Functional Dyspepsia and Duodenal Eosinophil Count and Degranulation: A Multiethnic US Veteran Cohort Study.

BACKGROUND: Duodenal eosinophilia may play a role in functional dyspepsia (FD), but existing study results are conflicted. We investigated the association between duodenal eosinophils (count and degranulation) and FD symptoms, accounting for atopic conditions, medications, and seasonal variations. METHODS: In a cross-sectional study conducted in the Michael E. DeBakey VA Medical Center in Houston, Texas, we analyzed duodenal histopathology of 436 patient samples from a prospective cohort with a validated symptom survey data and chart reviews. FD was defined using Rome II symptom criteria. Eosinophil count was number per 5 high-power fields (HPF), and eosinophil degranulation was eosinophilic granules in the stroma both determined by two independent investigators. RESULTS: The study cohort was predominantly male (87.4%) with a mean age of 59.3 (standard deviation (SD) ± 9.8). Mean and median eosinophil counts were 75.5 (± 47.8) and 63 (IQR: 43, 101) per five HPF, respectively. Duodenal eosinophilia (defined as ≥ 63 per 5 HPF) and eosinophil degranulation were present in 50.5% and 23.1% of patient samples, respectively. FD was observed in 178 patients (41.7%), but neither the mean eosinophil count nor duodenal eosinophilia was associated with FD. Eosinophil degranulation was independently associated with FD overall (OR 1.74; 95% CI 1.08, 2.78; p = 0.02) and early satiety (OR 2.04; 95% CI 1.26, 3.30; p = 0.004). CONCLUSIONS: In this large, ethnically diverse cohort of adult patients, we found no significant association between duodenal eosinophilia and FD. However, the presence of duodenal eosinophilic degranulation, an activated eosinophil marker, was significantly associated with FD, especially early satiety.

Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions.

INTRODUCTION: Dyspepsia and Helicobacter pylori are two of the most relevant digestive conditions in primary care. Several consensuses on the subject have been published, but the assimilation/implementation of these guidelines is uncertain. AIMS AND METHODS: To evaluate the attitudes, perceptions, limitations, and adherence to recommendations of Spanish primary care physicians using an open online survey. Responses were anonymously codified. Estimated margin of error was 3.4%. Responses were weighted by province, gender, age, and type of practice. Survey was performed using the AEG-REDCap platform. RESULTS: A total of 1445 responses, received between December 2017 and April 2018, were analyzed. Women represented 54%, and the average age was 48 years; 59% were from urban context, 20% from semi-urban, and 21% from rural; 93% provided public practice. Over 40% had read at least one Maastricht consensus (24% Maastricht V), and 34% had attended a course related to H. pylori. 16% reported no direct access to any validated diagnostic method, only 44% to urea breath test, and 33% did not systematically refer to eradication confirmation test. The first-line treatment of choice was standard triple therapy in 56%, followed by concomitant therapy (28%). Only 20% of physicians had optimal adherence to recommendations. CONCLUSION: Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed. To provide optimal primary care, the barriers for implementation, access to diagnostic tests and to continuous medical education, should be removed. Rigorous dissemination, implementation, and evaluation programs are desired in future consensuses.

Prevalence of Helicobacter pylori cagA, babA2, and dupA genotypes and correlation with clinical outcome in Malaysian patients with dyspepsia.

BACKGROUND/AIM: The severity of disease outcome in dyspepsia has been attributed to Helicobacter pylori virulence genes. The aim of this study was to determine the distribution of H. pylori virulence genes (cagA, babA2, and dupA) and to determine whether or not there arises a significant correlation with clinical dyspepsia outcomes. MATERIALS AND METHODS: H. pylori genotypes cagA, babA2, and dupA were identified by polymerase chain reactions from gastric biopsy samples in 105 H. pylori-positive patients. RESULTS: The positive rates for cagA, babA2, and dupA genes in H. pylori dyspeptic patients were 69.5%, 41.0%, and 22.9%, respectivel cagA was more prevalent in Indians (39.7%), babA2 was more prevalent in Malays (39.5%), and dupA detection occurred more frequently in both Indians and Malays and at the same rate (37.5%). The Chinese inhabitants had the lowest prevalence of the three genes. Nonulcer disease patients had a significantly higher distribution of cagA (76.7%), babA2 (74.4%), and dupA (75.0%). There was no apparent association between these virulence genes and the clinical outcomes. CONCLUSION: The lower prevalence of these genes and variations among different ethnicities implies that the strains are geographically and ethnically dependent. None of the virulence genes were knowingly beneficial in predicting the clinical outcome of H. pylori infection in our subjects.

Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia.

To our knowledge, no study has assessed the relationships between patterns of dietary behaviours, identified by latent class analysis (LCA), and chronic uninvestigated dyspepsia (CUD). The present study was conducted to determine the association between the patterns of dietary behaviours, identified by LCA, and CUD in a large sample of adults. In a cross-sectional study conducted on 4763 Iranian adults, we assessed the patterns of dietary behaviours in four domains, including 'meal patterns', 'eating rate', 'intra-meal fluid intake' and 'meal-to-sleep interval', as identified by LCA, using a pre-tested comprehensive questionnaire. Patients with CUD were identified using the Rome III diagnostic criteria. CUD was prevalent in 15·2 % (95 % CI 14·4, 16·2 %; n 723) of patients. Early satiation occurred in 6·3 % (n 302) of patients, bothersome postprandial fullness in 8·0 % (n 384) of patients and epigastric pain in 7·8 % (n 371) of patients. We defined two distinct classes of meal patterns: 'regular' and 'irregular'. For eating rates, three classes were defined: 'moderate', 'moderate-to-slow' and 'moderate-to-fast'. Participants were identified as ingesting fluid with meals in two major classes: 'moderate intra-meal drinking' and 'high intra-meal drinking'. In terms of the interval between meals and sleeping, two distinct classes were identified: 'short meal-to-sleep interval' and 'long meal-to-sleep interval'. After controlling for potential confounders, the 'irregular meal pattern' was significantly associated with a greater odds of CUD (OR 1·42, 95 % CI 1·12, 1·78) compared with a 'regular meal pattern'. Individuals with a 'moderate-to-fast eating rate' were more likely to have CUD compared with those who had a 'moderate eating rate' (OR 1·42, 95 % CI 1·15, 1·75). Patterns of the 'meal-to-sleep interval' and 'intra-meal fluid intake' were not significantly associated with CUD. In conclusion, the 'irregular meal pattern' and the 'moderate-to-fast eating rate' were significantly associated with a greater odds of CUD. Further prospective investigations are warranted to confirm this association.

CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF THE CHRONIC GASTRITIS WITH FUNCTIONAL DYSPEPSIA IN THE REPUBLIC OF SAKHA (YAKUTIA).

INTRODUCTION: Chronic gastritis with syndrome, functional dyspepsia (SFD) is one of the most pressing problems in medicine. Certain scientific and practical interest is the elucidation of the frequency and clinical manifestations of functional dyspepsia in patients hospitalized in the gastroenterology department YAGKB and frequency combinations of chronic gastritis (including H. pylori) with functional dyspepsia. AIM: The aim of the study was to investigate the clinical and morphological features of the chronic gastritis with syndrome pattern of functional dyspepsia in native-born and people of the Republic of Sakha (Yakutia), and to assess the effectiveness of treatment, depending on the gastric acid and H. pylori. MATERIALS AND METHODS: This study examined 105 patients with functional dyspepsia, including 41 patients with epigastric pain syndrome and 64 patients with postprandial distress syndrome. Considered groups of patients were homogeneous for age, gender, by ethnicity. Of the 105 patients included in the study, I group were 57 indigenous people (80% of them--Yakutia), 11 group--48 people visiting (Caucasians). RESULTS: Clinical presentation and course of chronic gastritis with functional dyspepsia in the Republic of Sakha (Yakutia) have a number of distinctive features: epigastric pain syndrome occurs in 26.8% of patients and 73.2% of the indigenous population of the visitor, the intensity of pain in the root is much lower than that of visitors--12 and 85% respectively. Postprandial distress syndrome was diagnosed in 71.9% of patients and 28.1% of the indigenous newcomers. At endoscopy in all patients with functional dyspepsia diagnosed chronic gastritis. The native inhabitants of the most common mixed gastritis (54.5%), the newcomers--superficial gastritis (66.7%). CONCLUSIONS: The found features of a current of functional dyspepsia can be further the basis for the individualized and differentiated approaches to treatment of this disease.

Mandarin version of the Leeds Dyspepsia Questionnaire: A valid instrument for assessing symptoms in Asians.

OBJECTIVE: To develop and validate a Mandarin version of the Leeds Dyspepsia Questionnaire (M-LDQ) in Asian patients with dyspepsia. METHODS: The M-LDQ was developed according to standardized methods. The validity, internal consistency, test-retest reliability and responsiveness of the instrument were evaluated in both primary and secondary care patients. RESULTS: A total of 184 patients (mean age 54.0 ± 15.8 years, of whom 59% were women and 72.3% of whom had at least secondary level education) were recruited between August 2012 and March 2013, from both primary (n = 100) and secondary care clinics (n = 84). Both the internal consistency of all components of the M-LDQ (Cronbach's α 0.79) and test-retest reliability (Spearman's correlation coefficient 0.78) were good. The M-LDQ was valid in diagnosing dyspepsia in primary care (area under the receiver operating characteristics curve 0.84) and was able to discriminate between secondary and primary care patients (median cumulative LDQ score 13.0 vs 3.0, P < 0.0001). Among eight patients with organic dyspepsia, the median M-LDQ score reduced significantly from 21.0 (pretreatment) to 9.5 (4 weeks post-treatment) (P < 0.0001). CONCLUSION: The M-LDQ is a valid and responsive instrument for assessing ethnic Chinese adults with dyspepsia.

Efficacy of Helicobacter pylori eradication therapy on functional dyspepsia: a meta-analysis of randomized controlled studies with 12-month follow-up.

BACKGROUND: Whether patients with functional dyspepsia (FD) should receive Helicobacter pylori eradication therapy remains controversial. AIMS: This meta-analysis was to evaluate the long-term effects of H. pylori eradication on dyspeptic symptoms of patients with FD, by selecting the most recent well-designed randomized controlled trials. METHODS: English-language articles in the medical literature containing information on the long-term (≥ 12 mo) effects of H. pylori eradication on dyspeptic symptoms in patients with FD were identified by searching the Medline, PubMed, and EMBASE databases. The MeSH and/or keywords included Helicobacter pylori OR H. pylori OR HP; functional dyspepsia OR non-ulcer dyspepsia; eradication OR cure or treatment; and improvement OR resolution. The Review Manager 4.2.2 was used for the meta-analysis. RESULTS: Fourteen randomized controlled studies were included in the meta-analysis. Improvements of dyspepsia symptoms in patients of eradication group were significantly better than in patients of the control group [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.18-1.62] (Z=4.00, P<0.0001) at the end of the follow-up period with low heterogeneity (I=51.8%, P=0.01). In a subgroup analysis on geographical regions, improvements of dyspepsia symptoms in patients of eradication group were all significantly better than in patients of control group in the European (OR, 1.49; 95% CI, 1.10-2.02), Asian (OR, 1.54; 95% CI, 1.07-2.21), and American populations (OR, 1.43; 95% CI, 1.12-1.83). CONCLUSIONS: H. pylori eradication therapy is associated with improvement of dyspeptic symptoms in patients with FD, which is consistently demonstrated in the Asian, European, and American populations.

[Prevalence of H. pylori CagA strain and characteristics of associated gastritis in schoolchildren with dyspepsia syndrome in Tyva Republic].

AIM: To study the prevalence of H. pylori CagA strain and the activity of associated gastritis in schoolchildren of Tyva Republic (Russia). MATERIALS AND METHODS: The cohorts had been formed out of 1064 native and alien schoolchildren picked up by random in Tyva Republic in the ages from 7 to 17 years. We determined IgG to H. pylori CagA antigen in serum (106 aliens and 112 natives). Out them 59 Tuvins and 72 Europoids with dyspeptic complaints were provided with endoscopic tests including biopsy of mucosa of antrum and stomach body. RESULTS: We had found ethnic peculiarities in the obtained indices in children, namely higher prevalence of the said strain of H. pylori and the absence of meaningful activity in antral sector and body of stomach in CagA-seropositive native children as compared to alien ones, in whom the activity of antral gastritis was higher than the activity in body of stomach.

Validation study of the Leeds Dyspepsia Questionnaire in a multi-ethnic Asian population.

BACKGROUND AND AIM: Outcome measures for clinical trials in dyspepsia require an assessment of symptom response. There is a lack of validated instruments assessing dyspepsia symptoms in the Asian region. We aimed to translate and validate the Leeds Dyspepsia Questionnaire (LDQ) in a multi-ethnic Asian population. METHODS: A Malay and culturally adapted English version of the LDQ were developed according to established protocols. Psychometric evaluation was performed by assessing the validity, internal consistency, test-retest reliability and responsiveness of the instruments in both primary and secondary care patients. RESULTS: Between April and September 2010, both Malay (n=166) and Malaysian English (n=154) versions were assessed in primary and secondary care patients. Both language versions were found to be reliable (internal consistency was 0.80 and 0.74 (Cronbach's α) for Malay and English, respectively; spearman's correlation coefficient for test-retest reliability was 0.98 for both versions), valid (area under receiver operating curve for accuracy of diagnosing dyspepsia was 0.71 and 0.77 for Malay and English versions, respectively), discriminative (median LDQ score discriminated between primary and secondary care patients in Malay (11.0 vs 20.0, P<0.0001) and English (10.0 vs 14.0, P=0.001), and responsive (median LDQ score reduced after treatment in Malay (17.0 to 14.0, P=0.08) and English (18.0 to 11.0, P=0.008) to dyspepsia. CONCLUSIONS: The Malaysian versions of the LDQ are valid, reliable and responsive instruments for assessing symptoms in a multi-ethnic Asian population with dyspepsia.

Gastroptosis is associated with less dyspepsia, rather than a cause of dyspepsia, in Japanese persons.

OBJECTIVE: Gastroptosis is recognized by its characteristic appearance on barium studies. The present prospective study assessed the relationship between gastroptosis and dyspeptic symptoms. METHODS: Japanese subjects underwent health screening, and gastroptosis was diagnosed by barium studies. Consecutive subjects (500 women and 167 men) with gastroptosis were identified and the same number of age-matched subjects without gastroptosis were selected as controls. Dyspepsia was classified as reflux-like (heartburn and belching), dysmotility-like (bloating and fullness), or ulcer-like dyspepsia (epigastralgia) based on the Rome II criteria. RESULTS: Body mass index was significantly lower in women with gastroptosis than in controls [19.7 ± 1.83 (SD) vs. 23.4 ± 3.70, p<0.0001], and also in men (19.7 ± 2.00 vs. 23.9 ± 2.89, p<0.0001). The incidence of dyspepsia was significantly lower in women with gastroptosis than in controls (56/500 vs. 87/500, p<0.01) and also in men (10/167 vs. 25/167, p<0.05), especially in women with ulcer-like dyspepsia (15/500 vs. 32/500, p<0.05) and in men with reflux-like dyspepsia (2/167 vs. 12/167, p<0.05). By logistic regression analysis, gastroptosis was associated with a lower risk of dyspepsia (odds ratio: 0.62, 95% CI: 0.405-0.941, p=0.025) and ulcer-like dyspepsia (odds ratio: 0.36, 95% CI: 0.177-0.726, p=0.004) in women. CONCLUSION: Dyspeptic symptoms were significantly less common in subjects with gastroptosis. Accordingly, gastroptosis may protect against dyspeptic symptoms, rather than causing functional dyspepsia.

Functional gastrointestinal disorders and overlap syndrome in Korea.

Functional gastrointestinal disorders (FGIDs) are common in clinical practice and in communities around the world, including Korea. In a recent point prevalence study on functional dyspepsia (FD) in Korea using the Rome III criteria, 13.4% of community respondents reported dyspepsia. Forty-seven percent of these FD cases were classified as postprandial distress syndrome, 26% as epigastric pain syndrome, and 27% as overlap syndrome. Upper and lower GI symptoms commonly overlap and FGIDs are related to psychological disorders. In our recent study of subjects recruited from a health-screening program, the point prevalence of FD, irritable bowel syndrome (IBS), and reflux esophagitis (RE) was 13.2%, 3.9%, and 8.2%, respectively. The odds ratio of having FD and IBS together was estimated to be 4.4 (95% CI: 1.21-15.71). We found a positive relationship between FD and IBS. Recently, several genetic studies have suggested that serotonin transporter (SERT) gene polymorphisms and the G-protein ß3 (GNß3) C825T gene polymorphism are associated with FD and IBS. However, we did not find an association between SERT and GNß3 C825T genetic polymorphisms and overlap syndrome, including FD and IBS, in our previous study in a Korean population. We therefore undertook a validation study of the Rome III criteria for FGIDs by factor analysis of symptoms. The sensitivity and specificity of Rome III criteria in discriminating FGIDs from organic diseases of the upper GI tract was 60% and 53%, respectively, while the sensitivity and specificity of these criteria for the lower GI tract was 80% and 50%, respectively, partially supporting the use of the Rome III criteria in Korea.

Functional gastrointestinal disorders in New Zealand.

BACKGROUND: Functional gastrointestinal disorders are common worldwide. AIM: To review functional gastrointestinal disorder prevalence, diagnosis and treatment in New Zealand. METHODS: A Medline search was performed to identify all published studies relating to prevalence, diagnosis and treatment of functional gastrointestinal disorders in New Zealand. RESULTS: Reflux prevalence is 30% and non-reflux dyspepsia is 34.2%. Helicobacter pylori prevalence varies considerably in NZ by geographical area and ethnicity and overall prevalence of infection is 24% in adults. 50% of patients with dyspepsia presenting for endoscopy in NZ will have no mucosal abnormality identified. National Dyspepsia Guidelines assist in management of patients. Guidelines exist for undifferentiated dyspepsia, Gastro-oesophageal Reflux Disease (GORD), H. pylori, peptic ulcer, NSAID's and gastrointestinal complications. Irritable Bowel Syndrome (IBS) is reported by 21% of adults. Symptoms were more than twice as frequent and severe in females than males. Access to colonoscopy for investigation of bowel symptoms is limited in NZ and priority is given to patients with "alarm features". Non-invasive markers of inflammation, such as faecal calprotectin, are being used to differentiate the patient with functional diarrhoea from inflammatory bowel disease. Treatment for irritable bowel symptoms is targeted to the predominant symptom. CONCLUSIONS: Functional gastrointestinal disorders are common in New Zealand. There is increasing awareness of dietary management for functional bowel symptoms.

Diagnosis and treatment of dyspeptic patients in Japan.

BACKGROUND AND AIM: Although functional gastrointestinal (GI) disorders has been paid more attention recently in Japan, similar to Western countries, the clinical characteristics of dyspeptic patients, current diagnostic approach to dyspeptic patients and current standard treatments for dyspeptic patients are not well known in Japan. This review, in the most part, summarizes two topics about Japanese dyspeptic patients. The first topic is the pros and cons of the diagnosis of Japanese dyspeptic patients using Rome III classification on the basis of our data and the second topic deals with standard treatments for dyspeptic patients-especially by primary care doctors in Japan. METHODS: We conducted a PubMed search using the following key words alone or in combination: functional dyspepsia (FD), medical treatment, Rome III classification and Japanese. RESULTS: The Rome III classification for FD does not adequately identify a large proportion of Japanese dyspeptic patients, primarily due to their earlier presentation for medical evaluation. There are many kinds of options for the treatment of FD in Japan: proton-pump inhibitors, histamine H(2) receptor antagonists, mucoprotective agents, Japanese traditional herbal medicines, Helicobacter pylori eradication therapy and prokinetics. Under the current situation, Japanese primary care doctors choose drugs according to each subtype of FD, which means that they prescribe medicine according to the pathogenesis of each patient. CONCLUSIONS: While the Rome III classification seems logical, some aspects need further evaluation for Japanese dyspeptic patients. Japanese primary care doctors choose drugs appropriately based on the pathogenesis of FD. However, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using modified Rome classification will be required.

Epidemiology, approach and management of functional dyspepsia in Thailand.

BACKGROUND AND AIM: Functional dyspepsia (FD) represents one of the important GI disorders confronting clinicians worldwide including Thailand. FD is a clinical syndrome with various underlying pathophysiologies, and their treatment remains a major challenge. This article aims at the approach of FD and its management. METHOD: For current situation, optimal therapy includes non-drug therapy namely reassurance by ruling out relevant differential diagnoses, general advice with regard to the underlying causes, dietary measures, lifestyle modification, and good doctor-patient relationship. Removing precipitating causes, such as medications, food or psychological factors/stress contributing to symptoms, is mandatory. A wide variety of drug treatments have been used to manage FD including antisecretory agents, prokinetics and H.pylori eradication. RESULTS: It is understandable that there is no ideal drug available. The overall gain over placebo ranges from less than 5% for H.pylori eradication to 15%-20% for antisecretory agents and prokinetics. CONCLUSION: Drug therapy includes acid inhibitory agents, prokinetics and H.pylori eradication are still the mainstay and should be adjusted accordingly on a case-by-case basis. In the future, it would be logical to develop multi-target therapies that simultaneously address various underlying mechanisms.

Clinical and epidemiological perspectives of dyspepsia in a multiracial Malaysian population.

Dyspepsia is perhaps the most common gastrointestinal disease universally. The prevalence of dyspepsia ranges from 7-40% in population based studies worldwide. These figures vary with definition of dyspepsia used and also with the survey methodology. As with Western studies, functional dyspepsia (FD) predominates in Asia. With a decline in peptic ulcer disease and gastric cancer, the proportion of FD is set to increase further. Studies have shown FD to account for 50-70% of cases of uninvestigated dyspepsia. In Malaysia dyspepsia has been reported in up to 15% of a rural and 25% of an urban population. No racial differences were seen in the rural survey. In the urban survey, Malays and Indians were found to have significantly more dyspepsia than Chinese. No clear explanation can be found for these racial differences. In clinical practice, Malays seem to complain a lot of wind and bloating in the "stomach." This is interesting to note when you compare it with the prevalence of H. pylori which is distinctly less common amongst Malays compared to the Indians and Chinese. As with many Asian populations, many Malaysians do not consult for complains of dyspepsia. Many will self medicate and others may even bear with their complains. This is probably true in the rural population. Traditional medications are often used and these are often ethnic based. Different types of lotions for example are used for massaging the putative area in the abdomen by Malay, Chinese and Indian patients. Moxibustion and acupuncture is still practiced by Chinese traditional physicians for treatment of dyspepsia. The notion that mood disorders may underlies dyspepsia is still poorly accepted by a less educated or rural population who consider a psychiatric consultation a taboo. Amongst urban dwellers where Westernized medical care is readily available and the awareness of potential serious disease like cancer is higher, consultation for dyspepsia is certainly higher. Indeed a higher education level has been identified as independent risk factors for dyspepsia in both an urban and rural population survey in Malaysia. With greater consultation for dyspepsia, there has also been a higher demand and utilization of endoscopy services for investigation of gastrointestinal diseases in the country.

Anxiety, depression and quality of life differences between functional and organic dyspepsia.

OBJECTIVE AND BACKGROUND: The role of psychological disturbance in the pathogenesis of functional dyspepsia is uncertain. We aimed to examine for differences in anxiety, depression and health-related quality of life (HRQOL) between adults with organic (OD) and functional dyspepsia (FD). METHODOLOGY: A prospective, cross-sectional study of Malaysian adults undergoing oesophago-gastro-duodenoscopy (OGDS) for the primary indication of dyspepsia was conducted. Prior to OGDS, locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS), Nepean Dyspepsia Index (NDI) and Leeds Dyspepsia Questionnaire (LDQ) were administered. RESULTS: 839 patients (mean age 49.6 ± 15.8 years, 55.7% female, ethnic division: Malays 30.5% , Chinese 38.4%, Indians 29.4%) were studied between June 2008 and March 2009. 472 (56.3%) and 367 (43.7%) patients had FD and OD respectively. There was no difference in the mean LDQ score between FD and OD patients (18.6 vs 18.1, P = 0.4). Moderate/severe anxiety was more prevalent in FD compared to OD patients (28.5% vs 23.1%, P = 0.05) but there was no significant difference in depression. Summary scores for the NDI revealed a lower mean value in FD patients compared to OD patients (68.6 ± 19.5 vs 71.4 ± 19.6, P = 0.04). CONCLUSION: Patients with FD have a lower HRQOL compared to those with OD, but this could not be attributed to differences in anxiety nor depression between both groups.

Genetic factors for functional dyspepsia.

BACKGROUND: Although familial clustering of functional dyspepsia (FD) has been reported, the role of genetics in the susceptibility to FD is still not well established. Several reports indicate the associations between FD and gene polymorphisms, however the data are inconsistent. This review summarized the evidence of genetics in FD based on genetic epidemiology. RESULTS: Genetic association studies with FD symptom phenotype have limited for several candidate genes investigated. There have been no genome wide association studies in FD. G-protein beta3 (GNB3) subunit C825T was first reported as a candidate gene for FD susceptibility. However, the data are inconsistent in countries. Significant link between homozygous 825C allele of GNB3 protein and dyspepsia was reported from Germany and the USA. On the other hand, the association between T allele of GNB3 C825T polymorphism and dyspepsia was reported from Japan and Netherlands. Association of serotonin transporter promoter (SERT-P) gene polymorphism and FD was reported negatively from a USA community and Netherlands. However we found that SERT SL genotype was significantly associated with PDS. Involvement of IL-17F, migration inhibitory factor (MIF), catechol-o-methyltransferase (COMT) gene val158met, 779 TC of CCK-1 intron 1, cyclooxygenase-1 (COX-1), transient receptor potential cation channel, subfamily V, member 1 (TRPV1) 315C and regulated upon activation normal T cell expressed and secreted (RANTES) polymorphisms was reported in Japanese studies. CONCLUSIONS: Genetic factors are associated with the development of dyspeptic symptoms. Further studies are needed to confirm these data and to determine how genetic factors influence the clinical manifestation of FD patients.

Ethnic variation, epidemiological factors and quality of life impairment associated with dyspepsia in urban Malaysia.

BACKGROUND: The role of ethnicity in the development of dyspepsia remains uncertain. AIMS: To examine the epidemiology of dyspepsia in a multi-ethnic Asian population and its impact on health-related quality of life (HRQOL). METHODS: A cross-sectional survey was conducted in a representative urban population in Kuala Lumpur, Malaysia. RESULTS: A total of 2039 adults (mean +/- s.d. age: 40.5 +/- 11.8 years, males 44.2%, ethnicity: Malays 45.3%, Chinese 38.0% and Indians 13.1%, tertiary education level 62%, professional employment 47.7% and median monthly income USD 850.00) were interviewed. Dyspepsia was prevalent in 496 (24.3%) adults. Independent predictors for dyspepsia, explored by logistic regression, were identified as: Malay (OR 2.17, 95% CI = 1.57-2.99) and Indian (OR 1.59, 95% CI = 1.03-2.45) ethnicity, heavy chilli intake (OR 2.35, 95% CI = 1.15-4.80), use of regular analgesia (OR 3.51, 95% CI = 2.54-4.87) and chronic illness (OR 1.67, 95% CI = 1.22-2.28). HRQOL was assessed with the EQ-5D and significantly lower scores were noted in dyspeptics compared with healthy controls (0.85 +/- 0.17 vs. 0.95 +/- 0.12, P < 0.0001). CONCLUSION: Ethnicity, in addition to recognized epidemiological factors, is a risk factor for dyspepsia in an urban multi-racial Asian population.

Risk factors associated with dyspepsia in a rural Asian population and its impact on quality of life.

OBJECTIVES: The epidemiology and impact of dyspepsia in rural Asia remains uncertain. We aimed to determine the prevalence epidemiology and impact of dyspepsia in a rural Malaysian community. METHODS: A door-to-door survey was conducted in a representative rural population in Malaysia. Dyspepsia was defined according to the Rome II criteria, and health-related quality of life (HRQOL) was assessed using the Euroqol (EQ-5D) instrument. RESULTS: Of 2,260 adults, 2,000 (88.5%) completed the survey. The mean age of respondents was 40.4+/-15.3 years, 62.7% were women, 79.0% were ethnic Malays, 8.4% had been educated up to the tertiary level, 49.7% were unemployed, and 63.4% resided in village-type housing with 49.1% having >8 residents per household. Dyspepsia was prevalent in 292 (14.6%) adults, and they had lower mean EQ-5D utility scores compared with healthy controls (0.91+/-0.17 vs. 0.97+/-0.08, P<0.0001). Dyspepsia was found to be associated with female gender (15.8 vs. 12.7% males, P=0.058), Chinese ethnicity (19.7 vs. 14.2% non-Chinese), higher education levels, medium-range incomes (19.1% medium range vs. 13.3% low range), non-village-type housing (16.3 vs. 13.5% village-type house, P=0.08), nonsmokers (18.7 vs. 13.7%, P=0.015), non-tea drinkers (19.5 vs. 12.3%, P<0.0001), regular analgesia intake (27 vs. 12.7%, P<0.0001), and adults with chronic illness (26.6 vs. 11.1%, P<0.0001). Logistic regression analysis showed that higher levels of education, i.e., secondary (odds ratio (OR) 2.13, 95% confidence interval (CI)=1.15-3.93) and tertiary (2.70, 95% CI=1.30-5.62) education, non-village housing (OR 1.36, 95% CI=1.02-1.80), regular analgesia (OR 2.22, 95% CI=1.60-3.09), and chronic illness (OR 2.83, 95% CI=2.12-3.77) were independent risk factors for dyspepsia. Conversely, regular tea drinking (OR 0.59) seemed to have an inverse relationship. CONCLUSIONS: Dyspepsia in rural Malaysians is associated with a lower HRQOL. Epidemiological risk factors include a higher socioeconomic status, regular analgesic consumption, and chronic illness.