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Tack J, Palsson OS, Bangdiwala SI, Schol J, Carbone F, Van Den Houte K, Broeders B, Drossman D, Dumitrascu DL, Fang X, Fukudo S, Ghoshal UC, Kellow J, Khatun R, Okeke E, Quigley EM, Schmulson M, Simrén M, Whitehead WE, Whorwell P, Sperber AD. Functional Dyspepsia and Its Subgroups: Prevalence and Impact in the Rome IV Global Epidemiology Study. Aliment Pharmacol Ther 2025. [PMID: 40434285 DOI: 10.1111/apt.70189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/04/2024] [Accepted: 04/28/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most common disorders of gut-brain interaction (DGBI). Varying reported population prevalences probably reflect different definitions and methodological approaches. AIM To study the prevalence and impact of FD and its subgroups in an internet survey. METHODS A total of 54,127 respondents from 26 countries completed the survey including the Rome IV diagnostic questionnaire, Patient Health Questionnaire-4 (PHQ-4), PHQ-12, PROMIS Global-10, demographics, and medical history. Respondents reporting a history of relevant organic disease, or fulfilling criteria for self-induced or cyclic vomiting, or cannabinoid hyperemesis were excluded. RESULTS Rome IV FD prevalence was 7.2% (range 2.2%-12.3%), significantly higher in women and decreased with age. The most prominent subtype was postprandial distress syndrome (PDS) (66.6%). Rome IV IBS was found in 26.1% of those fulfilling FD criteria. Functional heartburn and chronic nausea and vomiting criteria were fulfilled in, respectively, 9.0% and 7.0%. Fulfilling FD symptom criteria was significantly associated with increased prevalence of anxiety and depression and with lower quality of life and higher healthcare seeking behaviour. CONCLUSIONS Rome IV FD is one of the most prevalent DGBI globally. Across countries, it is associated with female sex, younger age, psychological distress, reduced quality of life, and higher health care utilisation. PDS is the dominant subgroup. Overlapping other DGBI are present in a minority.
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Affiliation(s)
- J Tack
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
- Gastroenterology-Hepatology Division, Leuven University Hospitals, Leuven, Belgium
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O S Palsson
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
| | - S I Bangdiwala
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - J Schol
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
| | - F Carbone
- Gastroenterology-Hepatology Division, Leuven University Hospitals, Leuven, Belgium
| | - K Van Den Houte
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
| | - B Broeders
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
| | - D Drossman
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
| | - D L Dumitrascu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - X Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Fukudo
- Tohoku University Graduate School of Medicine, Department of Behavioral Medicine, Sendai, Japan
| | - U C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, India
| | - J Kellow
- Discipline of Medicine, Northern Clinical School, University of Sydney, Sydney, Australia
| | - R Khatun
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - E Okeke
- Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - E M Quigley
- Center for Digestive Disorder, Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA
| | - M Schmulson
- Laboratory of Liver, Pancreas and Motility (HIPAM), unit of Research in Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de Mexico (UNAM). Hospital General de México, Mexico City, Mexico
| | - M Simrén
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - W E Whitehead
- Center for Functional GI & Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - P Whorwell
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - A D Sperber
- Rome Foundation Research Institute, Raleigh, North Carolina, USA
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Chen S, Jia X, Zhuang Q, Hou X, Siah KTH, Zhang M, Chen F, Tan N, Hu J, Xiao Y. Overlapping Reflux Symptoms in Functional Dyspepsia Are Mostly Unrelated to Gastroesophageal Reflux. J Neurogastroenterol Motil 2025; 31:218-226. [PMID: 40205898 PMCID: PMC11986649 DOI: 10.5056/jnm24091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/14/2024] [Accepted: 09/19/2024] [Indexed: 04/11/2025] Open
Abstract
Background/Aims Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis ≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms (55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.
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Affiliation(s)
- Songfeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Xingyu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Qianjun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Xun Hou
- Gastrointestinal Surgery Center, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Kewin T H Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Mengyu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Fangfei Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Niandi Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Junnan Hu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Yinglian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
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Barbara G, Aziz I, Ballou S, Chang L, Ford AC, Fukudo S, Nurko S, Olano C, Saps M, Sayuk G, Siah KTH, Van Oudenhove L, Simrén M. Rome Foundation Working Team Report on overlap in disorders of gut-brain interaction. Nat Rev Gastroenterol Hepatol 2025; 22:228-251. [PMID: 39870943 DOI: 10.1038/s41575-024-01033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2024] [Indexed: 01/29/2025]
Abstract
In patients with disorders of gut-brain interaction (DGBI), overlapping non-gastrointestinal conditions such as fibromyalgia, headaches, gynaecological and urological conditions, sleep disturbances and fatigue are common, as is overlap among DGBI in different regions of the gastrointestinal tract. These overlaps strongly influence patient management and outcome. Shared pathophysiology could explain this scenario, but details are not fully understood. This overlap has been shown to be of great relevance for DGBI. In addition, symptoms considered to be caused by a DGBI could have a detectable organic cause, and in patients with a diagnosed organic gastrointestinal disease, symptoms not clearly explained by the pathology defining this organic disease are common. Thus, the aims of this Rome Foundation Working Team Report were to review the literature on overlapping conditions among patients with paediatric and adult DGBI and, based on the available epidemiological and clinical evidence, make recommendations for the current diagnostic and therapeutic approach, and for future research. Specifically, we focused on other DGBI in the same or different gastrointestinal anatomical region(s), DGBI overlap with organic bowel diseases in remission, and DGBI overlap with non-gastrointestinal, non-structural conditions.
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Affiliation(s)
- Giovanni Barbara
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Imran Aziz
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Japanese Red Cross Ishinomaki Hospital, Research Center for Accelerator and Radioisotope Science, Tohoku University, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
| | - Carolina Olano
- Gastroenterology Department. Universidad de la República, Montevideo, Uruguay
| | - Miguel Saps
- Division of Gastroenterology, Hepatology, and Nutrition, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Gregory Sayuk
- Gastroenterology Division, Washington University School of Medicine, St. Louis, MO, USA
- St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA
| | - Kewin T H Siah
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Consultation-Liaison Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Trukhmanov AS, Rumyantseva DE. Functional Dyspepsia and Gastroesophageal Reflux Disease: From Pathogenesis to Current Treatment Strategies. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 34:83-92. [DOI: 10.22416/1382-4376-2024-34-5-83-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
Aim: to present a modern view on the combination of functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) and to evaluate the effectiveness of acotiamide in patients with FD and GERD.Key points. The high frequency of the combination of FD and GERD is caused by common pathogenetic mechanisms and presents an urgent problem in clinical practice. The concurrent occurrence of these diseases alters the clinical picture, complicates differential diagnostics, and leads to inadequate prescription of drugs. Medical treatment for patients with FD and GERD includes the use of proton pump inhibitors (PPIs) and prokinetics. Currently, acotiamide is recognized as an effective drug that affects the motility of the upper gastrointestinal tract. Acotiamide is an antagonist of muscarinic M1 and M2 receptors and a reversible inhibitor of acetylcholinesterase. The clinical efficacy of this drug has been demonstrated not only in patients with FD but also in those with a combination of FD and GERD.Conclusion. Administration of acotiamide is pathogenetically justified in patients with the combination of GERD and FD.
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Affiliation(s)
- A. S. Trukhmanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. E. Rumyantseva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Dowrick JM, Roy NC, Bayer S, Frampton CMA, Talley NJ, Gearry RB, Angeli-Gordon TR. Unsupervised machine learning highlights the challenges of subtyping disorders of gut-brain interaction. Neurogastroenterol Motil 2024; 36:e14898. [PMID: 39119757 DOI: 10.1111/nmo.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/17/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Unsupervised machine learning describes a collection of powerful techniques that seek to identify hidden patterns in unlabeled data. These techniques can be broadly categorized into dimension reduction, which transforms and combines the original set of measurements to simplify data, and cluster analysis, which seeks to group subjects based on some measure of similarity. Unsupervised machine learning can be used to explore alternative subtyping of disorders of gut-brain interaction (DGBI) compared to the existing gastrointestinal symptom-based definitions of Rome IV. PURPOSE This present review aims to familiarize the reader with fundamental concepts of unsupervised machine learning using accessible definitions and provide a critical summary of their application to the evaluation of DGBI subtyping. By considering the overlap between Rome IV clinical definitions and identified clusters, along with clinical and physiological insights, this paper speculates on the possible implications for DGBI. Also considered are algorithmic developments in the unsupervised machine learning community that may help leverage increasingly available omics data to explore biologically informed definitions. Unsupervised machine learning challenges the modern subtyping of DGBI and, with the necessary clinical validation, has the potential to enhance future iterations of the Rome criteria to identify more homogeneous, diagnosable, and treatable patient populations.
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Affiliation(s)
- Jarrah M Dowrick
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Nicole C Roy
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Simone Bayer
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chris M A Frampton
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Nicholas J Talley
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Richard B Gearry
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Timothy R Angeli-Gordon
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Irani MZ, Eslick GD, Burns GL, Potter M, Halland M, Keely S, Walker MM, Talley NJ. Coeliac disease is a strong risk factor for Gastro-oesophageal reflux disease while a gluten free diet is protective: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102577. [PMID: 38659976 PMCID: PMC11039972 DOI: 10.1016/j.eclinm.2024.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GORD) mechanisms are well described, but the aetiology is uncertain. Coeliac disease (CD), a gluten enteropathy with increased duodenal eosinophils overlaps with GORD. Functional dyspepsia is a condition where duodenal eosinophilia is featured, and a 6-fold increased risk of incident GORD has been observed. Perturbations of the duodenum can alter proximal gastric and oesophageal motor function. We performed a systematic review and meta-analysis assessing the association between CD and GORD. METHODS A systematic search of studies reporting the association of GORD and CD was conducted. CD was defined by combined serological and histological parameters. GORD was defined based on classical symptoms, oesophagitis (endoscopic or histologic) or abnormal 24-h pH monitoring; studies reporting oesophageal motility abnormalities linked with GORD were also included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model. FINDINGS 31 papers were included. Individuals with CD on a gluten containing diet were 3 times more likely to have GORD than controls (OR: 3.37, 95% CI: 2.09-5.44), and over 10 times more likely when compared to those on a gluten free diet (GFD) (OR: 10.20, 95% CI: 6.49-16.04). Endoscopic oesophagitis was significantly associated with CD (OR: 4.96; 95% CI: 2.22-11.06). One year of a GFD in CD and GORD was more efficacious in preventing GORD symptom relapse than treatment with 8 weeks of PPI in non-CD GORD patients (OR: 0.18, 95% CI: 0.08-0.36). Paediatric CD patients were more likely to develop GORD (OR: 3.29, 95% CI: 1.46-7.43), compared to adult CD patients (OR: 2.55, 95% CI: 1.65-3.93). INTERPRETATION CD is strongly associated with GORD but there was high heterogeneity. More convincingly, a GFD substantially improves GORD symptoms, suggesting a role for duodenal inflammation and dietary antigens in the aetiology of a subset with GORD. Ruling out CD in patients with GORD may be beneficial. FUNDING The study was supported by an Investigator Grant from the NHMRC to Dr. Talley.
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Affiliation(s)
- Mudar Zand Irani
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Guy D. Eslick
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Grace L. Burns
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Michael Potter
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Magnus Halland
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Marjorie M. Walker
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
| | - Nicholas J. Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, Australia
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Sun J, Gou J, Qin L, Liu T, Huang Y, Lu Y, Wang Y, Liu C, Li Y. Screening of anti-functional dyspepsia compounds in Cynanchum auriculatum: A spectrum-effect relationship analysis, and ATP-binding cassette transporters inhibitor evaluation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116867. [PMID: 37390880 DOI: 10.1016/j.jep.2023.116867] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Functional dyspepsia (FD) is a disorder caused by abnormal gut-brain axis regulation and is highly prevalent in China. Cynanchum auriculatum (CA) is often used to treat FD in the ethnic minority areas of Guizhou. Although several CA-based products are currently available in the market, it is unclear which components of CA are efficacious and what their oral absorption mechanism is. AIM OF THE STUDY This study aimed to screen anti-FD components of CA based on the spectrum-effect relationship. In addition, the study evaluated the intestinal absorption mechanism of these components using transporter inhibitors. MATERIALS AND METHODS The fingerprinting of compounds from CA extract and plasma after oral administration was conducted using ultra-high-performance liquid chromatography quadrupole-time-of-flight tandem mass spectrometry (UHPLC-Q-TOF-MS). The intestinal contractile parameters were then measured in vitro using the BL-420F Biofunctional Experiment System. Multivariate statistical analysis of the result of spectrum-effect relationship assessment was used to elucidate the correlation between prominent peaks of CA-containing plasma and intestinal contractile activity. The effect of ATP-binding cassette (ABC) transporter inhibitors, such as the P-gp inhibitor verapamil, the MRR inhibitor indomethacin, and the BCRP inhibitor Ko143, on the directional transport of the predicted active ingredients was assessed in vivo. RESULTS Twenty chromatographic peaks were identified in the CA extract. Of these, three were C21 steroids, four were organic acids, and one was a coumarin, and acetophenone by comparing with reference compounds. Additionally, it is discovered that there are totally 39 migratory components in CA-containing plasma, which was found to significantly promote the contractility of the isolated duodenum. Moreover, multivariate analysis of the spectrum-effect relationship demonstrated that 16 characteristic peaks (3, 6, 8, 10, 11, 13, 14, 18, 21, m1-m4, m7, m15, and m24) in CA-containing plasma were significantly associated with the anti-FD effect. These compounds included seven prototype compounds, i.e., cynanoneside A, syringic acid, deacylmetaplexigenin, ferulic acid, scopoletin, baishouwubenzophenone, and qingyangshengenin. The inhibition of ABC transporters demonstrated that the inhibitors verapamil and Ko143 significantly increased (P < 0.05) the uptake of scopoletin and qingyangshengenin. Thus, these compounds may be substrates for P-gp and BCRP. CONCLUSIONS The potential anti-FD components of CA and the effect of ABC transporter inhibitors on these active components were preliminarily clarified. These findings lay a foundation for subsequent in vivo studies.
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Affiliation(s)
- Jia Sun
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China.
| | - Jian Gou
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Lan Qin
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China; School of Pharmacy, Guizhou Medical University, No.9, Beijing Road, Yunyan District, Guiyang, 550004, China
| | - Ting Liu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Yong Huang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Yuan Lu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Yonglin Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang, 550004, China
| | - Chunhua Liu
- Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang, 550004, China.
| | - Yongjun Li
- Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang, 550004, China.
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Zamani M, Alizadeh-Tabari S, Chan WW, Talley NJ. Association Between Anxiety/Depression and Gastroesophageal Reflux: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2023; 118:2133-2143. [PMID: 37463429 DOI: 10.14309/ajg.0000000000002411] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION An association between gastroesophageal reflux disease (GERD) and common psychiatric conditions, most notably anxiety and depression, has been reported. However, the magnitude of this association is poorly understood. Therefore, we aimed to systematically assess this issue. METHODS We comprehensively searched multiple bibliographic databases (Embase, PubMed, Scopus, and Web of Science) from inception to May 15, 2023. We retrieved observational studies that reported the prevalence of anxiety and/or depressive symptoms diagnosed by validated questionnaires in ≥100 adults (aged 18 years or older) with GERD. We also included cohort studies that explored the risk of incident GERD in subjects with anxiety/depression vice versa scenario. Finally, we included Mendelian randomization studies that assessed the cause-and-effect relationship between anxiety/depression and GERD. The extracted data were combined using a random-effects model. RESULTS In total, 36 eligible studies were included. The pooled prevalences of anxiety and depressive symptoms were 34.4% (95% confidence interval [CI] 24.7-44.2; I2 = 99.4%) and 24.2% (95% CI 19.9-28.5; I2 = 98.8%) in subjects with GERD based on 30 studies, respectively. Both anxiety and depressive symptoms were more common in subjects with GERD compared with those in healthy controls (odds ratio = 4.46 [95% CI 1.94-10.25] and odds ratio = 2.56 [95% CI 1.11-5.87], respectively). According to 3 cohort studies, subjects with GERD were at an increased risk of developing anxiety/depression and vice versa. Finally, 3 Mendelian randomization studies showed that genetic liability to these mood disorders is linked to an increased risk of developing GERD and vice versa. DISCUSSION Up to 1 in 3 subjects with GERD experience anxiety and depression. There is likely a bidirectional causal relationship between anxiety/depression and GERD.
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Affiliation(s)
- Mohammad Zamani
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Alizadeh-Tabari
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Huang Q, Yuan H, Li Q, Li Y, Geng S, Zhu Y, Liao M, Jiang H. Global trends in research related to functional dyspepsia and anxiety or depression over the past two decades: a bibliometric analysis. Front Neurosci 2023; 17:1218001. [PMID: 38027507 PMCID: PMC10651763 DOI: 10.3389/fnins.2023.1218001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Functional dyspepsia (FD) is a prevalent global disorder of the upper digestive tract characterized by functional impairment. It often coexists with anxiety/depression, significantly impairing occupational productivity and overall quality of life. This study aimed to identify emerging patterns and prominent themes within FD and anxiety/depression research through bibliometric analysis to help explore new innovative avenues for investigating this type of FD. Methods A comprehensive review of literature encompassing FD and anxiety/depression was conducted using the Science Citation Index Extension of the Web of Science Core Collection from 2003 to 2023. Information extracted comprised "Full Record and Cited References." Bibliometric analysis of relevant publications, including country, institution, author, journal, citations, and keywords, was conducted using CiteSpace, VOSviewer, and Bibliometrix package in R and Excel. Results Studies related to FD and anxiety/depression have demonstrated an ascending trajectory since 2003. Our bibliometric analysis identified 338 studies published by 2023. NEUROGASTROENTEROLOGY AND MOTILITY emerged as the most prolific journal, while GASTROENTEROLOGY retained pre-eminence within the top 10 published journals. China emerged as the most prolific country, with two institutions within the top 10 in terms of volume of publications. The Mayo Clinic stood as the foremost institution in terms of publication volume, with the Chengdu University of Traditional Chinese Medicine exhibiting robust collaborative engagement. Eminent author influence was attributed to Talley NJ of Newcastle University, Australia. Clusters of extensively cited papers and prevalent keywords delineate the status and trend of FD and anxiety/depression research. This encompasses FD, anxiety, depression, sleep disorders, and functional gastrointestinal disorders. Furthermore, the timeline view map or trend-term analysis suggested that duodenal low-grade inflammation ("duodenal eosinophilia" and "mast cells") might be a new concern associated with FD and anxiety/depression. Conclusion Employing bibliometric analysis, this study revealed prevalent focal areas and new trends within FD and anxiety/depression research. These insights serve as valuable guidance for scholars seeking to delve into new research avenues.
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Affiliation(s)
- Qian Huang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huixiao Yuan
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingqing Li
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Li
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shasha Geng
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingqian Zhu
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Liao
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Barreyro FJ, Maiorana F, Caronia MV, Elizondo K, Schneider A, Zapata PD. Association between genetic polymorphisms of NOD1, Interleukin-1B, and cagA strain with low-grade duodenal eosinophilia in Helicobacter pylori-related dyspepsia. Helicobacter 2023; 28:e13002. [PMID: 37350445 DOI: 10.1111/hel.13002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and host genetic polymorphism of innate and pro-inflammatory cascade, nucleotide-binding oligomerization domain 1 (NOD-1), and interleukin-1 beta (IL-1β) in HpD was not explored. AIM To evaluate the association of NOD1-796G>A and IL-1B-511C>T gene variants and low-grade duodenal eosinophilia in HpD. METHODS A multicenter cross-sectional study was conducted. A total of 253 patients who met Rome-IV criteria were selected before upper endoscopy and 98 patients were included after unremarkable upper endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori cagA and duodenal histology, were evaluated. RESULTS Sixty-four (65%) patients had epigastric pain syndrome (EPS), 24 (25%) postprandial distress syndrome (PDS), and 10 (10%) EPS/PDS overlap. FD subtypes were not associated with NOD1-796G>A and IL-1B-511C>T gene variants. Low-grade duodenal eosinophilia was significantly increased in NOD1-796 GG versus single A-allele, but not in IL-1B-511 single T-allele or CC-allele. This association is dependent of cagA infection, since harboring cagA strain was significantly associated with low-grade duodenal eosinophilia with isolated variants NOD1-796 GG and IL-1B-511 single T-allele, but not without cagA. When we performed combined polymorphism analysis with NOD1-796 GG/IL-1B-511 single T-allele, a synergistic effect on low-grade duodenal eosinophilia was found between these two loci irrespective of cagA strain status in HpD. CONCLUSION Our findings suggest that low-grade duodenal eosinophilia is significantly associated with NOD1-796 GG allele specially in cagA strain and with allelic combination NOD1-796 GG/IL-1B-511 single T-allele independent of cagA strain infection in HpD patients.
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Affiliation(s)
- Fernando Javier Barreyro
- Laboratorio de Biotecnología Molecular (BIOTECMOL)., Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis). Facultad de Ciencias Exactas Químicas y Naturales. Universidad Nacional de Misiones, Posadas, Argentina
- CONICET, Buenos Aires, Argentina
| | - Facundo Maiorana
- Laboratorio de Biotecnología Molecular (BIOTECMOL)., Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis). Facultad de Ciencias Exactas Químicas y Naturales. Universidad Nacional de Misiones, Posadas, Argentina
| | - Maria Virginia Caronia
- Laboratorio de Biotecnología Molecular (BIOTECMOL)., Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis). Facultad de Ciencias Exactas Químicas y Naturales. Universidad Nacional de Misiones, Posadas, Argentina
| | - Karina Elizondo
- Instituto Universitario en Ciencias de la Salud, Fundación HA Barceló, Santo Tomé, Argentina
| | - Adolfo Schneider
- Instituto Universitario en Ciencias de la Salud, Fundación HA Barceló, Santo Tomé, Argentina
| | - Pedro Darío Zapata
- Laboratorio de Biotecnología Molecular (BIOTECMOL)., Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis). Facultad de Ciencias Exactas Químicas y Naturales. Universidad Nacional de Misiones, Posadas, Argentina
- CONICET, Buenos Aires, Argentina
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Caballero-Plasencia MR, Caballero-Mateos AM, Caballero-Plasencia AM. Inflammatory map of the gastroduodenal mucosa in patients with upper gastrointestinal symptoms. The role of H. pylori infection. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:238-245. [PMID: 35508602 DOI: 10.1016/j.rgmxen.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. MATERIALS AND METHODS We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. RESULTS The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). CONCLUSIONS The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis.
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Caballero-Plasencia M, Caballero-Mateos A, Caballero-Plasencia A. Mapa inflamatorio de la mucosa gastroduodenal en pacientes con síntomas gastrointestinales altos. Protagonismo de la infección por H. pylori. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2023; 88:238-245. [DOI: 10.1016/j.rgmx.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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Puig-Moltó M, Lumbreras B, López-Pintor E. Prevalence and risk factors of upper gastrointestinal symptoms in community pharmacies in Spain: a cross-sectional study. Front Pharmacol 2023; 14:1162370. [PMID: 37383720 PMCID: PMC10294224 DOI: 10.3389/fphar.2023.1162370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023] Open
Abstract
Background: Frequently, the community pharmacies are the only points of consultation for upper-gastrointestinal symptomology. However, the heterogeneity of symptoms often limits the correct management of the patient. The study aim is to describe the epidemiological and clinical characteristics of patients with upper-gastrointestinal symptoms who ask for advice in community pharmacies. Methods: A cross-sectional study was performed in 134 Spanish pharmacies (June-October 2022) and we included 1,360 patients. We collected sociodemographic, clinical variables and current medication data. The pharmacist evaluated the gastrointestinal symptoms through the application of the GERD Impact Scale (GIS questionnaire). Patients were classified into three groups according to their symptoms: epigastric, retrosternal and overlapping symptoms. Results: Median age was 49 years (interquartile range 36-62 years) and 59.3% were women. Most patients reported overlapping symptoms (738%, 54.3%), 433 (31.8%) retrosternal and 189 (13.9%) epigastric symptoms. Patients with overlapping symptoms were more likely to associated consumption of foods and/or drinks and symptoms and showed lower scores on the GIS scale (median 26, IQR 20-30) than those with epigastric (median 32, IQR 29-33) and retrosternal (median 32, IQR 28-34) symptoms (p < 0.001). Patients in treatment with a combination of alginates and antiacids were more likely to think that it better alleviated their symptoms in all the patients included (p = 0.012). Conclusion: More than half of the patients showed overlapping symptoms and were more likely to associate their symptoms with dietary habits and having poorer scores in the GIS scale. Clinical awareness of such overlapping condition would help optimize the management of patients with upper gastrointestinal symptoms in practice.
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Affiliation(s)
- María Puig-Moltó
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, Elche, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, Elche, Spain
- CIBER of Epidemiology and Public Health, Centro de Investigación Biomédica en Red, Madrid, Spain
| | - Elsa López-Pintor
- CIBER of Epidemiology and Public Health, Centro de Investigación Biomédica en Red, Madrid, Spain
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Miguel Hernandez University, Elche, Spain
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Talley NJ, Peterson KA, Genta RM, Chang AT, Dellon ES, Sandborn WJ, Lacy BE, Chehade M, Hirano I, Gonsalves N, Lembo A, Schmitt CM, Rothenberg ME, Jain N, Pletneva MA, Turner KO, Youngblood BA. High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate-Severe Abdominal Symptoms: A Prospective US Multisite Study. Gastroenterology 2023; 164:680-683.e2. [PMID: 36574864 DOI: 10.1053/j.gastro.2022.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | - Evan S Dellon
- University of North Carolina, Chapel Hill, North Carolina
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Barreyro FJ, Caronia MV, Elizondo K, Sanchez N, Jordá G, Schneider A, Zapata PD. Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia: A Prospective Real-life Study. J Clin Gastroenterol 2023; 57:362-369. [PMID: 36730183 DOI: 10.1097/mcg.0000000000001812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored. AIM To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice. MATERIALS AND METHODS A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters, Helicobacter pylori ( H. pylori), and duodenal histology were evaluated. RESULTS FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients were H. pylori+ . Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14; P <0.0001), adjusting for age, gender, H. pylori and nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28; P <0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particular H. pylori- , was highly accurate for PDS with the area under the curve 0.731 compared with H. pylori+ area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy. CONCLUSION Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non- H. pylori FD patients and could be a useful marker of treatment response.
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Affiliation(s)
- Fernando Javier Barreyro
- Laboratory of Molecular Biotechnology (BIOTECMOL). Misiones Biotechnology Institute "Dr. Maria Ebbe Reca" (InBioMis). Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
- Scientific and Technical Research Councils (CONICET). Buenos Aires, Argentina
| | - Maria Virgina Caronia
- Laboratory of Molecular Biotechnology (BIOTECMOL). Misiones Biotechnology Institute "Dr. Maria Ebbe Reca" (InBioMis). Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
| | - Karina Elizondo
- Microbiology Department. Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
| | - Nicolas Sanchez
- Laboratory of Molecular Biotechnology (BIOTECMOL). Misiones Biotechnology Institute "Dr. Maria Ebbe Reca" (InBioMis). Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
| | - Graciela Jordá
- University Institute of Health Sciences. HA Barceló Foundation. Santo Tome, Corrientes, Argenti
| | - Adolfo Schneider
- Microbiology Department. Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
| | - Pedro Dario Zapata
- Laboratory of Molecular Biotechnology (BIOTECMOL). Misiones Biotechnology Institute "Dr. Maria Ebbe Reca" (InBioMis). Faculty of Chemical and Natural Sciences. National University of Misiones. Misiones, Argentina
- Scientific and Technical Research Councils (CONICET). Buenos Aires, Argentina
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Zhang T, Zhang B, Ma X, Zhang J, Wei Y, Wang F, Tang X. Research trends in the field of the gut-brain interaction: Functional dyspepsia in the spotlight – An integrated bibliometric and science mapping approach. Front Neurosci 2023; 17:1109510. [PMID: 36968499 PMCID: PMC10035075 DOI: 10.3389/fnins.2023.1109510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
ObjectivesThis study aims to perform a bibliometric analysis of functional dyspepsia (FD), which includes visualizing bibliographic information, in order to identify prevailing study themes, topics of interest, contributing journals, countries, institutions, and authors as well as co-citation patterns.MethodsThe Web of Science™ Core Collection Database was used to retrieve all peer-reviewed scientific publications related to FD research. The validated search terms were entered into the “title” and “author keywords” fields, and the results were sorted by publication year from 2006 to 2022. There were no restrictions on language. On 12 February 2023, a manual export of the complete metadata for each original publication and review article was performed. CiteSpace was used to reveal co-authorship, publication, and co-citation patterns to find prominent authors, organizations, countries, and journals in FD research as well as to identify author keywords with strong citation bursts, which could indicate an emerging research area. VOSviewer was used to build the co-occurrence indicator (co-word) to identify the main author keywords on which previous studies focused and to induce clustered scientific landscape for two consecutive periods to identify intriguing areas for future research.ResultsA search of the database retrieved 2,957 documents. There was a wave-like pattern in the number of publications until 2017, after which there was a spike in publication volume. The USA, China, and Japan provided the majority of contributions. In terms of institution, Mayo Clin, Univ Newcastle, and Katholieke Univ Leuven were found to be the prolific institutions. Additionally, the results indicate that eastern Asian researchers contributed significantly to the global knowledge of literature that led other countries; however, Canada, the USA, Australia, England, and Germany were found to have the highest degree of betweenness centrality. Nicholas J. Talley, Jan Tack, Gerald Holtmann, Michael Camilleri, Ken Haruma, and Paul Moayyedi occupied the top positions based on productivity and centrality indicators. Six thematic clusters emerged (Helicobacter pylori infection; pathophysiological mechanisms of FD; extraintestinal co-morbidities and overlap syndromes associated with FD; herbal medicine in FD; diabetic gastroparesis; and dietary factors in FD). “Acupuncture,” “duodenal eosinophilia,” “gut microbiota,” and others were among the author keywords with rising prevalence.ConclusionIn FD research, eastern Asian countries have established themselves as major contributors with the highest publishing productivity; however, research has primarily been driven by North America, Europe, and Australia, where cooperation is generally more active and highly influential scientific results are produced. Our analysis suggests that increased investments, training of human resources, improved infrastructures, and expanded collaborations are essential to improving the quality of FD research in Asia. The emerging author keyword analysis suggests that eosinophil-mast cell axis, gut microbiota, mental disorders, and acupuncture are the key areas that attract researchers’ attention as future research boulevards. There is a highly skewed distribution of research output across Asia, with most focus on complementary and alternative medicine (CAM) coming from Chinese, Japanese, and South Korean centers. However, CAM remains an underexplored area of research in the context of FD, and it deserves greater research efforts in order to obtain quality scientific evidence. Furthermore, we propose that the research framework of CAM should not be limited to dysmotility; rather, it could be interpreted within a more holistic context that includes the brain-gut-microbiota axis, as well as novel concepts such as duodenitis, increased mucosal permeability, and infiltration and activation of eosinophils and mast cells, among others. Overall, we provided bibliometrics-based overviews of relevant literature to researchers from different backgrounds and healthcare professionals to provide an in-depth overview of major trends in FD research.
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Affiliation(s)
- Tai Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Beihua Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangxue Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaqi Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengyun Wang,
| | - Xudong Tang
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Xudong Tang,
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Barreyro FJ, Sanchez N, Caronia MV, Elizondo K, Jordá G, Schneider A, Zapata PD. Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia. J Gastroenterol Hepatol 2023; 38:274-282. [PMID: 36334009 DOI: 10.1111/jgh.16051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD. METHODS A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated. RESULTS Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902). CONCLUSION Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.
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Affiliation(s)
- Fernando Javier Barreyro
- Laboratorio de Biotecnología Molecular (BIOTECMOL), Universidad Nacional de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis), Misiones, Argentina.,CONICET, Buenos Aires, Argentina
| | - Nicolas Sanchez
- Laboratorio de Biotecnología Molecular (BIOTECMOL), Universidad Nacional de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis), Misiones, Argentina
| | - Maria Virginia Caronia
- Laboratorio de Biotecnología Molecular (BIOTECMOL), Universidad Nacional de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis), Misiones, Argentina
| | - Karina Elizondo
- Fundación HA Barceló, Instituto Universitario en Ciencias de la Salud, Santo Tomé, Argentina
| | - Graciela Jordá
- Departamento Microbiología, Universidad Nacional de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Misiones, Argentina
| | - Adolfo Schneider
- Fundación HA Barceló, Instituto Universitario en Ciencias de la Salud, Santo Tomé, Argentina
| | - Pedro Dario Zapata
- Laboratorio de Biotecnología Molecular (BIOTECMOL), Universidad Nacional de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Instituto de Biotecnología de Misiones "Dra. Maria Ebbe Reca" (InBioMis), Misiones, Argentina.,CONICET, Buenos Aires, Argentina
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Gwee KA, Lee YY, Suzuki H, Ghoshal UC, Holtmann G, Bai T, Barbara G, Chen MH, Chua ASB, Gibson PR, Hou X, Liu J, Nakajima A, Pratap N, Sachdeva S, Siah KTH, Soh AYS, Sugano K, Tack J, Tan VPY, Tang X, Walker M, Wu DC, Xiao YL, Zulkifli KK, Toh C. Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms. J Gastroenterol Hepatol 2023; 38:197-209. [PMID: 36321167 DOI: 10.1111/jgh.16046] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.
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Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Giovanni Barbara
- Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsong Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Victoria Ping Yi Tan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Xudong Tang
- Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Marjorie Walker
- Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Lian Xiao
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khairil Khuzaini Zulkifli
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Clarissa Toh
- Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore
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Rettura F, Lambiase C, Grosso A, Rossi A, Tedeschi R, Ceccarelli L, Bellini M. Role of Low-FODMAP diet in functional dyspepsia: "Why", "When", and "to Whom". Best Pract Res Clin Gastroenterol 2023; 62-63:101831. [PMID: 37094910 DOI: 10.1016/j.bpg.2023.101831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Functional dyspepsia (FD) is a frequent disorder of gut-brain interaction, affecting 5-7% of people globally, with significant impairment in quality of life. The management of FD is challenging due to the lack of specific therapeutic approaches. Although food seems to play a role in symptom production, its pathophysiologic role in patients with FD is not fully understood. Most FD patients report that their symptoms are triggered by food, especially in the post-prandial distress syndrome (PDS) group, although evidence to support the use of dietary interventions are limited. FODMAPs can increase production of gas in the intestinal lumen, through fermentation by intestinal bacteria, can exert osmotic effects by increasing water volume and can cause an excessive production of short-chain fatty acids (propionate, butyrate, and acetate). Emerging scientific evidence, confirmed by recent clinical trials, suggest that FODMAPs could be involved in the pathogenesis of FD. Given the consolidated approach of the Low-FODMAP Diet (LFD) in irritable bowel syndrome (IBS) management and emerging scientific evidence regarding the LFD in FD, a therapeutic role of this diet may be hypothesized also in FD, either alone or in combination with other therapies.
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Affiliation(s)
- Francesco Rettura
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Christian Lambiase
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy.
| | - Antonio Grosso
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Alessandra Rossi
- Clinical and Experimental Medicine-Rheumatology Unit, University of Pisa, 56100, Pisa, Italy
| | - Riccardo Tedeschi
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Linda Ceccarelli
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
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Hay PD, Corsetti M, Tucker E, Fox MR, Perkins A. Tolerability, gastric emptying patterns, and symptoms during the Nottingham Test Meal in 330 secondary care non-diabetic dyspeptic patients. Neurogastroenterol Motil 2022; 34:e14454. [PMID: 36082399 PMCID: PMC10078298 DOI: 10.1111/nmo.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 07/05/2022] [Accepted: 08/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Scintigraphy is used for overall assessment of gastric emptying. Adherence to an international consensus protocol is recommended to ensure quality; however, this has not been widely adopted because preparation of the "egg-beater" meal is inconvenient in clinical practice. In this report, we audit the tolerability and the results of gastric emptying scintigraphy with the 400 ml Tc-99 m-labeled liquid nutrient Nottingham Test Meal (NTM). METHODS Results from 330 consecutive adult, non-diabetic patients with dyspeptic symptoms referred for gastric scintigraphy were analyzed. Gastric half-emptying time (T50) and validated measurements of early- and late-phase gastric emptying were acquired. Postprandial sensations of fullness, bloating, heartburn, nausea, and epigastric pain were recorded using 100 mm visual analog scales (VAS) before and 0, 30, and 90 min after NTM ingestion. Results were compared with those previously obtained in healthy subjects. KEY RESULTS Almost all (98%) of the patients were able to consume the 400 ml NTM. Considering early- and late-phase gastric emptying, frequently observed patterns included normal early- with slow late-phase (25%) and fast early- with slow late-phase emptying (27%). Abnormal score of fullness and/ or dyspeptic symptoms were observed in 88% of dyspeptic patients. Abnormal fullness at T0 (after completed drink ingestion) was associated with slow late phase of gastric emptying, especially in women. CONCLUSIONS Gastric scintigraphy with the NTM is simple to perform and well tolerated. Whether the identified abnormal gastric emptying patterns could predict different treatment outcome in patients with functional dyspepsia is the subject of ongoing prospective studies.
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Affiliation(s)
- Peter D Hay
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK.,Translational Medical Sciences, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily Tucker
- Gastroenterology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS foundation Trust, Derby, UK
| | - Mark R Fox
- Clinic for Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland
| | - Alan Perkins
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Queen's Medical Centre Nottingham, Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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21
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Wang X, Liu H, Li W, Xiao H. Bibliometric analysis of functional dyspepsia research trends over the past 20 years. Front Public Health 2022; 10:1019110. [PMID: 36504925 PMCID: PMC9727411 DOI: 10.3389/fpubh.2022.1019110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Functional dyspepsia is one of the most common functional gastrointestinal disorders that affects the physical health and quality of life of many people. Its status as a chronic disease has received continued attention in the field of gastrointestinal research. Objective Bibliometric methods using network analysis were used to identify developments and research trends in functional dyspepsia with a view to informing and orienting further in-depth research on functional dyspepsia. Method Bibliometric methods were used to analyze the documents on functional dyspepsia published from 2002 to 2022 retrieved from Web of Science Core Collection on 1 July 2022, import literature data into Excel and VOSviewer, and extract relevant information to analyze and visualize the annual number of publications, authors, organizations, countries, journals published, citations, and keywords. Results A total of 3,532 documents were retrieved, and the abstracts of each remaining documents were read one by one after four duplicate documents were removed, and 2,220 documents were included after screening, with a fluctuating growth trend. Tack J ranked first with 171 documents, followed by Talley NJ (n = 167). The top three organizations in terms of number of publications were Katholieke Universiteit Leuven (n = 131), Mayo Clinic (n = 127), and the University of Newcastle (n = 91). The most prolific country was the United States with 499 documents. The three journals with the highest number of publications are "Neurogastroenterology and Motility" (n = 218), "Alimentary pharmacology & therapeutics" (n = 101), and "Journal of Gastroenterology and Hepatology" (n = 90). The top three most cited documents were "Functional gastroduodenal disorders," "Childhood Functional Gastrointestinal Disorders: Child/Adolescent," and "The Serotonin Signaling System: From Basic Understanding to Drug Development for Functional GI Disorders." Frequency counts and network co-occurrences of keywords reveal trends in this field, including "gastric emptying," "anxiety," "acupuncture," and "ghrelin." Conclusion The study of the mechanism of gut-brain interaction in functional dyspepsia and the combination of non-pharmacological treatment and pharmacological treatment may be the future research hotspots and trends. Our findings are helpful to comprehensively review the research history of FD and provide reference for researchers in this field to further study.
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Affiliation(s)
- Xinai Wang
- The School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hao Liu
- The School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenjing Li
- The School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongling Xiao
- The School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China,*Correspondence: Hongling Xiao
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Li Y, Duan Z. Updates in interaction of gastroesophageal reflux disease and extragastroesophageal digestive diseases. Expert Rev Gastroenterol Hepatol 2022; 16:1053-1063. [PMID: 35860994 DOI: 10.1080/17474124.2022.2056018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is one of the common chronic diseases with prevalence increasing in the last decades. Because of its prevalence and chronicity, GERD affects the quality of life and increases health-care costs. Gastroesophageal diseases leading to GERD have been thoroughly studied, while extragastroesophageal digestive diseases (EGEDDs) may coexist with GERD and affect the occurrence and persistence of GERD symptoms and therapeutic effect. AREAS COVERED In this review, we aim to summarize the EGEDDs correlated with GERD and explore the potential mechanisms of this interaction. EXPERT OPINION Individuals with troublesome GERD symptoms may have some common gastroesophageal etiologies, but EGEDDs may also overlap and impact on the progression of GERD, which are often ignored in clinic. The lesions in the small intestine, colon, and hepatobiliary tract as well as functional bowel disorders had positive or negative associations with GERD through potential mechanisms. These diseases aggravate GERD symptoms, increase the esophageal acid burden, cause esophageal hypersensitivity, and finally affect the response to therapy in GERD patients. Therefore, it is necessary to clear the interaction between GERD and EGEDDs and their mechanisms.
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Affiliation(s)
- Yanqiu Li
- Second Gastroenterology Department, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhijun Duan
- Second Gastroenterology Department, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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23
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Ho L, Chen S, Ho FF, Wong CHL, Ching JYL, Cheong PK, Wu IXY, Liu X, Leung TH, Wu JCY, Chung VCH. Comparing diagnostic performance of Cantonese-Chinese version of Rome IV criteria and a short Reference Standard for functional dyspepsia in China. BMC Gastroenterol 2022; 22:432. [PMID: 36224557 PMCID: PMC9558384 DOI: 10.1186/s12876-022-02520-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Functional dyspepsia (FD) is diagnosed based on self-reported symptoms and negative upper gastrointestinal endoscopic findings. The Rome criteria were not adopted as a diagnostic instrument in clinical guidelines due to their complexity. Different guidelines used relatively simple symptom assessment schemes with contents that vary significantly. A previously evaluated short Reference Standard may serve as a more standardised tool for guidelines. We evaluated its diagnostic accuracy against the Rome IV criteria in a cross-sectional study in Hong Kong. METHODS A total of 220 dyspeptic patients sampled consecutively from a tertiary hospital and the community completed the Rome IV diagnostic questionnaire, which was translated into Cantonese-Chinese, and the Reference Standard. Sensitivity, specificity, positive and negative likelihood ratios (LRs), and area under the receiver operating characteristics curve (AUC), with 95% confidence intervals (CIs), were calculated. RESULTS Among the participants, 160 (72.7%) fulfilled the Reference Standard with negative upper gastrointestinal endoscopic results. The Reference Standard identified patients with Rome IV-defined FD with 91.1% (95% CI 82.6%-96.4%) sensitivity and 37.6% (95% CI 29.6%-46.1%) specificity. The positive and negative LRs were 1.46 (95% CI 1.26-1.69) and 0.24 (95% CI 0.11-0.49), respectively. The AUC value was 0.64 (95% CI 0.59-0.69). CONCLUSIONS The Reference Standard can rule out patients without Rome IV-defined FD. It may be used as an initial screening tool for FD in settings where the use of the Rome IV criteria is impractical. It may also provide a uniform definition and diagnostic rule for future updates of clinical guidelines.
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Affiliation(s)
- Leonard Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shuijiao Chen
- Department of Gastroenterology, Xiangya Hospital, 110 Xiangya Road, Kaifu District, Changsha, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer-Aided Diagnosis and Treatment for Digestive Disease, Changsha, Hunan, China
| | - Fai Fai Ho
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene H L Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pui Kuan Cheong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X Y Wu
- Xiangya School of Public Health, Central South University, 238 Shang Ma Yuan ling Alley, Kaifu District, Changsha, Hunan, China.
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, 110 Xiangya Road, Kaifu District, Changsha, Hunan, China.
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer-Aided Diagnosis and Treatment for Digestive Disease, Changsha, Hunan, China.
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin C Y Wu
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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24
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Shah A, Fairlie T, Brown G, Jones MP, Eslick GD, Duncanson K, Thapar N, Keely S, Koloski N, Shahi M, Walker MM, Talley NJ, Holtmann G. Duodenal Eosinophils and Mast Cells in Functional Dyspepsia: A Systematic Review and Meta-Analysis of Case-Control Studies. Clin Gastroenterol Hepatol 2022; 20:2229-2242.e29. [PMID: 35123088 DOI: 10.1016/j.cgh.2022.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS This study explored the link between duodenal eosinophils and mast cells in patients with functional dyspepsia (FD). METHODS MEDLINE (PubMed) and Embase electronic databases were searched until June 2021 for case-control studies reporting duodenal eosinophils and mast cells in FD. Pooled standardized mean difference (SMD), odds ratio, and 95% CIs of duodenal eosinophils and mast cells in FD patients and controls were calculated, using a random-effects model. RESULTS Twenty-two case-control studies with 1108 FD patients and 893 controls were identified. Duodenal eosinophils (SMD, 1.29; 95% CI, 0.85-1.73; P = .0001) and mast cells (SMD, 2.11; 95% CI, 1.14-3.07; P = .0001) were increased in FD patients compared with controls. Substantial heterogeneity was found (I2 = 93.61, P = .0001; and I2 = 96.69, P = .0001, respectively) and visual inspection of funnel plots confirmed publication bias. Degranulation of duodenal eosinophils was significantly higher in FD patients compared with controls (odds ratio, 3.78; 95% CI, 6.76-4.48; P = .0001), without statistically significant heterogeneity. We conducted a sensitivity analysis for duodenal eosinophils, by including only high-quality studies, and the results remained unchanged (SMD, 1.73; 95% CI, 1.06-2.40; P = .0001), with substantial heterogeneity. Postinfectious FD patients had increased duodenal eosinophils compared with controls (SMD, 3.91; 95% CI, 1.32-6.51; P = .001) and FD patients without any history of infection (SMD, 1.42; 95% CI, 0.88-1.96; P = .001). Helicobacter pylori-negative FD patients had significantly higher duodenal eosinophils compared with controls (SMD, 3.98; 95% CI, 2.13-5.84; P = .0001), with substantial heterogeneity. No significant difference in duodenal eosinophils was seen according to FD subtypes. CONCLUSIONS This meta-analysis suggests a link between duodenal microinflammation and FD. However, the quality of evidence is very low, largely owing to the unexplained heterogeneity and serious risk of publication bias in all comparative analyses. Thus, causality remains uncertain and further studies are required.
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Affiliation(s)
- Ayesha Shah
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Gastroenterology and Hepatology, Queensland, Australia; Department of Anatomical Pathology, Princess Alexandra Hospital, Queensland, Australia
| | - Thomas Fairlie
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Gastroenterology and Hepatology, Queensland, Australia; Department of Anatomical Pathology, Princess Alexandra Hospital, Queensland, Australia
| | - Georgia Brown
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Guy D Eslick
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Nikhil Thapar
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Queensland, Australia
| | - Simon Keely
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Natasha Koloski
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Gastroenterology and Hepatology, Queensland, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Mohit Shahi
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Anatomical Pathology, Princess Alexandra Hospital, Queensland, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Gerald Holtmann
- Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Gastroenterology and Hepatology, Queensland, Australia.
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25
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Black CJ, Paine PA, Agrawal A, Aziz I, Eugenicos MP, Houghton LA, Hungin P, Overshott R, Vasant DH, Rudd S, Winning RC, Corsetti M, Ford AC. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut 2022; 71:1697-1723. [PMID: 35798375 PMCID: PMC9380508 DOI: 10.1136/gutjnl-2022-327737] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 01/30/2023]
Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, affecting approximately 7% of individuals in the community, with most patients managed in primary care. The last British Society of Gastroenterology (BSG) guideline for the management of dyspepsia was published in 1996. In the interim, substantial advances have been made in understanding the complex pathophysiology of FD, and there has been a considerable amount of new evidence published concerning its diagnosis and classification, with the advent of the Rome IV criteria, and management. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based diagnosis and treatment of patients. The approach to investigating the patient presenting with dyspepsia is discussed, and efficacy of drugs in FD summarised based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of pairwise and network meta-analyses. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system. These provide both the strength of the recommendations and the overall quality of evidence. Finally, in this guideline, we consider novel treatments that are in development, as well as highlighting areas of unmet need and priorities for future research.
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Affiliation(s)
- Christopher J Black
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Peter A Paine
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
- Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anurag Agrawal
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Maria P Eugenicos
- Department of Gastroenterology, University of Edinburgh, Edinburgh, UK
| | - Lesley A Houghton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Pali Hungin
- Primary Care and General Practice, University of Newcastle, Newcastle, UK
| | - Ross Overshott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
- Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sheryl Rudd
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard C Winning
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alexander C Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Turner KO, Collins MH, Walker MM, Genta RM. Quantification of Mucosal Eosinophils for the Histopathologic Diagnosis of Eosinophilic Gastritis and Duodenitis: A Primer for Practicing Pathologists. Am J Surg Pathol 2022; 46:557-566. [PMID: 34913877 PMCID: PMC8923360 DOI: 10.1097/pas.0000000000001843] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eosinophilic gastrointestinal diseases, specifically eosinophilic gastritis and duodenitis, are chronic inflammatory conditions characterized by persistent gastrointestinal (GI) symptoms and elevated levels of activated eosinophils in the GI tract. Both clinical and endoscopic findings are nonspecific, no clinical or histopathologic diagnostic guidelines are published, and disease awareness is low, both among clinicians and amongst pathologists, who tend to overlook mild or moderate increases in the density of eosinophils in GI biopsy specimens. Yet, evaluating and, at times, counting eosinophils in GI biopsies may have important clinical implications: the numbers of tissue eosinophils correlate with clinical manifestations, can be used as determinants of effective management, and are used to assess the effects of treatment. A most persuasive argument for providing a count rather than a value judgment is that patients read reports, understand numbers, and use them to help to understand the course of their disease. The objective of this primer is to provide pathologists with the tools to incorporate a quantitative assessment of eosinophilia in the diagnosis of gastric and duodenal biopsy specimens and to develop a systematic approach to their evaluation, counting, and reporting. To achieve this aim, we present our general approach to the biopsy (where to count), followed by details on the characteristics of a countable eosinophil (what to count), and provide with a set of suggestions on the counting methods (how to count). We conclude with suggestions on how to report GI tissue eosinophilia in a manner that alerts clinicians and prompts pertinent management steps.
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Affiliation(s)
| | - Margaret H. Collins
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Marjorie M. Walker
- Department of Pathology, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Robert M. Genta
- Inform Diagnostics, Irving
- Department of Pathology, Baylor College of Medicine, Houston, TX
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Pilot Double-Blind Randomised Controlled Trial: Effects of Jejunal Nutrition on Postprandial Distress in Diabetic Gastropathy (J4G Trial). Nutrients 2022; 14:nu14071321. [PMID: 35405934 PMCID: PMC9000869 DOI: 10.3390/nu14071321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 12/22/2022] Open
Abstract
Nausea, vomiting and abdominal pain in diabetic patients are often attributed to diabetic gastropathy (DG). Post-pyloric (“jejunal”) enteral nutrition (JN) may improve nutrition and glycaemia in difficult cases. The acute effects of JN on postprandial symptoms and gastric function in DG patients has not been studied. DG patients with moderate to severe symptoms (gastroparesis cardinal symptom index (GCSI) > 27), diabetic controls without symptoms (DC; GCSI < 14) and healthy controls (HV) were entered into a randomized, double blind controlled trial. JN with liquid nutrient (2 kcal/min) or water was infused for 60 min prior to ingestion of a standardized mixed solid/liquid test meal. Outcomes included postprandial symptoms and effects on gastrointestinal (GI)−peptide hormones and gastric emptying (GE) assessed by magnetic resonance imaging (MRI). Nine DG, nine DC and twelve HV were recruited. DG patients reported more symptoms after meals than other groups (p < 0.05). Post-prandial symptoms were reduced after JN in DG patients (p < 0.01). GE was more rapid after JN in DG and DC patients (p < 0.05). JN induced a GI−peptide response in all subjects; however, this was less pronounced in diabetic groups. JN has beneficial effects on DG patients’ symptoms after a meal. The mechanism is not primarily mediated by effects on GE, but appears to involve other aspects of GI function, including visceral sensitivity.
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Non-IgE/Mixed Food Allergies and Functional Gastrointestinal Disorder: A Common Thread between Childhood and Adulthood. Nutrients 2022; 14:nu14040835. [PMID: 35215484 PMCID: PMC8879813 DOI: 10.3390/nu14040835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
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29
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Yang NN, Tan CX, Lin LL, Su XT, Li YJ, Qi LY, Wang Y, Yang JW, Liu CZ. Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology. Front Neurosci 2022; 15:781215. [PMID: 35145373 PMCID: PMC8822151 DOI: 10.3389/fnins.2021.781215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Functional dyspepsia (FD), a common disorder of gastrointestinal function, originated from the gastroduodenum. Although the therapeutic effect of acupuncture has been investigated by various high-quality randomized controlled trials, the potential mechanisms showed obvious heterogeneity. This review summarized the potential mechanisms of acupuncture on FD in order to guide for future laboratory and clinical studies. Here, we argued that the primary cause of FD was gastroduodenal low-grade inflammation and acid exposure, which impaired mucosal integrity, caused brain-gut axis dysfunction, and impaired brain network connectivity, all of which generated various symptom patterns. Overall the clinical studies indicated that acupuncture was a promising treatment to alleviate symptoms in FD patients, whose efficacy was influenced by acupoints and individual variance. Mechanistically, studies with animal models of FD and patients have shown that acupuncture, a non-invasive strategy for nerve stimulation, may have the potential to control intestinal inflammation and suppress acid-secretion via different somatic autonomic reflex pathways, regulate the brain-gut axis through intestinal microbiota, and has the potential to ameliorate FD-symptoms. The cumulative evidence demonstrated that acupuncture is a promising treatment to alleviate symptoms of FD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture, Moxibustion and Tunia, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture, Moxibustion and Tunia, Beijing University of Chinese Medicine, Beijing, China
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30
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Zand Irani M, Talley NJ. Editorial: rumination-more frequent than previously thought. Authors' reply. Aliment Pharmacol Ther 2022; 55:114-115. [PMID: 34907562 DOI: 10.1111/apt.16682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Mudar Zand Irani
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia
| | - Nicholas J Talley
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia
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31
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Ronkainen J, Aro P, Jones M, Walker MM, Agréus L, Andreasson A, Talley NJ. Duodenal eosinophilia and the link to anxiety: A population-based endoscopic study. Neurogastroenterol Motil 2021; 33:e14109. [PMID: 33687126 DOI: 10.1111/nmo.14109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The concept of gut-to-brain communication via microbial or inflammatory pathways is gaining increased attention but genuine pathology directly linking gut perturbation to anxiety is lacking. We hypothesized that duodenal eosinophilia, as known to occur in functional dyspepsia (FD), may be an underlying cause of anxiety and may help explain the striking association between FD and anxiety. METHODS Randomly selected subjects from the national population register of Sweden completed the validated Abdominal Symptom Questionnaire; 1000 completed esophagogastroduodenoscopy and the Hospital Anxiety and Depression Scale questionnaire. Duodenal biopsies were obtained from 1st (D1) and 2nd portion (D2). Eligible subjects who underwent endoscopy (n = 887) were invited to participate in a 10-year follow-up study with the same questionnaires. Among endoscopy normal subjects, FD was identified by Rome criteria, and controls were symptom free. Duodenal eosinophilia was based on pre-defined cut-offs. Finding are reported as odds ratios (ORs) with 95% confidence interval and p-value. RESULTS The study population comprised 89 cases with FD and 124 healthy controls (mean age 62 years, SD 12, 34% male). Clinical anxiety at follow-up was elevated in those with D1 eosinophilia at baseline considering either new-onset anxiety (OR = 4.5, 95% CI 0.8, 23.8; p = 0.08) or follow-up anxiety adjusting for baseline anxiety (OR = 4.51 (95% CI 1.03, 19.81; p = 0.046). CONCLUSION Duodenal eosinophilia may potentially be a mechanism linked to anxiety independent of FD.
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Affiliation(s)
- Jukka Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Primary Health Care Center, Tornio, Finland
| | | | - Mike Jones
- Macquarie University, North Ryde, NSW, Australia
| | - Marjorie M Walker
- Priority Research Centre for Digestive Health and Neurogastroenterology, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Lars Agréus
- Division of Family Medicine and Primary Care, Division of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Macquarie University, North Ryde, NSW, Australia.,Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Talley
- Priority Research Centre for Digestive Health and Neurogastroenterology, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, Australia
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Wauters L, Ceulemans M, Vanuytsel T. Duodenum at a crossroads: Key integrator of overlapping and psychological symptoms in functional dyspepsia? Neurogastroenterol Motil 2021; 33:e14262. [PMID: 34561921 DOI: 10.1111/nmo.14262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
The study of the interaction between gastrointestinal (GI) function and psychological features is a complex and developing field. The bidirectional communication between the gut and the brain or gut-brain axis is considered as a pivotal player in the pathogenesis of the highly prevalent functional GI disorders, including irritable bowel syndrome and functional dyspepsia (FD), which have been redefined as disorders of gut-brain interaction. However, the mechanisms through which changes in the gut alter brain functioning, feelings, and behavior remain unclear. Based on the presence of duodenal pathology in adult FD patients, Ronkainen et al. provide the first prospective evidence for duodenal eosinophils potentially driving anxiety. Also in this edition, associations between gastroduodenal pathology and rumination syndrome, which may coexist with FD, have now been confirmed in children by Friesen et al. Together these findings confirm not only the potential role of duodenal alterations in determining overlapping upper GI but also psychological symptoms, which result from bidirectional and complex interactions. In this review, we provide an overview of the recent advances in this field and highlight the novel contributions of the original studies of Ronkainen et al. and Friesen et al. to this topic.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Matthias Ceulemans
- Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
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33
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Mokha JS, Hyams JS, Glidden NC, Balarezo F, Young E. Characterizing clinical features and location-specific gene expression profiles associated with pain burden in children with functional dyspepsia. Neurogastroenterol Motil 2021; 33:e14185. [PMID: 34120385 DOI: 10.1111/nmo.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/24/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND In children with functional dyspepsia (FD), genes involved in pain modulation may be differentially expressed contributing to chronic pain. METHODS Children with suspected FD (cases) and known eosinophilic esophagitis (controls) undergoing esophagogastroduodenoscopy completed the Rome IV Diagnostic, Pain Burden and Frequency Severity-Duration questionnaires. Two antral and two duodenal biopsies were collected and relative fold differences in gene expression for 84 pain-associated genes compared to pain-free controls were calculated. RESULTS Sixty-six subjects with FD (postprandial distress syndrome = 34, epigastric pain syndrome = 7, both = 25; 65% female; mean age 13.7 years) and 13 pain-free controls (8% female; mean age 12.7) were studied. There were no significant differences in antral and duodenal eosinophilic counts or distribution between the pain and pain-free groups. Pain severity and burden did not differ significantly between FD subgroups and neither measure significantly correlated with eosinophil counts in the antrum or duodenum. Analysis of 47 antral and 39 duodenal biospecimens revealed 5 candidate genes significantly associated with pain burden: antral EDN1, PTGES3 and duodenal HTR1A, P2Y1, SCN3A (p < 0.01). Subsequent stringent statistical analysis comparing those with significant pain versus no pain revealed antral PTGES3 and duodenal SCN3A were the highest priority candidate genes (p < 0.001). CONCLUSIONS Pain burden in pediatric FD may be linked to antral EDN1, PTGES3 and duodenal HTR1A, P2Y1, SCN3A differential expression. These genes are known to be involved in pain conduction, modulation, and neurotransmission, suggesting potential therapeutic targets for managing pain in FD.
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Affiliation(s)
- Jasmeet S Mokha
- 1Connecticut Children's Medical Center, Digestive diseases, Hartford, CT, US
| | - Jeffrey S Hyams
- 1Connecticut Children's Medical Center, Digestive diseases, Hartford, CT, US
| | - Nicole C Glidden
- Genetics, and Genome Sciences, University of Connecticut School of Medicine, Farmington, CT, US
| | - Fabiola Balarezo
- Hartford Hospital Department of Pathology and Laboratory Medicine, Hartford, CT, US
| | - Erin Young
- Department of Anesthesiology, University of Connecticut School of Nursing, University of Kansas School of Medicine, Storrs, CT, US
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34
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Moshiree B, Talley NJ. Functional dyspepsia: A critical appraisal of the European consensus from a global perspective. Neurogastroenterol Motil 2021; 33:e14216. [PMID: 34337832 DOI: 10.1111/nmo.14216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
The European Society for Neurogastroenterology and Motility's (ESNM) consensus document on functional dyspepsia (FD) has provided a critical review of the evidence for 36 statements highly relevant to the diagnosis and treatment of FD. We provide here our expert opinion on the North American, Australian and Asian assessments of the same topics discussed, and provide evidence where the ESNM consensus may deviate from those in the other continents. New and exciting data about the pathogenesis of FD are emerging including the possible central role of duodenal micro-inflammation (most notably eosinophilic duodenitis and intestinal mast cell disease), but this is a very dynamic field with several gaps remaining in our understanding that are summarized in this review. Identification of non-invasive biomarkers and testing of targeted therapies, including assessing the benefits of multidisciplinary teams in the management of FD, should be future priorities.
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Affiliation(s)
- Baha Moshiree
- Atrium Health Division of Gastroenterology, Hepatology and Nutrition, Charlotte, North Carolina, USA
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, Newcastle, NSW, Australia.,Australian GI Research Alliance (AGIRA, Newcastle, NSW, Australia
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35
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Talley NJ, Powell N, Walker MM, Jones MP, Ronkainen J, Forsberg A, Kjellström L, Hellström PM, Aro P, Wallner B, Agréus L, Andreasson A. Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies. Aliment Pharmacol Ther 2021; 54:32-42. [PMID: 33983640 DOI: 10.1111/apt.16372] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is uncertain if functional dyspepsia (FD) or irritable bowel syndrome (IBS) are linked to smoking, and smoking cessation is not part of the routine advice provided to these patients. AIM To assess if smoking is an independent risk factor for FD and IBS. METHODS Three population-based endoscopy studies in Sweden with 2560 community individuals in total (mean age 51.5 years, 46% male). IBS (14.9%), FD (33.5%), and associated symptoms were assessed using the validated abdominal symptom questionnaire, and smoking (17.9%) was obtained from standardised questions during a clinic visit. The effect of smoking on symptom status was analysed in an individual person data meta-analysis using mixed effect logistic regression, adjusted for snuffing, age and sex. RESULTS Individuals smoking cigarettes reported significantly higher odds of postprandial distress syndrome (FD-PDS) (OR 10-19 cig/day = 1.42, 95% CI 1.04-1.98 P = 0.027, OR ≥20 cig/day = 2.16, 95% CI 1.38-3.38, P = 0.001) but not epigastric pain. Individuals smoking 20 or more cigarettes per day reported significantly higher odds of IBS-diarrhoea (OR = 2.40, 95% CI 1.12-5.16, P = 0.025), diarrhoea (OR = 2.01, 95%CI 1.28-3.16, P = 0.003), urgency (OR = 2.21, 95%CI 1.41-3.47, P = 0.001) and flatus (OR = 1.77, 95%CI 1.14-2.76, P = 0.012) than non-smokers. Smoking was not associated with IBS-constipation or IBS-mixed. CONCLUSION Smoking is an important environmental risk factor for postprandial distress syndrome, the most common FD subgroup, with over a twofold increased odds of PDS in heavy smokers. The role of smoking in IBS-diarrhoea, but not constipation, is also likely important.
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Affiliation(s)
- Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, Australia, 2305, Australia
- NHMRC Centre for Research Excellence in Digestive Health, Australia
| | | | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, Australia, 2305, Australia
- NHMRC Centre for Research Excellence in Digestive Health, Australia
| | - Mike P Jones
- NHMRC Centre for Research Excellence in Digestive Health, Australia
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Jukka Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Primary Health Care Centre, Tornio, Finland
| | - Anna Forsberg
- Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | | | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Bengt Wallner
- Department of Surgical and Perioperatve Sciences, Umeå University, Umeå, Sweden
| | - Lars Agréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Andreasson
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
- Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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Talley NJ, Walker MM, Jones M, Keely S, Koloski N, Cameron R, Fairlie T, Burns G, Shah A, Hansen T, Harris G, Holtmann G. Letter: budesonide for functional dyspepsia with duodenal eosinophilia-randomised, double-blind, placebo-controlled parallel-group trial. Aliment Pharmacol Ther 2021; 53:1332-1333. [PMID: 34029411 DOI: 10.1111/apt.16396] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- N J Talley
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - M M Walker
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - M Jones
- NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia.,Department of Psychology, Macquarie University, Ryde, NSW, Australia
| | - S Keely
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - N Koloski
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia.,Department of Psychology, Macquarie University, Ryde, NSW, Australia.,Department of Gastroenterology, Princess Alexander Hospital, Woolloongabba, Qld, Australia
| | - R Cameron
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - T Fairlie
- Department of Gastroenterology, Princess Alexander Hospital, Woolloongabba, Qld, Australia
| | - G Burns
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - A Shah
- NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia.,Department of Gastroenterology, Princess Alexander Hospital, Woolloongabba, Qld, Australia.,School of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - T Hansen
- Department of Psychology, Macquarie University, Ryde, NSW, Australia
| | - G Harris
- University of Newcastle, Newcastle, NSW, Australia.,NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia
| | - G Holtmann
- NHMRC Centre of Research Excellence in Digestive Health, New Lambton Heights, NSW, Australia.,Department of Gastroenterology, Princess Alexander Hospital, Woolloongabba, Qld, Australia.,School of Medicine, University of Queensland, St Lucia, Qld, Australia
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Duncanson K, Burns G, Pryor J, Keely S, Talley NJ. Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia. Nutrients 2021; 13:1109. [PMID: 33800668 PMCID: PMC8066021 DOI: 10.3390/nu13041109] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of 'trigger' foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.
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Affiliation(s)
- Kerith Duncanson
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Grace Burns
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Pryor
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicholas J. Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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38
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Abstract
In 2016, the Rome criteria were updated as Rome IV, and only minor changes were introduced for functional dyspepsia (FD). The major symptoms of FD now include not only postprandial fullness, but also epigastric pain and burning, and early satiation at above the "bothersome" level. Investigations into the effect of meal ingestion on symptom generation have indicated that not only postprandial fullness and early satiety but also epigastric pain and burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered to be the cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such a condition has been termed H. pylori-associated dyspepsia. Prompt esophagogastroduodenoscopy and H. pylori "test and treat" may be beneficial, especially in regions with a high prevalence of gastric cancer, such as east Asia. In terms of treatment, acotiamide, tandospirone, and rikkunshito are newly listed in Rome IV as treatment options for FD. Clinical studies in the field of FD should be strictly based on the Rome IV criteria until the next Rome V is published in 2026.
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39
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Talley NJ, Zand Irani M. Optimal management of severe symptomatic gastroesophageal reflux disease. J Intern Med 2021; 289:162-178. [PMID: 32691466 DOI: 10.1111/joim.13148] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH-impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti-reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti-reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.
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Affiliation(s)
- N J Talley
- From the, NHMRC Centre of Research Excellence of Digestive Health, Faculty of Health and Medicine, University of Newcastle, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - M Zand Irani
- From the, NHMRC Centre of Research Excellence of Digestive Health, Faculty of Health and Medicine, University of Newcastle, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Drago L, Meroni G, Pistone D, Pasquale L, Milazzo G, Monica F, Aragona S, Ficano L, Vassallo R. Evaluation of main functional dyspepsia symptoms after probiotic administration in patients receiving conventional pharmacological therapies. J Int Med Res 2021; 49:300060520982657. [PMID: 33472489 PMCID: PMC7829611 DOI: 10.1177/0300060520982657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) are
the two main forms of functional dyspepsia (FD). Probiotics are a promising
therapy for FD, but current data remains heterogeneous. This work aims to
evaluate a probiotic combination of Lacticaseibacillus
rhamnosus LR04 (DSM 16605), Lactiplantibacillus
pentosus LPS01 (DSM 21980), Lactiplantibacillus
plantarum LP01 (LMG P-21021), and Lactobacillus
delbrueckii subsp. delbruekii LDD01 (DMS
22106), alone or together with other pharmacological therapies, for clinical
improvement of symptoms associated with FD. Methods Patients with FD were enrolled and divided into two groups: PDS and EPS.
Probiotic alone or combined with prokinetics, antacids, or
proton-pump-inhibitors were administered for 30 days. A progressive-score
scale was used to evaluate symptoms in all patients at the beginning of the
trial and at 15 days after the end of treatment. Results A cohort of 2676 patients were enrolled (1 357 with PDS; 1 319 with EPS). All
patients showed significant improvements in dyspeptic symptoms following
treatment. In patients with PDS, probiotic alone resulted in the lowest
prevalence of symptoms following treatment, while patients with EPS showed
no clear between-treatment differences. Conclusions Dyspeptic symptoms were reduced following treatment in all patients.
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Affiliation(s)
- Lorenzo Drago
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Gabriele Meroni
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Dario Pistone
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Luigi Pasquale
- Gastroenterology Unit, Avellino Hospital, Avellino, Italy
| | - Giuseppe Milazzo
- Department of Medicine, Vittorio Emanuele III Hospital, Salemi, Italy
| | - Fabio Monica
- Department of Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste, Italy
| | - Salvatore Aragona
- Centre of Regenerative Medicine, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Leonardo Ficano
- Gastroenterology Unit, 18998University of Palermo, Palermo, Italy
| | - Roberto Vassallo
- Department of Gastroenterology and Digestive Endoscopy, Buccheri la Ferla, Fatebenefratelli Hospital, Palermo, Italy
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Black CJ, Drossman DA, Talley NJ, Ruddy J, Ford AC. Functional gastrointestinal disorders: advances in understanding and management. Lancet 2020; 396:1664-1674. [PMID: 33049221 DOI: 10.1016/s0140-6736(20)32115-2] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/25/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Douglas A Drossman
- Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, University of North Carolina, Chapel Hill, NC, USA; The Rome Foundation, Raleigh, NC, USA
| | - Nicholas J Talley
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, NSW, Australia; Hunter Medical Research Institute, Lambton, NSW, Australia
| | - Johannah Ruddy
- The Rome Foundation, Raleigh, NC, USA; Center for Education and Practice of Biopsychosocial Care, DrossmanCare, Durham, NC, USA
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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42
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Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet 2020; 396:1689-1702. [PMID: 33049222 DOI: 10.1016/s0140-6736(20)30469-4] [Citation(s) in RCA: 266] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Alexander C Ford
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.
| | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Florencia Carbone
- Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Leuven, Belgium
| | | | - Nicholas J Talley
- Australian Gastrointestinal Research Alliance, University of Newcastle, Newcastle, NSW, Australia
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43
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44
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Systematic review with meta-analysis: Effects of probiotic supplementation on symptoms in functional dyspepsia. J Funct Foods 2020. [DOI: 10.1016/j.jff.2020.103902] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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45
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Wauters L, Talley NJ, Walker MM, Tack J, Vanuytsel T. Novel concepts in the pathophysiology and treatment of functional dyspepsia. Gut 2020; 69:591-600. [PMID: 31784469 DOI: 10.1136/gutjnl-2019-318536] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
Emerging data increasingly point towards the duodenum as a key region underlying the pathophysiology of functional dyspepsia (FD), one of the most prevalent functional GI disorders. The duodenum plays a major role in the control and coordination of gastroduodenal function. Impaired duodenal mucosal integrity and low-grade inflammation have been associated with altered neuronal signalling and systemic immune activation, and these alterations may ultimately lead to dyspeptic symptoms. Likely luminal candidates inducing the duodenal barrier defect include acid, bile, the microbiota and food antigens although no causal association with symptoms has been convincingly demonstrated. Recognition of duodenal pathology in FD will hopefully lead to the discovery of new biomarkers and therapeutic targets, allowing biologically targeted rather than symptom-based therapy. In this review, we summarise the recent advances in the diagnosis and treatment of FD with a focus on the duodenum.
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Affiliation(s)
- Lucas Wauters
- Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia .,School of medicine and public Health, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Marjorie M Walker
- Anatomical Pathology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jan Tack
- Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
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46
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Abstract
Chronic unexplained gastrointestinal symptoms impact more than 1 in 5 Americans and their families; these disorders include the irritable bowel syndrome (IBS) and functional dyspepsia (FD), currently classified by Rome IV as functional gastrointestinal disorders. By definition, IBS and FD have no established pathology, but emerging evidence suggests this paradigm may need revision. Immune activation and, in subsets, subtle intestinal pathology have been identified in FD (most notably, postprandial distress syndrome) and IBS-diarrhea. A disease model is proposed that accounts for all of the intestinal and extraintestinal symptoms, relationship to food and infection, and the overlap with gastroesophageal reflux disease. It is speculated that antigen presentation to the mucosa (e.g., microbial antigens or food proteins after acute gastroenteritis) induces, in a genetically primed host, immune activation of the intestine with low-grade intestinal inflammation and subsequently neuronal structural and functional alterations, producing regional intestinal hypersensitivity and motor dysfunction. Immune activation may explain the female predominance and fluctuations in immune activity for symptom variability over time. In the future, as further evidence accumulates, the management paradigm may potentially shift to objective pathology-based subtyping based on serological, microbiological, and clinical assessments to identify when targeted therapies should be deployed in subsets. Potential targeted interventions may include therapies to dampen down immune activation or block release of key mediators such as histamine, specific microbial targeted treatments that may reverse disease, and dietary advice to eliminate relevant food antigens after objective in vivo testing. Only by identifying causation can we eventually anticipate cure, and as the true pathology unravels in subsets, this may become a reality.
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47
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Affiliation(s)
- Nicholas J Talley
- From the Faculty of Health and Medicine, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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48
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Ronkainen J, Aro P, Walker MM, Agréus L, Johansson SE, Jones M, Talley NJ. Editorial: the overlap between dyspepsia and gastro-oesophageal reflux-is duodenal eosinophilia the missing link? Authors' reply. Aliment Pharmacol Ther 2019; 50:455-456. [PMID: 31359481 DOI: 10.1111/apt.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Jukka Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Primary Health Care Center, Tornio, Finland.,Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | | | - Marjorie M Walker
- Faculty of Health and Medicine, Priority Research Center for Digestive Health and Neurogastroenterology, University of Newcastle, Callaghan, NSW, Australia.,Australian GI Research Alliance (AGIRA), Canberra, Australia
| | - Lars Agréus
- Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health and Medicine, Priority Research Center for Digestive Health and Neurogastroenterology, University of Newcastle, Callaghan, NSW, Australia.,Australian GI Research Alliance (AGIRA), Canberra, Australia
| | - Sven-Erik Johansson
- Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Mike Jones
- Psychology Department, Macquarie University, North Ryde, NSW, Australia
| | - Nicholas J Talley
- Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health and Medicine, Priority Research Center for Digestive Health and Neurogastroenterology, University of Newcastle, Callaghan, NSW, Australia.,Australian GI Research Alliance (AGIRA), Canberra, Australia
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49
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Kanno T, Moayyedi P. Editorial: the overlap between dyspepsia and gastro-oesophageal reflux-is duodenal eosinophilia the missing link? Aliment Pharmacol Ther 2019; 50:454-455. [PMID: 31359477 DOI: 10.1111/apt.15388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Takeshi Kanno
- Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Paul Moayyedi
- Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
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