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The functional gastrointestinal diseases (FGIDs) are often noticed disturbances. Functional dyspepsia (FD) is the most frequent FGID of the upper part of the gastrointestinal tract while irritable bowel syndrome (IBS) occurs in the lower gastrointestinal part. Both clinical entities are characterized by rich symptomatology and the pattern of the di...
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Context 1
... hypothesis implicates that psy- chological factors may influence gastrointestinal sensitivity. The idea of the bidirectional communi- cation system between the enteric nervous system and the central nervous system (see Figure 2) is a key target of future FGIDs treatment. The ENS and CNS communicate through neural (autonomic nerv- ous system), neuroendocrine (HPA axis) and neu- Figure 1. ...
Citations
... The statistical study done by Khotimah and Ariani (2012) stated that stress level had the greatest influence to dyspepsia syndrome (Khotimah and Ariani, 2012). The clinical manifestations of functional dyspepsia, such as heartburn, bloating, early satiety, nausea, and vomiting, were able to affect patients' quality of life and disrupt their daily activities, including learning progress of students with dyspepsia (Dobrek, 2009). ...
... The symptoms induced by gastric distension are not region-specific. The measurement of gastric emptying is most accessible and is a good indicator of gastric motility disorders (3)(4)(5)(6). ...
Background: Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p<0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p <0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p <0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p <0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.
... To break these vicious cycles, centrally orientated therapy is something that comes adjunctively in an integrative approach, with psychoneuroimmunologal therapy being precisely the epitome. Treating symptoms occurring in IBD and FGID such as diarrhoea, constipation, fatigue, nausea or vomiting, and reduction in appetite with conventional pharmacotherapy and interventional procedures may be useful for short-term relief, but regulating the underlying pathophysiological mechanisms and possibly covering as much pathways as possible should provide long-term improvements [151]. Even though the therapy of GI-related pain should be guided according to the exact cause, oftentimes it remains difficult to identify the full extent of pathophysiological process and advance beyond symptomatic treatment. ...
Background and purpose (aims):
Psychoneuroimmunology is both a theoretical and practical field of medicine in which human biology and psychology are considered an interconnected unity. Through such a framework it is possible to elucidate complex syndromes in gastrointestinal related pain, particularly chronic non-malignant. The aim is to provide insight into pathophysiological mechanisms and suggest treatment modalities according to a comprehensive paradigm. The article also presents novel findings that may guide clinicians to recognize new targets or scientists to find new research topics.
Methods:
A literature search of 'PubMed' and 'Google Scholar' databases was performed. Search terms included: 'Visceral pain', 'Psychoneuroimmunology', 'Psychoneuroimmunology and pain', 'Pain in GI system', 'GI related pain', 'Pain and microbiota', 'Enteric nervous system', 'Enteric nervous system and inflammation', 'CNS and pain', 'Inflammation and pain in GI tract', 'Neurogastroenterology', 'Neuroendocrinology', 'Immune system in GI pain'. After searching and reading sources deemed recent and relevant, a narrative review was written with a tendency to discriminate the peripheral, intermediate, and central pathophysiological mechanisms or treatment targets.
Results:
Recent evidence point out the importance of considering the brain-gut axis as the main connector of the central and peripheral phenomena encountered in patients suffering from chronic non-malignant gastrointestinal related pain. This axis is also a prime clinical target with multiple components to be addressed in order for therapy to be more effective. Patients suffering from inflammatory bowel disease or functional gastrointestinal disorders represent groups that could benefit most from the proposed approach.
Conclusions (based on our findings):
Rather than proceeding with established allopathic single-target central or peripheral treatments, by non-invasively modulating the brain-gut axis components such as the psychological and neuroendocrinological status, microbiota, enteric nervous system, or immune cells (e.g. glial or mast cells), a favourable clinical outcome in various chronic gastrointestinal related pain syndromes may be achieved. Clinical tools are readily available in forms of psychotherapy, prebiotics, probiotics, nutritional advice, and off-label drugs. An example of the latter is low-dose naltrexone, a compound which opens the perspective of targeting glial cells to reduce neuroinflammation and ultimately pain.
Implications (our opinion on what our findings mean):
Current findings from basic science provide sound mechanistic evidence and once entering clinical practice should yield more effective outcomes for patients. In addition to well-established pharmacotherapy comprised notably of anti-inflammatories, antibiotics, and proton-pump inhibitors, valid treatment strategies may contain other options. These disease modulating add-ons include probiotics, prebiotics, food supplements with anti-inflammatory properties, various forms of psychotherapy, and low-dose naltrexone as a glial modulator that attenuates neuroinflammation. Clearly, a broader and still under exploited set of evidence-based tools is available for clinical use.
... Therefore, CCK 1 receptor antagonists are currently under development for the treatment motility disorders including FD and constipation-predominant IBS (Varga et al., 2004). Studies in FGID patients indicate that the clinical symptoms are exacerbated by CCK analogues, while they were significantly improved by administration of CCK 1 receptor antagonists (Cann et al., 1994;Dobrek and Thor, 2009;Varga, 2002). Despite the promising results from the existing studies, long term use of CCK receptor antagonists are highly limited due to their significant potential in gallstone formation and bile stasis (Varga et al., 2004). ...
... Functional dyspepsia (FD) is a clinical syndrome characterized by symptoms such as recurrent or persistent epigastric pain, abdominal discomfort, early satiety, abdominal fullness, nausea, and vomiting (1). Organic pathologies with similar symptoms should be excluded before diagnosing FD (2,3). Epidemiological studies have reported a similar incidence of functional gastrointestinal diseases in Europe and the United States of America (USA) and a lower incidence of such diseases in Asia (4). ...
Background/aims:
Pathogenesis of functional dyspepsia (FD) is unclear and not well documented. Some gastric motility abnormalities have been reported to be important factors. Transcutaneous electrogastrography (EGG) is an experimental method that is used to assess FD. We aimed to compare FD patients with control subjects in terms of motility abnormalities according to the EGG results.
Materials and methods:
Thirty patients with FD and thirty control subjects were included. EGG was preprandially and postprandially performed. The recordings were analyzed and compared between the two groups.
Results:
Mean ages of the cases and controls were 31.4±9.3 and 32.58±7.6 years, respectively. Female subjects constituted 80% of the FD group and 76.67% of the control group. In terms of the preprandial dominant frequency (DF), the FD group demonstrated lower incidence of normal subjects than the control group [13 (43.3%) and 22 (73.3%), respectively] and a higher incidence of bradygastria than the control group [17 (56.7%) and 8 (26.6%), respectively]. In the FD group, the rate of cases with normal postprandial DF was lower than that in the control group [10 (33.3%) and 23 (76.7%), respectively], whereas the rates of bradygastria [18 (60%) and 7 (23.3%), respectively] and tachygastria [2 (6.7%) and 0 (0%), respectively] were higher in the FD group (p<0.05). Preprandial and postprandial DF values were statistically significant in both groups.
Conclusion:
A high incidence of gastric motility and myoelectrical activity abnormalities was observed in patients with FD. EGG is an effective, reliable, and non-invasive method in differentiating the subgroups. After standardization of some parameters, EGG may be an essential and irreplaceable test to diagnose and follow-up FD patients with motor dysfunction.
... Similar to FD and IGP, IBS also presents with chronic abdominal pain and symptoms of GI dysmotility (GID). Dysmotility is one of the proposed mechanisms in the pathophysiology of IBS [4,5]. ...
Abdominal pain, bloating, early satiety, and changes in bowel habits are common presenting symptoms in individuals with functional GI disorders. Emerging data suggests that these symptoms may be associated with mast cell excess and/or mast cell instability in the GI tract. The aim of this retrospective study was to evaluate the contribution of mast cells to the aforementioned symptoms in individuals with a history of atopic disease. A retrospective chart review of individuals seen in a university GI practice was conducted and twenty-four subjects were identified. The majority had abdominal pain, early satiety, and nocturnal awakening. 66.7% and 37.5% had a history of environmental and/or food allergy. Solid gastric emptying was increased as were the mean number of mast cells reported on biopsies from the stomach, small bowel, and colon (>37/hpf) by CD117 staining. Mean whole blood histamine levels were uniformly elevated. This study suggests that in individuals with these characteristics, consideration should be given to staining their gastrointestinal biopsies for mast cells as this may provide them with relatively non-toxic but highly targeted treatment options. Allergic gastroenteritis and colitis may represent a third type of GI mast cell disorder along with mast cell activation syndrome and mastocytic enterocolitis.
Electrogastrogram is used for the abdominal surface measurement of the gastric electrical activity of the human stomach. The electrogastrogram technique has significant value as a clinical tool because careful electrogastrogram signal recordings and analyses play a major role in determining the propagation and coordination of gastric myoelectric abnormalities. The aim of this article is to evaluate electrogastrogram features calculated by line length features based on the discrete wavelet transform method to differentiate healthy control subjects from patients with functional dyspepsia and diabetic gastroparesis. For this analysis, the discrete wavelet transform method was used to extract electrogastrogram signal characteristics. Next, line length features were calculated for each sub-signal, which reflect the waveform dimensionality variations and represent a measure of sensitivity to differences in signal amplitude and frequency. The analysis was carried out using a statistical analysis of variance test. The results obtained from the line length analysis of the electrogastrogram signal prove that there are significant differences among the functional dyspepsia, diabetic gastroparesis, and control groups. The electrogastrogram signals of the control subjects had a significantly higher line length than those of the functional dyspepsia and diabetic gastroparesis patients. In conclusion, this article provides new methods with increased accuracy obtained from electrogastrogram signal analysis. The electrogastrography is an effective and non-stationary method to differentiate diabetic gastroparesis and functional dyspepsia patients from the control group. The proposed method can be considered a key test and an essential computer-aided diagnostic tool for detecting gastric myoelectric abnormalities in diabetic gastroparesis and functional dyspepsia patients.
