Motilin- and neuropeptide Y-like immunoreactivity in a psychophysiological stress experiment on patients with functional dyspepsia

Therapeutic massage/Tuina for treatment of functional dyspepsia: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

A systematic review of randomized controlled trials (RCTs) was conducted to assess the potential effect of therapeutic massage/Tuina on functional dyspepsia (FD) patients.

METHOD

Twelve databases and three clinical trial registries were searched until December 2021, for RCTs that compared Tuina combined with or without conventional therapy versus conventional therapy in FD. We assessed the methodological quality of included trials by the Cochrane Risk of Bias tool, and graded the quality of the evidence. The data were presented as risk ratio (RR) or mean difference (MD) respectively with their 95% confidence interval (CI).

RESULTS

In total, 14 RCTs with 1128 FD participants were included. Compared with conventional therapy, Tuina showed significant beneficial effects on improving overall symptom (RR = 1.12, 95% CI 1.06 to 1.19, low certainty evidence), and early satiation (MD -0.44 scores, 95% CI -0.72 to -0.16, very low certainty evidence). Compared with conventional therapy, Tuina plus conventional therapy also significantly improved overall symptom (RR = 1.14, 95% CI 1.06-1.23, low certainty evidence), quality of life (MD 10.44 scores, 95% CI 7.65-13.23, low certainty evidence), and epigastric pain (MD -0.76 scores, 95% CI -1.11 to -0.41, low certainty evidence). No adverse events related to Tuina and cost-effectiveness were reported.

CONCLUSION

Low certainty evidence showed that Tuina significantly improved overall symptom of FD participants compared with conventional therapy. Low certainty evidence showed that Tuina plus conventional therapy obviously improved overall symptom and quality of life of FD participants compared with conventional therapy.

Links Between Arts and Health, Examples From Quantitative Intervention Evaluations

The author presents eight of his own group’s studies. They have been published from early 1980s until 2016. Each study will be placed in its scientific context and discussed in relation to possible progress in arts and health research. In these examples, statistical methods with longitudinal designs and mostly control groups have been used. Some of them are randomized controlled trials. Physiological and endocrinological variables have been assessed in some of these studies in efforts to increase our understanding of how music experiences and other kinds of arts experiences interact with bodily reactions of relevance for health development. Although some of the studies have suffered from low statistical power and other methodological weaknesses, they show that it is possible to do statistical evaluations of arts interventions aiming at improved health.

Gut Hormones as Potential Therapeutic Targets or Biomarkers of Response in Depression: The Case of Motilin

Recent research has identified the gut–brain axis as a key mechanistic pathway and potential therapeutic target in depression. In this paper, the potential role of gut hormones as potential treatments or predictors of response in depression is examined, with specific reference to the peptide hormone motilin. This possibility is explored through two methods: (1) a conceptual review of the possible links between motilin and depression, including evidence from animal and human research as well as clinical trials, based on a literature search of three scientific databases, and (2) an analysis of the relationship between a functional polymorphism (rs2281820) of the motilin (MLN) gene and cross-national variations in the prevalence of depression based on allele frequency data after correction for potential confounders. It was observed that (1) there are several plausible mechanisms, including interactions with diet, monoamine, and neuroendocrine pathways, to suggest that motilin may be relevant to the pathophysiology and treatment of depression, and (2) there was a significant correlation between rs2281820 allele frequencies and the prevalence of depression after correcting for multiple confounding factors. These results suggest that further evaluation of the utility of motilin and related gut peptides as markers of antidepressant response is required and that these molecular pathways represent potential future mechanisms for antidepressant drug development.

Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review

BACKGROUND

Functional dyspepsia (FD) is a common digestive disease with limited therapeutic options. According to evidence-based clinical practice, acupuncture or electroacupuncture (EA) seems to be a promising therapy for patients with FD. However, there is still a lack of systematic reviews that have analyzed current clinical trials for a better understanding of mechanisms involved in the ameliorating effect of acupuncture and EA on FD.

AIM

To evaluate the results and qualities of existing clinical evidence for researching the underlying mechanisms of acupuncture/EA in treating FD.

METHODS

A systematic search of the literature was performed to identify randomized controlled trials in which research on the mechanism of acupuncture or EA was conducted in FD patients. Databases searched included PubMed, EMBASE, Cochrane Library, and Web of Science. Data extraction and quality assessment were completed by two investigators independently and the results of quality evaluation were exported through Review Manager V5.3.

RESULTS

Eight studies were included in this review with a total of 17 items for detecting techniques for mechanistic research. Positive effects of acupuncture and EA were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life.

CONCLUSION

The key findings of this systematic review support the potential of acupuncture and EA in altering the heterogeneous pathophysiology in patients with FD. However, high-quality studies with well-planned designs are necessary to provide more credible evidence.

Neuropeptide Y in PTSD, MDD, and chronic stress: A systematic review and meta-analysis

Previous studies have suggested that neuropeptide Y (NPY) levels may be altered in patients with major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and chronic stress. We investigated, through systematic review and meta-analysis, whether the mean levels of NPY are significantly different in patients with MDD, PTSD or chronic stress, compared to controls. The main outcome was the pooled standardized mean difference (SMD) with 95% confidence intervals between cases and controls, using the random-effects model. Heterogeneity and publication bias were evaluated. Thirty-five studies met eligibility criteria. Meta-regression determined that medication and sex could explain 27% of the between-study variance. Females and participants currently prescribed psychotropic medications had significantly higher levels of NPY. NPY levels were significantly lower in plasma and cerebrospinal fluid (CSF) in PTSD patients versus controls. Patients with MDD had significantly lower levels of NPY in plasma compared to controls, but not in the CSF. The magnitudes of the decrease in plasma NPY levels were not significantly different between PTSD and MDD. However, chronic stress patients had significantly higher plasma NPY levels compared to controls, PTSD or MDD. Our findings may imply a shared role of NPY in trauma and depression: nevertheless, it is not clear that the association is specific to these disorders. Psychotropic medications may help restore NPY levels. Further controlled studies are needed to better delineate the contribution of confounding variables such as type of depression, body mass index, appetite or sleep architecture.

Comparative Researches of Semen Arecae and Charred Semen Arecae on Gastrointestinal Motility, Motilin, Substance P, and CCK in Chronically Stressed Rats

Aims

To compare the effects of Semen Arecae (SA) and Charred Semen Arecae (CSA) on gastrointestinal motility, motilin, substance P (SP), and cholecystokinin (CCK) in chronically stressed rats.

Methods

Rats were randomly divided into control group and stress group. Rats in stress group were randomly exposed to a variety of unpredictable stimulations for 21 days. Then, the rats were treated orally with distilled water, SA, CSA, and mosapride for 7 days. Gastric residue rate and intestinal propulsion rate were evaluated. Serum levels of motilin and SP were measured by enzyme-linked immunosorbent assay (ELISA). CCK mRNA was quantified by using quantitative real-time PCR (qRT-PCR).

Results

Both SA and CSA improved the intestinal propulsion and reduced the gastric residue in chronically stressed rats. Furthermore, the serum levels of motilin and SP were significantly higher and the CCK mRNA expressions in intestine and hypothalamus were downregulated in SA and CSA groups. Furthermore, it was found that CSA is more effective.

Conclusion

Both SA and CSA enhanced gastrointestinal motility and increased serum levels of motilin and SP in chronically stressed rats via downregulating CCK mRNA expressions in intestine and hypothalamus. Importantly, CSA possessed more effective promoting effects.

Motilin: towards a new understanding of the gastrointestinal neuropharmacology and therapeutic use of motilin receptor agonists

The gastrointestinal hormone motilin has been known about for >40 years, but after identification of its receptor and subsequent development of new tools and methods, a reappraisal of its actions is required. Firstly, it is important to note that motilin and ghrelin receptors are members of the same family (similar genomic organization, gastrointestinal distribution and abilities to stimulate gastrointestinal motility), yet each fails to recognize the ligand of the other; and whereas ghrelin and ghrelin receptors are widespread outside the gastrointestinal tract, motilin and its receptors are largely restricted to the gastrointestinal tract. Secondly, although some studies suggest motilin has activity in rodents, most do not, and receptor pseudogenes exist in rodents. Thirdly, motilin preferentially operates by facilitating enteric cholinergic activity rather than directly contracting the muscle, despite the relatively high expression of receptor immunoreactivity in muscle. This activity is ligand-dependent, with short-lasting actions of motilin contrasting with longer-lasting actions of the non-selective and selective motilin receptor agonists erythromycin and GSK962040. Finally, the use of erythromycin (also an antibiotic drug) to treat patients requiring acceleration of gastric emptying has led to concerns over safety and potential exacerbation of antibiotic resistance. Replacement motilin receptor agonists derived from erythromycin (motilides) have been unsuccessful. New, non-motilide, small molecule receptor agonists, designed to minimize self-desensitization, are now entering clinical trials for treating patients undergoing enteral feeding or with diabetic gastroparesis. Thus, for the translational pharmacologist, the study of motilin illustrates the need to avoid overreliance on artificial systems, on structural information and on animal studies.

LINKED ARTICLES

This article is part of a themed section on Neuropeptides. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.170.issue-7.

Simotang enhances gastrointestinal motility, motilin and cholecystokinin expression in chronically stressed mice

AIM: To investigate the effect of Simotang (Decoction of Four Powered Drugs) on gastrointestinal motility, motilin and cholecystokinin expression in chronically stressed mice.

METHODS: Forty mice were randomly divided into control group, stress group (model group), mosapride group and Simotang group, 10 in each group. A variety of unpredictable stimulations were used to induce chronic stress in mice. Then, the mice were treated with distilled water, mosapride or Simotang for 7 d. Gastric emptying and intestinal propulsion function were detected. Serum level of motilin was measured by enzyme-linked immunosorbent assay. Expression of cholecystokinin (CCK) in intestine, spinal cord and brain of mice was detected by immunohistochemistry and semi-quantitative reverse transcription polymerase chain reaction, respectively.

RESULTS: Simotang improved the gastric emptying and intestinal propulsion in chronically stressed mice. Furthermore, the serum motilin level was significantly higher and the expression levels of CCK-positive cells and genes were significantly lower in intestine, spinal cord and brain of Simotang group than in those of model group (P < 0.05). No significant difference was found in serum motilin level and expression levels of CCK-positive cells and genes between the mosapride and Simotang groups.

CONCLUSION: Simotang enhances the gastrointestinal motility in chronically stressed mice by regulating the serum motilin level and the expression of cholecystokinin.

Effect of acupuncture point injection and abdominal hot fomentation with Chinese medicine on gastrointestinal function in patients after abdominal surgery

AIM: To investigate the effect of injection of vitamin B₁ into Zusanli point and abdominal hot fomentation with common fennel on gastrointestinal function in patients after abdominal surgery.

METHODS: A total of 146 patients, including 46 undergoing total gastrectomy for stomach cancer, 32 undergoing subtotal gastrectomy for gastroduodenal ulcer, and 39 undergoing radical resection for colon cancer, were included in the study. These patients were randomly divided into treatment group and control group. The control group was given routine treatment, while the treatment group underwent injection of vitamin B₁ into Zusanli point and abdominal hot fomentation with common fennel on the basis of routine treatment. The time to first bowel sounds, time to first flatus, time to defecation, and volume of drained gastric juice were observed from day 1 after surgery. The concentration of serum motilin (MTL) was determined before surgery, and on days 1 and 5 after surgery.

RESULTS: The time to first bowel sounds (t = 11.325, P < 0.01), time to first flatus (t = 21.277, P < 0.01), and time to defecation (t = 20.632, P < 0.01) were significantly improved in the treatment group compared with the control group. On day 5, the volume of drained gastric juice was significantly lower in the treatment group than in the control group (t = 15.833, P < 0.01). No statistical differences were noted in MTL concentrations before surgery and on day 1 after surgery between the control group and treatment group (both P > 0.05). However, serum MTL concentration on day 5 was significantly higher in the treatment group than in the control group (t = 4.2636, P < 0.01).

CONCLUSION: Injection of vitamin B₁ into Zusanli point and abdominal hot fomentation with common fennel can strengthen gastrointestinal motility, accelerate the recovery of gastrointestinal functions, and stimulate MTL release in patients after abdominal surgery.

Neurohumoral features of myocardial stunning due to sudden emotional stress

BACKGROUND

Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown.

METHODS

We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction.

RESULTS

The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons).

CONCLUSIONS

Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.

Relationships among symptom sub-groups, gastric emptying and blood gut hormones in patients with functional dyspepsia

AIM

To study the relationships among symptom subgroups, gastric emptying and gastrointestinal hormones in patients with functional dyspepsia (FD) and to explore pathogenesis of FD.

METHODS

The patients with FD were divided into 3 subgroups according to the RomeIIcriteria and 10 cases were selected randomly from each subgroup. Ten healthy subjects served as control. Thus 4 subgroups were set up, including the ulcer-like dyspepsia group (10 cases), the dysmotility-like dyspepsia group (10 cases), the unspecified dyspepsia group (10 cases) and the control group (10 healthy subjects). Changes of radionuclide gastric emptying and blood levels of relevant gastrointestinal hormones were observed synchronously. After gastric emptying was measured, the 30 cases of FD were divided into 2 groups: the normal gastric emptying group and the delayed gastric emptying group. Gastric emptying was recorded by ^99mTc-labelled solid food. Changes in motilin(MTL), somatostatin(SS), substance P(SP)and nitric oxide(NO)contents in peripheral blood were determined by radioimmunoassay and nitrate reductase technique.

RESULTS

In the ulcer-like group, 40% patients had gastric emptying delay while the half gastric emptying time (GET_1/2) and gastric emptying rate (GE%)at every time-point did not show significant changes(P<0.05)compared with control group and the other two subgroups of FD. The levels of SS in peripheral blood were increased significantly (P<0.05). However, the levels of MTL, SP, NO did not show significant changes (P<0.05) compared with control group. In the dysmotility-like group, 70% patients had gastric emptying delay, meanwhile, GET1/2 was prolonged significantly (P<0.05), and GE% was decreased significantly (15 min, P>0.05; 30 min, P>0.05; 45 min, P<0.05; 60 min, P<0.05; 90 min, P<0.01; and 120 min, P<0.01, respectively). Levels of SS in peripheral blood were increased significantly (P<0.05), whereas levels of MTL, SP, NO did not show significant changes (P>0.05). In the unspecified group, 70% of patients had gastric emptying delay, meanwhile, GET1/2 was prolonged significantly (P<0.05), and GE% was decreased significantly (15 min P>0.05; 30 min, P>0.05; 45 min, P<0.05; 60 min, P<0.05; 90 min, P<0.01; and 120 min, P<0.01, respectively). Levels of SS in peripheral blood were increased significantly (P<0.05), whereas levels of MTL, SP, NO did not show significant changes (P>0.05). In the normal gastric emptying group of FD, levels of SS in peripheral blood were increased significantly (P<0.05), whereas levels of MTL, SP, NO did not show significant changes (P>0.05). In the delayed gastric emptying group of FD, levels of SS and NO in peripheral blood were increased significantly (P<0.05), whereas levels of MTL were decreased significantly (P<0.05), meanwhile, levels of SP did not show significant changes (P>0.05).

CONCLUSION

Gastric motility disturbance plays an important role in pathogenesis of dysmotility-like dyspepsia and unspecified dyspepsia. Three subgroups of FD have different mechanisms and the Rome II criteria have practical importance in diagnosis and therapy of FD. Therefore, gastric emptying test has significance in evaluation of gastric motility function and in the treatment of FD. The increase of NO and the decrease of MTL are related to gastric emptying delay. The roles of SS and SP need to be studied further.