Attentional and physiological processing of food images in functional dyspepsia patients: A pilot study

Brain activity in response to food images in patients with irritable bowel syndrome and functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are caused and exacerbated by consumption of fatty foods. However, no study has evaluated brain activity in response to food images in patients with disorders of gut-brain interaction (DGBI). This study aimed to compare food preference and brain activity when viewing food images between patients with DGBI and healthy controls.

METHODS

FD and IBS were diagnosed using the ROME IV criteria. Food preference was assessed using a visual analog scale (VAS). Brain activity in the prefrontal cortex (PFC) in response to food images was investigated using functional near-infrared spectroscopy (fNIRS).

RESULTS

Forty-one patients were enrolled, including 25 with DGBI. The mean VAS scores for all foods (controls vs. FD vs. IBS: 69.1 ± 3.3 vs. 54.8 ± 3.8 vs. 62.8 ± 3.7, p = 0.02), including fatty foods (78.1 ± 5.4 vs. 43.4 ± 6.3 vs. 64.7 ± 6.1, p < 0.01), were the lowest in patients with FD among all groups. Patients with FD had significantly higher brain activity in the left PFC than those with IBS and healthy controls (mean z-scores in controls vs. FD vs. IBS: - 0.077 ± 0.03 vs. 0.125 ± 0.04 vs. - 0.002 ± 0.03, p < 0.001).

CONCLUSIONS

Patients with DGBI, particularly those with FD, disliked fatty foods. The brain activity in patients with DGBI differed from that in healthy controls. Increased activity in the PFC of patients with FD was confirmed.

Central Regulation of Eating Behaviors in Humans: Evidence from Functional Neuroimaging Studies

Neuroimaging has great potential to provide insight into the neural response to food stimuli. Remarkable advances have been made in understanding the neural activity underlying food perception, not only in normal eating but also in obesity, eating disorders, and disorders of gut-brain interaction in recent decades. In addition to the abnormal brain function in patients with eating disorders compared to healthy controls, new therapies, such as neurofeedback and neurostimulation techniques, have been developed that target the malfunctioning brain regions in patients with eating disorders based on the results of neuroimaging studies. In this review, we present an overview of early and more recent research on the central processing and regulation of eating behavior in healthy and patient populations. In order to better understand the relationship between the gut and the brain as well as the neural mechanisms underlying abnormal ingestive behaviors, we also provide suggestions for future directions to enhance our current methods used in food-related neuroimaging studies.

Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review

Functional gastrointestinal disorders (FGID) and gastroesophageal reflux (GERD) disease affect a large global population and incur substantial health care costs. Impairment in gut-brain communication is one of the main causes of these disorders. The central nervous system (CNS) provides its inputs to the enteric nervous system (ENS) by modulating the autonomic nervous system (ANS) to control the gastrointestinal functions. Therefore, GERD and FGID's might be associated with autonomic dysfunction, which can be identified via heart rate variability (HRV). FGIDs may be treated by restoring the autonomic dysfunction via neuromodulation. This article reviews the roles of HRV in the assessment of autonomic function and dysfunction in (i) gastroesophageal reflux (GERD), and the following FGIDs: (ii) functional dyspepsia (FD) and gastroparesis, (iii) irritable bowel syndrome (IBS) and (iv) constipation. The roles of HRV in the assessment of autonomic responses to various interventions were also reviewed. We used PUBMED, Web of Science, Elsevier/Science direct and Scopus to search the eligible studies for each disorder, which also included the keyword 'heart rate variability'. The retrieved studies were screened and filtered to identify the most suitable studies using HRV parameters to associate the autonomic function with any of the above disorders. Studies involving both human and animal models were included. Based on analyses of HRV, GERD as well as the FGIDs were found to be associated with decreased parasympathetic activity and increased sympathetic nervous system activity with the autonomic balance shifted towards the sympathetic nervous system. In addition, the HRV methods were also reported to be able to assess the autonomic responses to various interventions (mostly neuromodulation), typically the enhancement of parasympathetic activity. In summary, GERD and FGIDs are associated with impaired autonomic dysfunction, mainly due to suppressed vagal and overactive sympathetic tone, which can be assessed noninvasively using HRV.

Effectivity of treatment for children with functional dyspepsia

Functional dyspepsia is very common in children of all ages and has a significant impact on the patient’s family and quality of life. Since the revision of the Rome IV criteria with the introduction of two subtypes, the prevalence of functional dyspepsia has increased, but currently no guidelines for the treatment are available. The aim of this study was to characterize patients, who have been diagnosed with functional dyspepsia and analyze the outcome of different treatments they received. This is a retrospective study of pediatric patients, diagnosed with functional dyspepsia between March 2017 and September 2020. All patients aged between 0 and18 years, who complained about gastric symptoms, have had a normal full blood count, a normal thyroid function, a negative coeliac screening, and most importantly normal macro- and microscopic findings on esophago-gastro-duodenoscopy were included in the study. Patient’s data were extracted from the medical record and three months after the performance of the endoscopy, parents were interviewed about the effect of the treatment. A total of 154 patients (66.2% female, 33.8% male) between the age of 4 and 18 years were included. In 113 (73.4%) the leading symptom was epigastric pain, followed by nausea (22; 14.3%) and a fifth of the patients (females: 18.6%; males: 21.2%) self-reported a current stressor in clinic. After receiving the diagnosis of a functional nature, families chose following treatments: 50 STW5 (32.3%, overall, 10.4% added dietary changes, alternative treatment, and psychology support), psychological support (22.7%), alternative treatments (e.g., hypnotherapy, meditation; 19.5%), dietary changes (12.9%), lifestyle changes (9.7%), no treatment (11%) and in 10.4% no treatment was needed as symptoms resolved after endoscopy had been performed. Only lifestyle changes (p = 0.03) in females, dietary changes (p = 0.035 for girls, p = 0.06 for boys) and STW5 in males (p = 0.043) showed a statistically relevant correlation regarding duration of symptoms. There was no correlation between location of symptoms and effectiveness of treatment. It is recommended to treat patients from both subgroups of functional dyspepsia differently, in accordance with the currently available explanatory models of underlying pathophysiological processes. In this cohort of patients this could not be verified. As all patients did benefit from any treatment, it is likely that the treatment itself was not accountable for the relief of symptoms, but that most patients benefit from education on the diagnosis, reassurance and a recommendation of a healthy lifestyle. Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factor.

Impaired pain empathic abilities among patients with functional dyspepsia

INTRODUCTION

Brain structure or functioning abnormality in regions such as insula and anterior cingulate cortex (ACC) is associated with functional dyspepsia (FD) and pain empathy, but the relationship between FD and pain empathy remains unclear. The aim of this study was to compare the pain empathic abilities of FD patients and healthy controls (HCs) and investigate the association of pain empathy with clinical characteristics and quality of life of FD patients.

METHODS

Pain empathic abilities was measured in 30 FD patients and 30 HCs using a validated pain empathy paradigm. Demographic characteristics, Helicobacter pylori status, duration, dyspeptic symptom score and Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients.

RESULTS

FD patients scored higher than HCs when rating painful pictures, but the accuracy for painful pictures was significantly lower than HCs. Pearson correlation analysis showed significant negative correlation between NDLQI and pain rating scores for painful pictures. When sex, age, educational level, the number of complaints, duration, H. pylori infection and NDLQI were included in multiple linear regression analysis, NDLQI was independently associated with pain ratings.

CONCLUSIONS

FD patients showed abnormally enhanced pain empathic abilities, which may be associated with the severity of symptoms and quality of life.

Impaired decision-making under risk in patients with functional dyspepsia

INTRODUCTION

The cognitive processing in patients with functional dyspepsia (FD) has not been well established. Decision-making is an important component of cognitive function. Most brain regions involved in decision-making are abnormal in FD patients. This study aimed to investigate the decision-making under ambiguity and risk in FD patients.

METHODS

We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls (HCs) matched for age, sex, marital status, and education level. The Hamilton Anxiety Scale (HAMA) and the 17-item Hamilton Depression Scale (HAMD-17) were used to evaluate their anxiety and depression emotions. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to evaluate decision-making under ambiguity and risk, respectively. Helicobacter pylori status, disease duration, dyspeptic symptom score, and the Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients.

RESULTS

In IGT, FD patients had a lower total net score, chose more adverse choices, and showed a slower response to change their behavior than HCs. However, there was no significant difference in the net score of the first 2 blocks between the two groups. In GDT, FD patients had a lower total net score, higher risk score, and lower use of negative feedback than HCs. In addition, FD patients showed better GDT performance than those without early satiation.

CONCLUSIONS

FD patients showed impaired decision-making under risk. The deficiency might be related to dyspeptic symptoms of FD patients.

Mediating role of self-efficacy in social support and health-promoting lifestyle between elderly patients with functional dyspepsia

BACKGROUND

Both self-efficacy and social support can affect a patient's health. At present, there are few studies on elderly patients with functional dyspepsia (FD) from the perspective of self-efficacy and social support. Therefore, this study explored the mediating role of self-efficacy between social support and health-promoting lifestyle of elderly FD patients, and provided an objective basis for clinical work to improve the health level of elderly FD patients.

AIM

To investigate the mediating effect of self-efficacy on social support and health-promoting lifestyle in elderly patients with FD.

METHODS

One hundred and sixty-two elderly patients with FD who were hospitalized at Jinhua Second Hospital of Zhejiang Province from October 2018 to October 2019 were selected for the survey using the general self-efficacy questionnaire, social support scale, and health promotion lifestyle scale.

RESULTS

The total social support score in elderly FD patients was 37.65 ± 6.58, which was at the moderate level. The total score of the general self-efficacy scale was 27.62 ± 5.48, which was moderate. The total score of the health promotion lifestyle scale was 120.85 ± 20.73, which was at the fair level. Pearson correlation analysis showed that health promotion lifestyle, social support, and self-efficacy were positively correlated (P < 0.05), and total score of social support, objective support dimension, and general self-efficacy were positively correlated (P < 0.01). Stratified regression analysis was performed with self-efficacy as the mediating variable, social support as the independent variable, and health-promoting lifestyle as the dependent variable. The estimated mediating effect was 0.175 (0.458 × 0.384), accounting for 28.87% [(0.458 × 0.384)/(0.458 × 0.384 + 0.431)]. The results showed that all of the standardized regression coefficients reached significant levels (P < 0.01), indicating that self-efficacy had an intermediary effect between social support and health promotion in elderly FD patients. Based on multivariate linear regression analysis, adopting the percentile inspection sampling methods and taking the confidence interval of 95% using the Bootstrap method to test the mediation effect of self-efficacy, the results showed that the 95% confidence interval of the mediating effect of self-efficacy was 0.115-0.223 (P < 0.05), suggesting a mediating role for self-efficacy between social support and health promoting lifestyle.

CONCLUSION

Social support, self-efficacy, and health-promoting lifestyle of elderly FD patients are at the moderate or fair level. Self-efficacy is a partial mediator between social support and health promotion. Therefore, in clinical work, medical staff should strengthen the social support in elderly FD patients and improve their self-efficacy to improve their health promotion lifestyle level and health.

Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives

Hypervigilance and symptoms anticipation, visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia (FD) patients. Many patients recognize meals as the main triggering factor; thus, dietary manipulations often represent the first-line management strategy in this cohort of patients. Nonetheless, scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms, resulting in non-standardized nutritional approaches. Most dietary advises are indeed empirical and often lead to exclusion diets, reinforcing in patients the perception of “being intolerant” to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology (i.e., hypervigilance and symptom anticipation). Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals (i.e., dietitians) are only available in tertiary referral settings. This in turn, can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia. In this review, we aim at evaluating the relationship between dietary habits, macronutrients and specific foods in determining FD symptoms. We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients, providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.