsia (FD). Objective The objective of this article is to evaluate whether there is a direct association between the presence of FD and the severity of impaired sleep quality, and to calculate the economic loss due to the decreased work productivity associated with sleep quality. Methods In Study 1, using a web-based survey completed by workers with and without FD, we evaluated impaired sleep quality, work and daily productivity, and the severity of reflux and bowel symptoms. In Study 2, the association between the presence of FD and the severity of impaired sleep quality was validated in a hospital-based cohort. Results In both Study 1 and 2, although impaired sleep quality was more frequent in participants with FD than in those without FD, the independent association between the presence of FD and the severity of impaired sleep quality was not observed after adjustment for the severity of reflux and bowel symptoms. FD participants with impaired sleep quality reported additional economic loss of 53,500 Japanese yen/month. Conclusion Although the association between impaired sleep quality and FD was indirect, concomitant impaired sleep quality could worsen economic loss.
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Affiliation(s)
- Juntaro Matsuzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Koji Togawa
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Yamane
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Mori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Komori
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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15
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Ko SJ, Park JW, Leem J, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Dimisko L, Yeo I, Lee J, Kim J. Influence of the patient-practitioner interaction context on acupuncture outcomes in functional dyspepsia: study protocol for a multicenter randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:363. [PMID: 28709452 PMCID: PMC5513038 DOI: 10.1186/s12906-017-1869-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the treatment of functional dyspepsia, the placebo effect has been reported to be high, and the influence of the patient-practitioner relationship may be a major component of this effect. The specific and non-specific effects of acupuncture cannot be easily distinguished, and the patient-practitioner relationship may influence the total therapeutic effect in clinical practice. There have been no studies that investigate the influence of patient-practitioner relationship on acupuncture treatment for patients with functional dyspepsia. METHODS Patients with postprandial distress syndrome, a functional dyspepsia subtype, will be recruited at three hospitals (two in Korea and one in USA) for an international, multi-center, randomized, patient/assessor-blinded, clinical trial. The total anticipated sample size is 88. The participants will be randomly allocated into two groups: an augmented interaction group and a limited interaction group. Acupuncture, with total 12 acupoints, will be performed twice weekly for 4 weeks in both groups. Trained practitioners will provide an "augmented" or "limited" interaction context, as determined by random allocation. The primary outcome measure is the proportion of responders, the proportion of participants who answer "yes" to more than half of the adequate relief questions during the study. Secondary outcome measures include questionnaires for quality of life and symptoms of dyspepsia, and maximum tolerable volume of nutrient drink test. Data will be collected at baseline and following 4 weeks of acupuncture. DISCUSSION This study will evaluate the influence of the patient-practitioner interaction on clinical effects of acupuncture in patients with functional dyspepsia. TRIAL REGISTRATION CRIS Identifier: ( KCT0002229 ).
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16
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Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol 2017; 32:378-387. [PMID: 27262283 DOI: 10.1111/jgh.13465] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM As best estimates on functional gastrointestinal disorders (FGIDs) prevalence are expected from community studies, which are scanty from Asia, we evaluated the prevalence and risk factors of FGIDs in a rural Indian community. METHODS House-to-house survey was undertaken by trained interviewers using translated-validated Rome III and hospital anxiety and depression questionnaires. RESULT Among 3426 subjects ≥ 18 years old from 3 villages in Uttar Pradesh, 84% participated, of whom 80% were finally analyzed. Of these 2774 subjects (age 38.4 ± 16.5 years, 1573 [56.7%] male), 2654 [95.7%] were vegetarian and 120 [4.3%] non-vegetarian. Socioeconomic classes were upper (16.7%), upper middle (15.1%), lower middle (22%), upper lower (22.2%), and lower (24%) using Prasad's Classification; 603 (21.7%) had FGIDs (413 [14.9%] dyspepsia, 75 [2.7%] irritable bowel syndrome (IBS) and 115 [4.1%] dyspepsia-IBS overlap), by Rome III criteria. In subjects with dyspepsia, 49/528 (9%) had epigastric pain, 141 (27%) postprandial distress syndromes (EPS, PDS) and 338 (64%) EPS-PDS overlap. IBS was more often diarrhea than constipation-predominant subtype. On univariate analysis, chewing tobacco, aerated drink, tea/coffee, disturbed sleep, vegetarianism, and anxiety parameters and presence of dyspepsia predicting occurrence of IBS were associated with FGIDs. On multivariate analysis, chewing tobacco, aerated soft drink, tea/coffee, vegetarianism, anxiety parameters, and presence of dyspepsia predicting IBS were significant. CONCLUSION Functional gastrointestinal disorders, particularly dyspepsia-IBS overlap, are common in rural Indian population; the risk factors included chewing tobacco, aerated soft drink, tea/coffee, vegetarian diet, disturbed sleep, anxiety, and dyspepsia predicting occurrence of IBS.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Singh
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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17
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Margolskee A, Darwich AS, Pepin X, Pathak SM, Bolger MB, Aarons L, Rostami-Hodjegan A, Angstenberger J, Graf F, Laplanche L, Müller T, Carlert S, Daga P, Murphy D, Tannergren C, Yasin M, Greschat-Schade S, Mück W, Muenster U, van der Mey D, Frank KJ, Lloyd R, Adriaenssen L, Bevernage J, De Zwart L, Swerts D, Tistaert C, Van Den Bergh A, Van Peer A, Beato S, Nguyen-Trung AT, Bennett J, McAllister M, Wong M, Zane P, Ollier C, Vicat P, Kolhmann M, Marker A, Brun P, Mazuir F, Beilles S, Venczel M, Boulenc X, Loos P, Lennernäs H, Abrahamsson B. IMI - oral biopharmaceutics tools project - evaluation of bottom-up PBPK prediction success part 1: Characterisation of the OrBiTo database of compounds. Eur J Pharm Sci 2016; 96:598-609. [PMID: 27671970 DOI: 10.1016/j.ejps.2016.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/12/2016] [Accepted: 09/17/2016] [Indexed: 12/11/2022]
Abstract
Predicting oral bioavailability (Foral) is of importance for estimating systemic exposure of orally administered drugs. Physiologically-based pharmacokinetic (PBPK) modelling and simulation have been applied extensively in biopharmaceutics recently. The Oral Biopharmaceutical Tools (OrBiTo) project (Innovative Medicines Initiative) aims to develop and improve upon biopharmaceutical tools, including PBPK absorption models. A large-scale evaluation of PBPK models may be considered the first step. Here we characterise the OrBiTo active pharmaceutical ingredient (API) database for use in a large-scale simulation study. The OrBiTo database comprised 83 APIs and 1475 study arms. The database displayed a median logP of 3.60 (2.40-4.58), human blood-to-plasma ratio of 0.62 (0.57-0.71), and fraction unbound in plasma of 0.05 (0.01-0.17). The database mainly consisted of basic compounds (48.19%) and Biopharmaceutics Classification System class II compounds (55.81%). Median human intravenous clearance was 16.9L/h (interquartile range: 11.6-43.6L/h; n=23), volume of distribution was 80.8L (54.5-239L; n=23). The majority of oral formulations were immediate release (IR: 87.6%). Human Foral displayed a median of 0.415 (0.203-0.724; n=22) for IR formulations. The OrBiTo database was found to be largely representative of previously published datasets. 43 of the APIs were found to satisfy the minimum inclusion criteria for the simulation exercise, and many of these have significant gaps of other key parameters, which could potentially impact the interpretability of the simulation outcome. However, the OrBiTo simulation exercise represents a unique opportunity to perform a large-scale evaluation of the PBPK approach to predicting oral biopharmaceutics.
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18
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Ko SJ, Park K, Kim J, Kim M, Kim JH, Lee J, Mohamed AZ, Yeo I, Kim J, Choi SM, Kim H, Park JW, Lee JH. Effect of acupuncture and its influence on cerebral activity in functional dyspepsia patients: study protocol for a randomized controlled trial. Trials 2016; 17:183. [PMID: 27039086 PMCID: PMC4818864 DOI: 10.1186/s13063-016-1296-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/17/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a prevalent gastric disorder that is difficult to manage due to lack of satisfactory treatments. Acupuncture has been studied with regard to the rising need for treating FD, but the mechanism verifying its efficacy has not yet been fully revealed. The aim of this study is to explore the efficacy and mechanism of acupuncture for FD compared with a sham group. METHODS/DESIGN We describe a proposal for a randomized, assessor-blind, sham-controlled trial with 70 eligible participants who will be randomly allocated either into an acupuncture or a sham group. Participants in the acupuncture group will receive 10 sessions of real acupuncture treatment and those in the sham group will be treated with identical sessions using a Streitberger needle. Functional magnetic resonance imaging (fMRI) and metabolomics studies will be implemented before and after 4 weeks of treatment to investigate the mechanism of acupuncture. The primary outcome is a proportion of responders with adequate symptom relief and the secondary outcomes include the Nepean Dyspepsia Index - Korean version, Functional Dyspepsia-Related Quality of Life questionnaire, Ways of Coping Questionnaire, Coping Strategies Questionnaire, perception of bodily sensation questionnaire, State-Trait Anxiety Inventory, and the Center for Epidemiological Studies - Depression Scale. The outcomes will be evaluated before and after the treatment. DISCUSSION This is the first large-scale trial evaluating the efficacy and mechanism of acupuncture with fMRI and metabolomic methods. We will compare real acupuncture with the Streitberger sham needle to verify the specific effect of acupuncture. The results of this trial are expected to be relevant evidences affecting policy and decision-makers associated with routine healthcare. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358486 . Date of Registration: 21 January 2015.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyungmo Park
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Jieun Kim
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Minji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joo-Hee Kim
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeungchan Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea.,Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA
| | - Abdalla Z Mohamed
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Inkwon Yeo
- Department of Statistics, Sookmyung Women's University, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sun-Mi Choi
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Honggeol Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Jun-Hwan Lee
- Division of Clinical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea. .,Korean Medicine Life Science, University of Science & Technology, Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
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19
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Affiliation(s)
- Seiji Futagami
- Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Japan
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20
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Iwakura N, Fujiwara Y, Shiba M, Ochi M, Fukuda T, Tanigawa T, Yamagami H, Tominaga K, Watanabe T, Arakawa T. Characteristics of Sleep Disturbances in Patients with Gastroesophageal Reflux Disease. Intern Med 2016; 55:1511-7. [PMID: 27301498 DOI: 10.2169/internalmedicine.55.5454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances; however, the detailed differences in the characteristics of sleep disturbances between GERD and non-GERD patients are unknown. The aim of the present study was to analyze the clinical characteristics as well as health-related quality of life in GERD and non-GERD patients with sleep disturbances. Methods Three hundred and fifty patients, including 124 patients with GERD and 226 patients without GERD, completed a self-administered questionnaire that evaluated clinical information. The Pittsburg Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 8-item Short-Form Health Survey (SF-8) were also used. Sleep disturbance was considered to be present if the PSQI was >5.5. Results The prevalence of sleep disturbances was significantly higher in the GERD patients (66/124, 53.9%) than in the non-GERD patients (89/226, 39.3%). Depression and anxiety were significantly more common in the subjects with sleep disturbances than in those without sleep disturbances, although there were no differences between the GERD and non-GERD patients. Among the subjects with sleep disturbances, daytime sleepiness was more common in the GERD patients than in the non-GERD patients. The subjects with sleep disturbances had a poorer health-related quality of life. The physical components of quality of life were impaired, particularly in the GERD patients with sleep disturbances. Conclusion GERD patients with sleep disturbances commonly experience daytime sleepiness and an impaired health-related quality of life, especially in terms of physical components.
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Affiliation(s)
- Narika Iwakura
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Vakil N, Wernersson B, Wissmar J, Dent J. Sleep disturbance due to heartburn and regurgitation is common in patients with functional dyspepsia. United European Gastroenterol J 2015; 4:191-8. [PMID: 27087946 DOI: 10.1177/2050640615599716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/14/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Reflux symptoms (heartburn and regurgitation) are common in patients with functional dyspepsia who do not have gastroesophageal reflux disease (GERD). OBJECTIVE The purpose of this study was to assess the relationship of reflux symptoms with sleep disturbances in patients with functional dyspepsia without GERD and in those with GERD. METHODS This post-hoc analysis of data from the Diamond study (NCT00291746) included patients with frequent upper gastrointestinal symptoms, of whom 137 had functional dyspepsia and 193 had GERD (diagnosed by endoscopy and pH monitoring). Patients completed symptom questionnaires and were interviewed by physicians. RESULTS During the seven nights before study entry, 46.0% of patients with functional dyspepsia and 64.8% of those with GERD reported sleep disturbances (any frequency) related to reflux symptoms. Frequent (often/every night) sleep disturbances were experienced by 12.4% of patients with functional dyspepsia and 24.9% of those with GERD (p = 0.005). Among patients with functional dyspepsia, the prevalence of sleep disturbances was highest in those whose heartburn and/or regurgitation were moderate to severe (vs mild/very mild) and frequent (4-7 vs 1-3 days/week). CONCLUSIONS Sleep disturbances due to reflux symptoms are common in patients with functional dyspepsia who do not have GERD, and become more frequent with increasing reflux symptom severity and frequency.
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Affiliation(s)
- N Vakil
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | | | | | - J Dent
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
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Park JK, Huh KC, Shin CM, Lee H, Yoon YH, Song KH, Min BH, Choi KD. [Current issues in functional dyspepsia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:133-41. [PMID: 25252861 DOI: 10.4166/kjg.2014.64.3.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional dyspepsia is one of the most common gastrointestinal disorders encountered in clinical practice. Functional dyspepsia is currently defined by Rome III criteria as the chronic dyspeptic symptoms (postprandial fullness, early satiety, epigastric pain or burning) in the absence of underling structural or metabolic disease that readily explain the symptoms. According to the Rome III consensus, functional dyspepsia can be subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Although the Rome III criteria have been published more than 8 years ago, not much effort has been put into validating these criteria and direct scientific evidence supporting the validity of the subdividing functional dyspepsia into PDS and EPS are lacking. This article is intended to review the validity of the Rome III criteria on the subdivisions of functional dyspepsia, i.e. PDS and EPS. The impact of sleep disorder, Helicobacter pylori-associated dyspepsia, and the emerging drug therapies in functional dyspepsia will also be discussed in this article.
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Affiliation(s)
- Jong Kyu Park
- Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyu Chan Huh
- Konyang University College of Medicine, Daejeon, Korea
| | - Cheol Min Shin
- Seoul National University College of Medicine, Seongnam, Korea
| | - Hyuk Lee
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Kyung Ho Song
- Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Hoon Min
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kee Don Choi
- Departments of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Stanghellini V, Cogliandro R. Review article: adherence to Rome criteria in therapeutic trials in functional dyspepsia. Aliment Pharmacol Ther 2014; 40:435-66. [PMID: 25056101 DOI: 10.1111/apt.12865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/26/2014] [Accepted: 06/19/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Rome criteria are currently required by health authorities for the inclusion of patients affected by functional dyspepsia in therapeutic trials. However, the degree of adherence to these criteria has not been formally verified. AIM To review adherence to the Rome criteria for inclusion criteria, outcome measures and endpoints in therapeutic trials on functional dyspepsia and the potential impact on the conclusions that can be drawn from these studies. METHODS A total of 1818 articles were screened. Fifty-eight trials claiming to include adults affected by functional dyspepsia as defined by the Rome criteria published as full articles in English between 2000 and 2013 were considered. RESULTS Lack of full adherence to the Rome criteria of inclusion criteria was found in 54% of the studies, due to inclusion of patients with symptoms not reported in the Rome criteria or definitions of dyspeptic symptom that varied from those proposed by the Rome criteria. Ninety-five per cent of clinical trials adopted therapeutic outcome measures that were not adherent to the Rome criteria, using questionnaires that did not include all dyspeptic symptoms or including symptoms other than those proposed by the Rome criteria. CONCLUSIONS Stringent criteria have not been adopted for inclusion criteria and outcome measures in the vast majority of published studies on functional dyspepsia that claim to have been carried out according to the Rome criteria. Appropriate questionnaires should be developed to promote adherence to internationally accepted definitions of the syndrome in future studies.
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Affiliation(s)
- V Stanghellini
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Bologna, Italy
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Futagami S, Yamawaki H, Shimpuku M, Izumi N, Wakabayashi T, Kodaka Y, Nagoya H, Shindo T, Kawagoe T, Sakamoto C. Impact of coexisting irritable bowel syndrome and non-erosive reflux disease on postprandial abdominal fullness and sleep disorders in functional dyspepsia. J NIPPON MED SCH 2014; 80:362-70. [PMID: 24189354 DOI: 10.1272/jnms.80.362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The association between clinical symptoms and sleep disorders in functional dyspepsia (FD)-overlap syndrome has not been studied in detail. METHODS The subjects were 139 patients with FD, 14 with irritable bowel syndrome (IBS), 12 with nonerosive reflux disease (NERD), and 41 healthy volunteers. Gastric motility was evaluated with the (13)C-acetate breath test. We used Rome III criteria to evaluate upper abdominal symptoms, and Self-Rating Questionnaire for Depression (SRQ-D) scores to determine depression status. Sleep disorders were evaluated with Pittsburgh Sleep Quality Index (PSQI) scores. RESULTS There were no significant differences in age, body-mass index, alcohol intake, and smoking rate between patients with FD alone and those with FD-overlap syndrome. The postprandial abdominal fullness score in patients with FD-NERD-IBS was significantly greater than that in patients with FD-NERD overlap syndrome (p<0.001) or FD alone (p<0.001). The score for the feeling of hunger in patients with FD-NERD-IBS was significantly greater than that in patients with FD alone (p=0.0025), FD-NERD overlap syndrome (p=0.0088), or FD-IBS overlap syndrome (p=0.0057). The heartburn score in subjects with FD-NERD-IBS overlap syndrome was significantly greater than that in subjects with FD alone (p=0.0035) or FD-IBS overlap syndrome (p=0.0026). The Tmax in patients with FD-overlap syndrome or FD alone was significantly higher than that in healthy volunteers. The Pittsburgh Sleep Quality Index score in subjects with FD-NERD-IBS overlap syndrome was significantly greater than that in subjects with FD alone. CONCLUSION Symptom scores, such as those for postprandial abdominal fullness, heartburn, and the feeling of hunger, in patients with FD-overlap syndromes are significantly greater than those in patients with FD alone. Further studies are necessary to clarify whether various symptoms are related to sleep disorders in patients with FD-NERD-IBS overlap syndrome.
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Affiliation(s)
- Seiji Futagami
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School
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Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int 2014; 34:929-36. [DOI: 10.1007/s00296-014-2960-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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Park SY, Rew JS. Are there any differences in sleep disorder, quality of life and gastric motility among subtypes of functional dyspepsia? J Neurogastroenterol Motil 2014; 20:4-5. [PMID: 24466440 PMCID: PMC3895607 DOI: 10.5056/jnm.2014.20.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- Seon-Young Park
- Department of Internal Medicine, Chonnam National University Hosptial, Gwangju, Korea
| | - Jong-Sun Rew
- Department of Internal Medicine, Chonnam National University Hosptial, Gwangju, Korea
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Yamawaki H, Futagami S, Shimpuku M, Sato H, Wakabayashi T, Maruki Y, Kodaka Y, Nagoya H, Shindo T, Kawagoe T, Sakamoto C. Impact of sleep disorders, quality of life and gastric emptying in distinct subtypes of functional dyspepsia in Japan. J Neurogastroenterol Motil 2013; 20:104-12. [PMID: 24466451 PMCID: PMC3895596 DOI: 10.5056/jnm.2014.20.1.104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 12/14/2022] Open
Abstract
Background/Aims The association between clinical symptoms, gastric emptying, quality of life and sleep disorders in distinct functional dyspepsia (FD) patients has not been studied yet in detail. Methods We enrolled 79 FD patients (postprandial distress syndrome [PDS], n = 65; epigastric pain syndrome [EPS], n = 47; EPS-PDS overlap, n = 33) and 44 healthy volunteers. Gastric motility was evaluated. We used Rome III criteria to evaluate clinical symptoms and State-Trait Anxiety Inventory (STAI) scores to determine anxiety status. Sleep disorder was evaluated using the Pittsburgh Sleep Quality Index scores. Results There were no significant differences in age, sex and Helicobacter pylori positivity between FD subtypes and healthy volunteers. The scores of Glasgow dyspepsia severity scores (GDSS), SF-8 and Pittsburgh Sleep Quality Index (PSQI) in distinct subtypes of FD patients were significantly different from those in healthy volunteers. However, there were not significant differences in these scores, Tmax and T1/2 among 3 subtypes of FD patients. PSQI score was significantly (P = 0.027, P = 0.002 and P = 0.039, respectively) associated with GDSS among EPS, PDS and EPS-PDS overlap patients. In addition, 8-item short form health survey (SF-8; Physical Component Score and Mental Component Score) was significantly associated with global PSQI score in PDS and EPS-PDS overlap patients. In contrast, SF-8 (Mental Component Score) only was significantly linked to global PSQI score in EPS patients. Conclusions Prevalences for sleep disorders, gastric motility and quality of life in 3 subtypes of FD patients were similar levels. In PDS and EPS-PDS overlap patients, SF-8 was significantly associated with global PSQI score.
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Affiliation(s)
- Hiroshi Yamawaki
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Seiji Futagami
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Mayumi Shimpuku
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitomi Sato
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Taiga Wakabayashi
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuuta Maruki
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Kodaka
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Nagoya
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomotaka Shindo
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Tetsuro Kawagoe
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Choitsu Sakamoto
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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