An update on current pharmacotherapy options for dyspepsia.
ABSTRACT Introduction: Functional dyspepsia (FD) is a highly prevalent and challenging disorder which impacts patients' quality of life and poses a considerable socioeconomic burden. Given the vagueness of the definition of FD based on the current Rome III criteria's expert opinion, the diagnosis of FD continues to be one of exclusion. Despite efforts to better define what constitutes FD, validity of such diagnostic criteria remains controversial given the lack of a distinct pathophysiologic mechanism. Areas covered: New insights into the pathophysiology of FD have expanded our treatment options for the syndrome. This review will discuss the current pharmacologic treatments of FD with particular focus on the more robust randomized controlled trials to date. Expert opinion: Recently, the understanding of the pathophysiology of FD has evolved with novel hypothesis such as sensorimotor abnormalities of the stomach or duodenum, genetic polypmorphisms, psychological comorbidities, food sensitivities and allergies, and immune dysregulation found to be possibly responsible for its pathogenesis. Despite the expanding knowledge about the likely multifactorial pathophysiology of FD, its treatment remains a challenge.
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ABSTRACT: Function dyspepsia (FD) may cause patients to suffer from anxiety and depression, and psychosocial disorders would have a significant effect on FD symptoms. To examine the prevalence of anxiety and depression among function dyspepsia (FD) patients and to identify social factors of anxiety-depression among FD patients. Patients with FD, who fulfilled the Rome III criteria, were enrolled. All patients were administered a validated Chinese version of the self-rating scale (SDS) and self-rating anxiety scale (SAS), and investigated regarding the patients' social factors. A total of 907 patients were enrolled, including 516 (56.89%) FD patients within anxiety-depression status; SDS mean scores were 51.57 ±8.22; SAS mean scores were 51.04 ±7.53; 52.28% were male and 64.25% were female (χ(2) = 262.54, p < 0.01); 56.16% were aged 18-29 years, 54.15% were aged 30-39 years, 54.77% were aged 40-49 years, 62.02% were aged 50-59 years, 69.23% were aged above 60 years (χ(2) = 18.14, p < 0.01); 67.44% were the retirees; 63.31% were manual workers; 55.10% were soldiers; 43.57% were mental workers; 38.89% were students (χ(2) = 716.53, p < 0.01); 64.20% had junior high school degree or below; 57.36% had high school degrees; 42.03% had college degrees; 44.44% had master's or above degrees (χ(2) = 27.21, p < 0.05); 38.10% were in good health condition; 61.90% were in poor health condition (χ(2) = 7.94, p < 0.01); 20.31% had correlative family history; and 79.69% had no correlative family history (χ(2) = 2.23, p > 0.05). The FD patients have higher rates of anxiety and depression. Gender, age, occupation, education level, and health condition have a significant effect on anxiety and depression status. Female gender, advanced age, high-stress occupation, lower education level, and poor health condition all are risk factors. Family history has no relationship with anxiety and depression among FD patients.
Article: Dyspepsia.[Show abstract] [Hide abstract]
ABSTRACT: Dyspepsia is a common and complex condition consisting of chronic upper gastrointestinal symptoms. A rational approach to diagnosis and treatment of dyspepsia includes identifying those patients with alarm symptoms and referring them for prompt endoscopy. Those without alarm symptoms can be differentiated into patients who do and do not have symptoms consistent with gastroesophageal reflux disease. In the absence of predominant heartburn and regurgitation, patients should be tested and treated for Helicobacter pylori. Functional (nonulcer) dyspepsia is a multifactorial disorder with several possible pathophysiologic mechanisms, but no clear guidelines for therapy. There is some evidence of efficacy of proton pump inhibitors, antisecretory agents, antidepressants, and psychotherapy for functional dyspepsia.The Medical clinics of North America 05/2014; 98(3):549-564. DOI:10.1016/j.mcna.2014.01.007 · 2.18 Impact Factor
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ABSTRACT: Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.Digestive Diseases and Sciences 04/2014; DOI:10.1007/s10620-014-3144-0 · 2.26 Impact Factor