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.

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.

Exploring the mechanism of Xiaopi Hewei capsule in treating functional dyspepsia based on network pharmacology

Objective:Functional dyspepsia(FD)is a widely prevalent gastrointestinal disorder throughout the world,whereas the efficacy of current treatment in the Western countries is limited.The traditional Chinese herbal formula Xiaopi Hewei capsule(XHC)is a clinically validated remedy in treating FD,but there is no literature expounds the underlying therapeutic mechanism of XHC so far.Methods:In the present study,the network pharmacology technology was used to explore the therapeutic mechanism of XHC in treating FD.We obtained relative compounds of XHC,potential targets of these compounds and FD-related targets by retrieving particular websites.Based on the matching results between XHC potential targets and disease targets,Protein-Protein Interaction(PPI)network was constructed to screen the hub targets by topology.Furthermore,DAVID bioinformatics resources were utilized for the enrichment analysis on GO and KEGG.Results:A total of 62 active compounds and 547 putative identified targets were screened from XHC,of which 241 overlapped with the targets of FD and were considered potential therapeutic targets.14 hub genes were recognized as potential targets of treatments.Moreover,the results of DAVID enrichment analysis indicated that XHC participated in the complex treating effects associated with anti-depression,inflammatory reaction and eradicating Helicobacter Pylori(HP).Molecular docking stimulation results showed that most bioactive compounds of XHC had a strong binding efficiency with hub genes.Conclusions:This study demonstrated that XHC has the characteristics of multi-compounds,multi-targets and multi-pathways in treating FD,which provides the theoretical basis for further research of XHC.

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.

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.

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.

Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia:A systematic review

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.

Functional dyspepsia:Are psychosocial factors of relevance?

机能性消化不良(FD ) 的致病仍然保持不清楚，显得多样并且是不充分地理解的 thus。与另外的功能的胃肠的混乱类似，研究表明了在这普通诊断和精神分析聚会因素和精神病学的病态之间的一个协会。Conceptualising 在 FD 的症候群以内的这些因素的关联要求疾病的 biopsychosocial 模型的申请。用这个范例，在大脑和内脏之间的相互的通讯的 dysregulation 对症状产生，解释和恶化中央。对各种各样的心理状态的 neurobiological 相互关联的欣赏和理解也是相关的。精神分析聚会因素施加的看法他们在 FD 的影响也主要通过寻求的护理的动机坚持。这显得太一个维考虑到可得到的证据的断言支持一个更内在的病因论的连接。病原的机制的演变理解和症候群的异构的性质将便于有效管理。公司疾病的精神病学的病与常规治疗保证处理。在 FD，其度服从于变化，承认精神分析聚会变量的关联为评价和管理有含意。可得到的证据建议心理治疗可以特别地有益于 FD 病人那些与长期的症状。为在 FD 的治疗精神病的药的使用的基本原理是明显的，但是支持抗抑郁剂药物疗法的使用的证据底是标明日期有限的。

Reassessment of functional dyspepsia:From the editor

Functional dyspepsia (FD) is a heterogeneous disorder of yet unsure etiology. Commonly encountered, it poses a substantial social and economic burden. It can be classified into different subgroups based on the most predominant symptom. Early studies seem to suggest that such sub-classifications correlate to different etiological factors. However, the most important pathogenetic factor appears to be that of visceral hypersensititivity; the stomach seems to

Novel mechanisms in functional dyspepsia

机能性消化不良(FD ) 是多重病原的机制涉及的高度流行却异构的混乱。尽管有许多研究，调查了各种各样的 pathophysiologic 机制，与 FD 联系的内在的随便小径仍然保持阴暗。与 FD 联系的当前建议的 pathophysiologic 机制包括基因危险性，推迟以及加速胃的倒空的、内脏的超敏性到酸或机械膨胀，损害胃的住所，反常底的的局面的收缩，反常 antro 十二指肠的活动性，急性、长期的感染，和精神分析社会 comorbidity。位于 FD 下面的畸形的更大的理解可以导致改进管理。这篇社论的目的是在机能性消化不良提供当前的 pathophysiologic 概念的批评概述。

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.

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.

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.

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 Pub Med, 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 < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year(RR = 1.24; 95%CI: 1.12-1.37, P < 0.0001) but not during short-term follow-up at < 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 < 0.00001).CONCLUSION: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.

Cholecystokinin hyperresponsiveness in functional dyspepsia

机能性消化不良(FD ) 是还不明确的病原学的普通混乱。消化不良的症状通常是联系的饭并且建议一个协会到胃肠(官方补给) 感觉运动的机能障碍。缩胆囊素(CCK ) 是在胃肠的功能起一个重要规章的作用的确定的大脑勇气肽。它禁止胃的活动性并且经由辣椒辣素倒空敏感迷走神经小径。倒空上的效果经由它近似的胃和幽门上的行动。CCK 也涉及食物摄取的规定。导致饱足经由迷走神经 afferents 响应饭和幕在内脏被释放。而且， CCK 也被显示了涉及恐慌的混乱，焦虑和疼痛的致病。另外的 neurotransmitters 象血清素那样并且也不肾上腺素可以在官方补给的活动的协作与 CCK 被含有。另外， CCK 的静脉内的管理被观察了在 FD 复制症状，这效果能被颠茄碱和 loxiglumide 两个都堵住(CCK -- 一个对手) 。对 CCK 的改变的回答可能为通常观察的胃的感觉运动的机能障碍负责，是可能的，它然后可以与消化不良的症状的开始被联系。

Gastrointestinal hormone abnormalities and G and D cells in functional dyspepsia patients with gastric dysmotility

AIM: To investigate the relationship between gastric dysmotility,gastrointestinal hormone abnormalities, and neuroendocrine cells in gastrointestinal mucosa in patients with functional dyspepsia (FD).METHODS: Gastric emptying was assessed with solid radiopaque markers in 54 FD patients, and the patients were divided into two groups according to the results, one with delayed gastric emptying and the other with normal gastric emptying. Seventeen healthy volunteers acted as normal controls. Fasting and postprandial plasma levels and gastroduodenal mucosal levels of gastrointestinal hormones gastrin, somatostatin (SS) and neurotensin (NT)were measured by radioimmunoassay in all the subjects.G cells (gastrin-producing cells) and D cells (SS-producing cells) in gastric antral mucosa were immunostained with rabbit anti-gastrin polyclonal antibody and rabbit anti-SS polyclonal antibody, respectively, and analyzed quantitatively by computerized image analysis.RESULTS: The postprandial plasma gastrin levels, the fasting and postprandial plasma levels and the gastric and duodenal mucosal levels of NT were significantly higher in the FD patients with delayed gastric emptying than in those with normal gastric emptying and normal controls. The number and gray value of G and D cells and the G cell/D cell number ratio did not differ significantly between normal controls and the FD patients with or without delayed gastric emptying.CONCLUSION: Our findings suggest that the abnormalities of gastrin and NT may play a role in the pathophysiology of gastric dysmotility in FD patients, and the abnormality of postprandial plasma gastrin levels in FD patients with delayed gastric emptying is not related to the changes both in the number and gray value of G cells and in the G cell/D cell number ratio in gastric antral mucosa.

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM:To evaluate the effect of prokinetic drugs on electrogastrography(EGG) parameters according to symptomatic changes in patients with functional dyspepsia(FD).METHODS:Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010.We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment.We also measured cutaneous pre-prandial and postprandial EGG recordings including percentage of gastric waves(normogastria,bradygastria,tachygastria),dominant frequency(DF),dominant power(DP),dominant frequency instability coefficient(DFIC),dominant power instability coefficient(DPIC),and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.RESULTS:Fifty-two patients(70%) achieved symptomatic improvement after prokinetic drug treatment.Patients who had normal gastric slow waves showed symptom improvement group after treatment.Postprandial DF showed a downward trend in the symptom improvement group,especially in the itopride group.Post-prandial DP was increased regardless of symptom improvement,especially in the itopride group and mosapride group.Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment.The EGG power ratio was increased after treatment in the symptom improvement group(0.50 ± 0.70 vs 0.93 ± 1.77,P = 0.002),especially in the itopride and levosulpiride groups.CONCLUSION:Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity,and EGG could be a useful tool in evaluating the effects of various prokinetics.

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, placebocontrolled trial with patients from three centers. Two hundred and sixteen subjects diagnosed with FD according to ROME Ⅲ 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 m L of water. Participants in both groups were administered 130 m L(45 ℃) 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.

Itopride therapy for functional dyspepsia:A meta-analysis

AIM:To evaluate the therapeutic effects of itopride vs other drugs(placebo,domperidone,mosapride) for functional dyspepsia(FD).METHODS:Randomized controlled trials(RCTs) of itopride for FD were retrieved from databases.Relevant information was extracted and analyzed,using the relative risk(RR) and weighted mean deviation,as appropriate.A random or fixed effect model was used,based on the heterogeneity of the included articles,and visual inspection of funnel plots was used to evaluate publication bias.RESULTS:Nine RCTs enrolling 2620 FD cases were included;1372 cases received itopride treatment and 1248 cases received placebo or other drugs(control groups).Compared with control groups,itopride had superior RR values of 1.11 [95%CI:(1.03,1.19),P = 0.006],1.21 [95%CI:(1.03,1.44),P = 0.02],and1.24 [95%CI:(1.01,1.53),P = 0.04] for global patient assessment,postprandial fullness,and early satiety,respectively.For the Leeds Dyspepsia Questionnaire score,the weighted mean deviation was-1.38 [95%CI:(-1.75,-1.01),P < 0.01].The incidence of adverse effects was similar in the itopride and control groups.The funnel plots for all indicators showed no evidence of publication bias.CONCLUSION:Itopride has good efficacy in terms of global patients assessment,postprandial fullness,and early satiety in the treatment of patients with FD and shows a low rate of adverse reactions.Itopride can greatly improve FD syndromes-score.

Role of cholecystokinin and central serotonergic receptors in functional dyspepsia

机能性消化不良的症状被上面的腹的不快或疼痛描绘，早饱足，饭后的充分，膨胀，恶心并且呕吐。它非常是长期的混乱，与症状 3 瞬间每器质性病的年，和没有证据。不正常的活动性，改变的内脏的感觉，和精神分析聚会因素都作为主要 pathophysiological 机制被识别了。这些 pathophysiological 机制交往生产观察症状，这被相信。消化不良基于主导的症状被分成了三亚群。象 Dysmotility 一样消化不良描述其综合征通常与一个胃的感觉运动的机能障碍有关的病人的亚群。大脑勇气肽缩胆囊素(CCK ) 和血清素(5-HT ) 分享某些生理的效果。被显示了胃的倒空减少并且影响饱足。而且， CCK 导致了取决于的厌食可能经由中央小径行动的 serotonergic 功能。我们相信和一只亢奋的应答的海角工作到 CCK 或他们的相互作用的中央 serotonergic 受体的畸形可能为在机能性消化不良(FD ) 的症状的开始负责。