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Proposed mechanism of duodenal inflammation underlying symptom generation in functional dyspepsia. A loss of mucosal integrity caused by any combination of stress, acid exposition, genetic predisposition or dysbiosis may lead to a low‐grade inflammation involving eosinophils and mast cells with a non‐IgE‐dependent activation of mast cells, possibly through possibly the MRGPRX2 receptor. This may lead to a neuronal dysfunction of duodenal submucous ganglia and systemic immune activation leading to central nervous co‐morbidities and altered gastroduodenal motility. ECP, eosinophil cationic protein; EDN, eosinophil derived neurotoxin; IL‐10, Interleukin‐10; IL‐1β, interleukin‐β; MBP, major basic protein; MRGPRX2, mas‐related G‐protein coupled receptor member X2; TNF‐α, tumour necrosis factor alpha.
Source publication
Background
Functional dyspepsia (FD) is one of the most frequent conditions in gastroenterological outpatient health care. Most recent research in FD has shifted its focus to duodenal pathophysiological mechanisms, although current treatments still focus mainly the stomach.
Aim
The aim of the study was to provide a comprehensive overview of the pa...
Citations
... The pathophysiological mechanisms underlying clinical symptoms in AIG are poorly understood. Appropriate evaluation, including endoscopy, is therefore required to differentiate these entities; indeed, based on the Rome Global Epidemiology Study, the diagnosis of FD requires the absence of organic, systemic, or metabolic disease upon routine investigation, including endoscopy [7,8]. ...
... The observation of a role of GERD in these patients' symptoms independently of acid is clinically relevant because it can guide their management. These patients may benefit from drugs that lower their visceral sensitivity (i.e., tricyclic antidepressants and selective serotonin reuptake inhibitors) [7,54]. Furthermore, for those with severe drug-unresponsive symptoms anti-reflux surgery is an option [55,56]. ...
... Conversely, if MII-pH-impedance diagnoses a non-acidic reflux disease, as well as functional heartburn and reflux hypersensitivity, these patients may benefit from drugs that lower their visceral sensitivity (i.e. tricyclic antidepressants and selective serotonin reuptake inhibitors) [7,54]. Moreover, patients who did not respond to medical treatment as well as patients with a high burden of non-acidic reflux, may benefit from anti-reflux surgery [55,56]. ...
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.
Functional gastrointestinal disorders (FGID) present a challenge in the field of gastroenterology with irritable bowel syndrome (IBS) and functional dyspepsia (FD) as the most significant functional disorders of the spectrum. According to current evidence and current classifications, FGIDs are categorized as disorders of gut–brain (microbiome) axis (DGBI). The updated S3 guideline for irritable bowel syndrome offers a pragmatic approach for clinical practice to diagnose and treat functional gastrointestinal disorders based on predominant symptoms. The underlying pathophysiological mechanisms were considered in the updated S3 guidelines and integrated into personalized treatment concepts that should always be understood as individualized therapy plans. Treatment options include nutritional therapeutic approaches and methods, psychoeducational options, as well as complementary medical approaches, including phytotherapeutics and probiotics, along with traditional pharmacological agents. The goal of the treatment concept for functional gastrointestinal disorders is to alleviate symptoms and improve patient quality of life. Ongoing research of the gut–brain- microbiome axis significantly contributes to our understanding of symptom generation.
LINKED CONTENT
This article is linked to Broeders et al paper. To view this article, visit https://doi.org/10.1111/apt.17414
