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1.
Lancet Gastroenterol Hepatol ; 6(10): 784-792, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34358486

RESUMO

BACKGROUND: Current treatments for functional dyspepsia have limited efficacy or present safety issues. We aimed to assess spore-forming probiotics in functional dyspepsia as monotherapy or add-on therapy to long-term treatment with proton-pump inhibitors. METHODS: In this single-centre, randomised, double-blind, placebo-controlled pilot trial that took place at University Hospitals Leuven (Leuven, Belgium), adult patients (≥18 years) with functional dyspepsia (as defined by Rome IV criteria, on proton-pump inhibitors or off proton-pump inhibitors) were randomly assigned (1:1) via computer-generated blocked lists, stratified by proton-pump inhibitor status, to receive 8 weeks of treatment with probiotics (Bacillus coagulans MY01 and Bacillus subtilis MY02, 2·5 × 109 colony-forming units per capsule) or placebo consumed twice per day, followed by an open-label extension phase of 8 weeks. Individuals with a history of abdominal surgery, diabetes, coeliac or inflammatory bowel disease, active psychiatric conditions, and use of immunosuppressant drugs, antibiotics, or probiotics in the past 3 months were excluded. All patients and on-site study personnel were masked to treatment allocation in the first 8 weeks. Symptoms, immune activation, and faecal microbiota were assessed and recorded. The primary endpoint was a decrease of at least 0·7 in the postprandial distress syndrome (PDS) score of the Leuven Postprandial Distress Scale in patients with a baseline PDS score of 1 or greater (at least mild symptoms), assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT04030780. FINDINGS: Between June 3, 2019, and March 11, 2020, of 93 individuals assessed for eligibility, we included 68 patients with functional dyspepsia (51 [75%] women, mean age 40·1 years [SD 14·4], 34 [50%] on proton-pump inhibitors). We randomly assigned 32 participants to probiotics and 36 to placebo. The proportion of clinical responders was higher with probiotics (12 [48%] of 25) than placebo (six [20%] of 30; relative risk 1·95 [95% CI 1·07-4·11]; p=0·028). The number of patients with adverse events was similar with probiotics (five [16%] of 32) and placebo (12 [33%] of 36). Two serious adverse events occurring during the open-label phase (appendicitis and syncope in two separate patients) were assessed as unlikely to be related to the study product. INTERPRETATION: In this exploratory study, B coagulans MY01 and B subtilis MY02 were efficacious and safe in the treatment of functional dyspepsia. Participants had potentially beneficial immune and microbial changes, which could provide insights into possible underlying mechanisms as future predictors or treatment targets. FUNDING: MY HEALTH.


Assuntos
Suplementos Nutricionais/efeitos adversos , Dispepsia/dietoterapia , Dispepsia/fisiopatologia , Probióticos/uso terapêutico , Adulto , Bacillus coagulans , Bacillus subtilis , Bélgica/epidemiologia , Estudos de Casos e Controles , Método Duplo-Cego , Dispepsia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placebos/administração & dosagem , Prevalência , Probióticos/administração & dosagem , Probióticos/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Segurança , Esporos/química , Resultado do Tratamento
2.
Am J Gastroenterol ; 116(7): 1387-1395, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33941747

RESUMO

INTRODUCTION: Functional dyspepsia (FD) is a prevalent condition with multifactorial pathophysiology, including impaired gastric accommodation (GA), hypersensitivity to gastric distention, and delayed gastric emptying. Drink tests (DT) have been proposed as a potential biomarker for the presence and severity of gastric sensorimotor dysfunction. Thus, we aimed to summarize the state of knowledge on different DT and their potential as a biomarker for FD. METHODS: A PubMed and MEDLINE search was conducted for English language articles, reviews, meta-analyses, case series, and randomized controlled trials, including also published meeting abstracts. RESULTS: Several DT have been described in literature (e.g., different type of liquid, number of calories used, pace of drinking, and subject's awareness of the amount of liquid drunk). FD patients ingest significantly less volume in the different variants of the tests. The slow nutrient ("satiety drinking") test (SDT) studies show the most consistent separation between health and FD and correlation with GA. However, sensitivity to distention may be correlated with rapid DT. SDTs were used to evaluate the effect of several pharmacological agents, often showing concordance between their effects on GA and tolerated nutrient volume. This correlation was not found mainly for agents with central actions. DISCUSSION: An SDT is a potential diagnostic biomarker in FD, reflecting GA. Additional studies are required to confirm its role as a predictive biomarker for treatment outcome in FD.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Dispepsia/diagnóstico , Esvaziamento Gástrico/fisiologia , Biomarcadores , Estudos de Casos e Controles , Comportamento de Ingestão de Líquido , Água Potável , Dispepsia/fisiopatologia , Humanos , Nutrientes , Saciação , Índice de Gravidade de Doença , Fatores de Tempo
4.
Am J Physiol Gastrointest Liver Physiol ; 320(5): G700-G711, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33624527

RESUMO

This study was designed to investigate whether transcutaneous auricular vagal nerve stimulation (taVNS) would be able to improve major pathophysiologies of functional dyspepsia (FD) in patients with FD. Thirty-six patients with FD (21 F) were studied in two sessions (taVNS and sham-ES). Physiological measurements, including gastric slow waves, gastric accommodation, and autonomic functions, were assessed by the electrogastrogram (EGG), a nutrient drink test and the spectral analysis of heart rate variability derived from the electrocardiogram (ECG), respectively. Thirty-six patients with FD (25 F) were randomized to receive 2-wk taVNS or sham-ES. The dyspeptic symptom scales, anxiety and depression scores, and the same physiological measurements were assessed at the beginning and the end of the 2-wk treatment. In comparison with sham-ES, acute taVNS improved gastric accommodation (P = 0.008), increased the percentage of normal gastric slow waves (%NSW, fasting: P = 0.010; fed: P = 0.007) and vagal activity (fasting: P = 0.056; fed: P = 0.026). In comparison with baseline, 2-wk taVNS but not sham-ES reduced symptoms of dyspepsia (P = 0.010), decreased the scores of anxiety (P = 0.002) and depression (P < 0.001), and improved gastric accommodation (P < 0.001) and the %NSW (fasting: P < 0.05; fed: P < 0.05) by enhancing vagal efferent activity (fasting: P = 0.015; fed: P = 0.048). Compared with the HC, the patients showed increased anxiety (P < 0.001) and depression (P < 0.001), and decreased gastric accommodation (P < 0.001) and %NSW (P < 0.001) as well as decreased vagal activity (fasting: P = 0.047). The noninvasive taVNS has a therapeutic potential for treating nonsevere FD by improving gastric accommodation and gastric pace-making activity via enhancing vagal activity.NEW & NOTEWORTHY Treatment of functional dyspepsia is difficult due to various pathophysiological factors. The proposed method of transcutaneous auricular vagal nerve stimulation improves symptoms of both dyspepsia and depression/anxiety, and gastric functions (accommodation and slow waves), possibly mediated via the enhancement of vagal efferent activity. This noninvasive and easy-to-implement neuromodulation method will be well received by patients and healthcare providers.


Assuntos
Dispepsia/terapia , Estimulação do Nervo Vago/métodos , Nervo Vago/fisiopatologia , Adolescente , Adulto , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Dispepsia/fisiopatologia , Feminino , Esvaziamento Gástrico/fisiologia , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/inervação , Resultado do Tratamento , Adulto Jovem
5.
Gastroenterology ; 160(6): 2006-2017, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33548234

RESUMO

BACKGROUND: The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. METHODS: Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. RESULTS: Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. CONCLUSIONS: A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. CLINICALTRIALS. GOV IDENTIFIER: NCT00398801, NCT01696747.


Assuntos
Dispepsia/diagnóstico , Dispepsia/fisiopatologia , Gastroparesia/diagnóstico , Gastroparesia/fisiopatologia , Dor Abdominal/etiologia , Adulto , Estudos de Casos e Controles , Dispepsia/complicações , Dispepsia/patologia , Feminino , Esvaziamento Gástrico , Gastroparesia/complicações , Gastroparesia/patologia , Humanos , Células Intersticiais de Cajal/patologia , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Sistema de Registros , Índice de Gravidade de Doença , Estômago/patologia , Avaliação de Sintomas , Centros de Atenção Terciária , Vômito/etiologia
6.
Neurogastroenterol Motil ; 33(5): e14092, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550640

RESUMO

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.


Assuntos
Ansiedade/psicologia , COVID-19 , Dispepsia/fisiopatologia , Gastroenteropatias/fisiopatologia , Azia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Estresse Psicológico/psicologia , Dor Abdominal/fisiopatologia , Dor Abdominal/psicologia , Adulto , Dor no Peito/fisiopatologia , Dor no Peito/psicologia , Controle de Doenças Transmissíveis , Dispepsia/psicologia , Feminino , Gastroenteropatias/psicologia , Azia/psicologia , Humanos , Síndrome do Intestino Irritável/psicologia , Itália , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Política Pública , SARS-CoV-2 , Inquéritos e Questionários
7.
J Gastroenterol Hepatol ; 36(3): 680-686, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32710649

RESUMO

BACKGROUND AND AIM: Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post-infectious FD. METHODS: Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty-seven healthy children were enrolled for assessing PS and satiety drink test. RESULTS: Fifty-five FD children (33 boys, age 12 [6-18] years) with symptoms for 4 (2-48) months and dyspeptic score of 5 (1-13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P < 0.001). Median satiety drink volume was 360 mL (180-1320 mL); no patients had satiety drink volume of < 5th centile of healthy children. The frequency (98% vs 85%; P = 0.01) and severity (65 [10-175] vs 50 [5-130]; P < 0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P = 0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post-infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. CONCLUSIONS: Abnormality of gastric sensorimotor function is seen in one-fourth of FD cases. HP infection and post-infectious FD are present in 11% and 13% cases, respectively.


Assuntos
Dispepsia/diagnóstico , Dispepsia/etiologia , Adolescente , Criança , Técnicas de Diagnóstico do Sistema Digestório , Dispepsia/fisiopatologia , Feminino , Esvaziamento Gástrico , Gastrite/complicações , Gastrite/microbiologia , Infecções por Helicobacter , Humanos , Masculino , Índice de Gravidade de Doença , Estresse Psicológico/complicações
8.
J Pharmacol Sci ; 145(1): 122-129, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33357770

RESUMO

Functional dyspepsia (FD) is thought to be mainly based on gastric motility dysfunction and chronic hypersensitivity, yet FD animal models has been reported a few. We studied to establish the mouse model of impaired gastric motility induced by a pungent ingredient of wasabi allyl isothiocyanate (AITC), which is reliable to evaluate prokinetic agents. Male ddY mice were used. Gastric motility was measured by 13C-acetic acid breath test in conscious mice. AITC (80 mM) was given 60 min before the measurement of motility. Prokinetic agents including itopride (30, 100 mg/kg), mosapride (0.1-1 mg/kg), neostigmine (30 µg/kg), acotiamide (10-100 mg/kg), and daikenchuto (100-1000 mg/kg) were given 40 min before the measurement. AITC impaired gastric motility without mucosal damages, which reverted 24 h after AITC treatment. The decreased motility induced by AITC was restored by prokinetic agents such as itopride, mosapride, neostigmine, and acotiamide. In separate experiment, daikenchuto recovered the decreased motility induced by AITC, although daikenchuto had no effect on motility in normal condition. In conclusion, it is considered that the AITC-induced impaired gastric motility mouse model is useful to develop new prokinetic agents for treatment of FD, and to re-evaluate traditional Japanese herbal medicines.


Assuntos
Benzamidas/administração & dosagem , Compostos de Benzil/administração & dosagem , Dispepsia/tratamento farmacológico , Motilidade Gastrointestinal , Isotiocianatos/efeitos adversos , Morfolinas/administração & dosagem , Neostigmina/administração & dosagem , Fitoterapia , Extratos Vegetais/administração & dosagem , Tiazóis/administração & dosagem , Wasabia/química , Animais , Benzamidas/farmacologia , Compostos de Benzil/farmacologia , Modelos Animais de Doenças , Dispepsia/fisiopatologia , Motilidade Gastrointestinal/efeitos dos fármacos , Isotiocianatos/isolamento & purificação , Masculino , Camundongos Endogâmicos , Morfolinas/farmacologia , Neostigmina/farmacologia , Extratos Vegetais/farmacologia , Tiazóis/farmacologia
9.
Med Clin North Am ; 105(1): 19-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246519

RESUMO

Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. Patients without any identifiable cause for their symptoms are diagnosed with functional dyspepsia. Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.


Assuntos
Dispepsia , Antibacterianos/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapias Complementares , Diagnóstico Diferencial , Dieta , Dispepsia/diagnóstico , Dispepsia/etiologia , Dispepsia/fisiopatologia , Dispepsia/terapia , Fármacos Gastrointestinais/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Humanos , Período Pós-Prandial , Prebióticos , Probióticos/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Síndrome
10.
Medicine (Baltimore) ; 99(51): e23869, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371173

RESUMO

BACKGROUND: The objective of this meta-analysis was to summarize and identify the available evidence from studies to estimate the clinical value of acupoint sticking combined with massage (ASM) in the treatment of functional dyspepsia (FD), and provide clinicians with evidence on which to base their clinical decision making. METHODS: This review will include all studies comparing clinical efficacy of ASM in the treatment of FD. The search strategy will be performed in 10 databases. We will not establish any limitations to language and publication status, published from inception to the August 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is alleviation of global dyspeptic symptoms, alleviation of individual dyspeptic symptoms, quality-of-life improvement, and safety. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS: This study will summarize current evidence to assess the efficacy and safety of ASM in the treatment of FD. CONCLUSION: The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as studying the value of ASM. REGISTRATION NUMBER: INPLASY2020110072 (DOI number: 10.37766/inplasy2020.11.0072).


Assuntos
Pontos de Acupuntura , Protocolos Clínicos , Dispepsia/terapia , Massagem/normas , Dispepsia/fisiopatologia , Humanos , Massagem/métodos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
11.
Medicine (Baltimore) ; 99(45): e23014, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157947

RESUMO

BACKGROUND: Functional dyspepsia (FD) is a common functional gastrointestinal disease. Acupuncture, including electroacupuncture (EA) is widely used as a complementary and alternative treatment for patients with FD. This study aimed to explore the effectiveness of EA for the treatment of FD. METHODS: We searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Cochrane Library) for randomized controlled trials of FD treated by EA from inception to February 3, 2020. Two reviewers will independently screen studies for data extraction and assess the quality and risk of bias. The Cochrane Collaboration's risk of bias tool, RevMan 5.3 software were used for meta-analysis. Data were pooled to calculate relative risk and 95% confidence intervals (CIs) of substantial improvement after treatment for dichotomous data and mean differences (SMDs) and 95% CIs for continuous data. RESULTS: Seven randomized clinical trials included 853 patients. This meta-analysis investigated the effectiveness of EA alone in the treatment of FD relative to sham-EA or pharmacologic medication (PM). The results showed that EA could significantly improve clinical symptoms. Compared with sham-EA, EA was more effective in reducing symptom scores (SMD -3.44, 95% CI -4.21 to -2.67) and increasing normal slow waves of electrogastrogram (SMD 0.93, 95% CI -0.30 to1.55). When EA was combined with PM, there was no significant difference in reducing symptom scores (SMD -0.18, 95% CI -0.51 to 0.16), increasing the effective rate of clinical symptoms (risk ratio 1.04, 95% CI 0.96 to 1.13), enhancing the level of plasma motilin (SMD 0.93, 95% CI -0.30 to1.55), and reducing gastric half-emptying time (SMD 0.02, 95% CI -0.16 to 0.20). The results also showed that there were very few adverse events reported. CONCLUSION: This meta-analysis suggests that EA is better than the placebo (sham-EA) in treating FD, and the therapeutic effect of EA on FD is equivalent to that of PM on FD. Compared with PM, EA for FD is safer and has fewer adverse reactions. Despite limitations due to the quality and number of the included studies, EA might be used as an effective and safe treatment for FD.


Assuntos
Dispepsia/fisiopatologia , Dispepsia/terapia , Eletroacupuntura/métodos , Terapia por Acupuntura/métodos , Estudos de Casos e Controles , Eletroacupuntura/efeitos adversos , Humanos , Motilina/sangue , Placebos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(48): e23292, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235086

RESUMO

BACKGROUND: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders (FGIDs) and significantly influences patients' quality of life. Many studies have found that patients with FD show significant functional abnormalities in multiple brain regions. However, these functional cerebral abnormalities are not fully consistent. This protocol aims to qualitatively and quantitatively assess and synthesize the functional cerebral abnormalities found in FD. METHODS: A systematic search will be conducted in 4 electronic databases (Medline, Web of Science, EMBASE, and the Cochrane Library) from inception to June 30, 2019, with the language restricted to English. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment will be performed with a custom 11-point checklist. The functional changes in brain regions and the correlations between these altered brain regions and clinical variables in patients with FD will be evaluated through qualitative review. If data are available, an Anisotropic Effect Size version of Signed Differential Mapping (AES-SDM) will be used to synthesize the brain functional alterations and clinical variables in patients with FD. RESULTS: This review and meta-analysis will qualitatively and quantitatively assess and synthesize functional cerebral abnormalities consistently found in FD. CONCLUSION: This may assist in mapping functional brain abnormalities to characterize imaging-based neural markers of FD and improve our knowledge of the pathogenesis of FD. PROSPERO REGISTRATION NUMBER: CRD42019134983 (https://www.crd.york.ac.uk/prospero/).


Assuntos
Encéfalo/fisiopatologia , Dispepsia/fisiopatologia , Neuroimagem/métodos , Adulto , Idoso , Encéfalo/anatomia & histologia , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Dispepsia/complicações , Feminino , Neuroimagem Funcional/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida
13.
Lancet ; 396(10263): 1664-1674, 2020 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-33049221

RESUMO

Gastrointestinal symptoms are highly prevalent, but many people who have them will have no organic explanation for their symptoms. Most of these people will be labelled as having a functional gastrointestinal disorder, such as irritable bowel syndrome, functional dyspepsia, or functional constipation. These conditions affect up to 40% of people at any one point in time, and two-thirds of these people will have chronic, fluctuating symptoms. The pathophysiology of functional gastrointestinal disorders is complex, but involves bidirectional dysregulation of gut-brain interaction (via the gut-brain axis), as well as microbial dysbiosis within the gut, altered mucosal immune function, visceral hypersensitivity, and abnormal gastrointestinal motility. Hence, nomenclature refers to the conditions as disorders of gut-brain interaction. Psychological comorbidity is common; however, whether or not this predates, or is driven by, symptoms is not clear. Patients with functional gastrointestinal disorders can feel stigmatised, and often this diagnosis is not communicated effectively by physicians, nor is education provided. Prompt identification and treatment of these conditions is crucial as they have a considerable impact on health-care systems and society as a whole because of repeated consultations, unnecessary investigations and surgeries, prescriptions and over-the-counter medicine use, and impaired health-related quality of life and ability to work. Symptom-based criteria are used to make a diagnosis, with judicious use of limited investigations in some patients. The general principles of treatment are based on a biopsychosocial understanding and involve management of physical symptoms and, if present, psychological comorbidity. In the future, treatment approaches to functional gastrointestinal disorders are likely to become more personalised, based not only on symptoms but also underlying pathophysiology and psychology.


Assuntos
Encéfalo/fisiopatologia , Gastroenteropatias , Dispepsia/fisiopatologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/psicologia , Humanos , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/psicologia , Qualidade de Vida
14.
Lancet ; 396(10263): 1689-1702, 2020 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-33049222

RESUMO

Dyspepsia is a complex of symptoms referable to the gastroduodenal region of the gastrointestinal tract and includes epigastric pain or burning, postprandial fullness, or early satiety. Approximately 80% of individuals with dyspepsia have no structural explanation for their symptoms and have functional dyspepsia. Functional dyspepsia affects up to 16% of otherwise healthy individuals in the general population. Risk factors include psychological comorbidity, acute gastroenteritis, female sex, smoking, use of non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. The pathophysiology remains incompletely understood, but it is probably related to disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and alterations in gastrointestinal microbiota, mucosal and immune function, and CNS processing. Although technically a normal endoscopy is required to diagnose functional dyspepsia, the utility of endoscopy in all patients with typical symptoms is minimal; its use should be restricted to people aged 55 years and older, or to those with concerning features, such as weight loss or vomiting. As a result of our incomplete understanding of its pathophysiology, functional dyspepsia is difficult to treat and, in most patients, the condition is chronic and the natural history is one of fluctuating symptoms. Eradication therapy should be offered to patients with functional dyspepsia who test positive for Helicobacter pylori. Other therapies with evidence of effectiveness include proton pump inhibitors, histamine-2 receptor antagonists, prokinetics, and central neuromodulators. The role of psychological therapies is uncertain. As our understanding of the pathophysiology of functional dyspepsia increases, it is probable that the next decade will see the emergence of truly disease-modifying therapies for the first time.


Assuntos
Dor Abdominal/etiologia , Encéfalo/fisiopatologia , Dispepsia , Fármacos Gastrointestinais/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Dispepsia/diagnóstico por imagem , Dispepsia/tratamento farmacológico , Dispepsia/fisiopatologia , Endoscopia , Microbioma Gastrointestinal , Infecções por Helicobacter , Helicobacter pylori/isolamento & purificação , Humanos , Fatores de Risco
15.
J Tradit Chin Med ; 40(4): 654-663, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744033

RESUMO

OBJECTIVE: To evaluate the efficacy of the extract from Ganjiangdazao recipe (EGR) on functional dyspepsia in rats with spleen-stomach deficiency cold pattern (SSDCP) in terms of Traditional Chinese Medicine, and to investigate its pharmacodynamics. METHODS: Sixty Sprague-Dawley rats were randomly divided into the control group, SSDCP group, low-EGR SSDCP group, high-EGR SSDCP group, probiotics group, EGR group. SSDCP model was induced by gavage with the 0 ?edible vinegar. The symptoms and manifestations were scored by method from the relative literature, the ecological changes in cecal microflora was analyzed by 16SrRNA high-throughput sequencing technology, gastric tissues were treated by immunohistochemistry, the levels of related biochemical components related to the gastrointestinal functions were detected by enzyme-linked immunosorbent assay and colorimetry, gastric juice was measured by pH meter, blood pressure measurement by trapping tail method, surface temperature measured by infrared thermal imaging, and the content of 6-gingerol in the serum was determined by liquid-mass chromatography before and after EGR was given. RESULTS: It was found that EGR could effectively relieve the symptoms and manifestations of the SSDCP rats (P < 0.05); the value of the relative abundance of Lactobacillus, Streptococcus, Enterococcus and Coprobacillus increased, while the value of the relative abundance of Clostridium decreased (P < 0.05) in the cecal microflora in the SSDCP rats after high-EGR administration; It was also found that EGR had no substantial effect on the related biochemical components related to the gastrointestinal functions of in the SSDCP rats; and a certain amount of 6-gingerol was detected in the serum of EGR group. CONCLUSION: The pharmacodynamic site of EGR is the intestinal tract, and the mechanism behind the effect of EGR on SSDCP rats, involves increasing the beneficial bacteria and decreasing the proinflammatory bacteria in the intestinal tract. The blood pharmacodynamics of EGR remains to be further studied in the future.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Dispepsia/tratamento farmacológico , Animais , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Pressão Sanguínea/efeitos dos fármacos , Dispepsia/microbiologia , Dispepsia/fisiopatologia , Fezes/microbiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Masculino , Medicina Tradicional Chinesa , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
16.
Gastroenterol Clin North Am ; 49(3): 499-517, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32718567

RESUMO

This article reviews the latest enhancements in standards and technology for performing gastric emptying and associated small bowel and colon transit scintigraphic studies. It discusses how developments in appropriate use criteria, American Medical Association Current Procedural Terminology coding, and advanced commercial software permit clinicians to obtain more comprehensive physiologic studies of gastric, small bowel, and colon gastrointestinal motility disorders. It shows how gastrointestinal scintigraphy has expanded to permit assessments of global and regional (fundic and antral) gastric motility and how it permits a single study (whole-gut transit scintigraphy), including measurement of solid and liquid gastric emptying and small bowel and colon transit.


Assuntos
Colo/diagnóstico por imagem , Colo/fisiopatologia , Dispepsia/diagnóstico por imagem , Dispepsia/fisiopatologia , Motilidade Gastrointestinal , Aumento da Imagem/métodos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/fisiopatologia , Cintilografia/métodos , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Esvaziamento Gástrico , Humanos , Cintilografia/tendências , Software
17.
Biol Res Nurs ; 22(4): 544-551, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32677465

RESUMO

INTRODUCTION: This study aimed to identify the Helicobacter pylori cagA+ genotype prevalent in a region of north-eastern Brazil and find possible associations between this genotype and socioeconomic variables. METHODS: This cross-sectional study included 751 patients with dyspepsia from a public endoscopy clinic. Genotyping was carried out on 98 samples from gastric tissue with positive urease test for H. pylori using polymerase chain reaction (PCR). Socioeconomic variables were collected via forms. Pearson's χ2 test was used to analyze associations between variables and odds ratios were obtained to compare effects. Statistical significance was defined as p < 0.05 for univariate and multivariate analyses. RESULTS: H. pylori infection was present in 52.7% of the patients and associated with low income and consumption of untreated drinking water. The prevalence of the cagA+ genotype was 25.5%. Low income was inversely related to the presence of cagA+ genotype, even after adjustment. Untreated drinking water consumption was associated with the presence of the cagA+ genotype in both the univariate (p = 0.03; OR = 2.55; 95% CI: 1.008-6.48) and multivariate (p = 0.03; OR = 2.89; 95% CI: 1.08-7.67) analyses. CONCLUSION: The findings of this study suggest that water can be an important vehicle for the transmission of pathogenic H. pylori strains and may be a public health challenge, especially in less developed regions with precarious water and sanitary conditions.


Assuntos
Água Potável/microbiologia , Dispepsia/microbiologia , Dispepsia/fisiopatologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Adulto Jovem
18.
Nat Rev Dis Primers ; 6(1): 58, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678103

RESUMO

The main inherited cardiac arrhythmias are long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome. These rare diseases are often the underlying cause of sudden cardiac death in young individuals and result from mutations in several genes encoding ion channels or proteins involved in their regulation. The genetic defects lead to alterations in the ionic currents that determine the morphology and duration of the cardiac action potential, and individuals with these disorders often present with syncope or a life-threatening arrhythmic episode. The diagnosis is based on clinical presentation and history, the characteristics of the electrocardiographic recording at rest and during exercise and genetic analyses. Management relies on pharmacological therapy, mostly ß-adrenergic receptor blockers (specifically, propranolol and nadolol) and sodium and transient outward current blockers (such as quinidine), or surgical interventions, including left cardiac sympathetic denervation and implantation of a cardioverter-defibrillator. All these arrhythmias are potentially life-threatening and have substantial negative effects on the quality of life of patients. Future research should focus on the identification of genes associated with the diseases and other risk factors, improved risk stratification and, in particular for Brugada syndrome, effective therapies.


Assuntos
Gastrite Atrófica/complicações , Gastrite Atrófica/diagnóstico , Anemia/etiologia , Anemia/fisiopatologia , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/fisiopatologia , Gerenciamento Clínico , Dispepsia/etiologia , Dispepsia/fisiopatologia , Gastrite Atrófica/fisiopatologia , Humanos , Resposta de Saciedade/fisiologia
20.
Medicina (Kaunas) ; 56(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650518

RESUMO

Background and Objectives: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD. Materials and Methods: Α multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. The Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test. Results: Of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. The groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). The 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group, p = 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM. Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation.


Assuntos
Dispepsia/tratamento farmacológico , Trimebutina/farmacologia , Adulto , Método Duplo-Cego , Dispepsia/fisiopatologia , Feminino , Fármacos Gastrointestinais/farmacologia , Fármacos Gastrointestinais/uso terapêutico , Grécia , Humanos , Jordânia , Masculino , Pessoa de Meia-Idade , Placebos , Polônia , Estudos Prospectivos , Romênia , Estatísticas não Paramétricas , Trimebutina/uso terapêutico , Turquia
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