Impact of eating attitude and impairment of physical quality of life between tertiary clinic and primary clinic functional dyspepsia outpatients in Japan

Positive Association Between Sleep Disturbance and Prevalence of Functional Dyspepsia in Japanese Young People

BACKGROUND

Evidence regarding the association between sleep disturbance and functional dyspepsia (FD) remains limited in the young population.

AIMS

This study aimed to investigate the association between sleep disturbance and FD including subgroups among Japanese young people.

METHODS

Study subjects were 8923 university students. FD was defined according to the Rome III criteria. Subjects with FD were further categorized as having postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS). Subjects completed a self-reported questionnaire assessing self-reported sleep duration, sleep disturbance, difficulty falling asleep, deep sleep disorder, nocturnal awakening, early awakening, and daytime sleepiness.

RESULTS

The prevalence of FD was 1.9%. After adjustment, all types of sleep disturbances were independently positively associated with FD (total sleep disturbance: OR 4.11 [95% CI: 2.89-5.78], difficulty falling asleep: OR 3.97 [95% CI: 2.53-6.01], deep sleep disorder: OR 4.85 [95% CI: 3.06-7.40], nocturnal awakening: OR 4.35 [95% CI: 1.90-8.67], early awakening: OR 4.50 [95% CI: 1.97-8.97], and daytime sleepiness: OR 2.83 [95% CI: 1.25-5.56]). While nocturnal awakening and daytime sleepiness were not associated with EPS, the other types of sleep disturbance were independently positively associated with EPS and PDS. No association between self-reported sleep duration and FD was found.

CONCLUSIONS

Sleep disturbance may be independently positively associated with the prevalence of FD among Japanese young people. Nocturnal awakening and daytime sleepiness were not associated with EPS; the other types of sleep disturbance were independently positively associated with EPS and PDS.

Sleep Quality and Insomnia Are Associated With Quality of Life in Functional Dyspepsia

Background

Sleep disturbances are common in patients with functional dyspepsia. Our aim was to assess the relationship between subjective sleep and quality of life and to identify factors associated with impaired sleep in functional dyspepsia.

Methods

One thousand two hundred and twenty patients referred for functional gastrointestinal disorders at a single tertiary care center between end 2017 and June 2019 were studied using a self-administered questionnaire. 355 patients with Rome IV-based functional dyspepsia were identified. Sleep was assessed using both the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). The severity of dyspeptic symptoms was assessed using the Total Symptom Score (TSS). Quality of life was assessed by the GastroIntestinal Quality of Life Index (GIQLI). Anxiety and depression levels were evaluated using the Hospital Anxiety and Depression (HAD) scale.

Key Results

Among the 355 patients with functional dyspepsia, 66 (18.6%) patients displayed normal sleep quality whereas 289 (81.4%) patients had altered sleep quality. Functional dyspepsia patients with sleep disturbances were older (48.1 ± 15.4 vs. 41.4 ± 16.0, p = 0.0009), had decreased quality of life (GIQLI: 75.3 ± 18.5 vs. 92.1 ± 15.4, p < 0.0001), greater severity of their symptoms (TSS: 18.9 ± 3.6 vs. 17.2 ± 3.9, p = 0.0007), and higher anxiety and depression scores (HADS: 17.7 ± 7.2 vs. 11.9 ± 5.1, p < 0.0001). A correlation was found between sleep quality and quality of life [r = −0.43 (95% CI: −0.51 to −0.34), p < 0.0001]. Independent factors predicting poor sleep quality were age [OR 1.03 (95% CI = 1.01–1.05), p = 0.006], depression level [OR 1.27 (95% CI = 1.16–1.39); p < 0.0001], and the severity of dyspeptic symptoms [OR 1.13 (95% CI = 1.04–1.22); p = 0.004].

Conclusion and Inferences

A high prevalence of sleep disturbances was found in patients suffering from functional dyspepsia, with 81% of them having altered sleep quality and 61% having insomnia based on subjective assessment. Altered sleep quality and insomnia were associated with altered quality of life, higher severity of symptoms, and higher anxiety and depression scores in this disorder.

Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders

PURPOSE OF REVIEW

Functional dyspepsia (FD) is a chronic functional gastrointestinal disorder characterised by upper gastrointestinal symptoms. Here, we aimed to examine the evidence for immune responses to food in FD and overlap with food hypersensitivity conditions.

RECENT FINDINGS

A feature of FD in a subset of patients is an increase in mucosal eosinophils, mast cells, intraepithelial cytotoxic T cells and systemic gut-homing T cells in the duodenum, suggesting that immune dysfunction is characteristic of this disease. Rates of self-reported non-celiac wheat/gluten sensitivity (NCW/GS) are higher in FD patients. FD patients commonly report worsening symptoms following consumption of wheat, fermentable oligosaccharides, disaccharides, monosaccharides, or polyols (FODMAPs), high-fat foods and spicy foods containing capsaicin. Particularly, wheat proteins and fructan in wheat may drive symptoms. Immune mechanisms that drive responses to food in FD are still poorly characterised but share key effector cells to common food hypersensitivities including non-IgE-mediated food allergy and eosinophilic oesophagitis.

Management of functional dyspepsia: state of the art and emerging therapies

Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. Several etiologies have been associated with the disorder. In the Rome IV criteria, the brain-gut axis was acknowledged as an important factor in the etiology of functional gastrointestinal (GI) disorders. The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. A previous study has reported that proton pump inhibitors (PPIs) and H₂-blockers were equally effective in functional dyspepsia. A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. The pharmacological mechanisms of acotiamide remain unknown; whether acotiamide alters gastric emptying and gastric accommodation in patients with functional dyspepsia remains an open question. Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs). Different drugs are needed to accommodate the clinical symptoms and etiology in individual patients.

Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease

PURPOSE

The present study evaluated the efficacy of a nursing educational intervention in alleviating the level of parental anxiety in the parents of children who required heart surgery for the first time.

DESIGN AND METHODS

A comparative study was used to explore the parents of children who had to undergo cardiac surgery. Parents of children were randomized into 2 groups: 1) control group and 2) experimental group or parents that received the educational intervention about PICU stay.

RESULT

The results of STAY-1 showed that the average anxiety score of group 1 was lower than that of group 2 (63.0 [SD=3.5] vs. 70.4 [SD=2.8]).

CONCLUSION

In order to decrease levels of parental anxiety and stress prior to paediatric surgery, parents should be adequately informed about planned therapeutic procedures.

PRACTICE IMPLICATIONS

We speculate that pre-surgery parent education on what to expect before, during and after their child's cardiac surgery may improve parents' knowledge and satisfaction and decrease anxiety.

The low-FODMAP diet in the management of functional dyspepsia in East and Southeast Asia

Functional dyspepsia (FD) is a common disorder in East and Southeast Asia where subjects experience post prandial fullness/bloating, early satiety, belching, epigastric pain, and/or burning. A subset of patients with FD experience triggers exclusively related to meals, defined as the post prandial distress syndrome in the Rome IV guidelines. There is significant overlap of symptoms and implicated pathogenic factors with another common functional gastrointestinal disorder, irritable bowel syndrome (IBS) and in fact, a significant proportion of subjects have FD/IBS overlap. The introduction of the low-FODMAP diet has changed the paradigm of treatment for IBS. Like IBS, dietary management appears to be important to patients with FD and clinicians treating the condition. This review aims to examine the current role of diet in the management of FD in East and Southeast Asia, with an exploration of the likely efficacy and mechanisms of action of the low-FODMAP diet in this region.

Research progress on functional dyspepsia

Functional dyspepsia (FD) is considered to be a series of integrated responses to dysfunction of the brain-gut axis caused by a combination of biological factors and socio-psychological factors. Gastrointestinal motility disorder and mental emotional disorder are important factors leading to the development of FD, and abnormal function of the brain-gut axis is the core mechanism of FD pathogenesis. The high incidence of FD has caused a high degree of attention. In this paper, we will review the latest advances in the understanding of the pathogenesis of FD and in its treatment.

The Usefulness of Water-drinking Ultrasonography Combined Test for Evaluating Patients with Functional Dyspepsia

BACKGROUND/AIMS

The major causes of functional dyspepsia (FD) are motility dysfunction and visceral hypersensitivity. Despite the large number of diagnostic tests, there are no convenient methods for evaluation of gastric functions. Therefore, this study was conducted to assess the relationship between the degree of dyspepsia and gastric accommodation, emptying, and sensitivity.

METHODS

A total of 120 FD patients that met the Rome III criteria and 30 healthy volunteers were included in this cross-sectional study. The mean cross-sectional area of the fornix was measured to investigate fundic accommodation and gastric emptying during and after water intake. During the test, abdominal symptoms were evaluated using the 4-point Likert scale.

RESULTS

The water-drinking ultrasonography combined test revealed impairment of gastric accommodation in FD after 1,000 mL of water intake, delayed emptying after 5 min of water intake and statistically significant hyperesthesia after 400 mL of water intake in the FD group compared with healthy controls (p <œœ 0.05). Postprandial distress syndrome (PDS) and overlap syndrome were independently associated with gut motor disturbances instead of epigastric pain syndrome (EPS) (p <œœ 0.01).

CONCLUSIONS

The results of the present study suggest that the water-drinking ultrasonography combined test could be used for diagnosis of gastric motor and sensory dysfunction, particularly in PDS and EPS-PDS patients. This test is easy, well tolerated by the patient and can be widely applied in clinical practice.