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Gabbard S, Vijayvargiya N. Functional dyspepsia: How to manage the burn and the bloat. Cleve Clin J Med 2024; 91:301-307. [PMID: 38692696 DOI: 10.3949/ccjm.91a.23062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.
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Affiliation(s)
- Scott Gabbard
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Ko SJ, Kim K, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Ha NY, Lee J, Kelley JM, Park JW, Kim J. Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea. Patient Educ Couns 2024; 121:108133. [PMID: 38199174 DOI: 10.1016/j.pec.2023.108133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. METHODS The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. RESULTS Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. CONCLUSION Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. PRACTICE IMPLICATIONS Clinicians should consider cultural differences when applying acupuncture therapy.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Keumji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Gastroenterology Unit, Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gerber
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Na-Yeon Ha
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Junhee Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychology Department, Endicott College, Beverly, MA, USA
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
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Farcas RA, Grad S, Grad C, Dumitrașcu DL. Microbiota and Digestive Metabolites Alterations in Functional Dyspepsia. J Gastrointestin Liver Dis 2024; 33:102-106. [PMID: 38386888 DOI: 10.15403/jgld-5024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/19/2023] [Indexed: 02/24/2024]
Abstract
Functional dyspepsia (FD), a widespread and debilitating digestive disease, is thought to originate from disrupted gut-brain communication. The cause of FD is not completely understood, but recent evidence suggests it could be due to multiple factors and can vary among different patient groups. Factors like gut motility changes, increased sensitivity to pain in the gut, ongoing low-level inflammation, and increased gut permeability have all been linked to the development of FD. Additionally, changes in the gut microbiome have been suggested to play a significant role in the disease. The gut microbiota in the duodenum could either be a cause or a result of the immune and nervous system issues seen in FD, but the ways in which the gut flora in the small intestine affects gut function, digestive metabolites and symptoms are not yet clear, more studies being needed in order to completely assess the relationship between gastrointestinal microbiota and development and progression of FD. This review summarizes the available research on the relationship between FD and the microbiota and examines the various treatments, including probiotics, that have been shown to relieve symptoms. Finally, suggestions for improving diagnosis and treatment for those with FD are presented.
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Affiliation(s)
- Radu Alexandru Farcas
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Medical Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania. .
| | - Simona Grad
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Medical Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania. .
| | - Cosmin Grad
- 2nd Medical Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
| | - Dan Lucian Dumitrașcu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Medical Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
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Xu Z, Zhang X, Shi H, Liang M, Ning F, Wang Q, Jia H. Efficacy of acupuncture for anxiety and depression in functional dyspepsia: A systematic review and meta-analysis. PLoS One 2024; 19:e0298438. [PMID: 38452033 PMCID: PMC10919749 DOI: 10.1371/journal.pone.0298438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To assess the effectiveness of acupuncture for treating depression and anxiety in patients diagnosed with functional dyspepsia (FD). METHODS PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, Sinomed, and VIP Database were searched until April 30, 2023 for Randomized Controlled Trials (RCTs) comparing acupuncture to placebo or drugs for symptom alleviation. Two independent reviewers conducted the study search, data extraction, and bias risk assessment using the Cochrane Risk of Bias tool. Mean difference (MD), risk ratio (RR), and corresponding 95% confidence intervals (CI) were computed. Subgroup and sensitivity analyses were also performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was employed to evaluate the evidence level. RESULTS A total of 16 RCTs involving 1315 participants were included. Acupuncture demonstrated marked superiority over placebo (MD = -7.07, 95%CI: -11.03 to -3.10, very low quality evidence) in mitigating Self-Rating Anxiety Scale (SAS) scores and was found to be more effective in reducing Self-Rating Depression Scale (SDS) scores than either placebo (MD = -4.63, 95%CI: -6.28 to -2.98, low quality evidence) or first-line drugs (MD = -2.71, 95%CI: -5.19 to -0.23, very low quality evidence). In terms of attenuating Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores, acupuncture consistently outperformed both placebo (HAMA: MD = -2.58, 95%CI: -4.33 to -0.83, very low quality evidence; HAMD: MD = -1.89, 95%CI: -3.11 to -0.67, low quality evidence) and first-line drugs (HAMA: MD = -5.76, 95%CI: -10.18 to -1.35, very low quality evidence; HAMD: MD = -5.59, 95%CI: -7.59 to -3.59, very low quality evidence). However, no significant difference was observed between acupuncture and placebo in terms of improvement in Hospital Anxiety and Depression Scale (HADS) scores. CONCLUSIONS Based on current clinical evidence, acupuncture might have a positive effect on depression and anxiety in patients with FD. Further large-sample, multi-center, high-quality RCTs validation are required, as the conclusion is limited by the quantity and quality of the included studies.
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Affiliation(s)
- Zhiwei Xu
- School of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xuecheng Zhang
- Department of Proctology, China-Japan Friendship Hospital, Beijing, China
| | - Hongshuo Shi
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Minghao Liang
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fenglan Ning
- Department of Acupuncture and Rehabilitation, Longkou Traditional Chinese Medicine Hospital, Yantai, Shandong, China
| | - Qi Wang
- Acupuncture Department, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hongling Jia
- Acupuncture Department, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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He YQ, Zhang P, Mao YK, Li SY, Zeng F, Yin T. Neuroimaging research progress of acupuncture treatment for patients with functional dyspepsia. Zhen Ci Yan Jiu 2024; 49:192-197. [PMID: 38413041 DOI: 10.13702/j.1000-0607.20221289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Neuroimaging technology provides objective and visualized research tool to study the mechanisms of acupuncture effects. Building on a systematic review of previous clinical studies on acupuncture treatment for functional dyspepsia using neuroimaging technology, this paper summarizes and synthesizes past researches from 4 aspects: acupoint-specific effects, factors influencing the effects, different physiological responses, and predictive factors for acupuncture efficacy. It suggests that acupuncture treatment for FD involves central integration with disease-targeted (acupuncture treatment can target and regulate abnormal brain functional activity patterns in patients with FD), meridian-specific (stimulation of specific acupuncture points along the stomach meridian can significantly regulate abnormal brain functional activity patterns in FD patients), and dynamic conditional features(the effects of acupuncture treatment for FD are influenced by multiple factors). Lastly, considering the current research status, this paper outlines prospects in terms of research subjects, influencing factors, and result validation, aiming to provide references for future in-depth research.
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Affiliation(s)
- Yu-Qi He
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Pan Zhang
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
- Acupuncture-moxibustion and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137
| | - Yang-Ke Mao
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
- Acupuncture-moxibustion and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137
| | - Si-Yang Li
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Fang Zeng
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
- Acupuncture-moxibustion and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137
- Key Laboratory of Sichuan Province for Acupuncture-moxibustion and Chronobiology, Chengdu 610075
| | - Tao Yin
- Acupuncture-moxibustion and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
- Acupuncture-moxibustion and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137.
- Key Laboratory of Sichuan Province for Acupuncture-moxibustion and Chronobiology, Chengdu 610075.
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Guo Y, Gharibani P. Analgesic Effects of Vagus Nerve Stimulation on Visceral Hypersensitivity: A Direct Comparison Between Invasive and Noninvasive Methods in Rats. Neuromodulation 2024; 27:284-294. [PMID: 37191611 DOI: 10.1016/j.neurom.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The aims of this study were to investigate analgesic effects of vagus nerve stimulation (VNS) on visceral hypersensitivity (VH) in a rodent model of functional dyspepsia (FD) and to compare invasive VNS with noninvasive auricular VNS (aVNS). MATERIALS AND METHODS Eighteen ten-day-old male rats were gavaged with 0.1% iodoacetamide (IA) or 2% sucrose solution for six days. After eight weeks, IA-treated rats were implanted with electrodes for VNS or aVNS (n = 6 per group). Different parameters, varying in frequency and stimulation duty cycle, were tested to find the best parameter based on the improvement of VH assessed by electromyogram (EMG) during gastric distension. RESULTS Compared with sucrose-treated rats, visceral sensitivity was increased significantly in IA-treated "FD" rats and ameliorated remarkably by VNS (at 40, 60, and 80 mm Hg; p ≤ 0.02, respectively) and aVNS (at 60 and 80 mm Hg; p ≤ 0.05, respectively) with the parameter of 100 Hz and 20% duty cycle. There was no significant difference in area under the curve of EMG responses between VNS and aVNS (at 60 and 80 mm Hg, both p > 0.05). Spectral analysis of heart rate variability revealed a significant enhancement in vagal efferent activity while applying VNS/aVNS compared with sham stimulation (p < 0.01). In the presence of atropine, no significant differences were noted in EMG after VNS/aVNS. Naloxone blocked the analgesic effects of VNS/aVNS. CONCLUSIONS VNS/aVNS with optimized parameter elicits ameliorative effects on VH, mediated by autonomic and opioid mechanisms. aVNS is as effective as direct VNS and has great potential for treating visceral pain in patients with FD.
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Affiliation(s)
- Yu Guo
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Payam Gharibani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Division of Neuroimmunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Santucci NR, Beigarten AJ, Khalid F, El-Chammas KI, Graham K, Sahay R, Fei L, Rich K, Mellon M. Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia-Integrating a Behavioral Intervention. Neuromodulation 2024; 27:372-381. [PMID: 37589640 PMCID: PMC10869640 DOI: 10.1016/j.neurom.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Functional dyspepsia (FD) includes postprandial distress and epigastric pain syndrome. Percutaneous electrical nerve field stimulation (PENFS) in addition to behavioral interventions (BI) has shown benefits in children with functional abdominal pain but not specifically in FD. We aimed to assess the efficacy of PENFS for treating FD and compare the outcomes with those who received the combination of PENFS + BI. MATERIALS AND METHODS Charts of patients with FD who completed four weeks of PENFS were evaluated. A subset of patients received concurrent BI. Demographic data, medical history, and symptoms were documented. Outcomes at different time points included subjective symptom responses and validated questionnaires collected clinically (Abdominal Pain Index [API], Nausea Severity Scale [NSS], Functional Disability Inventory [FDI], Pittsburgh Sleep Quality Index [PSQI], Children's Somatic Symptoms Inventory [CSSI], Patient-Reported Outcomes Measurement Information Systems [PROMIS] Pediatric Anxiety and Depression scales). RESULT Of 84 patients, 61% received PENFS + BI, and 39% received PENFS alone. In the entire cohort, API (p < 0.0001), NSS (p = 0.001), FDI (p = 0.001), CSSI (p < 0.0001), PSQI (p = 0.01), PROMIS anxiety (p = 0.02), and depression (p = 0.01) scores improved from baseline to three weeks and at three months. Subjective responses showed nausea improvement (p = 0.01) and a trend for improvement in abdominal pain (p = 0.07) at week three. Abdominal pain subjectively improved at week three and three months (p = 0.003 and 0.02, respectively), nausea at week three and three months (p = 0.01 and 0.04, respectively), and a trend for improvement in sleep disturbances at week three and three months (p = 0.08 and p = 0.07, respectively) in the PENFS + BI group vs PENFS alone. CONCLUSION Abdominal pain, nausea, functioning, somatization, sleep disturbances, anxiety, and depression improved at three weeks and three months after PENFS in pediatric FD. Subjective pain and nausea improvement were greater in the PENFS + BI group than in the group with PENFS alone, suggesting an additive effect of psychologic therapy.
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Affiliation(s)
- Neha R Santucci
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Alan J Beigarten
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Fatima Khalid
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Khalil I El-Chammas
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Kahleb Graham
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Rashmi Sahay
- Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lin Fei
- Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristin Rich
- Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael Mellon
- Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Zhou JZ, Chen H, Xu WL, Fu Z, Zhou S, Zhu WJ, Zhang ZH. Auricular Vagal Nerve Stimulation Inhibited Central Nerve Growth Factor/Tropomyosin Receptor Kinase A/Phospholipase C-Gamma Signaling Pathway in Functional Dyspepsia Model Rats With Gastric Hypersensitivity. Neuromodulation 2024; 27:273-283. [PMID: 36801128 DOI: 10.1016/j.neurom.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Functional dyspepsia (FD), which has a complicated pathophysiologic process, is a common functional gastrointestinal disease. Gastric hypersensitivity is the key pathophysiological factor in patients with FD with chronic visceral pain. Auricular vagal nerve stimulation (AVNS) has the therapeutic effect of reducing gastric hypersensitivity by regulating the activity of the vagus nerve. However, the potential molecular mechanism is still unclear. Therefore, we investigated the effects of AVNS on the brain-gut axis through the central nerve growth factor (NGF)/ tropomyosin receptor kinase A (TrkA)/phospholipase C-gamma (PLC-γ) signaling pathway in FD model rats with gastric hypersensitivity. MATERIALS AND METHODS We established the FD model rats with gastric hypersensitivity by means of colon administration of trinitrobenzenesulfonic acid on ten-day-old rat pups, whereas the control rats were given normal saline. AVNS, sham AVNS, K252a (an inhibitor of TrkA, intraperitoneally), and K252a + AVNS were performed on eight-week-old model rats for five consecutive days. The therapeutic effect of AVNS on gastric hypersensitivity was determined by the measurement of abdominal withdrawal reflex response to gastric distention. NGF in gastric fundus and NGF, TrkA, PLC-γ, and transient receptor potential vanilloid 1 (TRPV1) in the nucleus tractus solitaries (NTS) were detected separately by polymerase chain reaction, Western blot, and immunofluorescence tests. RESULTS It was found that a high level of NGF in gastric fundus and an upregulation of the NGF/TrkA/PLC-γ signaling pathway in NTS were manifested in model rats. Meanwhile, both AVNS treatment and the administration of K252a not only decreased NGF messenger ribonucleic acid (mRNA) and protein expressions in gastric fundus but also reduced the mRNA expressions of NGF, TrkA, PLC-γ, and TRPV1 and inhibited the protein levels and hyperactive phosphorylation of TrkA/PLC-γ in NTS. In addition, the expressions of NGF and TrkA proteins in NTS were decreased significantly after the immunofluorescence assay. The K252a + AVNS treatment exerted a more sensitive effect on regulating the molecular expressions of the signal pathway than did the K252a treatment. CONCLUSION AVNS can regulate the brain-gut axis effectively through the central NGF/TrkA/PLC-γ signaling pathway in the NTS, which suggests a potential molecular mechanism of AVNS in ameliorating visceral hypersensitivity in FD model rats.
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Affiliation(s)
- Jing-Zhu Zhou
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
| | - Huan Chen
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wan-Li Xu
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhe Fu
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shuai Zhou
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wei-Jian Zhu
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhao-Hui Zhang
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Shah ED. Concise Commentary: Red Mucosa Is Not Enough-Another Approach to Treating Dyspeptic Symptoms. Dig Dis Sci 2024; 69:320-321. [PMID: 38091177 PMCID: PMC10923084 DOI: 10.1007/s10620-023-08171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Eric D Shah
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E Medical Center Drive, 3912 Taubman Center SPC 5362, Ann Arbor, MI, 48109, USA.
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Zhang Q, Li G, Zhao W, Wang X, He J, Zhou L, Zhang X, An P, Liu Y, Zhang C, Zhang Y, Liu S, Zhao L, Liu R, Li Y, Jiang W, Wang X, Wang Q, Fang B, Zhao Y, Ren Y, Niu X, Li D, Shi S, Hung WL, Wang R, Liu X, Ren F. Efficacy of Bifidobacterium animalis subsp. lactis BL-99 in the treatment of functional dyspepsia: a randomized placebo-controlled clinical trial. Nat Commun 2024; 15:227. [PMID: 38172093 PMCID: PMC10764899 DOI: 10.1038/s41467-023-44292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Current treatment for functional dyspepsia (FD) has limited and unsustainable efficacy. Probiotics have the sustainable potential to alleviate FD. This randomized controlled clinical trial (Chinese Clinical Trial Registry, ChiCTR2000041430) assigned 200 FD patients to receive placebo, positive-drug (rabeprazole), or Bifidobacterium animalis subsp. lactis BL-99 (BL-99; low, high doses) for 8-week. The primary outcome was the clinical response rate (CRR) of FD score after 8-week treatment. The secondary outcomes were CRR of FD score at other periods, and PDS, EPS, serum indicators, fecal microbiota and metabolites. The CRR in FD score for the BL-99_high group [45 (90.0%)] was significantly higher than that for placebo [29 (58.0%), p = 0.001], BL-99_low [37 (74.0%), p = 0.044] and positive_control [35 (70.0%), p = 0.017] groups after 8-week treatment. This effect was sustained until 2-week after treatment but disappeared 8-week after treatment. Further metagenomic and metabolomics revealed that BL-99 promoted the accumulation of SCFA-producing microbiota and the increase of SCFA levels in stool and serum, which may account for the increase of serum gastrin level. This study supports the potential use of BL-99 for the treatment of FD.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Guang Li
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen Zhao
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Xifan Wang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Jingjing He
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Limian Zhou
- School of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Xiaoxu Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
| | - Peng An
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Yinghua Liu
- Department of Nutrition, Chinese PLA General Hospital, Beijing, China
| | - Chengying Zhang
- Department of General Practice, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong Zhang
- Department of Nutrition, Chinese PLA General Hospital, Beijing, China
| | - Simin Liu
- Center for Global Cardiometabolic Health, Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI, USA
| | - Liang Zhao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
| | - Rong Liu
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Yixuan Li
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Wenjian Jiang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Wang
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Qingyu Wang
- Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Bing Fang
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Yuyang Zhao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
| | - Yimei Ren
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
| | - Xiaokang Niu
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Dongjie Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoqi Shi
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Wei-Lian Hung
- National Center of Technology Innovation for Dairy, Inner Mongolia Dairy Technology Research Institute Co. Ltd., Hohhot, China.
| | - Ran Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.
| | - Xinjuan Liu
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Fazheng Ren
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, Department of Nutrition and Health, China Agricultural University, Beijing, China.
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Cangemi DJ, Montenegro M, Spiegel BMR, Lacy ABE. Virtual Reality Improves Symptoms of Functional Dyspepsia: Results of a Randomized, Double-Blind, Sham-Controlled, Pilot Study. Am J Gastroenterol 2024; 119:210-213. [PMID: 37655713 DOI: 10.14309/ajg.0000000000002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION We investigated the efficacy and safety of virtual reality (VR) for functional dyspepsia. METHODS Patients were randomized 2:1 between active vs sham VR. Symptoms were assessed using the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) over 2-week. RESULTS Patients in the active VR group had greater numerical improvement in PAGI-SYM scores (mean difference -0.7; P < 0.001) compared with sham VR (mean difference -0.4; P = 0.032). Active VR led to significant improvements for all PAGI-SYM subscales, except lower abdominal pain, whereas sham only improved heartburn/regurgitation and nausea/vomiting. Half of the total patients reported nonserious adverse effects, although only 1 patient withdrew from the study because of adverse effects. DISCUSSION VR is safe and results in significant symptom improvement in functional dyspepsia. Larger trials are warranted.
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Affiliation(s)
- David J Cangemi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Marilia Montenegro
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Brennan M R Spiegel
- Division of Health Sciences Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California, USA
| | - And Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Zhang S, Liu Y, Li S, Ye F, Yin J. Autonomic and cytokine mechanisms of acute electroacupuncture in a rodent model of functional dyspepsia. Neurogastroenterol Motil 2024; 36:e14702. [PMID: 37983919 DOI: 10.1111/nmo.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Cytokines have been presumed to play an important role in the pathophysiology of functional dyspepsia (FD). Electroacupuncture (EA) has been used for FD treatment; however, its mechanisms remain largely unknown. This study aimed to (1) compare the plasma levels of cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10, in "FD" rats with normal control rats; (2) investigate whether EA, using chronically implanted electrodes, could inhibit the release of these cytokines; and (3) explore the correlation of cytokine levels with plasma norepinephrine (NE) levels and gastric emptying (GE). METHODS A rodent model of FD was established via neonatal treatment with intragastric iodoacetamide. After 8 weeks, the rats were implanted with electrodes at acupoint ST36 for EA. The plasma levels of cytokines and NE were measured using enzyme-linked immunosorbent assay. We explored the correlations of cytokine levels with NE levels and GE. KEY RESULTS (i) "FD" rats demonstrated increased levels of TNF-α, IL-1β, and IL-6 (p < 0.05 each) compared with the control rats. (ii) EA significantly decreased the plasma levels of TNF-α, IL-1β, and IL-6 in "FD" rats (p < 0.05 each) compared with sham EA. (iii) The plasma levels of NE were positively correlated with those of IL-6 (r = 0.86, p < 0.05) and IL-1β (r = 0.81, p < 0.05), whereas NE levels and GE were negatively correlated with IL-10 levels (r = -0.870, p < 0.05 and r = -0.791, p < 0.05, respectively). CONCLUSIONS EA inhibits the release of proinflammatory cytokines probably via the suppression of sympathetic activity in "FD" rats.
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Affiliation(s)
- Sujuan Zhang
- Department of Gastroenterology, No. 983 Hospital of Chinese People's Liberation Army, Tianjin, China
| | - Yi Liu
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shiying Li
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Feng Ye
- Department of Hepatology, First Affiliated Hospital of Xi'an Jiao tong University, Xi'an, China
| | - Jieyun Yin
- Transtimulation Research Inc., Houston, Texas, USA
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Xiao Y, Zhou JY, Yin HZ, Liu Q, Luo R, Liu WA, DU GS, Zhong H, Liu M. Effect of electroacupuncture at "Neiguan" (PC 6) and "Zusanli" (ST 36) on gastrointestinal hormone in the antral tissue of rats with functional dyspepsia. Zhongguo Zhen Jiu 2023; 43:1435-1440. [PMID: 38092545 DOI: 10.13703/j.0255-2930.20230809-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVES To observe the effects of electroacupuncture (EA) at "Neiguan" (PC 6) and "Zusanli"(ST 36) on the gastric emptying rate, the level of serotonin (5-HT) and the protein expression of motilin (MTL), ghrelin, substance P (SP) and vasoactive intestinal peptide (VIP) in the antral tissue of the rats with functional dyspepsia (FD) and explore the effect mechanism of EA in treatment of FD. METHODS A total of 21 SPF male SD rat pups were randomly divided into a normal group, a model group and an EA group, with 7 rats in each group. In the model group and the EA group, FD model was prepared by the gavage with 0.1% sucrose iodoacetamide solution combined with the modified small platform method. After the successful modeling, EA was applied to "Neiguan" (PC 6) and "Zusanli"(ST 36) in the rats of the EA group, with disperse-dense wave, 20 Hz/100 Hz in frequency, stimulated for 30 min, once daily, for 7 days consecutively. Before and after intervention, the general condition of the rats was observed in each group. After the completion of intervention, the gastric emptying rate was measured, the morphological changes of gastric antral tissue were observed using HE staining, the level of 5-HT was detected with ELISA method, and the protein expression of MTL, ghrelin, SP, and VIP was determined with Western blot method in the antral tissue of rats. RESULTS In the normal group, the rats were in a good mental state, with lustrous fur, flexible movement and the increase of food intake and body mass. In the model group, the rats were poor in mental state, lack of lustre in fur, preference for the body curled up, reduced activity and response; and a part of rats had loose stool, obviously enlarged gastric body and gastric food retention. In the EA group, the general condition of rats, e.g. the mental state, food intake and activity, were improved, the gastric body got smaller obviously and the gastric food retention was reduced when compared with the model group. The antral structure was intact, the glands were rich and no injury of the gastric mucosa was found, e.g. inflammatory reaction and edema in the rats of each group. Compared with the normal group, the gastric emptying rate was decreased (P<0.01), 5-HT level was increased (P<0.01), the protein expression of MTL and ghrelin was reduced (P<0.01) and that of VIP was elevated (P<0.01) in the rats of the model group. The gastric emptying rate was increased (P<0.01), 5-HT level was decreased (P<0.01), and the protein expression of MTL and ghrelin was elevated (P<0.05, P<0.01) in the rats of the EA group when compared with those in the model group. CONCLUSIONS Electroacupuncture at "Neiguan" (PC 6) and "Zusanli"(ST 36) may effectively relieve gastric dysfunction, strengthen gastric motility and promote gastric emptying so as to alleviate the symptoms of dyspepsia in FD rats, and its mechanism may be related to the regulation of gastrointestinal hormones in the antral tissue.
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Affiliation(s)
- Yi Xiao
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China.
| | - Jing-Ying Zhou
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China
| | - Hong-Zhi Yin
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China
| | - Qian Liu
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China
| | - Rong Luo
- Department of Acupuncture-Moxibustion, Tuina and Rehabilitation,First Affiliated Hospital of Hunan University of CM
| | - Wei-Ai Liu
- Department of Acupuncture-Moxibustion, Tuina and Rehabilitation, Second Affiliated Hospital of Hunan University of CM
| | - Ge-Shu DU
- Department of Acupuncture-Moxibustion and Rehabilitation, Changsha Hospital of TCM
| | - Huan Zhong
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China
| | - Mi Liu
- College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of CM, Changsha 410208, China.
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Wang D, Zhang J, Yang D, Wang J, Li J, Han Y, Kang Z, Zhang H. Electroacupuncture restores intestinal mucosal barrier through TLR4/NF-κB p65 pathway in functional dyspepsia-like rats. Anat Rec (Hoboken) 2023; 306:2927-2938. [PMID: 34713984 DOI: 10.1002/ar.24800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
Functional dyspepsia (FD) is a common functional gastrointestinal disorder with high morbidity. Electroacupuncture (EA) has been applied to treat FD for a long time. The aim of this study was to investigate the effects of EA and its mechanism about intestinal mucosal barrier in rodent model of FD. Male Sprague-Dawley rats were randomly divided into the control group and the model group. Then, the rats in model group were established to the FD model by multifactor interventions. In Experiment 1, qualified FD-like rats were randomly divided into three groups: FD, EA, and acupuncture (AP) groups. The interventions of EA and AP lasted 14 days, food intake, and body weight were recorded every 5 days. In Experiment 2, qualified FD-like rats were randomly divided into five groups: FD, EA, AP, EA + TAK242, and TAK242 groups. The interventions of EA and AP lasted 14 days, while TAK242 injection continued for 6 days. The rats were sacrificed for the measurement of serum Interleukin- 6 (IL-6) and Tumor necrosis factor-α (TNF-α) assayed by ELISA. Western blotting was used to assess the expression of TLR4, Myd88, NF-κB p65, p-NF-κB p65, TRAF6, ZO-1, and occludin in the duodenum. The transmission electron microscope was used to observe the ultrastructure of intestinal epithelial cells. Compared with the rats in the group FD, the rats in EA group had significantly increase of body weight, food intake, and protein expressions of ZO-1 and occludin, while expressions of TLR4, Myd88, NF-κB p65, p-NF-κB p65, TRAF6 in the duodenum and IL-6, and TNF-α in serum were decreased. The EA + TAK242 treatment had similar effects to the EA treatment but with increased potency; compared with EA, AP showed similar but reduced effects. Our data demonstrated that EA is more effective than AP in improving intestine mucosal barrier. The possible mechanisms of EA may involve the TLR4/NF-κB p65 pathway.
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Affiliation(s)
- Dan Wang
- Chongqing Medical University, College of Traditional Chinese Medicine, Chongqing, China
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Daye Yang
- Hubei University of Chinese Medicine, Wuhan, China
| | - Junying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jia Li
- Hubei University of Chinese Medicine, Wuhan, China
| | - Yongli Han
- Hubei University of Chinese Medicine, Wuhan, China
| | - Zhaoxia Kang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
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15
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Yu H, Deng H, Zhou W, Liang Z. Effects of electroacupuncture combined with acupoint catgut embedding on gastrointestinal motility and gastrointestinal hormones in rats with functional dyspepsia. CHINESE J PHYSIOL 2023; 66:526-533. [PMID: 38149565 DOI: 10.4103/cjop.cjop-d-23-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Electroacupuncture (EA) or acupoint catgut embedding (ACE) plays a therapeutic role in functional dyspepsia (FD). Herein, we aimed to elucidate the influences of EA combined with ACE on gastrointestinal motility and gastrointestinal hormones in rats with FD. Sprague-Dawley rats were randomized into the control group, model group, EA group, ACE group, and EA + ACE group (n = 10). Except for the control group, the rats in all groups were modeled by combining neonatal iodoacetamide gastrogavage and modified tail-clamping stimulation. The rats were treated with different treatments according to their groups. The rats were observed for changes in general behavior, body weight, food intake, and paw mechanical pain threshold. Gastric emptying rate (GER) and intestinal propulsive ratio (IPR) were measured in each group, and serum gastrointestinal hormone (motilin [MTL], leptin, gastrin [GAS], vasoactive intestinal peptide [VIP], calcitonin gene-related peptide [CGRP], and somatostatin [SS]) levels, oxidative stress factors (superoxide dismutase [SOD] and malondialdehyde [MDA]) and 5-hydroxytryptamine (5-HT) levels were also measured. Decreased mean body weight, paw mechanical pain thresholds, food intake, and GER and IPR were found in rats of the model group in comparison to the control group. Serum MTL, GAS, SS, and SOD levels were reduced, and serum leptin, VIP, CGRP, MDA, and 5-HT levels were increased in rats of the model group in comparison to the control group. Elevated mean body weight, paw mechanical pain threshold, food intake, GER and IPR, and serum MTL, GAS, SS, and SOD levels, and reduced serum leptin, VIP, CGRP, MDA, and 5-HT levels were observed in rats of the EA, ACE, and EA + ACE groups relative to the model group. EA combined with ACE treatment was more effective than the EA or ACE treatment alone. EA combined with ACE treatment improves gastrointestinal motility and gastrointestinal hormone levels, promotes food intake, and reduces visceral hypersensitivity in FD rats.
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Affiliation(s)
- Hui Yu
- Department of Geriatrics, Changsha Third Hospital, Changsha, Hunan, China
| | - Huiqian Deng
- Department of Geriatrics, Changsha Third Hospital, Changsha, Hunan, China
| | - Wei Zhou
- Department of Geriatrics, Changsha Third Hospital, Changsha, Hunan, China
| | - Zhenling Liang
- Department of General Practice, Changsha Third Hospital, Changsha, Hunan, China
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16
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Yin T, Qu Y, Mao Y, Zhang P, Ma P, He Z, Sun R, Lu J, Chen Y, Yin S, Gong Q, Tang Y, Liang F, Zeng F. Clinical-functional brain connectivity signature predicts longitudinal symptom improvement after acupuncture treatment in patients with functional dyspepsia. Hum Brain Mapp 2023; 44:5416-5428. [PMID: 37584456 PMCID: PMC10543106 DOI: 10.1002/hbm.26449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
Whilst acupuncture has been shown to be an effective treatment for functional dyspepsia (FD), its efficacy varies significantly among patients. Knowing beforehand how each patient responds to acupuncture treatment will facilitate the ability to produce personalized prescriptions, therefore, improving acupuncture efficacy. The objective of this study was to construct the prediction model, based on the clinical-neuroimaging signature, to forecast the individual symptom improvement of FD patients following a 4-week acupuncture treatment and to identify the critical predictive features that could potentially serve as biomarkers for predicting the efficacy of acupuncture for FD. Clinical-functional brain connectivity signatures were extracted from samples in the training-test set (100 FD patients) and independent validation set (60 FD patients). Based on these signatures and support vector machine algorithms, prediction models were developed in the training test set, followed by model performance evaluation and predictive features extraction. Subsequently, the external robustness of the extracted predictive features in predicting acupuncture efficacy was evaluated by the independent validation set. The developed prediction models possessed an accuracy of 88% in predicting acupuncture responders, as well as an R2 of 0.453 in forecasting symptom relief. Factors that contributed significantly to stronger responsiveness of patients to acupuncture therapy included higher resting-state functional connectivity associated with the orbitofrontal gyrus, caudate, hippocampus, and anterior insula, as well as higher baseline scores of the Symptom Index of Dyspepsia and shorter durations of the condition. Furthermore, the robustness of these features in predicting the efficacy of acupuncture for FD was verified through various machine learning algorithms and independent samples and remained stable in univariate and multivariate analyses. These findings suggest that it is both feasible and reliable to predict the efficacy of acupuncture for FD based on the pre-treatment clinical-neuroimaging signature. The established prediction framework will promote the identification of suitable candidates for acupuncture treatment, thereby improving the efficacy and reducing the cost of acupuncture for FD.
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Affiliation(s)
- Tao Yin
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Key Laboratory of Sichuan Province for Acupuncture and ChronobiologyChengduSichuanChina
| | - Yuzhu Qu
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Yangke Mao
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Pan Zhang
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Peihong Ma
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
- School of Acupuncture‐Moxibustion and TuinaBeijing University of Chinese MedicineBeijingChina
| | - Zhaoxuan He
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Key Laboratory of Sichuan Province for Acupuncture and ChronobiologyChengduSichuanChina
| | - Ruirui Sun
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Jin Lu
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Yuan Chen
- International Education CollegeChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Shuai Yin
- First Affiliated HospitalHenan University of Traditional Chinese MedicineZhengzhouHenanChina
| | - Qiyong Gong
- Departments of RadiologyHuaxi Magnetic Resonance Research Center (HMRRC), West China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yong Tang
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Key Laboratory of Sichuan Province for Acupuncture and ChronobiologyChengduSichuanChina
| | - Fanrong Liang
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Fang Zeng
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Acupuncture and Brain Science Research CenterChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Key Laboratory of Sichuan Province for Acupuncture and ChronobiologyChengduSichuanChina
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Burton Murray H, Ljótsson B, Healy B, Van Oudenhove L, Williams JS, Keefer L, Lawson EA, Kuo B, Thomas JJ. Brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of functional dyspepsia: Study protocol for a feasibility randomized controlled trial. Contemp Clin Trials 2023; 134:107336. [PMID: 37722485 DOI: 10.1016/j.cct.2023.107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with functional dyspepsia (FD), a disorder of gut-brain interaction characterized by early satiation, post-prandial fullness, epigastric pain, and/or epigastric burning. Using an 8-session exposure-based cognitive-behavioral treatment (CBT) for adults with FD + ARFID compared to usual care (UC) alone, we aim to: (1) determine feasibility, (2) evaluate change in clinical outcomes in, and (3) explore possible mechanisms of action. METHODS We will randomize adults with FD who meet criteria for ARFID with ≥5% weight loss (N = 50) in a 1:1 ratio to CBT (with continued UC) or to UC alone. A priori primary benchmarks will be: ≥75% eligible participants enroll; ≥75% participants complete assessments; ≥70% participants attend 6/8 sessions; ≥70% of sessions have all content delivered; ≥70% participants rate Client Satisfaction Questionnaire scores above scale midpoint. We will also examine the size of changes in FD symptom severity and related quality of life within and between groups, and explore possible mechanisms of action. CONCLUSIONS Findings from this trial will inform next steps with treatment development or evaluation-either for further refinement or for next-step efficacy testing with a fully-powered clinical trial.
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Affiliation(s)
- Helen Burton Murray
- Harvard Medical School, Boston, MA, USA; Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brian Healy
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium; Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Jonathan S Williams
- Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | - Laurie Keefer
- Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Elizabeth A Lawson
- Harvard Medical School, Boston, MA, USA; Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Braden Kuo
- Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer J Thomas
- Harvard Medical School, Boston, MA, USA; Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA, USA; Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
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18
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Ford AC, Howden CW. Relative Cost-effectiveness of Management Strategies for Uninvestigated Dyspepsia. Clin Gastroenterol Hepatol 2023; 21:2986-2987. [PMID: 36806626 DOI: 10.1016/j.cgh.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; and, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Colin W Howden
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee
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Voirol-Perrin J, Stamm GM, Salvador Nunes L, Schoepfer A. [Functional dyspepsia : update 2023]. Rev Med Suisse 2023; 19:1554-1557. [PMID: 37650593 DOI: 10.53738/revmed.2023.19.839.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Functional dyspepsia is defined by epigastric pain/burning, postprandial fullness and/or early satiety that have been present for at least six months before diagnosis, including three consecutive months, without evidence of an organic cause likely to explain these symptoms. The pathogenesis is complex and incompletely understood. The initial assessment includes a thorough history, physical examination, blood work, celiac disease serology and ruling out Helicobacter pylori infection. Most patients will undergo upper gastrointestinal endoscopy and abdominal ultrasound to exclude organic differential diagnoses. The therapy is multi-facetted and includes, among others, proton pump inhibitors, Helicobacter pylori eradication, herbal agents, and neuromodulators.
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Affiliation(s)
- Julia Voirol-Perrin
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Gian-Marco Stamm
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Luis Salvador Nunes
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Alain Schoepfer
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Oshima T. Functional Dyspepsia: Current Understanding and Future Perspective. Digestion 2023; 105:26-33. [PMID: 37598673 DOI: 10.1159/000532082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a common disorder characterized by chronic or recurrent upper abdominal pain or discomfort without any structural abnormalities in the gastrointestinal tract. FD is categorized into two subgroups based on symptoms: postprandial distress syndrome (PDS) and epigastric pain syndrome. SUMMARY The pathophysiology of FD involves several mechanisms. Delayed gastric emptying is observed in approximately 30% of FD patients but does not correlate with symptom patterns or severity. Impaired gastric accommodation is important in the pathophysiology, particularly for PDS. Visceral hypersensitivity, characterized by heightened sensitivity to normal activities, contributes to the perception of discomfort or pain in FD. Alterations to the duodenal mucosa, including impaired mucosal barrier function and low-grade inflammation, are also implicated in the pathogenesis of FD. Microbial dysbiosis and psychological factors such as stress can further exacerbate symptoms. Treatment options include dietary modifications, establishing a physician-patient relationship, acid suppressants, prokinetics, neuromodulators, and behavioral therapies. Dietary recommendations include eating smaller, more frequent meals, and avoiding trigger foods. Acid suppressants are used as the first-line treatment. Prokinetics and neuromodulators aim to improve gastric motility and central pain processing, respectively. Behavioral therapies, including cognitive behavioral therapy and hypnotherapy, have shown benefits for refractory FD. Severe and refractory cases may require combination therapies or experimental treatments. KEY MESSAGES FD is a disorder of gut-brain interaction involving diverse pathophysiological mechanisms. Individualized treatment based on symptoms and responses to interventions is crucial. Further research is needed to improve the understanding of FD and advance the development of effective therapies.
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Affiliation(s)
- Tadayuki Oshima
- Department of Gastroenterology, Okazaki City Medical Association Public Health Center, Okazaki, Japan
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Ebell MH. British Society of Gastroenterology Guidelines for the Evaluation and Management of Dyspepsia. Am Fam Physician 2023; 108:Online. [PMID: 37440724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
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Rossi RE, Elvevi A, Sciola V, Mandarino FV, Danese S, Invernizzi P, Massironi S. Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis: Insights into mechanisms, pathophysiology, and treatment options. World J Gastroenterol 2023; 29:3733-3747. [PMID: 37398891 PMCID: PMC10311608 DOI: 10.3748/wjg.v29.i23.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/23/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Autoimmune gastritis (AIG) is a progressive, chronic, immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic factor. Gastrointestinal symptoms such as dyspepsia and early satiety are very common, being second in terms of frequency only to anemia, which is the most typical feature of AIG.
AIM To address both well-established and more innovative information and knowledge about this challenging disorder.
METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature (retrospective and prospective studies, systematic reviews, case series) published in the last 10 years.
RESULTS A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.
CONCLUSION AIG can cause a range of clinical manifestations, including dyspepsia. The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion, gastric motility, hormone signaling, and gut microbiota, among other factors. Managing dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in AIG. While proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease, they may not be appropriate for AIG. Prokinetic agents, antidepressant drugs, and non-pharmacological treatments may be of help, even if not adequately evidence-based supported. A multidisciplinary approach for the management of dyspepsia in AIG is recommended, and further research is needed to develop and validate more effective therapies for dyspepsia.
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Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
| | - Alessandra Elvevi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Valentina Sciola
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano 20100, Italy
| | | | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan 20132, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
| | - Pietro Invernizzi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Sara Massironi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
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Chen X, Chen X, Chen B, Du L, Wang Y, Huang Z, Dai N, Chen JDZ, Cao Q. Electroacupuncture Enhances Gastric Accommodation via the Autonomic and Cytokine Mechanisms in Functional Dyspepsia. Dig Dis Sci 2023; 68:98-105. [PMID: 35503488 DOI: 10.1007/s10620-022-07495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to complex pathophysiology of functional dyspepsia, medications to treat functional dyspepsia are not effective for all patients. Transcutaneous electrical acustimulation (TEA) is an potentially effective therapy for functional dyspepsia without proofs of definite mechanisms. AIMS We aimed to investigate the therapeutic impacts of TEA on postprandial distress syndrome (PDS) and explore potential neuroimmune mechanisms. METHODS We conducted a double-blinded, randomized, controlled trial in 30 PDS patients randomized for 4-week TEA or sham-TEA. Dyspeptic symptoms, gastric accommodation, gastric emptying and heart rate variability (HRV) were assessed. Duodenal mucosal inflammation was also evaluated. RESULTS The dyspeptic symptoms were improved with TEA compared with sham-TEA (P = 0.03). The initial satiety volume and the maximum tolerable volume (MTV) were both improved after the TEA treatment, compared with the sham-TEA group (P all < 0.05). The gastric emptying time (T1/2) was not altered with TEA or sham-TEA. The TEA treatment increased vagal activity and decreased sympathovagal ratio assessed by HRV (P all < 0.01). The IL-6 expression in bulb mucosa was downregulated by the TEA treatment compared to the baseline (P < 0.05). CONCLUSIONS Noninvasive TEA improves gastric accommodation and dyspeptic symptoms, possibly by downregulating the IL-6 expression in duodenal bulb mucosa via the vagal efferent pathway.
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Affiliation(s)
- Xiaoli Chen
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Binrui Chen
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lijun Du
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Wang
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhihui Huang
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Dai
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Qian Cao
- Division of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Taclob JA, Lee BJ, Ortega AJ, Sarosiek I, McCallum RW. Gastric Electrical Stimulation as a New Treatment Modality for Refractory Nausea and Vomiting with Normal Gastric Emptying. J Investig Med High Impact Case Rep 2023; 11:23247096231201214. [PMID: 37731269 PMCID: PMC10515512 DOI: 10.1177/23247096231201214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/22/2023] Open
Abstract
Nausea and vomiting are cardinal symptoms affecting many patients with delayed or normal gastric emptying. The current therapies are very limited and less than optimal. Therefore, gastrointestinal symptoms persist despite using all the standard approaches for gastroparesis, functional dyspepsia, or unexplained nausea and vomiting. It is well established that gastric electrical stimulation (GES) is effective in reducing nausea and vomiting in gastroparesis, but there are essentially no data available that detail the efficacy of GES in symptomatic patients without gastroparesis. We present a unique case of a female patient diagnosed with functional dyspepsia, whose nausea and vomiting which were refractory to all standard therapies were successfully addressed with the implantation of a GES system.
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Affiliation(s)
| | - Brian J. Lee
- Texas Tech University Health Sciences Center El Paso, TX, USA
| | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center El Paso, TX, USA
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Ali Ismail AM, Saad AE, Fouad Abd-Elrahman NA, Abdelhalim Elfahl AM. Effect of Benson's relaxation therapy alone or combined with aerobic exercise on cortisol, sleeping quality, estrogen, and severity of dyspeptic symptoms in perimenopausal women with functional dyspepsia. Eur Rev Med Pharmacol Sci 2022; 26:8342-8350. [PMID: 36459044 DOI: 10.26355/eurrev_202211_30367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Besides repeated stress exposure, a sedentary lifestyle and low estrogen levels are risk factors for the development of functional dyspepsia (FD). The aim of this study was to find out the effect of adding aerobic exercise (5 sessions per week) to the daily application of a 40-minute Benson's relaxation therapy (BRT) (diaphragmatic breathing and progressive muscle relaxation applied for 20 minutes in the morning and evening) on Glasgow dyspepsia severity score (GDSS), cortisol, visual analogue scale (VAS) (for abdominal symptoms), estradiol (one of the endogenous estrogens), Pittsburgh sleep quality index (PSQI), and 42-item depression, anxiety, and stress scales (DASS-42) in 60 perimenopausal women with FD. PATIENTS AND METHODS Women who consumed a daily dose of pantoprazole (40 mg tablet administered as a proton pump inhibitor drug) were randomly assigned to an 8-week study group (this group received aerobic exercise plus BRT, N=30) or an 8-week control group (this group received BRT only, N=30). RESULTS Significant improvements were reported in all measured variables within women groups (except estradiol of the control group). Compared to the control group, the reported within-group significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 were higher in the study group. CONCLUSIONS Significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 could be achieved after adding adjunctive therapies - aerobic exercise and BRT - to the medications of FD in perimenopausal women. Compared to BRT alone, physical exercise plus BRT significantly increases the levels of estradiol in perimenopausal women with FD.
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Affiliation(s)
- A M Ali Ismail
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
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Mbadu Mbuzi E, Weber IP, Humair JP, Gillabert C, Bastid C. [Dyspepsia: a more complex approach]. Rev Med Suisse 2022; 18:1784-1787. [PMID: 36170129 DOI: 10.53738/revmed.2022.18.797.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Dyspepsia is defined as epigastric pain that lasts at least one month and may be associated with a range of other upper gastrointestinal symptoms. Approximately 2/3 of outpatients with dyspepsia have a functional dyspepsia. The clinical assessment of dyspepsia is based on age of patients as well and the search for severity criteria. The endoscopy in cases of new-onset dyspepsia is recommended from an age of 55-60 and the presence of at least 1 severity criteria. A non-invasive test for Helicobacter pylori (HP) should be performed in all patients and followed by HP eradication when HP test is positive. The first-choice treatment of functional dyspepsia is a proton pump inhibitor (PPI) at maximal dose for 8 weeks. A therapeutic trial with a prokinetic or a central neuromodulator are alternatives to consider in case of failure of PPI treatment.
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Affiliation(s)
- Eminence Mbadu Mbuzi
- Service de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Irène Paola Weber
- Service de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jean-Paul Humair
- Service de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | | | - Caroline Bastid
- Service de gastroentérologie et hépatologie, Hôpitaux universitaires de Genève, 1211 Genève 14
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Peng T, Huang X, Zhu M, Hou X, Xiong Y, Fang X, Lin Z, Liu L, Lan W, Lin X. Effect of different acupuncture and moxibustion methods on functional dyspepsia caused by sequelae of COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30770. [PMID: 36197210 PMCID: PMC9508946 DOI: 10.1097/md.0000000000030770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a group of diseases that cannot be explained after routine clinical examination, and is characterized by postprandial fullness, early satiety, and upper abdominal pain or burning. According to the statistics, FD continues to become one of the high-risk sequelae of coronavirus disease 2019 (COVID-19), affecting patients' quality of life, increasing psychological burden and increasing economic costs. However, its optimal treatment is still an urgent problem. A large number of studies have shown that acupuncture and moxibustion is effective and safe in the treatment of FD caused by sequelae of COVID-19, which is of research value. Therefore, based on the current literatures, the effectiveness and safety of different acupuncture and moxibustion methods were systematically evaluated to provide possible alternative therapy on FD. METHODS Studies search for eligible randomized controlled trials that use different acupuncture and moxibustion methods as the sole treatment on FD and their data extraction will be done by 2 researchers. In case of disagreement, a third researcher will be introduced for arbitration. Mean difference or relative risk with fixed or random effect model in terms of 95% confidence interval will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I2 > 50%). RESULTS This meta-analysis will provide an authentic synthesis of different acupuncture and moxibustion methods on FD caused by sequelae of COVID-19. CONCLUSION This meta-analysis will evaluate the effect of acupuncture and moxibustion on FD caused by sequelae of COVID-19, providing evidence as to the treatment in these patients.
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Affiliation(s)
- Tianzhong Peng
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
| | - Xuedi Huang
- Jiangxi Province Hospital of Integrated Chinese Western Medicine, Jiangxi, China
| | - Manhua Zhu
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
| | - Xinju Hou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
| | - Yue Xiong
- Jiangxi Province Hospital of Integrated Chinese Western Medicine, Jiangxi, China
| | - Xinyue Fang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zitong Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wanning Lan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingzhen Lin
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
- *Correspondence: Xingzhen Lin, Nanchang Hongdu Hospital of Traditional China Medicine, No. 1399, Diezihu Avenue, Honggutan District, Nanchang, Jiangxi, China (e-mail: )
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Subspecialty Group of Gastroenterology, the Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Gastroenterology, China Association of Traditional Chinese Medicine Children′s Health and Drug Research Professional Committee, Editorial Board, Chinese Journal of Pediatrics. [Expert consensus on diagnosis and treatment of functional dyspepsia in Chinese children (2022)]. Zhonghua Er Ke Za Zhi 2022; 60:751-5. [PMID: 35922183 DOI: 10.3760/cma.j.cn112140-20220417-00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Dong JZ, Rong PJ, Ma TM, Wang D, Wang XT, Qiao Y. [Influence of electroacupuncture of"Zusanli"(ST36)on mast cells/TRPV1 signaling pathway in visceral hypersensitivity rats with functional dyspepsia]. Zhen Ci Yan Jiu 2022; 47:592-597. [PMID: 35880275 DOI: 10.13702/j.1000-0607.20210937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the interventional mechanism of electroacupuncture (EA) of "Zusanli"(ST36)based on the involvement of mast cells/ transient receptor potential vanilloid type1 (TRPV1) signaling pathway in relieving visceral hypersensitivity in functional dyspepsia (FD) rats. METHODS Sixty SD rats (half male and half female, 10 days in age) were randomly divided into normal control, model, medication (ketotifen) and EA groups, with 15 rats in each group. The FD model was established by gavage of iodoacetamide combined with tail clamping (stress stimulation). Rats of the medication group received intraperitoneal injection of ketotifen (1 mg·kg-1·d-1) for 14 d, and those of the EA group received EA of ST36 for 20 min, once a day for 14 d. An air-balloon was inserted into the rat's stomach for recording changes of the intragastric pressure (mL/mm Hg) via a pressure transducer. The visceral hypersensitivity was assessed using abdominal withdrawal reflex (AWR) score and the number and degranulation of mast cells of gastric mucosa were observed using toluidine blue staining. The expression levels of TRPV1 and proteinase activated receptor 2 (PAR2) in the stomach were observed using immunofluorescence histochemistry and Western blot, separately, and the contents of SP and CGRP in the stomach detected using ELISA. RESULTS When the intragastric pressure was at 50, 60 and 70 mm Hg, the gastric compliance was significantly decreased (P<0.01), and the levels of visceral sensitivity increased in the model group (P<0.01)。 TRPV1 immunofluorescence tensity, expression of PAR2 and TRPV1 proteins, and contents of SP and CGRP in the stomach were considerably up-regulated in the model group compared with the normal control group (P<0.01). In comparison with the model group, under intragastric pressure of 50,60 and 70 mm Hg, the gastric compliance was obviously increased, and the visceral hypersensitivity decreased in the EA group (P<0.01,P<0.05). TRPV1 immunofluorescence intensity, expression levels of PAR2 and TRPV1 proteins, and the contents of SP and CGRP in the stomach were considerably down-regulated in both medication and EA groups compared with the model group (P<0.01, P<0.05). The therapeutic effect of EA was significantly superior to that of medication in up-regulating the gastric compliance (at 70 mm Hg), and down-regulating the contents of SP and CGRP (P<0.05). No significant differences were found between the EA and medication groups in up-regulating gastric compliance at intragastric pressure of 50 and 60 mm Hg, and in down-regulating the visceral sensitivity, TRPV1 fluorescence intensity, and expression of PAR2 and TRPV1 proteins (P>0.05). Toluidine blue staining showed an apparent increase of mast cell number with obvious degranulation in the gastric mucosa of rats in the model group, which was milder in the EA and medication groups. CONCLUSION EA of ST36 can suppress visceral hypersensitivity and increase the gastric compliance in FD rats, which may be related with its effects in inhibiting the activation of gastric mast cells, and down-regulating the expression of gastric PAR2 and TRPV1 proteins and SP and CGRP contents.
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Affiliation(s)
- Jia-Zi Dong
- School of Acupuncture-moxibustion and Tuina, Liaoning University of Traditional Chinese Medicine, Liaoning 110847, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Tie-Ming Ma
- School of Acupuncture-moxibustion and Tuina, Liaoning University of Traditional Chinese Medicine, Liaoning 110847, China
| | - Dan Wang
- School of Acupuncture-moxibustion and Tuina, Liaoning University of Traditional Chinese Medicine, Liaoning 110847, China
| | - Xiao-Tong Wang
- School of Acupuncture-moxibustion and Tuina, Liaoning University of Traditional Chinese Medicine, Liaoning 110847, China
| | - Ye Qiao
- School of Acupuncture-moxibustion and Tuina, Liaoning University of Traditional Chinese Medicine, Liaoning 110847, China; The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning 110032
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Dong JZ, Rong PJ, Wang XT, Wang D, Leng MH, Xiao LJ. [Effect of electroacupuncture at "Zusanli" (ST 36) on duodenal mast cells, NGF and NTRK1 in rats with functional dyspepsia]. Zhongguo Zhen Jiu 2022; 42:767-772. [PMID: 35793886 DOI: 10.13703/j.0255-2930.20211230-k0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) on duodenal mast cells, nerve growth factor (NGF) and neurotrophic tyrosine kinase receptor type 1 (NTRK1), and to explore the mechanism of electroacupuncture at Zusanli (ST 36) on functional dyspepsia (FD). METHODS Sixty SPF-grade 10-day-old SD rats were randomly divided into a normal group, a model group, a ketotifen group and an EA group, 15 rats in each group. The FD model was prepared by iodoacetamide combined with rat tail clamping method in the model group, the ketotifen group and the EA group. The rats in the ketotifen group were injected intraperitoneally with ketotifen (1 mg•kg-1•d-1) for 7 days; the rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36), with disperse-dense wave, frequency of 2 Hz/50 Hz and intensity of 0.5 mA, 20 min each time, once a day for 14 days. The gastric emptying rate and small intestinal propulsion rate in each group were observed; the morphology of duodenal mucosa was observed by HE staining; the toluidine blue staining was used to observe the number and degranulation of mast cells in duodenal mucosa; the protein and mRNA expressions of NGF, NTRK1 in duodenum were detected by Western blot and real-time PCR; the level of interleukin-1β (IL-1β) in duodenum was measured by ELISA. RESULTS Compared with the normal group, the gastric emptying rate and small intestinal propulsion rate in the model group were decreased (P<0.01); compared with the model group, the gastric emptying rate and small intestinal propulsion rate in the ketotifen group and the EA group were increased (P<0.01); the small intestinal propulsion rate in the EA group was higher than that in the ketotifen group (P<0.01). In the model group, local defects in duodenal mucosa were observed with a small amount of inflammatory cell infiltration; no obvious abnormality was found in duodenal mucosa of the other groups. Compared with the normal group, the mast cells of duodenal mucosa in the model group were increased significantly with significant degranulation; compared with the model group, the mast cells of duodenal mucosa in the ketotifen group and the EA group were decreased significantly, and the degranulation was not obvious. Compared with the normal group, the protein and mRNA expressions of NGF, NTRK1 as well as the level of IL-1β in duodenum in the model group were increased (P<0.01); compared with the model group, the protein and mRNA expressions of NGF, NTRK1 as well as the levels of IL-1β in duodenum in the ketotifen group and the EA group were decreased (P<0.01, P<0.05); compared with the ketotifen group, the mRNA expression of NGF, as well as the protein and mRNA expressions of NTRK1 in duodenum in the EA group were decreased (P<0.05, P<0.01). CONCLUSION EA at "Zusanli" (ST 36) could inhibit the activation of duodenal mast cells and regulate the expressions of NGF and its receptor to improve the low-grade inflammatory response of duodenum, resulting in treatment effect on FD.
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Affiliation(s)
- Jia-Zi Dong
- College of Acupuncture-Moxibustion and Tuina, Liaoning University of TCM, Shenyang 110847, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Xiao-Tong Wang
- College of Acupuncture-Moxibustion and Tuina, Liaoning University of TCM, Shenyang 110847, China
| | - Dan Wang
- College of Acupuncture-Moxibustion and Tuina, Liaoning University of TCM, Shenyang 110847, China
| | - Ming-Hui Leng
- College of Acupuncture-Moxibustion and Tuina, Liaoning University of TCM, Shenyang 110847, China
| | - Lu-Jia Xiao
- College of Acupuncture-Moxibustion and Tuina, Liaoning University of TCM, Shenyang 110847, China
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Millan-Alanis JM, González-Torres LA. Comment On "Placebo Response Rates in Acupuncture Therapy Trials for Functional Dyspepsia: A Systematic Review and Meta-Analysis". J Clin Gastroenterol 2022; 56:552-553. [PMID: 35537129 DOI: 10.1097/mcg.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Juan Manuel Millan-Alanis
- Internal Medicine Department, University Hospital "Dr. Jose E. Gonzalez" Universidad Autonoma de Nuevo Leon Monterrey, Mexico
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Han J, Wei W, Wang HC, Zhang T, Wang Y, Hou LW, Li SY, Zhang JL, Rong PJ. [Transcutaneous auricular vagus nerve stimulation promotes gastric motility by up-rgulating α7nAChR and suppressing NF-κB p65 expression in duodenum in rats with functional dyspepsia]. Zhen Ci Yan Jiu 2022; 47:517-524. [PMID: 35764519 DOI: 10.13702/j.1000-0607.20220111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on gastric sensitivity and motility in rats with functional dyspepsia (FD), so as to explore its underlying mechanism in improving FD. METHODS A total of 48 young SD rats were randomly divided into control (n=10), model (n=9), taVNS (n=9), subdiaphragmatic vagus nerve stimulation (SDVNS, n=9) and sham SDVNS (n=7) groups. The FD model was established by gavage of 0.1% iodoa-cetamide+2% glucose, once daily for 6 days. Rats in the taVNS group received taVNS (0.5 mA) of optopoint "Heart" and "Stomach" for 30 min, once daily for 14 days, while rats in the SDVNS group received subdiaphragmatic vagus nerve stimulation through the implanted electrode, and those of the sham SDVNS group received only application of the same electrodes without electrical stimulation. Electromyogram (EMG) of the cervical trapezius muscle (reflecting gastric sensitivity) was recorded before and after intragastric expansion via an air ballon and the gastric emptying rate was calculated for assessing the gastric motility. The contents of acetylcholine (ACh), nicotinic acetylcholine receptor α7 subunit (α7nAChR), interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the duodenum tissue were detected by enzyme-linked immunosorbent assay (ELISA). The expression of nuclear factor kappa B (NF-κB) p65 in the duodenum tissue was determined by Western blot. RESULTS In comparison with the control group, the EMG change rate at intragastric pressure levels of 40, 60 and 80 mm Hg, expression of NF-κB p65 protein, and contents of IL-6, IL-1β and TNF-α were significantly increased (P<0.05,P<0.01, P<0.001), while the gastric emptying rate, ACh and α7nAChR contents considerably decreased (P<0.05, P<0.001) in the model group. After interventions, the EMG change rate, contents of IL-6, IL-1β and TNF-α, and expression of NF-κB p65 were notably decreased (P<0.05, P<0.01, P<0.001), and the gastric emptying rate, ACh and α7nAChR contents obviously increased (P<0.05, P<0.001) in both taVNS and SDVNS groups relevant to the model group. In comparison with the sham SDVNS group, the EMG change rate, contents of IL-6, IL-1β and TNF-α, and expression of NF-κB p65 were notably decreased (P<0.01, P<0.05,P<0.001), and the gastric emptying rate, ACh and α7nAChR contents obviously increased (P<0.01, P<0.001) in the both SDVNS and taVNS groups. CONCLUSION taVNS can reduce gastric sensitivity and promote gastric emptying in FD model rats, which may be closely related to its functions in up-regulating ACh and α7nAChR contents and inhibiting the activation of NF-κB p65 signaling in the duodenum.
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Affiliation(s)
- Juan Han
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Wei Wei
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102
| | - Hong-Cai Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Tao Zhang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Li-Wei Hou
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shao-Yuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jin-Ling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Cheng M, Zhou XE, Xu YC, Dou HM. The efficacy of cognitive behavior stress management on functional dyspepsia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29157. [PMID: 35583527 PMCID: PMC9276094 DOI: 10.1097/md.0000000000029157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Functional dyspepsia and digestive disorders are common, debilitating and costly. Little information is available about the role of stress management in terms of cognitive-behavioral treatment of dyspepsia. We performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia. METHODS A comprehensive search of several databases from 1966 to March 2022 will be conducted. The databases include Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The primary outcome for this study was the rate of successful treatment (presence of no more than mild pain or discomfort after treatment). The secondary outcomes were improvement of dyspepsia at short-term (<1 year) and long-term (≥1 year) follow up, improvement in quality of life, and development of treatment-related adverse events. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) will be used to analyze the data. RESULTS We will synthesize the current studies to evaluate the effectiveness and safety of cognitive behavior stress management on functional dyspepsia. CONCLUSION The result of this review will provide more reliable references to help clinicians make decisions when dealing with functional dyspepsia.
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Affiliation(s)
- Min Cheng
- Digestive Endoscopy Center, Taizhou People's Hospital, Jiangsu, China
| | - Xiu-E. Zhou
- Department of Gastroenterology, Taizhou People's Hospital, Jiangsu, China
| | - Yu-Chen Xu
- Department of Radiology, Taizhou People's Hospital, Jiangsu, China
| | - Hong-Mei Dou
- Department of Operation Room, Taizhou People's Hospital, Jiangsu, China
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Huang J, Liu J, Liu Z, Ma J, Ma J, Lv M, Wang F, Tang X. Reliability of the Evidence to Guide Decision-Making in Acupuncture for Functional Dyspepsia. Front Public Health 2022; 10:842096. [PMID: 35433619 PMCID: PMC9010971 DOI: 10.3389/fpubh.2022.842096] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Aims There has been a significant increase in the number of systematic reviews (SRs)/meta-analyses (MAs) investigating the effects of acupuncture for functional dyspepsia (FD). To systematically collate, appraise, and synthesize the current evidence, we carried out an umbrella review of SRs/MAs. Methods Systemic reviews/meta-analyses on acupuncture for FD were collected by searching major medical databases. The included studies were evaluated in terms of methodological quality, reporting quality, and evidence quality using the criteria from the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system, respectively. Results Ten SRs/MAs were analyzed for this study. The methodological quality, reporting quality, and evidence quality of the included SRs/MAs were generally unsatisfactory. Lack of protocol registration, no list of excluded trials, or lack of a comprehensive search strategy were the main limitations. No high-quality evidence was found to support the effects of acupuncture for FD; the qualitative data synthesis relied on low quality trials with small sample sizes and was the main factor for evidence degradation. Conclusions Acupuncture seems to have a promising efficacy in the treatment of FD. It provides a new and prospective therapeutic method for FD. Although the quality of the included SRs/MAs was generally low and defects were frequent, this umbrella review highlights areas where improvement in methodology is required.
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Affiliation(s)
- Jinke Huang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiali Liu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhihong Liu
- Department of Gastroenterology, Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China
| | - Jing Ma
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinxin Ma
- Department of Gastroenterology, Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China
| | - Mi Lv
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengyun Wang
| | - Xudong Tang
- China Academy of Chinese Medical Sciences, Beijing, China
- Xudong Tang
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Liu J, Song G, Huang Y, Lv C, Wang Y, Wu D, Sun C, Jing M, Yu Y. Placebo Response Rates in Acupuncture Therapy Trials for Functional Dyspepsia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2022; 56:299-310. [PMID: 35180148 PMCID: PMC8900996 DOI: 10.1097/mcg.0000000000001679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/01/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a functional digestive disease with limited management selection. Previous studies revealed that acupuncture therapy is effective for FD. However, because sham controls were not implemented in most clinical trials following acupuncture therapy, it is difficult to differentiate overall treatment responses from placebo. This study aims to quantify placebo responses in clinical trials in which FD patients received sham manual acupuncture (MA) and sham electroacupuncture (EA). MATERIALS AND METHODS Randomized controlled trials of MA and EA for FD patients were searched in PubMed, Web of Science, Cochrane Library, and Embase databases, as well as 4 Chinese language databases from inception to January 2021. RevMan 5.20 software was used for pooled analysis of symptom scores and quality of life. The symptom scores were combined using standard mean difference (SMD) or weighted mean difference (WMD) with a 95% confidence interval (CI). The quality of included studies was tested using modified Jadad scale and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. Egger's test, Begg's test, and sensitivity analyses were conducted using Stata 11.0 statistical software. The protocol of this study is registered in PROSPERO as CRD42021233858. RESULTS After screening, the current systematic review included 13 randomized controlled trials, of which 8 studies were used in the meta-analysis. Regarding subjective outcomes, the combined effect of sham MA on FD symptoms was [SMD=-0.42, 95% CI (-0.72, -0.12); P=0.005], whereas sham EA treatment was [SMD=-0.54, 95% CI (-0.81, -0.27); P<0.001]. The combined effect on FD quality of life of post-sham MA group was [SMD=-0.32, 95% CI (-0.52, -0.12); P=0.002]. With regard to objective outcomes, the combined effect of sham EA on dominant frequency was [WMD=-0.11, 95% CI (-0.30, -0.08); P=0.24], while the combined effect of sham EA on dominant power was [WMD=-3.35, 95% CI (-8.04, 1.35); P=0.16]. CONCLUSIONS Sham MA and sham EA remarkably improve symptoms and quality of life scores of FD without influencing objective outcomes, highlighting the significance of sham controls in acupuncture therapy clinical trials.
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Affiliation(s)
- Jie Liu
- Department of Gastroenterology
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Ying Wang
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Dandan Wu
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL
| | - Meng Jing
- Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Yue Yu
- Department of Gastroenterology
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Chona DL, Tubb MR, Gilinsky NH. Dyspepsia: A stepwise approach to evaluation and management. J Fam Pract 2021; 70:320-325. [PMID: 34818163 DOI: 10.12788/jfp.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Let a patient's age and specific symptoms steer your initial investigation. Consider treatment options beyond antibiotics for H pylori gastritis and PPIs.
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Affiliation(s)
- Deepika L Chona
- Division of Digestive Diseases, University of Cincinnati College of Medicine, OH (Drs. Chona and Gilinsky); Department of Family and Community Medicine, University of Cincinnati College of Medicine (Dr. Tubb)
| | - Matthew R Tubb
- Division of Digestive Diseases, University of Cincinnati College of Medicine, OH (Drs. Chona and Gilinsky); Department of Family and Community Medicine, University of Cincinnati College of Medicine (Dr. Tubb)
| | - Norman H Gilinsky
- Division of Digestive Diseases, University of Cincinnati College of Medicine, OH (Drs. Chona and Gilinsky); Department of Family and Community Medicine, University of Cincinnati College of Medicine (Dr. Tubb)
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Zhang Y, Bian L, Long H, Zhang W, Hu Y. Efficacy evaluation of acupuncture combined with Liujunzi Decoction in the treatment of functional dyspepsia: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24528. [PMID: 33663059 PMCID: PMC7909152 DOI: 10.1097/md.0000000000024528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common and frequently-occurring disease in internal medicine. It is known that Liujunzi decoction and acupuncture are widely used in the treatment of FD, but there are few studies on the combination of Liujunzi decoction and acupuncture in the treatment of FD, and its safety and efficacy are still controversial. Therefore, the purpose of this study is to evaluate the efficacy and safety of acupuncture combined with Liujunzi decoction in the treatment of FD. METHODS We designed a prospective randomized controlled trial. The study protocol was approved by the Clinical Research Ethics Committee of our hospital. Patients with FD were randomly assigned to the treatment group of acupuncture combined with Liujunzi Decoction (the experimental group) and the treatment group of Liujunzi Decoction (the control group) in a ratio of 1:1. Outcome indicators were Nepean Dyspepsia Index, the MOS item short from health survey, and adverse reactions. Finally, SPSS 18.0 software would be used for statistical analysis of the data. DISCUSSION This study will evaluate the efficacy and safety of acupuncture combined with Liujunzi Decoction in the treatment of FD and provide clinical basis for the use of acupuncture combined with Liujunzi Decoction in the treatment of FD. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/67GKN.
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Affiliation(s)
| | - Lihong Bian
- Wuhan Children's Welfare Home, Wuhan, Hubei Province, China
| | | | | | - Yuqiong Hu
- Wuhan Children's Welfare Home, Wuhan, Hubei Province, China
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Kwon CY, Ko SJ, Lee B, Cha JM, Park JW. Acupuncture as add-on treatment for functional dyspepsia: A protocol for systematic review. Medicine (Baltimore) 2021; 100:e24403. [PMID: 33607774 PMCID: PMC7899868 DOI: 10.1097/md.0000000000024403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common functional gastrointestinal disease with a high prevalence. However, due to the limitations of conventional Western treatments, such as acid suppressants, prokinetics, Helicobacter pylori eradication treatment, and antidepressants, the popularity of complementary and alternative medicine, such as acupuncture, is steadily increasing. We describe the methods that will be used to evaluate the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD. METHODS AND ANALYSIS A total of 12 English, Korean, and Chinese electronic databases will be searched by 2 researchers from their inception dates to December 2020. Randomized controlled trials assessing the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD will be included. The primary outcome measure will be the symptom score of FD, and secondary outcome measures will be total effective rate, quality of life, level of gut peptide hormones, incidence of adverse events, and recurrence rate. Data analysis will be performed using the Review Manager version 5.3. The risk of bias of the included studies and the quality of evidence for the main findings will be evaluated using the Cochrane Collaborations risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation approach, respectively. CONCLUSION The findings of this review will provide evidence on the complementary effectiveness and safety of acupuncture for FD for clinicians, patients, and policy makers in decision making. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/MXREN (https://osf.io/mxren).
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dong-eui University, Busan
| | - Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul
| | - Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul
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Medić B, Babić Ž, Banić M, Ljubičić L. Modern Approach to Dyspepsia. Acta Clin Croat 2021; 60:731-738. [PMID: 35734496 PMCID: PMC9196234 DOI: 10.20471/acc.2021.60.04.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022] Open
Abstract
Dyspepsia is a disorder characterized by dyspeptic symptoms which are located in the epigastrium and related to digestion of food in the initial part of the digestive system. In functional dyspepsia, unlike organic dyspepsia, there is no underlying organic disease that would cause dyspeptic symptoms. Immune and mucosal function changes, gastric dysmotility, different composition of the gastrointestinal microbiota, and altered central nervous system processing are considered responsible for the onset of the disorder. The diagnosis is based on history, clinical presentation, and exclusion of other organic diseases of the gastrointestinal tract manifested by dyspeptic symptoms. Therapy includes eradication of Helicobacter pylori infection, proton pump inhibitors, prokinetics, neuromodulators, and herbal preparations. Unfortunately, in some patients, this therapy leads to little or no improvement. The prevalence of functional dyspepsia is increasing. It has become one of the more common gastroenterological diagnoses. In order to reduce the costs associated with the diagnosis and treatment of the disorder itself, its mechanisms need to be fully elucidated and thus enable finding appropriate therapy for all patient subgroups.
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Abstract
Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. Patients without any identifiable cause for their symptoms are diagnosed with functional dyspepsia. Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.
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Affiliation(s)
- Alia Chisty
- Division of General Internal Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA.
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Wu X, Jiang W, Shi C, Qian H, Fan X, Zhou P. The clinical efficacy of acupoint sticking combined with massage to treatment functional dyspepsia: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23869. [PMID: 33371173 PMCID: PMC7748355 DOI: 10.1097/md.0000000000023869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The objective of this meta-analysis was to summarize and identify the available evidence from studies to estimate the clinical value of acupoint sticking combined with massage (ASM) in the treatment of functional dyspepsia (FD), and provide clinicians with evidence on which to base their clinical decision making. METHODS This review will include all studies comparing clinical efficacy of ASM in the treatment of FD. The search strategy will be performed in 10 databases. We will not establish any limitations to language and publication status, published from inception to the August 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is alleviation of global dyspeptic symptoms, alleviation of individual dyspeptic symptoms, quality-of-life improvement, and safety. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS This study will summarize current evidence to assess the efficacy and safety of ASM in the treatment of FD. CONCLUSION The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as studying the value of ASM. REGISTRATION NUMBER INPLASY2020110072 (DOI number: 10.37766/inplasy2020.11.0072).
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Zhou KL, Dong S, Shen Q, Wang K, Wei PD, Bai X, Cai MH, Guo S, Liu Y. Efficacy of massage therapy for postprandial distress syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23473. [PMID: 33235136 PMCID: PMC7710185 DOI: 10.1097/md.0000000000023473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postprandial distress syndrome (PDS), characterized by the presence of prevalently meal-related early satiation and fullness, is a highly prevalent condition with major socioeconomic and healthcare impact. To date, there is a lack of pharmacological treatment proven value for PDS. Therefore, an ideal strategy to relieve PDS is urgently needed. In recent years, massage therapy has been increasingly accepted by PDS patients due to its lower costs, fewer unwanted side effects and safety for clinical use. In this systematic review, we aim to evaluate the effectiveness and safety of massage therapy for patients with postprandial distress syndrome. METHODS We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating postprandial distress syndrome: Wanfang and Pubmed Database, CNKI, CENTRAL, CINAHL, and EMBASE. Each database will be searched from inception to October 2020. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses. RESULTS This proposed study will evaluate the effectiveness and safety of massage therapy for patients with postprandial distress syndrome. The outcomes will include changes in PDS relief and adverse effect. CONCLUSIONS This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with postprandial distress syndrome. DISSEMINATION AND ETHICS The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/9WRX8.
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Affiliation(s)
- Ke-Lin Zhou
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Shuo Dong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Shen
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Kang Wang
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Pei-Dong Wei
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Xiao Bai
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Ming-Heng Cai
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Sheng Guo
- Dongfang Hospital of Beijing University of Chinese Medicine
| | - Yang Liu
- Dongfang Hospital of Beijing University of Chinese Medicine
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Chen P, Chen AP. [Clinical observation of "experienced ten acupoints" for functional dyspepsia of liver stagnation and spleen deficiency]. Zhongguo Zhen Jiu 2020; 40:1169-1171. [PMID: 33788483 DOI: 10.13703/j.0255-2930.20191115-k0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To verify the clinical effect of acupuncture at "experienced ten acupoints" for functional dyspepsia (FD) of liver stagnation and spleen deficiency. METHODS A total of 96 patients with FD of liver stagnation and spleen deficiency were randomly divided into an observation group and a control group, 48 cases in each group. In the observation group, "experienced ten acupoint" prescription was applied,acupoints included Shangwan (CV 13), Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Tianshu (ST 25), Zusanli (ST 36) and Neiguan (PC 6). In the control group, irrelevant acupoint prescription was applied, acupoints included Feiyang (BL 58), Heding (EX-LE 2), Yingu (KI 10), Tianfu (LU 3), Xiabai (LU 4). The needles were retained for 30 min in both groups, 5 times a week for 2 weeks. Before and after treatment, the symptom score was compared in the two groups, and the clinical effect was evaluated. RESULTS Compared before treatment, the symptom score after treatment was decreased in the observation group (P<0.05), and was lower than the control group (P<0.05). The total effective rate was 95.8% (46/48) in the observation group, which was higher than 33.3% (16/48) in the control group (P<0.05). CONCLUSION Acupuncture at "experienced ten acupoints" can improve symptoms in patients with FD of liver stagnation and spleen deficiency, has the better clinical effect.
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Affiliation(s)
- Peng Chen
- Beijing TCM Hospital Affiliated to Capital Medical University, Beijing 100010, China
| | - Ai-Ping Chen
- Beijing TCM Hospital Affiliated to Capital Medical University, Beijing 100010, China
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Mao X, Guo S, Ni W, Zhang T, Liu Q, Du S, Luo M, Pan Y, Wu B, Su X, Yang Y, Guo Y, Chen JJ, Rong P, Wei W. Electroacupuncture for the treatment of functional dyspepsia: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23014. [PMID: 33157947 PMCID: PMC7647594 DOI: 10.1097/md.0000000000023014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common functional gastrointestinal disease. Acupuncture, including electroacupuncture (EA) is widely used as a complementary and alternative treatment for patients with FD. This study aimed to explore the effectiveness of EA for the treatment of FD. METHODS We searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Cochrane Library) for randomized controlled trials of FD treated by EA from inception to February 3, 2020. Two reviewers will independently screen studies for data extraction and assess the quality and risk of bias. The Cochrane Collaboration's risk of bias tool, RevMan 5.3 software were used for meta-analysis. Data were pooled to calculate relative risk and 95% confidence intervals (CIs) of substantial improvement after treatment for dichotomous data and mean differences (SMDs) and 95% CIs for continuous data. RESULTS Seven randomized clinical trials included 853 patients. This meta-analysis investigated the effectiveness of EA alone in the treatment of FD relative to sham-EA or pharmacologic medication (PM). The results showed that EA could significantly improve clinical symptoms. Compared with sham-EA, EA was more effective in reducing symptom scores (SMD -3.44, 95% CI -4.21 to -2.67) and increasing normal slow waves of electrogastrogram (SMD 0.93, 95% CI -0.30 to1.55). When EA was combined with PM, there was no significant difference in reducing symptom scores (SMD -0.18, 95% CI -0.51 to 0.16), increasing the effective rate of clinical symptoms (risk ratio 1.04, 95% CI 0.96 to 1.13), enhancing the level of plasma motilin (SMD 0.93, 95% CI -0.30 to1.55), and reducing gastric half-emptying time (SMD 0.02, 95% CI -0.16 to 0.20). The results also showed that there were very few adverse events reported. CONCLUSION This meta-analysis suggests that EA is better than the placebo (sham-EA) in treating FD, and the therapeutic effect of EA on FD is equivalent to that of PM on FD. Compared with PM, EA for FD is safer and has fewer adverse reactions. Despite limitations due to the quality and number of the included studies, EA might be used as an effective and safe treatment for FD.
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Affiliation(s)
- Xinyong Mao
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Song Guo
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Wenchao Ni
- Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Tao Zhang
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Qian Liu
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Sijing Du
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Mengxue Luo
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Yuyan Pan
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Baoqi Wu
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Xiaolan Su
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Yang Yang
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Yu Guo
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
| | - Jiande J.D. Chen
- Division of Gastroenterology and Hepatology University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Wei
- Department of Gastroenterology, Beijing Key Laboratory of Functional Gastrointestinal Disorders Diagnosis and Treatment of Traditional Chinese Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences
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Zhang B, Chen YQ, Zhou CX, Chen RX. [Technical elements and clinical application of umbilical refining of heat-sensitive moxibustion]. Zhongguo Zhen Jiu 2020; 40:965-967. [PMID: 32959592 DOI: 10.13703/j.0255-2930.20191214-k0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Under the guidance of the theory and technique of arrival of qi of heat-sensitive moxibustion, the technical elements of umbilical refining of moxibustion proposed in The Guide to Medicine by LI Yan were analyzed. It is believed that the parameters of moxibustion temperature and time are the key points. The standard of "quantitative moxa" is established to achieve the appropriate moxibustion temperature and moxibustion time. The umbilical refining of heat-sensitive moxibustion is established to reappear the magic effect of LI Yan's umbilical refining of moxibustion. The umbilical refining of heat-sensitive moxibustion is recommended for stomachache, diarrhea, constipation, dysmenorrhea, impotence, etc. with significant curative effect.
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Affiliation(s)
- Bo Zhang
- Department of Acupuncture for Knee Arthropathy, Affiliated Hospital of Jiangxi University of TCM, Nanchang 330006, China
| | - Yan-Qi Chen
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of TCM
| | - Chong-Xiu Zhou
- Department of Acupuncture for Knee Arthropathy, Affiliated Hospital of Jiangxi University of TCM, Nanchang 330006, China
| | - Ri-Xin Chen
- Department of Acupuncture for Knee Arthropathy, Affiliated Hospital of Jiangxi University of TCM, Nanchang 330006, China
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Abstract
PURPOSE OF REVIEW To review the nature, current evidence of efficacy, recent developments, and future prospects for cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, the two best established psychological interventions for managing gastrointestinal (GI) disorders. RECENT FINDINGS New large randomized controlled trials are showing that cost-effective therapy delivery formats (telephone-based, Internet-based, fewer therapist sessions, or group therapy) are effective for treating GI disorders. CBT and hypnotherapy can produce substantial improvement in the digestive tract symptoms, psychological well-being, and quality of life of GI patients. However, they have long been hampered by limited scalability and significant cost, and only been sufficiently tested for a few GI health problems. Through adoption of more cost-effective therapy formats and teletherapy, and by expanding the scope of efficacy testing to additional GI treatment targets, these interventions have the potential to become widely available options for improving clinical outcomes for patients with hard-to-treat GI disorders.
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Affiliation(s)
- Olafur S Palsson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, P.O. Box 9126, Chapel Hill, NC, 27515, USA.
| | - Sarah Ballou
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW To review the nature, current evidence of efficacy, recent developments, and future prospects for cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, the two best established psychological interventions for managing gastrointestinal (GI) disorders. RECENT FINDINGS New large randomized controlled trials are showing that cost-effective therapy delivery formats (telephone-based, Internet-based, fewer therapist sessions, or group therapy) are effective for treating GI disorders. CBT and hypnotherapy can produce substantial improvement in the digestive tract symptoms, psychological well-being, and quality of life of GI patients. However, they have long been hampered by limited scalability and significant cost, and only been sufficiently tested for a few GI health problems. Through adoption of more cost-effective therapy formats and teletherapy, and by expanding the scope of efficacy testing to additional GI treatment targets, these interventions have the potential to become widely available options for improving clinical outcomes for patients with hard-to-treat GI disorders.
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Affiliation(s)
- Olafur S Palsson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, P.O. Box 9126, Chapel Hill, NC, 27515, USA.
| | - Sarah Ballou
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Guo Y, Wei W, Chen JDZ. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol 2020; 26:2440-2457. [PMID: 32476804 PMCID: PMC7243644 DOI: 10.3748/wjg.v26.i19.2440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common digestive disease with limited therapeutic options. According to evidence-based clinical practice, acupuncture or electroacupuncture (EA) seems to be a promising therapy for patients with FD. However, there is still a lack of systematic reviews that have analyzed current clinical trials for a better understanding of mechanisms involved in the ameliorating effect of acupuncture and EA on FD.
AIM To evaluate the results and qualities of existing clinical evidence for researching the underlying mechanisms of acupuncture/EA in treating FD.
METHODS A systematic search of the literature was performed to identify randomized controlled trials in which research on the mechanism of acupuncture or EA was conducted in FD patients. Databases searched included PubMed, EMBASE, Cochrane Library, and Web of Science. Data extraction and quality assessment were completed by two investigators independently and the results of quality evaluation were exported through Review Manager V5.3.
RESULTS Eight studies were included in this review with a total of 17 items for detecting techniques for mechanistic research. Positive effects of acupuncture and EA were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life.
CONCLUSION The key findings of this systematic review support the potential of acupuncture and EA in altering the heterogeneous pathophysiology in patients with FD. However, high-quality studies with well-planned designs are necessary to provide more credible evidence.
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Affiliation(s)
- Yu Guo
- Department of Gastroenterology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | - Wei Wei
- Department of Gastroenterology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Jiande DZ Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI 48109, United States
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Zhang S, Xu Z, Cao X, Xie Y, Lin L, Zhang X, Zou B, Liu D, Cai Y, Liao Q, Xie Z. Shenling Baizhu San improves functional dyspepsia in rats as revealed by 1H-NMR based metabolomics. Anal Methods 2020; 12:2363-2375. [PMID: 32930262 DOI: 10.1039/d0ay00580k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Functional dyspepsia (FD), a common gastrointestinal disorder around the world, is driven by multiple factors, making prevention and treatment a major challenge. Shenling Baizhu San (SBS), a classical prescription of traditional Chinese medicine, has been proven to be effective in gastrointestinal disorders. However, studies on SBS improving FD are few. Thus, our study aimed to evaluate the effect of SBS on FD and further to explore the mechanism underlying the interactions between FD and SBS by the metabolomics approach. A FD rat model was induced by multiple forms of mild stimulation, and proton nuclear magnetic resonance (1H-NMR) spectroscopy and multivariate data analysis were used to profile the fecal and urinary metabolome in the FD rats during SBS intervention. Significant dyspeptic symptoms such as weight loss, poor appetite, reduced gastrointestinal motility and decreased absorptive capacity were observed in the FD rats, which were subsequently improved by SBS. Additionally, the levels of citrate, branched chain acids and pyruvate decreased, and the levels of choline, trimethylamine and taurine increased in the FD rats. Furthermore, the metabolic disorders were amended with SBS intervention mainly by modulating the metabolic pathways involved in energy metabolism, amino acid metabolism, and gut microbiota and host co-metabolism. Overall, our study highlighted the effect of SBS on the disturbed metabolic pathways in the FD rats, providing new insight into the mechanism of SBS treatment for FD from the perspective of metabolomics.
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Affiliation(s)
- Shaobao Zhang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China.
| | - Zengmei Xu
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Xueqing Cao
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Yuzhen Xie
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Lei Lin
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China.
| | - Xiao Zhang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Baorong Zou
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Deliang Liu
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Ying Cai
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Qiongfeng Liao
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiyong Xie
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China.
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou, 510006, China
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Abstract
BACKGROUND Functional dyspepsia (FD) is a functional gastrointestinal disorder. Evidence suggests that disturbance of the gastrointestinal microbiota may be implicated in FD. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics and probiotics for FD. METHODS MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (through September 2018). Randomized controlled trials (RCTs) that recruited adults with FD and that compared prebiotics, probiotics, or synbiotics with placebo or no therapy were eligible. Eligibility assessment and data extraction were performed by two independent researchers. Dichotomous symptom data were pooled to obtain a relative risk (RR) with a 95% confidence interval (CI) of remaining symptomatic after therapy. Continuous data were pooled using a standardized or weighted mean difference with a 95% CI. RESULTS The search strategy identified 1062 citations. Five RCTs were eligible for inclusion. The RR of FD symptoms improving with probiotics or probiotics vs placebo was 1.15 (95% CI 1.01-1.30). Probiotics and prebiotics had beneficial effects on symptom scores of FD. Data for synbiotics in the context of FD were sparse, and no definite conclusions could be drawn. ETHICS AND DISSEMINATION This study belongs to the category of systematic reviews, not clinical trials. Therefore, it does not require ethical approval. The results of this study will be published in influential international academic journals related to this topic. CONCLUSION Probiotics and prebiotics seemed to be effective treatments for FD, although the individual species and strains that are the most beneficial remain unclear. Using only probiotics failed to improve the symptoms of FD. Further evidence is required before the role of probiotics, prebiotics, and synbiotics in FD can be fully understood.
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Affiliation(s)
- Jiaqi Zhang
- Department of Gastroenterology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing
| | - Hao Meng Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Xue Wang
- Experimental Research Center of China Academy of Chinese Medical Sciences
| | | | - Xia Li
- Beijing University of Chinese Medicine
| | - Jinxin Ma
- Department of Gastroenterology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing
| | - Fengyun Wang
- Department of Gastroenterology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing
| | - Xudong Tang
- China Academy of Chinese Medical Sciences, Beijing, China
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