Hypersensitivity for capsaicin in patients with functional dyspepsia. Neurogastroenterol Motil

Abteilung für Gastroenterologie und Hepatologie, Medical University of Vienna, Vienna, Austria.
Neurogastroenterology and Motility (Impact Factor: 3.59). 03/2008; 20(2):125-33. DOI: 10.1111/j.1365-2982.2007.00997.x
Source: PubMed


The pathophysiology of functional dyspepsia is poorly understood, thus diagnostic and therapeutic options for this disease are limited. We assessed the relevance of a simple test for chemical hypersensitivity by applying an oral capsaicin load. After a preliminary dose-finding study, 61 healthy controls and 54 functional dyspepsia patients swallowed a capsule containing 0.75 mg capsaicin. A graded questionnaire evaluated severity of symptoms before and after capsule ingestion; an aggregate symptom score was calculated by adding all symptom scores. Controls developed moderate symptoms (symptom score: 6.0+/-4.1; median: 5.0). The 75% quartile (9.0) was considered the upper limit of normal. Functional dyspepsia patients had significantly higher symptom scores (10.0+/-6.5) than controls. About 54% of functional dyspepsia patients tested positive; clinically this group was not different from the group testing negative besides being on average younger and suffering more from bloating. In additional 13 patients with functional dyspepsia who tested positive (symptom score: 15.8+/-0.9), symptom response to placebo capsules (1.9+/-0.6) was similar to controls. In reliability testing, the Cronbach alpha-value of the capsaicin test was 0.86. The capsaicin test is a simple and non-invasive method to detect a subgroup of functional dyspepsia with chemical hypersensitivity.

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    • "In this study, a lower amount of capsaicin was required to induce pain in patients with FD compared to healthy subjects [29]. However, Hammer et al. failed to show any correlation between hypersensitivity to capsaicin and any specific symptom or severity of symptoms in FD patients [30]. "
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    ABSTRACT: Functional dyspepsia is a common disorder which imposes significant diagnostic and treatment challenges for patients and physicians. The most recent update of the diagnostic criteria subdivides functional dyspepsia into two subcategories based on the main symptom of epigastric pain or postmeal fullness. As we discuss in this review, several studies have shown significant overlap in symptoms and pathophysiology between functional dyspepsia, irritable bowel syndrome, and the spectrum of reflux disorders. This overlap in symptoms can be informative in helping us to understand the underlying pathophysiology, diagnostic approaches, and treatment strategies. The addition of diagnostic testing such as pH impedance manometry of the distal esophagus to the current common diagnostic tests might be helpful in distinguishing between functional dyspepsia and reflux disease. Importantly, various treatment modalities may be more effective than others if the main symptom is burning rather than pain or postmeal fullness rather than early satiation.
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    • "Hypersensitivity to endogenous and exogenous chemicals, gastric acid or nutrients has been suggested to be associated with dyspeptic symptoms.75-77 Since patients with visceral hypersensitivity are considered to have enhanced sensory nerve activity, stimulation of luminal chemoreceptors in the upper GI mucosa may generate or aggravate dyspeptic symptoms. "
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    Full-text · Article · Apr 2012 · Journal of neurogastroenterology and motility
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    • "Upregulation of TRPV1 in the mucosa, with a correlation to pain sensitivity in irritable bowel syndrome and in inflammatory bowel disease with irritable bowel syndrome-like symptoms Facer et al., 2001; Yiangou et al., 2001; Chan et al., 2003; Matthews et al., 2004; Bhat & Bielefeldt, 2006; Akbar et al., 2008, 2010; Guarino et al., 2010; Shieh et al., 2010 Esophagus, stomach, intestine and pancreas Acid-induced oesophagitis, gastric acidevoked injury of the stomach, trinitrobenzene sulfonic acid-induced pancreatitis and colitis in rodents Upregulation of TRPV1 in vagal and spinal afferent neurons Schicho et al., 2004; Banerjee et al., 2007; Miranda et al., 2007; Xu et al., 2007 Esophagus, stomach and small intestine Abdominal pain in human volunteers Induction by intraluminal capsaicin Schmidt et al., 2004; Hammer, 2006a, 2006b; Hammer & Vogelsang, 2007; Hammer et al., 2008; Führer & Hammer, 2009; Kindt et al., 2009; Chen et al., 2010; van Boxel et al., 2010 Stomach Behavioral pain response to intragastric acid challenge in rats Prevention by TRPV1 antagonism Lamb et al., 2003 Stomach and upper small intestine Functional dyspepsia Hypersensitivity to the algesic effect of capsaicin Hammer et al., 2008 Stomach and upper small intestine Functional dyspepsia Beneficial effect of 5 week ingestion of capsaicin capsules Bortolotti et al., 2002 Duodenum Pain sensitivity to capsaicin exposure and balloon distension in humans "
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