多潘立酮联合复方消化酶治疗功能性消化不良84例

A Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial of Qi-Zhi-Wei-Tong Granules on Postprandial Distress Syndrome-Predominant Functional Dyspepsia

Background:

Functional dyspepsia (FD) is a common upper gastrointestinal disorder worldwide, but the current treatments for FD are still unsatisfactory. The aims of this study were to investigate the efficacy and safety of Qi-Zhi-Wei-Tong granules in patients with postprandial distress syndrome (PDS)-predominant FD.

Methods:

The study was conducted as a randomized, double-blinded, multicenter, placebo-controlled design in 197 patients with PDS. All participants received placebo treatment for 1 week. Patients whose total symptom score decreased by <50% after the placebo treatment were recruited into the 4-week treatment period, in which they were randomly assigned to be treated with either Qi-Zhi-Wei-Tong granules or placebo. The patients were then followed for 2 weeks without any treatment. Dyspeptic symptoms were scored at weeks 2 and 4 during the random treatment period and 2 weeks after the treatment. Anxiety and depression symptoms were also scored and compared.

Results:

(1) The total effective rates in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 during the random treatment period and 2 weeks after treatment were all significantly higher than those in the placebo group (38.82% vs. 8.75%, P < 0.001; 69.14% vs. 16.25%, P < 0.001; 77.65% vs. 21.25%, P < 0.001). (2) The total dyspeptic symptoms scores in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 and 2 weeks after treatment were significantly lower than those in the placebo group. (3) The severity and frequency of each dyspeptic symptom at weeks 2 and 4 and the follow-up period were all significantly lower than those in the placebo group. (4) The anxiety scores in the Qi-Zhi-Wei-Tong granules group were significantly lower than those in the placebo group. (5) Qi-Zhi-Wei-Tong granules did not have more adverse effects than the placebo.

Conclusion:

Qi-Zhi-Wei-Tong granules offer significant symptomatic improvement in PDS with no more adverse effects than placebo.

Trial Registration:

https://clinicaltrials.gov/, NCT02460601.

Effect of Tongxie Yaofang on gastrointestinal motility, ultrastructure of interstitial cells of cajal and connexin 43 expression in rats with functional dyspepsia

AIM

To evaluate the effect of Tongxie Yaofang on gastrointestinal motility, the ultrastructure of interstitial cells of Cajal (ICC) and connexin 43 (Cx43) expression in functional dyspepsia (FD) rats.

METHODS

FD was induced in rats by stimulating the rat tail using sponge forceps. FD rats were then treated with different doses of Tongxie Yaofang, with domperidone as a positive control. After treatment, rat appetite and weight were recorded. The rats were then sacrificed, and gastric emptying and intestinal transit were recorded. Transmission electron microscopy was used to observe the ultrastructure of ICC, and immunohistochemistry was used to detect the expression of Cx43 in gastrointestinal tissues of FD rats.

RESULTS

After rats were stimulated using sponge forceps, they developed symptoms compatible with those of FD. The appetite and weight of FD rats were lower than those of normal controls, and the gastric emptying rate and intestinal transit rate were also significantly lower (p < 0.05 for both). After treatment with high-dose Tongxie Yaofang (3.412 g/kg) or domperidone, rat body weight, appetite, the gastric emptying rate and intestinal transit rate recovered to normal levels, although these were not fully achieved in rats treated with low- or medium dose Tongxie Yaofang (0.853 g/kg and 1.706 g/kg, respectively). Moreover, the altered ultrastructure of ICC and the decreased expression of Cx43 in the stomach and small intestine of FD rats were back to normal after treatment with high-dose Tongxie Yaofang (3.412 g/kg) or domperidone.

CONCLUSION

Tongxie Yaofang (3.412 g/kg) has a positive effect on gastrointestinal motility in FD rats, and the underlying mechanism may be related to the modulation of ICC and Cx43 expression in gastrointestinal tissues.

Combined treatment with itopride, domperidone and metoclopramide improves gastrointestinal function and upregulates serum ghrelin level in patients with functional dyspepsia

AIM: To investigate the effects of combined treatment with itopride, domperidone and metoclopramide on digestive function, gastrointestinal emptying and serum ghrelin level in patients with functional dyspepsia (FD).

METHODS: One hundred and twenty FD patients were divided into six groups according to the Rome II criteria: those treated with itopride, domperidone and metoclopramide, alone or in double combination. The clinical symptoms, gastrointestinal emptying rate and serum ghrelin level were observed before and after treatment.

RESULTS: The symptoms of FD patients were significantly improved after each treatment. The symptomatic relief rates achieved in the combination groups were much better than those in single-drug groups (all P < 0.01). The gastric emptying rates achieved in the combination groups were also much better than those in single-drug groups (54.26% ± 18.57%, 55.12% ± 18.22% and 47.17% ± 15.21% vs 36.23% ± 11.68%, 32.16% ± 10.08% and 32.24% ± 10.12%, respectively; all P < 0.01). The intestinal emptying rates in the itopride plus domperidone group and the itopride plus metoclopramide group were much better than that in the domperidone plus metoclopramide group (89.27% ± 11.36% and 88.67% ± 13.25% vs 69.16% ± 19.26%, respectively; both P < 0.01). The intestinal emptying rate in the itopride group was much better than those in the domperidone group and the metoclopramide group (78.23% ± 12.56% vs 58.96% ± 12.20% and 58.33% ± 12.57%, respectively; both P < 0.01). The level of serum ghrelin in FD patients was significantly lower than that in normal controls (P < 0.05). After drug treatment, the level of serum ghrelin rose obviously. The levels of serum ghrelin in combination groups were higher than those in single-drug groups (all P < 0.05 or 0.01).

CONCLUSION: Treatment with itopride, domperidone and metoclopramide in double combination achieves better efficacy in FD patients than treatment with these drugs alone. Combination therapy significantly improves dyspepsia and gastric motility in FD patients perhaps by altering the level of serum ghrelin.