The Therapeutic Effect of Biling Weitong Granules Combined with Oryz-Aspergillus Enzyme and Pancreatin Tablet on Reflux Esophagitis with Functional Dyspepsia

Objective:To investigate the therapeutic effect of Biling Weitong Granules combined with oryz-aspergillus enzyme and pancreatin tablets on patients with reflux esophagitis with functional dyspepsia.Methods:Sixty patients diagnosed with reflux esophagitis with functional dyspepsia who were admitted to the Affiliated Hospital of Hebei University between June 2020 and June 2023 were selected and divided into two groups:the control group and the observation group,each consisting of 30 cases.The control group received oryz-aspergillus enzyme and pancreatin tablets only,while the observation group received Biling Weitong Granules in addition to the tablets.The clinical efficacy,Chinese medicine syndrome points,esophageal kinetic indexes,gastrointestinal hormone levels,and therapeutic safety of both groups were evaluated.Results:The total efficiency of the observation group reached 93.33%,significantly higher than the 73.33%of the control group(P<0.05).After treatment,patients in the observation group exhibited significantly lower scores for Chinese medicine symptoms such as early satiety,belching,abdominal distension,abdominal pain,and loss of appetite compared to the control group(P<0.05).Furthermore,the observation group showed significantly higher upper esophageal sphincter pressure,lower esophageal sphincter pressure,and distal esophageal contraction scores compared to the control group(P<0.05).Additionally,levels of gastric motility hormone,vasoactive intestinal peptide,and gastrin were significantly higher in the observation group compared to the control group(P<0.05).Throughout the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups,indicating comparable safety of the two treatment modalities(P>0.05).Conclusion:The combination of Biling Weitong Granules with oryz-aspergillus enzyme and pancreatin tablets demonstrates significant efficacy in the treatment of reflux esophagitis with functional dyspepsia,with a better safety profile.This finding warrants further clinical promotion.

Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia

BACKGROUND Dyspepsia is a very prevalent upper gastrointestinal tract symptoms complex.Some of these symptoms might arise from serious underlying diseases,so the promotion of evidence-based guidelines could potentially better align evaluation and treatment.AIM To determine the value of alarm features as a predictive factor for significant endoscopic findings(SEFs)among hospitalized patients presenting with dyspepsia.METHODS We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized patients.Patients were divided into two groups,with and without SEFs,and compared to elucidate the ability of the different alarm features to predict SEFs.RESULTS During the study,605 patients fulfilled the inclusion criteria.When the demographics and clinical characteristics of the two groups were compared,tachycardia(P<0.05),normocytic anemia,(P<0.05),leukocytosis(P<0.05),and hypoalbuminemia(P<0.05)documented on admission prior to endoscopy were strong predictors of SEFs.Among the alarm features,upper gastrointestinal bleeding,persistent vomiting,odynophagia[odds ratio(OR)=3.81,P<0.05;OR=1.75,P=0.03;and OR=7.81,P=0.07,respectively]were associated with SEFs.Unexplained weight loss was strongly associated with malignancy as an endoscopic finding(OR=2.05;P<0.05).In addition,long-term use of anti-aggregate medications other than aspirin(P<0.05)was correlated to SEFs.CONCLUSION Novel predictors of SEFs were elucidated in this study.These parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

Jianqu,a traditional Chinese medicine,alleviates functional dyspepsia in high-calorie and high-protein diet mice

Background:Jianqu has been used to alleviate symptoms in patients with functional dyspepsia,but its specific anti-functional dyspepsia effect is still unclear.Therefore,our study aimed to investigate the impact of Jianqu on functional dyspepsia in mice.Methods:The phytochemical profile of Jianqu was analyzed by UPLC-Q-TOF-MS.Subsequently,Kunming mice were fed a high-calorie or high-protein diet(HCHP)for 7 days,and then orally treated with vehicle or Jianqu(1.62 g/kg body weight(b.w.)and 3.25 g/kg b.w.)for 10 days.A carbon powder solution was used to detect the gastric emptying and intestinal transit rate.The pathological changes in stomach and duodenum were evaluated by hematoxylin-eosin staining.The occludin,claudin-1,ZO-1 and CD45 expression was measured by immunocytochemical staining.Importantly,the serum gastrointestinal hormones were detected by ELISA.In addition,the gut microbiota composition was determined using 16S rRNA gene sequencing.The cecal short chain fatty acids were assessed by gas chromatography.Results:In general,17 phytochemical compounds were identified from Jianqu,which significantly improved the gastric emptying rate and intestinal transit rate(p<0.01),increased the body weight and food intake(p<0.0001)in HCHP mice as well.Though HCHP did not cause significant pathological lesions in the gastrointestinal tract,increased the expression of CD45 in the duodenum(p<0.05)was observed.Notably,Jianqu attenuated this abnormal expression of CD45(p<0.05).The levels of serum gastrointestinal hormones were significantly normalized by Jianqu intervention(p<0.05).Moreover,Jianqu increased the relative abundance of Roseburia as well as short chain fatty acids levels in cecum(p<0.05).Conclusion:The present results showed that Jianqu alleviated dyspeptic symptoms in HCHP mice possibly through reducing the duodenal leukocyte infiltration,and regulating the expression of gastrointestinal hormones.These effects may be partly related to the increasing cecal short chain fatty acids levels probably via gut microbial modulation.

Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis:Insights into mechanisms,pathophysiology,and treatment options

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.

A Clinical Study of Integrated Traditional Chinese and Western Medicine in the Treatment of Liver-Stomach Disharmony Functional Dyspepsia

Objective:To explore the clinical effect of integrated traditional Chinese and Western medicine in the treatment of liver-stomach disharmony functional dyspepsia.Methods:Sixty patients with functional dyspepsia of liver-stomach disharmony type admitted to our hospital from January to August 2022 were selected as research subjects and randomly divided into two groups,a study group and a control group,with 30 cases in each group.The main observations were stomachache or pain over bilateral flanks,emotionally depressed,belching,fullness and discomfort over the abdomen and flanks,acid regurgitation,loss of appetite,frequent sighing,noisy epigastric,and the treatment effect.Results:According to the classification of symptom severity on the traditional Chinese medicine(TCM)symptom score table,statistics were made on the corresponding severity of the main symptoms and secondary symptoms of the two groups of patients,and the data of the two groups were compared by Wilcoxon test.The results showed that there was no significant difference in the distribution of TCM symptoms between the two groups;the study group’s total effective rate of pain relief(recovery+markedly effective+effective)was 96.67%,and Fisher’s χ^(2) test indicated a significant difference in the total effective rate of pain relief between the two groups(P=0.027<0.05).Conclusion:The use of integrated traditional Chinese and western medicine is clearly better than the simple application of western medicine.It is safe and has no side effects.It can be used as a treatment for patients with functional dyspepsia.

Study of the potential mechanism of acupuncture treatment for functional dyspepsia based on association rule mining and bioinformatics/network pharmacology approach

Objective:To explore the main acupoint prescription and mechanism of acupuncture in treating Functional dyspepsia(FD)by analyzing the clinical randomized controlled trial literature on acupoints and targets of acupuncture in the treatment of FD combined with association rule mining and bioinformatics/network pharmacology methods.Methods:Search relevant clinical randomized controlled trial literature on acupoints and therapeutic targets of acupuncture in the treatment of FD from eight databases from their inception to June 18th,2022.We obtained acupuncture selection points,meridian,and therapeutic targets and established acupoints database for acupuncture treatment of FD.FD-related targets were collected from GeneCards,DisGeNET,OMIM,and DrugBank databases.We obtained the potential targets of acupuncture on FD by taking the intersection of acupuncture for FD therapeutic targets and FD-related targets.We performed the protein-protein interaction network,Gene Ontology(GO)analysis,and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Results:In this study,26 Randomized Controlled Trials related to acupuncture treatment of FD were retrieved.We obtained 29 acupoints,17 acupuncture for FD therapeutic targets,and 10 intersection targets.Tumor necrosis factor(TNF),Interleukin(IL)-1,and Neuropeptide Y(NPY)are key targets of acupuncture in the treatment of FD.Conclusion:ST36-CV12-PC6-LR3 is the main acupoint prescription for FD.Acupuncture may affect Neuroactive ligand-receptor interaction,Gastric acid secretion,and IL-17,TNF signaling pathways by regulating related key targets,and play a synergistic role in the treatment of FD by inhibiting gastric acid secretion,alleviating inflammatory response,regulating the brain-gut axis,improving mood and other aspects.

Reassessment of functional dyspepsia:From the editor

Dyspepsia refers to group of upper gastrointestinal symptoms that occur commonly in adults. Dyspepsia is known to result from organic causes, but the majority of patients suffer from non-ulcer or functional dyspepsia. Epidemiological data from population-based studies of various geographical locations have been reviewed, as they provide more realistic information. Population-based studies on true functional dyspepsia （FD） are few, due to the logistic difficulties of excluding structural disease in large numbers of people. Globally, the prevalence of uninvestigated dyspepsia （UD） varies between 7%- 45%, depending on definition used and geographical location, whilst the prevalence of FD has been noted to vary between 11%-29.2%. Risk factors for FD have been shown to include females and underlying psychological disturbances, whilst environmental/lifestyle habits such as poor socio-economic status, smoking, increased caffeine intake and ingestion of non-steroidal anti-inflammatory drugs appear to be more relevant to UD. It is clear that dyspepsia and FD in particular are common conditions globally, affecting most populations, regardless of location.

Translation and validation of the Nepean Dyspepsia Index for functional dyspepsia in China

AIM： To assess the reliability and validity of the translated version of Nepean Dyspepsia Index （NDI） in Chinese patients with documented functional dyspepsia （FO）. METHODS： The translation process included forward translation, back translation, pretest and cross-cultural adaptation. Reliability and validity of the translated version were examined by asking 300 subjects to complete the Chinese version of the NDI. The mean age of subjects was 39.24 years and 68.7% of the subjects were women. Internal consistency analysis with Cronbach＇s α was performed to test the reliability. Correlation analysis was used to assess the content validity. Factor analysis and structural equation models were used to assess the construct validity. RESULTS： The Cronbach＇s α coefficients ranged 0.833-0.960, well above the acceptable level of 0.70. Correlation analysis showed that each item had a strong correlation with the corresponding domain, but a weak correlation with other domains. Confirmatory factor analysis indicated that the comparative fit index was 0.94, higher than the acceptable level of 0.90.CONCLUSION： The Chinese version of the NDI is a reliable and valid scale for measuring health-related quality of life and disease severity in Chinese patients with FD.

Itopride for gastric volume,gastric emptying and drinking capacity in functional dyspepsia

AIMTo study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD). METHODSRandomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. 13C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink was checked using satiety drinking capacity test. The intervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTSMean age of the recruited participant 33 years (SD = 7.6) and most of the recruited individuals, i.e., 21 (67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach (P = 0.14), at 20 min (P = 0.38), 30 min (P = 0.30), 40 min (P = 0.43), 50 min (P = 0.50), 60 min (P = 0.81), 90 min (P = 0.25) and 120 min (P = 0.67). Gastric emptying done on a sub sample (n = 11) showed no significant difference (P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo (P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score (P = 0.74). The change in QT interval in itopride group was not significantly different from placebo (0.10). CONCLUSIONOur study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.

Management of functional dyspepsia: Unsolved problems and new perspectives

The common characteristic criteria of all functional gastrointestinal(GI)disorders are the persistence and recurrence of variable gastrointestinal symptoms that cannot be explained by any structural or biochemical abnormalities. Functional dyspepsia (FD) represents one of the important GI disorders in Western countries because of its remarkably high prevalence in general population and its impact on quality of life. Due to its dependence on both subjective determinants and diverse country-specific circumstances, the definition and management strategies of FD are still variably stated.Clinical trials with several drug classes (e.g., proton pump inhibitors, H2-blockers, prokinetic drugs) have been performed frequently without validated diseasespecific test instruments for the outcome measurements.Therefore, the interpretation of such trials remains difficult and controversial with respect to comparability and evaluation of drug efficacy, and definite conclusions can be drawn neither for diagnostic management nor for efficacious drug therapy so far. In view of these unsolved problems, guidelines both on the clinical management of FD and on the performance of clinical trials are needed. In recent years, increasing research work has been done in this area. Clinical trials conducted in adequately diagnosed patients that provided validated outcome measurements may result in better insights leading to more effective treatment strategies.Encouraging perspectives have been recently performed by methodologically well-designed treatment studies with herbal drug preparations. Herbal drugs, given their proven efficacy in clinical trials, offer a safe therapeutic alternative in the treatment of FD which is often favored by both patients and physicians. A fixed combination of peppermint oil and caraway oil in patients suffering from FD could be proven effective by well-designed clinical trials.

PRESENT SITUATION OF STUDY AND VIEW ON FUNCTIONAL DYSPEPSIA TREATED WITH SPECIFIC ACUPOINTS IN ACUPUNCTURE

Acupuncture plays a dominant role in treating functional dyspepsia （FD）. By reviewing and e- valuating clinical ROT and fundamental research with high quality in the past 17 years, it is found that specific acupoints are the chief in the treatment of FD; additionally, there are differences between specific acupoints and non-specific acupoints in therapeutic effect, explaining that the specificity of meridian points plays an im- portant role in treatment. However, because of inadequate high-quality researches in clinics, the specificity of acupoints can＇t be proved until the researches of clinical effect and mechanism of therapeutic difference are intensified.

Effect of clinician-patient communication on compliance with flupentixol-melitracen in functional dyspepsia patients

AIM: To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia(FD) patients with psychological symptoms. METHODS: A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen(FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal(GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3.RESULTS: After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3(Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index(Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantlyhigher compliance rate than Groups 2 and 3(Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia(Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores(anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were greater than those in Groups 2-4. The compliance indices were positively correlated with the reduction in symptom scores in Groups 1-3. CONCLUSION: Appropriate clinician-patient communication regarding the reasons for prescribing psychoactive drugs that emphasizes both the psychological and GI mechanisms might improve adherence to FM in patients with FD.

Symptom-based tendencies of Helicobacter pylori eradication in patients with functional dyspepsia

AIM: To investigate whether there were symptom-based tendencies in the Helicobacter pylori (H. pylori) eradication in functional dyspepsia (FD) patients. METHODS: A randomized, single-blind, placebo-controlled study of H. pylori eradication for FD was conduct- ed. A total of 195 FD patients with H. pylori infection were divided into two groups: 98 patients in the treatment group were treated with rabeprazole 10 mg twice daily for 2 wk, amoxicillin 1.0 g and clarithromycin 0.5 g twice daily for 1 wk; 97 patients in the placebo group were given placebos as control. Symptoms of FD, such as postprandial fullness, early satiety, nausea, belching,epigastric pain and epigastric burning, were assessed 3 mo after H. pylori eradication. RESULTS: By per-protocol analysis in patients with successful H. pylori eradication, higher effective rates of 77.2% and 82% were achieved in the patients with epigastric pain and epigastric burning than those in the placebo group (P < 0.05). The effective rates for postprandial fullness, early satiety, nausea and belching were 46%, 36%, 52.5% and 33.3%, respectively, and there was no significant difference from the placebo group (39.3%, 27.1%, 39.1% and 31.4%) (P > 0.05). In 84 patients who received H. pylori eradication therapy, the effective rates for epigastric pain (73.8%) and epigastric burning (80.7%) were higher than those in the placebo group (P < 0.05). The effective rates for postprandial fullness, early satiety, nausea and belch- ing were 41.4%, 33.3%, 50% and 31.4%, respective- ly, and did not differ from those in the placebo group (P > 0.05). By intention-to-treat analysis, patients with epigastric pain and epigastric burning in the treatment group achieved higher effective rates of 60.8% and 65.7% than the placebo group (33.3% and 31.8%) (P < 0.05). The effective rates for postprandial fullness, early satiety, nausea and belching were 34.8%, 27.9%, 41.1% and 26.7% respectively in the treatment group, with no significant difference from those in the placebo group (34.8%, 23.9%, 35.3% and 27.1%) (P > 0.05). CONCLUSION: The efficacy of H. pylori eradication has symptom-based tendencies in FD patients. It may be effective in the subgroup of FD patients with epigastric pain syndrome.

Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis

AIM: To evaluate whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with functional dyspepsia (FD).METHODS: Randomized controlled trials (RCTs) investigating the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (up to May 2015) were identified by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.RESULTS: This systematic review included 25 RCTs with a total of 5555 patients with FD. Twenty-three of these studies were used to evaluate the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.23 (95%CI: 1.12-1.36, P &#x0003c; 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at &#x02265; 1 year (RR = 1.24; 95%CI: 1.12-1.37, P &#x0003c; 0.0001) but not during short-term follow-up at &#x0003c; 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Seven studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -0.11 to 0.08, P = 0.80). Six studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy (RR = 0.35; 95%CI: 0.18-0.68, P = 0.002). Eight studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy (RR = 2.02; 95%CI: 1.12-3.65, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy (RR = 7.13; 95%CI: 3.68-13.81, P &#x0003c; 0.00001).CONCLUSION: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.

Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss

AIM: To explore the effects and mechanism of action of antidepressant mirtazapine in functional dyspepsia(FD) patients with weight loss.METHODS: Sixty depressive FD patients with weight loss were randomly divided into a mirtazapine group(MG), a paroxetine group(PG) or a conventional therapy group(CG) for an 8-wk clinical trial. Adverse effects and treatment response were recorded. The Nepean Dyspepsia Index-symptom(NDSI) checklist and the 17-item Hamilton Rating Scale of Depression(HAMD-17) were used to evaluate dyspepsia and depressive symptoms, respectively. The body composition analyzer was used to measure body weight and fat. Serum hormone levels were measured by ELISA.RESULTS:(1) After 2 wk of treatment, NDSI scores were significantly lower for the MG than for the PG and CG;(2) After 4 or 8 wk of treatment, HAMD-17 scores were significantly lower for the MG and PG than for the CG;(3) After 8 wk of treatment, patients in the MG experienced a weight gain of 3.58 ± 1.57 kg, which was significantly higher than that observed for patients in the PG and CG. Body fat increased by 2.77 ± 0.14kg, the body fat ratio rose by 4%, and the visceral fat area increased by 7.56 ± 2.25 cm2; and(4) For the MG, serum hormone levels of ghrelin, neuropeptide Y(NPY), motilin(MTL) and gastrin(GAS) were significantly upregulated; in contrast, those of leptin, 5-hydroxytryptamine(5-HT) and cholecystokinin(CCK) were significantly downregulated. CONCLUSION: Mirtazapine not only alleviates symptoms associated with dyspepsia and depression linked to FD in patients with weight loss but also significantly increases body weight(mainly the visceral fat in body fat). The likely mechanism of mirtazapine action is regulation of brain-gut or gastrointestinal hormone levels.

Incidence and psychological-behavioral characteristics of refractory functional dyspepsia:A large, multi-center, prospective investigation from China

AIM:To explore the incidence and psychological and behavioral characteristics of refractory functional dyspepsia(RFD)in China.METHODS:The subjects of this study were 1341 new outpatients with functional dyspepsia(FD)who were diagnosed according to the RomeⅢcriteria at four hospitals in Guangdong Province between June and September 2012,and 100 healthy volunteers.All subjects completed questionnaires and scales administered.RESULTS:Three-hundred and twenty-seven of the 1341patients with FD had RFD(24.4%).Patients with RFD had a longer disease duration and a more severe form of the disease than patients with non-refractory FD(NRFD).The prevalence of depression and anxiety symptoms was higher in patients with RFD than in patients with NRFD.The prevalence of unhealthy eating behaviors,lack of physical activity,and sleeping disorders was higher in patients with RFD than in patients with NRFD.Patients with RFD sought medical advice on more occasions and spent more money on treatment than patients with NRFD.Finally,patients with RFD had poorer quality of life than patients with NRFD.CONCLUSION:RFD is not rare in clinical practice and should get attention by patients and doctors because of its long duration,severe symptoms,and associations with abnormal psychology and poor quality of life.

Effect of domperidone therapy on nocturnal dyspeptic symptoms of functional dyspepsia patients

AIM:To investigate the incidence of nocturnal dyspeptic symptoms in patients with functional dyspepsia(FD) and whether prokinetic drugs can alleviate them. METHODS:Eighty-five consecutive Chinese patients with FD were included in this study.One week after single-blinded placebo run-in treatment,baseline nocturnal intragastric pH,bile reflux and nocturnal dyspeptic symptoms of eligible patients,including epigastric pain or discomfort,abdominal distention and belching, were investigated with questionnaires.Patients exhibiting nocturnal dyspeptic symptoms were randomly and double-blindly assigned to domperidone group or placebo group.Nocturnal intragastric pH and percentage of duodenogastric bile reflux time were determined after treatment. RESULTS:Of the 85 FD patients,2 females withoutnocturnal symptoms,who responded to placebo run-in treatment,were excluded from the study,30(36.1%) exhibited nocturnal dyspeptic symptoms with increased duodenogastric bile reflux time(intragastric bilirubin absorbance>0.14)and mean gastric pH(confirming the existence of bile reflux)(P=0.021,0.023) at night were included in the study.Of these 30 patients,21(70%)had overt nocturnal duodenogastric bile reflux,which was significantly higher than that of those without nocturnal symptoms(P=0.026).The 30 patients were allocated to domperidone group or placebo group(n=15).The nocturnal duodenogastric bile reflux and gastric pH were significantly decreased after domperidone treatment(P=0.015,0.021).The severity score of nocturnal dyspeptic symptoms was also significantly decreased after domperidone treatment (P=0.010,0.015,0.026),which was positively correlated with the reduced nocturnal bile reflux or gastric pH(r=0.736,0.784,0.753 or r=0.679,0.715,0.697, P=0.039,0.036,0.037 or P=0.043,0.039,0.040). CONCLUSION:A subgroup of Chinese FD patients show overt nocturnal dyspeptic symptoms,which may be correlated with the excessive nocturnal duodenogastric bile reflux.Domperidone therapy can alleviate these symptoms.

Functional dyspepsia:Are psychosocial factors of relevance?

The pathogenesis of Functional Dyspepsia （FD） remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intdnsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to vadation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.

Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives

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

Efficacy and safety of Xiangsha Liujunzi granules for functional dyspepsia: A multi-center randomized double-blind placebo-controlled clinical study

AIM To assess the efficacy and safety of a Chinese herbal medicine (CHM), Xiangsha Liujunzi granules, in the treatment of patients with functional dyspepsia (FD). METHODS We performed a randomized, double-blind, placebo-controlled trial with patients from three centers. Two hundred and sixteen subjects diagnosed with FD according to ROME. criteria and confirmed by upper gastrointestinal endoscopy and spleen-deficiency and Qi-stagnation syndrome were selected to receive Xiangsha Liujunzi granules or placebo for 4 wk in a 2: 1 ratio by blocked randomization. The subjects also received follow-up after the 4-wk intervention. Herbal or placebo granules were dissolved in 300 mL of water. Participants in both groups were administered 130 mL (45 degrees C) three times a day. Participants were evaluated prior to and following 4 wk of the intervention in terms of changes in the postprandial discomfort severity scale (PDSS) score, clinical global impression (CGI) scale score, hospital anxiety and depression scale (HADS) score, traditional Chinese medicine symptoms score (SS), scores of various domains of the 36-item short form health survey (SF-36), gastric emptying (GE) and any observed adverse effects. RESULTS Compared with the placebo group, patients in the CHM group showed significant improvements in the scores of PDSS, HADS, SS, SF-36 and CGI scale (P < 0.05 or P < 0.01). They also showed the amelioration in the GE rates of the proximal stomach and distal stomach (P < 0.05 or P < 0.01). CONCLUSION Xiangsha Liujunzi granules offered significant symptomatic improvement in patients with FD.