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1.
Medicine (Baltimore) ; 100(13): e25426, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787652

RESUMO

ABSTRACT: The aim of this study was to assess the relationship of heartburn in pediatric patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) with gastrointestinal symptoms, sleep disturbances, and psychologic distress.The overlap in symptoms of FD, IBS, and gastroesophageal reflux disease (GERD) predicts greater symptom severity and decreased quality of life and presents opportunities for improved diagnostic classification and personalized therapeutics.A cross-sectional observational study of 260 pediatric patients with abdominal pain was conducted. Patients completed standardized questionnaires assessing clinical symptoms, sleep quality, and psychologic symptoms during routine clinical care. Questionnaire data were compared for patients reporting heartburn and not reporting heartburn using χ2 and t tests where appropriate.Gastrointestinal symptoms were significantly more prevalent among patients with a positive report of heartburn (vs a negative report of heartburn): pain with eating (83% vs 67%, P = .007), bloating (63% vs 44%, P = .005), acid regurgitation (47% vs 24%, P ≤ .001), and chest pain (45% vs 20%, P ≤ .001). Likewise, initiating and maintaining sleep (P = .007), arousal/nightmares (P = .046), sleep-wake transition (P = .001), hyperhidrosis during sleep (P = .016), and anxiety (P = .001) and depression (P = .0018) were also significantly increased in patients who reported heartburn versus patients who did not report heartburn.Patients with a positive report of heartburn, whether classified as having FD and/or IBS, had increased gastrointestinal symptoms, sleep disturbances, anxiety, and depression than patients with a negative report of heartburn. A better understanding of these associations may allow for personalized treatment for youth with abdominal pain and heartburn as a primary symptom.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Dispepsia/complicações , Azia/etiologia , Síndrome do Intestino Irritável/complicações , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Biópsia , Criança , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Dispepsia/diagnóstico , Dispepsia/patologia , Dispepsia/psicologia , Endoscopia do Sistema Digestório , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/patologia , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Azia/psicologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Síndrome do Intestino Irritável/psicologia , Masculino , Questionário de Saúde do Paciente/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Autorrelato/estatística & dados numéricos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia
2.
PLoS One ; 16(3): e0248041, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33690620

RESUMO

Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in people living with HIV (PLHIV). To evaluate the Helicobacter pylori infection prevalence rate trends in HIV co-infected individuals in comparison to the HIV-negative population, we compared histopathological findings of H. pylori positive gastritis (gastritis topography and histopathology) between 303 PLHIV and 2642 HIV-negative patients who underwent esophagogastroduodenoscopy (EGD) between 1993 and 2014 due to dyspeptic symptoms. The prevalence of H. pylori infection was significantly higher in HIV-negative controls than in PLHIV (50.2% vs. 28.1%). A significantly positive linear trend of H. pylori co-infection in PLHIV was revealed in the observed period (b = 0.030, SE = 0.011, p = 0.013), while this trend was significantly negative in HIV-negative patients (b = - 0.027, SE = 0.003, p < 0.001). Patients with HIV/H. pylori co-infection had significantly higher CD4+ T cell counts and more often had undetectable HIV viremia, due to successful anti-retroviral therapy (ART). Stomach histopathological findings differed between HIV co-infected and H. pylori mono-infected patients. Our findings confirm that the ART has changed the progression of HIV infection, leading to a significant increase in the prevalence of H. pylori infection in dyspeptic PLHIV over time. Our data also suggests that a functional immune system may be needed for H. pylori-induced human gastric mucosa inflammation.


Assuntos
Dispepsia/microbiologia , Infecções por HIV/complicações , Infecções por Helicobacter/epidemiologia , Adulto , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos , Estudos de Casos e Controles , Coinfecção/patologia , Dispepsia/epidemiologia , Dispepsia/patologia , Feminino , Mucosa Gástrica/patologia , Gastrite/microbiologia , Gastrite/patologia , Infecções por HIV/epidemiologia , Soropositividade para HIV/epidemiologia , HIV-1/patogenicidade , Helicobacter pylori/patogenicidade , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sérvia/epidemiologia , Trato Gastrointestinal Superior/patologia
3.
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
4.
Am J Gastroenterol ; 115(11): 1891-1901, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33156108

RESUMO

INTRODUCTION: Duodenal epithelial barrier impairment and immune activation may play a role in the pathogenesis of functional dyspepsia (FD). This study was aimed to evaluate the duodenal epithelium of patients with FD and healthy individuals for detectable microscopic structural abnormalities. METHODS: This is a prospective study using esophagogastroduodenoscopy enhanced with duodenal confocal laser endomicroscopy (CLE) and mucosal biopsies in patients with FD (n = 16) and healthy controls (n = 18). Blinded CLE images analysis evaluated the density of epithelial gaps (cell extrusion zones), a validated endoscopic measure of the intestinal barrier status. Analyses of the biopsied duodenal mucosa included standard histology, quantification of mucosal immune cells/cytokines, and immunohistochemistry for inflammatory epithelial cell death called pyroptosis. Transepithelial electrical resistance (TEER) was measured using Ussing chambers. Epithelial cell-to-cell adhesion proteins expression was assessed by real-time polymerase chain reaction. RESULTS: Patients with FD had significantly higher epithelial gap density on CLE in the distal duodenum than that of controls (P = 0.002). These mucosal abnormalities corresponded to significant changes in the duodenal biopsy samples of patients with FD, compared with controls, including impaired mucosal integrity by TEER (P = 0.009) and increased number of epithelial cells undergoing pyroptosis (P = 0.04). Reduced TEER inversely correlated with the severity of certain dyspeptic symptoms. Furthermore, patients with FD demonstrated altered duodenal expression of claudin-1 and interleukin-6. No differences in standard histology were found between the groups. DISCUSSION: This is the first report of duodenal CLE abnormalities in patients with FD, corroborated by biopsy findings of epithelial barrier impairment and increased cell death, implicating that duodenal barrier disruption is a pathogenesis factor in FD and introducing CLE a potential diagnostic biomarker in FD.


Assuntos
Duodeno/patologia , Dispepsia/patologia , Endoscopia do Sistema Digestório , Epitélio/patologia , Mucosa Intestinal/patologia , Microscopia Confocal , Piroptose , Adulto , Idoso , Biópsia , Estudos de Casos e Controles , Caspase 1/metabolismo , Adesão Celular/genética , Claudina-1/genética , Duodeno/metabolismo , Dispepsia/genética , Dispepsia/metabolismo , Impedância Elétrica , Epitélio/metabolismo , Feminino , Humanos , Interleucina-6/genética , Mucosa Intestinal/metabolismo , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Curr Gastroenterol Rep ; 22(10): 51, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32797313

RESUMO

PURPOSE OF REVIEW: Functional dyspepsia (FD) is a chronic functional gastrointestinal disorder characterised by upper gastrointestinal symptoms. Here, we aimed to examine the evidence for immune responses to food in FD and overlap with food hypersensitivity conditions. RECENT FINDINGS: A feature of FD in a subset of patients is an increase in mucosal eosinophils, mast cells, intraepithelial cytotoxic T cells and systemic gut-homing T cells in the duodenum, suggesting that immune dysfunction is characteristic of this disease. Rates of self-reported non-celiac wheat/gluten sensitivity (NCW/GS) are higher in FD patients. FD patients commonly report worsening symptoms following consumption of wheat, fermentable oligosaccharides, disaccharides, monosaccharides, or polyols (FODMAPs), high-fat foods and spicy foods containing capsaicin. Particularly, wheat proteins and fructan in wheat may drive symptoms. Immune mechanisms that drive responses to food in FD are still poorly characterised but share key effector cells to common food hypersensitivities including non-IgE-mediated food allergy and eosinophilic oesophagitis.


Assuntos
Dispepsia/imunologia , Hipersensibilidade Alimentar/imunologia , Alimentos/efeitos adversos , Mucosa Intestinal/imunologia , Capsaicina/imunologia , Gorduras na Dieta/imunologia , Dissacarídeos/imunologia , Duodeno/imunologia , Duodeno/patologia , Dispepsia/patologia , Humanos , Imunoglobulina E/imunologia , Mucosa Intestinal/patologia , Monossacarídeos/imunologia , Oligossacarídeos/imunologia , Polímeros , Triticum/imunologia
6.
Scand J Gastroenterol ; 55(7): 780-784, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32536237

RESUMO

Introduction: Duodenal eosinophilia is a key feature of functional dyspepsia, particularly in those with early satiety. Duodenal eosinophilia is also recognised in coeliac disease, although its relevance to symptoms is not understood. We aimed to determine if duodenal eosinophilia is present in patients with coeliac disease presenting with dyspepsia, and whether other histological characteristics were associated with clinical features on presentation.Methods: The coeliac study population comprised 61 patients with a new presentation of coeliac disease to a single centre from 2003 to 2013. A standard symptom assessment was documented for all patients. The control population (55 adults) presenting for endoscopy without coeliac disease was drawn from the same centre with similar demographics for age and gender. Duodenal biopsies from both groups were assessed for eosinophil counts and histological features.Results: Dyspepsia was present in 18.0% of coeliac patients and early satiety in 24.6%. The eosinophil counts were significantly higher in the stomach (12.1/mm2 vs. 4.0/mm2, p < .001) and duodenum (60.4/mm2 vs. 18.0/mm2, p < .001) of coeliac patients compared with controls. There was no significant difference in the mean duodenal eosinophil count in coeliac disease with and without early satiety (55.4/mm2 vs. 66.9/mm2, p = .51). Duodenal eosinophilia was not associated with the severity of coeliac enteropathy. The degree of villous atrophy was associated with iron deficiency at presentation (p = .01), but not symptoms.Conclusions: Although duodenal eosinophil counts are higher in coeliac disease than controls, we were not able to demonstrate an association with presenting symptoms or markers of disease severity.


Assuntos
Doença Celíaca/complicações , Duodeno/patologia , Dispepsia/etiologia , Eosinofilia/complicações , Resposta de Saciedade , Adulto , Biomarcadores , Doença Celíaca/patologia , Doença Celíaca/fisiopatologia , Dispepsia/patologia , Eosinofilia/patologia , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
7.
Clin Transl Gastroenterol ; 11(6): e00184, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32568476

RESUMO

INTRODUCTION: Helicobacter pylori-infected individuals may present low-density infection, undetectable by conventional tests such as histology, rapid urease test, or urea breath test. Droplet digital polymerase chain reaction (ddPCR) is more sensitive than other polymerase chain reaction methods. We aimed to evaluate the ability of ddPCR to detect H. pylori infection in patients diagnosed as negative by conventional tests. METHODS: Dyspeptic patients (n = 236) were tested for H. pylori by histology, urea breath test, and rapid urease test. Patients were classified as having 3 positive (n = 25, control group), 2 positive (n = 12), one positive (n = 41), or zero positive (n = 158) diagnostic tests. DNA was extracted from gastric biopsies. Triplicate ddPCR testing for each of the 16S rDNA, ureA, and vacA(s) genes was performed using a QX200 ddPCR system (Bio-Rad). A gene was considered positive when detected by at least 2 of 3 repeated ddPCRs. H. pylori positivity was defined as having 2 or more positive genes. RESULTS: All the biopsies of the control patients were positive for all 3 16S rDNA, ureA, and vacA(s) genes. H. pylori infection was detected in 57 (36%), 22 (54%), and 9 (75%) patients with zero, 1, and 2 positive diagnostic tests, respectively. The density of infection was 5, 121, 599, and 3,133 copies of H. pylori genome equivalents for patients with zero, 1, and 2 of 3 positive test results and for the control group, respectively. DISCUSSION: ddPCR detected low-density "occult" H. pylori infection in a significant proportion (36%) of patients diagnosed as negative by conventional methods. The number of conventional positive tests was related to the density of infection.


Assuntos
Dispepsia/diagnóstico , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Adulto , Idoso , Proteínas de Bactérias/análise , Proteínas de Bactérias/genética , Biópsia , Testes Respiratórios , DNA Bacteriano/isolamento & purificação , Dispepsia/microbiologia , Dispepsia/patologia , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastroscopia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/genética , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Prospectivos , RNA Ribossômico 16S/genética , Urease/análise , Urease/genética
8.
Arq Gastroenterol ; 57(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294739

RESUMO

BACKGROUND: The role of Helicobacter pylori infection on eosinophilic infiltration in duodenal mucosa is poorly studied. An increase in the number of eosinophils in duodenum has been associated with functional dyspepsia. OBJECTIVE: To evaluate the influence of H. pylori infection on duodenal eosinophil count and the role of eosinophilic infiltrate of duodenum in functional dyspepsia. METHODS: Positive and negative H. pylori individuals were included. Both functional dyspeptic patients according to Rome III criteria (cases) and individuals without gastrointestinal symptoms (controls) were enrolled. They were submitted to upper endoscopy and H. pylori infection was verified by gastric histopathology and urease test. Eosinophils in the duodenal mucosa were counted in five high-power fields, randomly selected on slides of endoscopic biopsies. RESULTS: Thirty-nine H. pylori positive (mean age 40.5 and 69.2% women) and 24 negative patients (mean age 37.3 and 75% women) were included. The influence of the infection was observed in the duodenal eosinophil count, which was higher in infected individuals: median 13.2 vs 8.1 in non-infected individuals (P=0.005). When we analyzed patients according to symptoms, cases - mean age 39.6; 71.4% women - and controls - mean age 38.7; 71.4% women - had similar duodenal eosinophil count: median 11.9 and 12.6 respectively (P=0.19). CONCLUSIONS: We did not demonstrate association of duodenal eosinophil count with functional dyspepsia but found association with H. pylori infection.


Assuntos
Duodeno/patologia , Dispepsia/microbiologia , Eosinofilia/patologia , Mucosa Gástrica/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori , Adulto , Biópsia , Estudos de Casos e Controles , Duodeno/microbiologia , Dispepsia/patologia , Feminino , Mucosa Gástrica/microbiologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Zhonghua Nei Ke Za Zhi ; 59(2): 117-123, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074684

RESUMO

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.


Assuntos
Benzamidas/uso terapêutico , Dispepsia/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Motilidade Gastrointestinal/efeitos dos fármacos , Glicosídeo Hidrolases/uso terapêutico , Morfolinas/uso terapêutico , Pancreatina/uso terapêutico , Peptídeo Hidrolases/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Benzamidas/efeitos adversos , China , Combinação de Medicamentos , Dispepsia/diagnóstico , Dispepsia/patologia , Feminino , Fármacos Gastrointestinais/efeitos adversos , Glicosídeo Hidrolases/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Morfolinas/efeitos adversos , Pancreatina/efeitos adversos , Peptídeo Hidrolases/efeitos adversos , Período Pós-Prandial , Estudos Prospectivos , Resultado do Tratamento
10.
Arq. gastroenterol ; 57(1): 74-78, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1098051

RESUMO

ABSTRACT BACKGROUND: The role of Helicobacter pylori infection on eosinophilic infiltration in duodenal mucosa is poorly studied. An increase in the number of eosinophils in duodenum has been associated with functional dyspepsia. OBJECTIVE: To evaluate the influence of H. pylori infection on duodenal eosinophil count and the role of eosinophilic infiltrate of duodenum in functional dyspepsia. METHODS: Positive and negative H. pylori individuals were included. Both functional dyspeptic patients according to Rome III criteria (cases) and individuals without gastrointestinal symptoms (controls) were enrolled. They were submitted to upper endoscopy and H. pylori infection was verified by gastric histopathology and urease test. Eosinophils in the duodenal mucosa were counted in five high-power fields, randomly selected on slides of endoscopic biopsies. RESULTS: Thirty-nine H. pylori positive (mean age 40.5 and 69.2% women) and 24 negative patients (mean age 37.3 and 75% women) were included. The influence of the infection was observed in the duodenal eosinophil count, which was higher in infected individuals: median 13.2 vs 8.1 in non-infected individuals (P=0.005). When we analyzed patients according to symptoms, cases - mean age 39.6; 71.4% women - and controls - mean age 38.7; 71.4% women - had similar duodenal eosinophil count: median 11.9 and 12.6 respectively (P=0.19). CONCLUSIONS: We did not demonstrate association of duodenal eosinophil count with functional dyspepsia but found association with H. pylori infection.


RESUMO CONTEXTO: O papel de infecção por Helicobacter pylori no infiltrado eosinofílico duodenal ainda é pouco compreendido. Um aumento no número de eosinófilos duodenais tem sido associado a dispepsia funcional. OBJETIVO: Avaliar a influência do H. pylori na contagem de eosinófilos duodenais e o papel do infiltrado eosinofílico duodenal na dispepsia funcional. MÉTODOS: Indivíduos H. pylori positivo e negativo foram incluídos. Ambos os grupos, compreendendo dispépticos funcionais pelos critérios de Roma III (casos) e indivíduos sem sintomas gastrointestinais (controles), foram submetidos à endoscopia digestiva alta para pesquisa de H. pylori, efetuada por histopatologia e teste de urease. Eosinófilos na mucosa duodenal foram contabilizados em cinco campos de maior aumento, selecionados randomicamente nas lâminas de biópsia endoscópicas. RESULTADOS: Trinta e nove indivíduos H. pylori positivo (média de idade 40,5 e 69,2% mulheres) e 24 H. pylori negativos (média de idade 37,3 e 75% mulheres) foram incluídos. A influência da infecção por H. pylori foi observada na contagem de eosinófilos, que foi maior nos positivos: mediana 13,2 vs 8,1 (P=0,005). Quando analisados pacientes de acordo com sintomas, os casos (média de idade 39,6 e 71,4% mulheres) e controles (média de idade 38,7 e 71,4% mulheres), apresentaram semelhante contagem de eosinófilos duodenais: mediana 11,9 e 12,6, respectivamente (P=0,19). CONCLUSÃO: Não demonstramos associação da contagem de eosinófilos duodenais com dispepsia duodenal, mas encontramos associação com infecção por H. pylori.


Assuntos
Humanos , Masculino , Feminino , Adulto , Helicobacter pylori , Infecções por Helicobacter/patologia , Duodeno/patologia , Dispepsia/microbiologia , Eosinofilia/patologia , Mucosa Gástrica/patologia , Biópsia , Estudos de Casos e Controles , Gastroscopia , Duodeno/microbiologia , Dispepsia/patologia , Mucosa Gástrica/microbiologia , Pessoa de Meia-Idade
11.
Neurogastroenterol Motil ; 32(1): e13719, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574212

RESUMO

BACKGROUND: Low-grade inflammation may be involved in the pathogenesis of functional dyspepsia (FD). We hypothesis that altered gastric permeability is involved in the onset and persistence of this disorder. Therefore, our aim was to evaluate gastric mucosal integrity and mast cell numbers in patients with FD. METHODS: We enrolled 58 patients with FD fulfilling the Rome III criteria (H Pylori negative), 20 inflammatory control subjects (H Pylori positive), and 20 healthy controls (H Pylori negative). Probe-based confocal endomicroscopy was performed using intravenous fluorescein to assess the paracellular fluorescein leakage and cell shedding. Mast cells were identified with quantitative immunohistochemistry on mucosal biopsies. KEY RESULTS: Endomicroscopic score of paracellular permeability was significantly higher in H pylori-negative FD patients compared with healthy controls (1.45 ± 1.27 vs 3.69 ± 3.18, P = .006). However, FD patients and healthy controls did not show differences in cell shedding score (0.75 ± 0.79 vs 1.29 ± 1.14, P = .069). Mast cell numbers were significantly increased compared with healthy control samples (18.91 ± 5.47 vs 14.1 ± 3.88, P < .001). The magnitude of increase in permeability was positively correlated with mast cell numbers of FD patients (rs = .6588, P < .0001), but not dyspepsia symptom scores. CONCLUSION AND INFERENCES: Impaired gastric barrier function is present in FD patients. This might provide a new pathophysiological mechanism and therapeutical target in FD.


Assuntos
Dispepsia/patologia , Endoscopia Gastrointestinal/métodos , Mucosa Gástrica/patologia , Microscopia Confocal/métodos , Adulto , Idoso , Permeabilidade da Membrana Celular , Feminino , Infecções por Helicobacter , Helicobacter pylori , Humanos , Masculino , Mastócitos/patologia , Pessoa de Meia-Idade
13.
Int J Colorectal Dis ; 34(11): 1971-1978, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31686199

RESUMO

PURPOSE: This prospective, randomized, double-blind, placebo-controlled, parallel-group study aimed to determine the efficacy and safety of a multistrain (Bacillus coagulans [SNZ 1969], Bacillus clausii [SNZ 1971], and Bacillus subtilis [SNZ 1972]) probiotic blend (SNZ TriBac) in managing symptoms of gastrointestinal (GI) discomfort in the absence of specific pathologies. METHODS: Sixty adults with symptoms of GI discomfort were enrolled (mean age, 34.89 ± 9.95 years) and randomized to receive either SNZ TriBac or placebo. Changes from baseline in Severity of Dyspepsia Assessment (SODA), Gastrointestinal Symptom Rating Scale (GSRS), and Quality of Life (QoL) scales over the course of product use were determined at baseline and on days 30 and 37 as study outcomes. RESULTS: On day 30, significant improvement with SNZ TriBac was noted in SODA burping/belching (P = 0.025), bloating (P = 0.048), sour taste (P = 0.025), and total (P = 0.007) scores as well as pain (P = 0.003), non-pain (P = 0.04), and satisfaction (P = 0.03) subscores. Significant improvement with SNZ TriBac was also observed in SODA burping/belching (P = 0.011), sour taste (P = 0.011), and total SODA scores (P < 0.001), and in SODA pain (P = 0.005), non-pain (P = 0.06), and satisfaction (P = 0.004) subscores on day 37. No adverse events were reported. CONCLUSION: Significant improvement in final SODA scores and subscores with SNZ TriBac versus placebo indicates improvement in several symptoms of gastrointestinal discomfort. This multistrain probiotic blend was well tolerated and could be an effective option for treatment of GI discomfort. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2018/05/014071).


Assuntos
Bacillus/fisiologia , Gastroenteropatias/terapia , Probióticos/efeitos adversos , Probióticos/uso terapêutico , Adulto , Método Duplo-Cego , Dispepsia/patologia , Feminino , Humanos , Masculino , Placebos , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Biomed Pharmacother ; 120: 109442, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546083

RESUMO

AIM: To evaluate whether Xiaoerfupi (XEFP), a traditional Chinese medicine formula, can ameliorate functional dyspepsia (FD) through regulation of the HTR3A and c-FOS. METHOD: The FD rat model was established through administration of iodoacetamide (IA) and interval fasting. XEFP group rats received XEFP for 3 weeks. Detection of gastric emptying and gastrin were performed to assess the interventional effect of XEFP. The constituents of XEFP were submitted to BATMAN-TCM, an online bioinformatics analysis tool, to predict the targets related to dyspepsia. Furthermore, the prediction was validated via Western blot assay. RESULTS: XEFP enhanced gastric emptying of rats (XEFP middle dose vs. FD model: 71.87 ±â€¯15.21% vs. 30.07 ±â€¯12.76%, P <  0.01) and simultaneously increased gastrin in FD rats (XEFP middle dose vs. FD model: 63.61 ± 17.90 vs. 26.14 ± 7.78 pg/ml, P <  0.01). KEGG enrichment analysis revealed that the neuroactive ligand-receptor interaction was successfully enriched (P-value = 2.2E-13, Benjamini = 2.0E-11). Combining different Bioinformatics analysis implied that XEFP regulates HTR3A and c-FOS. Subsequently molecular biological studies confirmed that the expression of HTR3A and c-FOS in the model group was upregulated in rats in comparison with the control group. Furthermore, the expression of HTR3A and c-FOS in the XEFP group (middle dose) compared with the model group was significantly reduced (P <  0.01). CONCLUSION: XEFP may ameliorate FD through regulation of the HTR3A and c-FOS.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Dispepsia/tratamento farmacológico , Proteínas Proto-Oncogênicas c-fos/metabolismo , Receptores 5-HT3 de Serotonina/metabolismo , Animais , Dispepsia/patologia , Esvaziamento Gástrico/efeitos dos fármacos , Masculino , Ratos , Ratos Sprague-Dawley
15.
Medicine (Baltimore) ; 98(28): e16106, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305393

RESUMO

The aim of this study was to examine the correlation between the tongue coating thickness (TCT) and ultraviolet (UV) fluorescence and propose a new method for the estimation of TCT using a computerized tongue image acquisition system (CTIS).In this prospective and observational single-center study, we acquired tongue images under visible light and near-UV light for 60 patients with functional dyspepsia. Tongue images were acquired twice within a 30-minute interval to assess the reliability of CTIS. Then, the tongue coating was scraped and weighed to derive the wet weight of the tongue coating (WWTC). The percentage of the tongue coating area was calculated from the tongue images acquired under visible light. Mean color values (mCVs) for the UV fluorescence of the dorsal surface of the tongue were also computed.The reliabilities of the derived mCVs and percentage of the tongue coating area were acceptable (intraclass correlation coefficients, 0.907-0.947). The mCVs were more strongly correlated with WWTC than with the area, with mCV of modified lightness showing the strongest association (r = 0.785, P < .01). Finally, we suggested an estimation model for TCT based on the results.The results of this study suggest that both UV fluorescence of the dorsal tongue and the distribution area of tongue coating are useful parameters for the quantitative assessment of tongue coating. We believe that these findings will contribute to the development of a clinically useful CTIS.


Assuntos
Dispepsia/diagnóstico por imagem , Imagem Óptica , Língua/diagnóstico por imagem , Dispepsia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Língua/patologia , Raios Ultravioleta
16.
Georgian Med News ; (289): 102-107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31215888

RESUMO

Functional dyspepsia (FD) is the most common cause of chronic epigastric pain and abdominal fullness. Helicobacter pylori-associated gastritis is one of the pathophysiological factors of FD, however the peculiarities of it are still unknown. Aim of the study - to compare the morphological changes in biopsy specimens of gastroduodenal area in patients with different types of functional dyspepsia. This study was conducted as a cross-sectional study in adult subjects with FD. Biopsy specimens were taken from the stomach as per the Houston-updated gastric biopsy sampling protocol. To measure gastritis grade we used OLGA and OLGIM staging systems. Analysis was performed by pathologist who was blinded to the clinical diagnosis of the patients. We compare the degree of inflammation, activity of gastritis, presence and degree of atrophy, metaplasia and dysplasia in patients with different types of FD. This study included 33 subjects with postprandial distress syndrome (PDS) and 28 subjects with epigastric pain syndrome (EPS) according to Rome IV criteria. The level of gastric body and antral inflammation, activity degree, and metaplasia were detected at the same frequency in both groups (p>0.05). The grade of antral atrophy was significantly higher in patients with PDS (p=0,002) with no difference in the gastric body.


Assuntos
Dispepsia , Gastrite , Infecções por Helicobacter , Helicobacter pylori , Adulto , Estudos Transversais , Dispepsia/patologia , Gastrite/patologia , Infecções por Helicobacter/patologia , Humanos , Metaplasia
17.
Rev Gastroenterol Peru ; 39(1): 21-26, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042233

RESUMO

INTRODUCTION: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. OBJECTIVE: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. MATERIAL AND METHODS: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. RESULTS: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). CONCLUSIONS: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.


Assuntos
Duodenopatias/epidemiologia , Dispepsia/epidemiologia , Eosinofilia/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Anemia Ferropriva/patologia , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Diarreia/patologia , Duodenopatias/patologia , Dispepsia/patologia , Eosinofilia/patologia , Feminino , Intolerância Alimentar/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Mastocitose/epidemiologia , Saciação , Fumar/epidemiologia , Avaliação de Sintomas
18.
Aliment Pharmacol Ther ; 50(1): 24-32, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31107579

RESUMO

BACKGROUND: It is unexplained why functional dyspepsia and gastro-oesophageal reflux disease (GERD) overlap more often than expected by chance. Post-prandial distress syndrome has been linked to impaired gastric fundic accommodation which may induce increased transient lower oesophageal sphincter relaxations and consequent GERD. Duodenal eosinophilia has been linked to functional dyspepsia and post-prandial distress syndrome. AIM: To identify if there is an association between duodenal eosinophilia in functional dyspepsia and symptoms of GERD and whether post-prandial distress syndrome or epigastric pain syndrome are associated with new onset GERD. METHODS: Participants (n = 1000) were randomly selected from the national Swedish population register and surveyed by questionnaires and oesophagogastroduodenoscopy in 1999-2001. All eligible subjects (n = 887) were invited to a follow-up study in 2010 (response rate 79%). In a case-control study of 213 subjects (functional dyspepsia vs healthy controls), histology from the duodenum was evaluated at baseline and the possible association of eosinophilia to new onset GERD symptoms was analysed. RESULTS: Functional dyspepsia (OR 7.6; 95% CI 2.93-19.4, P < 0.001) and post-prandial distress syndrome at baseline (OR 9.0, 95% CI 3.36-24.0, P < 0.001) were associated with an increased risk of GERD at follow-up. Eosinophilia in the second part of duodenum only was independently associated with an increased risk of GERD amongst those with functional dyspepsia (OR 4.2; 95% CI 1.2-4.77, P = 0.024) and post-prandial distress syndrome at baseline (OR 6.0; 95% CI 1.50-23.6, P = 0.011), respectively. CONCLUSIONS: Duodenal eosinophilia is associated with increased risk of GERD at 10-year follow-up in those with functional dyspepsia and post-prandial distress syndrome at baseline. Duodenal eosinophilia may explain the link between GERD and functional dyspepsia, suggesting subsets of functional dyspepsia and GERD may be part of the same disease spectrum.


Assuntos
Dor Abdominal/epidemiologia , Duodeno , Dispepsia/epidemiologia , Eosinofilia/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Dor Abdominal/imunologia , Dor Abdominal/patologia , Dor Abdominal/fisiopatologia , Estudos de Casos e Controles , Duodeno/imunologia , Duodeno/patologia , Duodeno/fisiopatologia , Dispepsia/imunologia , Dispepsia/patologia , Dispepsia/fisiopatologia , Eosinofilia/imunologia , Eosinofilia/patologia , Eosinofilia/fisiopatologia , Feminino , Seguimentos , Refluxo Gastroesofágico/imunologia , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Suécia/epidemiologia
19.
Korean J Gastroenterol ; 73(2): 77-83, 2019 Feb 25.
Artigo em Coreano | MEDLINE | ID: mdl-30845383

RESUMO

Dyspepsia is a common problem, and when dyspeptic symptoms develop within a short period of time, organic diseases such as gastroesophageal reflux disease, peptic ulcer diseases, pancreatoduodenal diseases, and gastrointestinal cancers should be suspected. Furthermore, functional dyspepsia (FD) should be considered if chronic or recurrent symptoms persist after eliminating underlying disease. FD is classified as epigastric pain syndrome (EPS) or postprandial distress syndrome (PDS), but these two conditions may overlap. Patients with the EPS subtype can be treated with proton pump inhibitors (PPIs), whereas patients with the PDS subtype may be managed primarily with prokinetics, and patients with EPS and PDS can be co-administered PPIs and prokinetics. Helicobacter pylori eradication therapy can be administered on a test-and-treat basis when PPIs and prokinetics are ineffective or to younger patients with chronic dyspepsia, and tricyclic antidepressants can be used as a secondary treatment because they are effective in patients with the EPS subtype. In addition, because the pathophysiology of FD is diverse, dietary education and stress management are required in addition to medical therapy, and should substantially aid treatment and long-term management. Here, we introduce and summarize recently published guidelines for the treatment of FD.


Assuntos
Dispepsia/patologia , Ansiolíticos/uso terapêutico , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Antipsicóticos/uso terapêutico , Dispepsia/tratamento farmacológico , Guias como Assunto , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/patologia , Humanos , Estilo de Vida , Inibidores da Bomba de Prótons/uso terapêutico
20.
Neurogastroenterol Motil ; 31(10): e13576, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30790378

RESUMO

BACKGROUND: Duodenal changes in functional dyspepsia (FD) might be related to the development of symptoms. However, relationships among low-grade inflammation, Helicobacter pylori infection, and protein expression by tight junctions (TJs) in the duodenum are unclear. We therefore aimed to determine whether duodenal inflammation and genes associated with TJ proteins are associated with FD. METHODS: We evaluated inflammatory cell infiltration of the duodenum, H pylori infection, and genes associated with TJ proteins in duodenal biopsy specimens from 35 patients with FD according to the Rome III diagnostic questionnaire and from 31 asymptomatic controls without structural diseases. We immunohistochemically detected eosinophils and mast cells and counted them. The expression of claudins, occludin, and zonula occludens (ZO)-1 mRNA was evaluated using quantitative RT-PCR. Infection with H pylori was determined by measuring serum antibodies, rapid urease or urea breath tests, and endoscopic findings. RESULTS: Sex, age, and H pyloriinfection rates did not differ between patients with FD and controls. The numbers of eosinophils and mast cells were significantly increased in patients with FD compared with controls and were significantly correlated. Inflammatory cell counts in the duodenum were not associated with H pylori infection status. Claudin-3 mRNA expression was increased in the patients with FD. CONCLUSIONS: Subtle inflammation identified in the duodenum of patients with FD might be associated with the onset and persistence of dyspeptic symptoms.


Assuntos
Duodeno/patologia , Dispepsia/patologia , Eosinófilos/patologia , Infecções por Helicobacter/patologia , Inflamação/patologia , Mastócitos/patologia , Proteínas de Junções Íntimas/genética , Adulto , Idoso , Biópsia , Claudina-3/genética , Claudina-3/metabolismo , Claudinas/genética , Duodeno/metabolismo , Dispepsia/epidemiologia , Dispepsia/genética , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/genética , Helicobacter pylori , Humanos , Masculino , Pessoa de Meia-Idade , Ocludina/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Proteína da Zônula de Oclusão-1/genética
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