Regional cerebral blood flow during gastric balloon distention in functional dyspepsia. Visceral and somatic sensory function in functional dyspepsia. The proximal stomach and postprandial symptoms in functional dyspeptics A placebo-controlled trial of the 5-HT1A agonist R-137696 on symptoms, visceral hypersensitivity and on impaired accommodation in functional dyspepsia. The water load test: observations from healthy controls and patients with functional dyspepsia. Effect of acute and chronic levosulpiride administration on gastric tone and perception in functional dyspepsia Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Effect of Amitriptyline and Escitalopram on Functional Dyspepsia: A Multicenter, Randomized Controlled Study. Cisapride in functional dyspepsia in general practice. A placebo‐controlled, randomized, double‐blind study Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials Dyspepsia and IBS Symptoms in Patients with NERD, ERD and Barrett’s Esophagus Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders Overlap of Erosive and Non-erosive Reflux Diseases With Functional Gastrointestinal Disorders According to Rome III Criteria Role of cognitive factors in symptom induction following high and low fat meals in patients with functional dyspepsia Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss. A double-blind, randomized, placebo-controlled trial of cisapride in Saudi Arabs with functional dyspepsia. Functional dyspepsia: outcome of focus groups for the development of a questionnaire for symptom assessment in patients suffering from postprandial distress syndrome (PDS). Gastric antral motility in functional dyspepsia. Effect of mental stress and cisapride. A pilot study to assess the efficacy of biofeedback-assisted relaxation training as an adjunct treatment for pediatric functional dyspepsia associated with duodenal eosinophilia. Dyspeptic patients with visceral hypersensitivity: sensitisation of pain specific or multimodal pathways? Effect of Profound Acid Suppression in Functional Dyspepsia: a Double-Blind, Randomized, Placebo-Controlled Trial
BACKGROUND & AIMS Hypersensitivity to proximal gastric distention as a result of abnormal central nervous system processing of visceral stimuli is a possible pathophysiologic mechanism in functional dyspepsia ( FD ) . Increasing evidence suggests involvement of both lateral and medial pain systems in normal visceral sensitivity and aberrant brain activation patterns in visceral hypersensitivity . We hypothesized that there is involvement of aberrant brain activation in FD with hypersensitivity to gastric distention . Our aim was to investigate regional cerebral blood flow during painful proximal gastric distention in hypersensitive FD . METHODS Brain (15)O-water positron emission tomography was performed in 13 FD patients with symptoms of gastric hypersensitivity during 3 conditions : no distention , sham distention , and isobaric distention to unpleasant or painful sensation .  Pain , discomfort , nausea , and bloating during maximal distention were rated on visual analogue scales . Data were analyzed using statistical parametric mapping . RESULTS The threshold for painful distention was 6.6 + /- 3.8 mm Hg greater than the minimal distending pressure . At the corrected P level of less than .05 , subtraction analysis ( painful distention - no distention ) showed activations in bilateral gyrus pre central is , bilateral gyrus frontalis inferior , bilateral gyrus frontalis medialis , bilateral gyrus temporalis superior , bilateral cerebellar hemisphere , and left gyrus temporalis inferior . Sham distention minus no distention showed no activations . CONCLUSIONS Similar to healthy volunteers , proximal stomach distention in FD activates components of the lateral pain system and bilateral frontal inferior gyri , putatively involved in regulation of hunger and satiety . In hypersensitive FD , these activations occur at significantly lower distention pressures . In contrast to findings in normosensitivity , none of the components of the medial pain system were significantly activated BACKGROUND Visceral hypersensitivity is one of the proposed underlying mechanisms in functional dyspepsia ( FD ) . It is not clear whether visceral hypersensitivity in FD is a manifestation of a central sensitization also encompassing somatic sensitization . Transient receptor potential vanilloid-1 ( TRPV(1 ) ) pathways are involved in gastric mechanosensory physiology and the TRPV(1 ) receptor agonist , capsaicin , has been used as a chemical stimulant . METHODS In this double-blind , r and omized study we evaluated both visceral and somatic sensory function in 34 FD patients and 42 healthy controls using quantitative sensory testing . Visceral pain sensitivity was assessed using a vali date d gastric pain model with oral capsaicin capsule titration and somatic pain sensitivity was determined by foot heat and h and electric stimulation . KEY RESULTS The median capsaicin dose required to attain moderate pain was 0.5 mg in FD and 1 mg in controls ( P = 0.03 ) . At these doses , mean pain intensities on a 0 - 100 visual analog scale were greater for FD than controls [ 56.9 ( 95 % confidence intervals , 52.2 - 61.5 ) vs 45.1 ( 41.6 - 48.6 ) , resp . ] ( P = 0.005 ) . Overall , mean somatic sensory and pain thresholds were similar in FD and control groups , but in a subgroup of FD pain hypersensitivity was seen on the h and and on the foot at different stimulation thresholds . CONCLUSIONS & INFERENCES A majority of patients with FD have visceral chemo-hypersensitivity involving TRPV(1 ) pathways . A substantial subgroup also has somatic hypersensitivity as evidence of central sensitization OBJECTIVE : It remains unclear whether postpr and ial symptom profiles in patients with visceral hypersensitivity and in those with impaired fundic accommodation differ . Therefore , we evaluated the postpr and ial symptoms in functional dyspepsia ( FD ) patients classified according to proximal stomach function . In addition , the effect of gastric relaxation induced by sumatriptan on postpr and ial symptoms was studied in FD patients with impaired fundic accommodation . METHODS : Twenty-five healthy volunteers ( HVs ) and 44 FD patients filled out a disease-specific question naire ( Nepean Dyspepsia Index ) and underwent a gastric barostat study to evaluate visceral sensitivity , meal-induced fundic relaxation , and postpr and ial symptoms . Postpr and ial symptoms evoked by a drink test or reported during the barostat study were compared between FD patients subdivided according to the underlying pathophysiological mechanism . Finally , the effect of sumatriptan on postpr and ial symptoms evoked by a drink test was investigated in HVs and in FD patients with impaired fundic accommodation . RESULTS : There was no clear relationship between any of the 15 Nepean Dyspepsia Index symptoms and proximal stomach function . Postpr and ial symptoms evoked during the barostat study or after the drink tests were significantly higher in FD patients than in HVs ; however , no clear differences in symptom profile could be demonstrated between the different subclasses of FD . Sumatriptan did not affect the maximal ingested volume or the postpr and ial symptoms in HVs or FD patients after a drink test . CONCLUSIONS : No clear relationship could be demonstrated between postpr and ial symptoms and proximal stomach function Acute studies suggested a therapeutic benefit for fundus-relaxing drugs in functional dyspepsia ( FD ) with visceral hypersensitivity ( VH ) to gastric distention or impaired accommodation ( IA ) , but long-term studies are lacking . R-137696 is a serotonin-1A ( 5-HT(1A ) ) receptor agonist which relaxes the proximal stomach in man . Our aim was to investigate the influence of R-137696 on symptoms in FD with VH or IA . R and omized , double-blind , placebo-controlled , parallel group study of 4 weeks R-137696 2 mg t.i.d . in FD with VH or IA . Symptoms were assessed using the  patient assessment of upper gastrointestinal symptom severity index ( PAGI-SYM ) total score and individual symptom subscales . Barostat studies were performed before and after 4 weeks of treatment . Fifty-three patients ( 33 VH and 20 IA ) , 18 men , mean age 40 + /- 13 years were recruited . Twenty-four received placebo and 29 received R-137696 . In VH patients , both placebo and R-137696 improved total symptom scores , with a tendency for superiority of placebo ( -1.12 vs-0.51 , P = 0.07 ) . Placebo was superior for the subscales of early satiety , bloating , fullness and discomfort ( all P < 0.05 ) . In IA , both placebo and R-137696 had no significant influence on total or individual symptom scores ( -0.08 and -0.27 ) . In VH , both placebo and R-137696 increased the discomfort volume , without a statistical difference between both arms ( + 120 and + 164 mL ) . In IA , both placebo and R-137696 enhanced accommodation , without a statistical difference between both ( + 77 and + 159 mL ) . Adverse events were similar for drug and placebo . A 4-week administration of the fundus-relaxing 5-HT(1A ) agonist R-137696 failed to significantly improve symptoms , VH or gastric accommodation compared to placebo Gastric sensation and accommodation are studied by barostat , but this is invasive . The drink test is noninvasive and may provide similar information . We evaluated relationships between drink test , gastric function , symptoms , and psychiatric distress .  Controls ( 73 ) and functional dyspeptics ( FD ) ( 92 ) were studied using a 5-min water load test ( WL5 ) , gastric emptying , and electrogastrography ( EGG ) .  Symptoms , quality of life , and psychiatric distress were measured using st and ardized measures . Controls underwent test-retest of WL5 and comparison of WL5 with 100 ml/min water-based drink test ( WL100 ) or nutrient drink .  Controls , FD , and gastroparetics estimated drinking capacity before WL5 using a visual analog scale . WL5 correlated with WL100 ( r = 0.7929 ) but not nutrient drink test ( r = 0.1995 ) . WL5 was significantly less in FD than controls , and abnormal WL5 was seen in 46 % . In FD , volume to fullness inversely correlated with symptom severity ( r = -0.29 ; P = 0.0154 ) and WL5 produced more symptoms , particularly nausea . Gastric function was not different between FD with normal or abnormal WL5 . Symptoms and psychiatric distress were similar between normal and abnormal WL5 groups , but the abnormal group had significantly poorer quality of life .  Controls and gastroparetics had good correlation of estimated and ingested volumes , but FD did not . Versus FD with normal WL5 capacity , FD with impaired drinking capacity have normal gastric function and similar symptoms but poorer quality of life . FD are less able to predict drinking capacity . These data suggest that WL5 identifies FD with intact gastric function but abnormal visceral perception Altered visceral perception is common in functional dyspepsia ( FD ) . Dopaminergic pathways control gastrointestinal motility , but whether they modulate visceral sensitivity is unknown Abstract Introduction . Gastroesophageal reflux disease ( GERD ) , functional dyspepsia ( FD ) and irritable bowel syndrome ( IBS ) are common functional gastrointestinal conditions with significant impact on the daily lives of individuals . The objective was to investigate the prevalence and overlap of the three conditions in a Western general population . Material and methods . A nationwide study of 100,000 individuals 20 years and above , r and omly selected in the general population . A web-based question naire survey formed the basis of this study . Questions regarding FD and IBS were extracted from the ROME III adult question naire . Questions regarding GERD were developed based on the Montreal definition . Prevalence estimates for GERD , FD IBS were calculated in total and for each sex separately and for four age groups . A Venn diagram was constructed , illustrating the overlap between the three conditions . Results . The overall response rate was 52.2 % . The prevalence of GERD , FD and IBS was 11.2 % , 7.7 % and 10.5 % , respectively , and overlap between two or three of these conditions was seen among 6.5 % of the respondents . Among individuals meeting the criteria of one or more of the conditions GERD , FD and IBS , 30.7 % had overlap between two or all three conditions . Conclusion . GERD , FD and IBS are common conditions in the general population and the overlap between these conditions is also quite common . When diagnosing patients with GERD , FD and IBS , physicians should keep in mind that these patients could be suffering from more than one of these conditions BACKGROUND & AIMS This study aim ed to determine whether brief psychodynamic-interpersonal ( PI ) psychotherapy is more efficacious than a psychological control for patients with chronic , intractable functional dyspepsia ( FD ) , and whether patients with abnormal gastric function respond differently than those with normal gastric function . METHODS Ninety-five consecutive patients with chronic symptoms of FD who had failed to respond to conventional pharmacologic treatments were approached . Thirty-seven received  PI psychotherapy , and 36 the control condition ( supportive therapy ) . Patients completed self-report question naires before and after treatment and 12 months later . The patients ' gastroenterologists , who were blind to the study groups , conducted independent ratings before and after treatment . Forty-nine patients also underwent a radioisotope gastric emptying study . An intention-to-treat analysis was used with baseline scores as covariates . RESULTS At the end of treatment , there were significant advantages for PI psychotherapy compared with controls for the gastroenterologists ' ( P = 0.002 ) and patients ' total symptom score ( P = 0.015 ) . One year after treatment , the symptomatic scores were similar . However , a sub analysis showed that PI therapy was superior to the control condition at 1 year , when patients with severe heartburn were excluded . There was no difference in outcome between patients with normal and abnormal gastric emptying . CONCLUSIONS PI therapy may have both short- and long-term effects in patients with dyspepsia , but further evaluation is required . Its cost-effectiveness needs to be determined BACKGROUND & AIMS Antidepressants are frequently prescribed to treat functional dyspepsia ( FD ) , a common disorder characterized by upper abdominal symptoms , including discomfort or postpr and ial fullness . However , there is little evidence of the efficacy of these drugs in patients with FD . We performed a r and omized , double-blind , placebo-controlled trial to evaluate the effects of antidepressant therapy on symptoms , gastric emptying ( GE ) , and meal-induced satiety in patients with FD . METHODS We performed a study at 8 North American sites of patients who met the Rome II criteria for FD and did not have depression or use antidepressants . Patients ( n = 292 ; 44 ± 15 years old , 75 % were female , 70 % with dysmotility-like FD , and 30 % with ulcer-like FD ) were r and omly assigned to groups given placebo , 50 mg amitriptyline , or 10 mg escitalopram for 10 weeks . The primary end point was adequate relief of FD symptoms for ≥5 weeks of the last 10 weeks ( of 12 ) . Secondary end points included GE time , maximum tolerated volume in Nutrient Drink Test , and FD-related quality of life . RESULTS An adequate relief response was reported by 39 subjects given placebo ( 40 % ) , 51 given amitriptyline ( 53 % ) , and 37 given escitalopram ( 38 % ) ( P = .05 , after treatment , adjusted for baseline balancing factors including all subjects ) . Subjects with ulcer-like FD given amitriptyline were > 3-fold more likely to report adequate relief than those given placebo ( odds ratio = 3.1 ; 95 % confidence interval : 1.1 - 9.0 ) . Neither amitriptyline nor escitalopram appeared to affect GE or meal-induced satiety after the 10-week period in any group . Subjects with delayed GE were less likely to report adequate relief than subjects with normal GE ( odds ratio = 0.4 ; 95 % confidence interval : 0.2 - 0.8 ) . Both antidepressants improved overall quality of life . CONCLUSIONS Amitriptyline , but not escitalopram , appears to benefit some patients with FD , particularly those with ulcer-like ( painful ) FD . Patients with delayed GE do not respond to these drugs . Clinical Trials.gov ID : NCT00248651 Background : Functional dyspepsia is recognized as a common disorder in clinical practice . The aim of this study was to determine the efficacy and adverse effects of cisapride compared to a placebo in patients from a general practice with functional dyspepsia ( FD ) . Secondly we investigated whether Helicobacter pylori‐positive FD patients present with specific symptoms and determined the efficacy of cisapride for FD patients with H. pylori BACKGROUND & AIMS Impaired accommodation and hypersensitivity to gastric distention are believed to be involved in the development of functional dyspepsia ( FD ) . Buspirone , a 5-hydroxytryptamine 1A receptor agonist , relaxes the proximal stomach in healthy individuals . We studied the effects of buspirone on symptoms and mechanisms of FD . METHODS We performed a r and omized , double-blind , placebo-controlled , crossover study of 17 patients ( 13 women ; mean age , 38.5 ± 2.4 years ) . The study included 2 treatment periods of 4 weeks each , separated by a 2-week washout period . In the first period , 7 participants were given buspirone ( 10 mg , 3 times daily for 4 weeks ) and 10 were given placebo 15 minutes before meals ; patients switched groups for the second period . We assessed meal-related symptoms and severity , along with gastric sensitivity , accommodation , and emptying ( by using barostat and breath tests ) before and after 4 weeks of treatment . RESULTS Buspirone significantly reduced the overall severity of symptoms of dyspepsia ( 7.5 ± 1.3 vs 11.5 ± 1.2 for placebo ; P < .005 ) and individual symptoms of postpr and ial fullness , early satiation , and upper abdominal bloating , whereas placebo had no significant effect ( all P < .05 ) . Buspirone did not alter the rate of gastric emptying of solids or sensitivity to gastric distention , but it significantly increased gastric accommodation , compared with placebo ( 229 ± 28 vs 141 ± 32 mL , respectively ; P < .05 ) , and delayed gastric emptying of liquids ( half-life = 64 ± 5 vs 119 ± 24 minutes , respectively ) . Adverse events were similar when patients were given buspirone or placebo . CONCLUSIONS In patients with FD , 4 weeks of administration of buspirone significantly improved symptoms and gastric accommodation , compared with placebo , whereas gastric emptying of liquids was delayed Background : Functional dyspepsia ( FD ) is a common disorder but there is currently little efficacious drug therapy . Itopride , a prokinetic approved in several countries , showed promising efficacy in FD in a phase IIb trial . The aim of this study was to test the efficacy and safety of this drug in FD . Methods : Two similar placebo-controlled clinical trials were conducted ( International and North America ) . Males and females , 18–65 years old , with a diagnosis of FD ( Rome II ) and the absence ( by upper endoscopy ) of any relevant structural disease were recruited . All were negative for Helicobacter pylori and , if present , heartburn could not exceed one episode per week . Following screening , patients were r and omised to itopride 100 mg three times daily or identical placebo . The co- primary end points were : ( 1 ) global patient assessment ( GPA ) of efficacy ; and ( 2 ) Leeds Dyspepsia Question naire ( LDQ ) . Symptoms were evaluated at weeks 2 , 4 and 8 . Secondary measures of efficacy included Nepean Dyspepsia Index ( NDI ) quality of life . Results : The GPA responder rates at week 8 on itopride versus placebo were similar in both trials ( 45.2 % vs 45.6 % and 37.8 vs 35.4 % , respectively ; p = NS ) . A significant benefit of itopride over placebo was observed for the LDQ responders in the International ( 62 % vs 52.7 % , p = 0.04 ) but not the North American trial ( 46.9 % vs 44.8 % ) . The safety and tolerability profile were comparable with placebo , with the exception of prolactin elevations , which occurred more frequently on itopride ( 18/579 ) than placebo ( 1/591 ) . Conclusion : In this population with FD , itopride did not show a difference in symptom response from placebo Introduction : Irritable bowel syndrome ( IBS ) and functional dyspepsia ( FD ) are highly prevalent in the general population as does gastroesophageal reflux disease ( GERD ) . Therefore , it is expected that these conditions may frequently overlap . Objective : We aim ed at evaluating the presence ofFD and IBS symptoms in patients with erosive ( ERD ) , non-erosive reflux disease ( NERD ) and Barrett ’s esophagus ( BE ) . Patients and Methods : 71 patients presenting at the reflux disease outpatient clinic were prospect ively included in this study . 33 patients had NERD , 25 ERD and 13 BE according to the Montreal classification . All patients with ERD and NERD had typical reflux symptoms , as assessed by a vali date d GERD question naire ( RDQ ) . The diagnosis of functional dyspepsia and IBS symptoms was assessed according to the Rome III criteria . Results : IBS symptoms ( bloating , abdominal pain , constipation and diarrhea ) were slightly more prevalent in NERD ( 54.6 , 63.6 , 21.20 , 24.2 % , respectively ) than in ERD ( 48.0 , 44.0 , 12.0 , 20.0 % , respectively ) and in BE ( 53.9 , 23.10 , 15,4 , 23.1 % , respectively ) , but none of these differences reached statistical significance . NERD patients had more FD symptoms than patients with ERD or BE , but again this difference did not reach statistical significance . Conclusion : Our data show that IBS and FD are common in the entire spectrum of GERD . The presence of these disorders might explain why many patients with GERD are deemed as treatment failures if they have no complete symptom relief with proton pump inhibitors Background / Aims Small intestinal bacterial overgrowth ( SIBO ) is considered to be involved in the pathogenesis of functional gastrointestinal disorders ( FGID ) . However , the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully eluci date d. Here , we examined the frequency of SIBO in patients with refractory FGID . Methods We prospect ively enrolled patients with refractory FGID based on Rome III criteria .  A glucose hydrogen breath test ( GHBT ) was performed using a gas analyzer after an overnight fast , with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours . A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO . Results A total of 38 FGID patients , including 11 with functional dyspepsia ( FD ) , 10 with irritable bowel syndrome ( IBS ) , and 17 with overlapping with FD and IBS , were enrolled . Of those , 2 ( 5.3 % ) were diagnosed with SIBO ( one patient diagnosed with FD ; the other with overlapping FD and IBS ) . Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days . Conclusions Two patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT . Although the frequency of SIBO is low among patients with FGID , it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms , especially bloating , as a part of routine clinical care Background / Aims Gastroesophageal reflux disease ( GERD ) is increasing in Asian countries . Functional dyspepsia ( FD ) or irritable bowel syndrome ( IBS ) are also prevalent and commonly overlapped with GERD . This study was conducted to compare the proportion and risk factors for overlapping reflux esophagitis ( RE ) and non-erosive reflux disease ( NERD ) with functional gastrointestinal disorders ( FGIDs ) . Methods A total of 2,388 [ male , 55.9 % ; mean age ( ± SD ) , 43.2 years ( ± 8.4 ) ] Korean subjects who underwent the upper endoscopy for health screening were prospect ively included . The subjects were asked about demographic , medical and social history by using a structured question naire , and FD and IBS were assessed according to the Rome III criteria . Results The subjects with RE were 286 ( 12.0 % , male 88.5 % , 42.8 years ) and 74 subjects had NERD ( 3.1 % ) while the prevalence of FD and IBS were 8.1 % and 10.1 % , respectively . The proportion of FD and IBS in NERD was higher than that of RE ( 74.3 % vs. 10.5 % , p = 0.000 ; 41.9 % vs. 11.2 % , p = 0.000 , respectively ) . The epigastric pain syndrome ( EPS ) was more prevalent than postpr and ial distress syndrome in NERD . According to multiple regression analysis , high somatization score and the presence of FD increased the odd ratio for NERD . However , male gender and current smoker were significant risk factors for RE . Conclusions Compared to RE , NERD is more frequently overlapped with FD , especially EPS , and also are associated with significantly increased frequency of IBS . Our data draws attention to the possibility of subgrouping FGIDs and GERD to be important in underst and ing the pathophysiology of these conditions Background and aims : Dietary fat plays a role in the pathophysiology of symptoms in functional dyspepsia ( FD ) . In healthy subjects , cognitive factors enhance postpr and ial fullness ; in FD patients , attention increases gut perception . We hypothesised that the information given to patients about the fat content of a meal would affect dyspeptic symptoms . Methods : Fifteen FD patients were each studied on four occasions in a r and omised double blind fashion . Over two days they ingested a high fat yoghurt ( HF ) and over the other two days a low fat yoghurt ( LF ) . For each yoghurt , the patients received the correct information about its fat content on one day ( HF-C , LF-C ) and the opposite ( wrong ) information on the other day ( HF-W , LF-W ) . Dyspeptic symptoms , plasma cholecystokinin ( CCK ) concentrations , and gastric volumes were evaluated . Results : Both the fat content and information about the fat content affected fullness and bloating scores — both were higher after HF-C compared with LF-C , and LF-W compared with LF-C , with no differences between HF-C and HF-W. Nausea scores were higher after HF compared with LF , with no effect of the information about fat content . No differences between discomfort and pain scores were found between study conditions . Plasma CCK and gastric volumes were greater following HF compared with LF , with no effect of the information given to the patients . All differences are p<0.05 . Conclusions : Cognitive factors contribute to symptom induction in FD . Low fat foods may also elicit symptoms if patients perceive foods as high in fat , while CCK and gastric volumes do not appear to be affected by cognitive factors 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 r and omly 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 ± 0.14 kg , the body fat ratio rose by 4 % , and the visceral fat area increased by 7.56 ± 2.25 cm(2 ) ; 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 BACKGROUND Trials on functional dyspepsia ( FD ) have been performed mostly in Western population s. We evaluated the effect of cisapride in Saudi Arabs with FD . METHODS In a double-blind , r and omized ,  placebo-controlled  trial patients were treated with cisapride three times daily or matching placebo and assessed at 2 and 4 weeks . RESULTS  Cisapride ( n = 44 ) was significantly superior to  placebo ( n = 45 ) in improving heartburn , postpr and ial bloating , epigastric pain , early satiety , epigastric burning , and nausea . The global response to treatment was excellent or good in 86.7 % and 26.7 % of the cisapride and placebo groups , respectively . Treatment was judged more effective than the previous therapy in 86.4 % and 33.3 % of those receiving cisapride and placebo , respectively . There were no adverse drug effects . CONCLUSIONS Cisapride is an effective and well-tolerated treatment for FD in Saudi Arabs . Pharmacogenetic factors are unlikely to play any role in its effects BACKGROUND To date , no patient reported outcomes ( PRO ) instrument is available for evaluation of treatment efficacy in functional dyspepsia (FD)/postpr and ial distress syndrome ( PDS ) . The aim of our study was to perform focus group interviews for the development of a new question naire for assessing symptom pattern and severity in PDS . METHODS R and om ambulatory patients diagnosed with FD/PDS based on Rome III criteria and no predominant gastro-esophageal reflux disease ( GERD ) symptoms were invited to participate . Focus group sessions were organized where patients reported and discussed their symptoms , facilitated by an experienced physician . After reaching saturation of identified symptom items , questions for a pilot PRO instrument were drafted and evaluated in cognitive interviews for relevance , clarity , and consistency . KEY RESULTS Of 225 screened patients , 26 patients were diagnosed with PDS without overlapping GERD as single final diagnosis . Fifteen of these ( 87 % female , 48 ± 3.2 years ) participated in one of three focus groups . All ( 100 % ) confirmed experiencing symptoms that were triggered or aggravated by ingestion of a meal , corresponding to early satiation ( 100 % ) , and postpr and ial fullness ( 100 % ) . In addition reported gastroduodenal symptoms were nausea ( 40 % , postpr and ial in all , interpr and ial in 20 % ) , upper abdominal bloating ( 33 % ) , excessive belching ( 27 % ) , and vomiting ( 13 % ) . Epigastric pain and burning were present in respectively 20 % and 13 % . Non-gastroduodenal symptoms that patients reported included heartburn ( 33 % , but mostly sporadic ) , weight loss ( 93 % , on average 5.0 ± 1.7 kg ) , and fatigue ( 67 % ) . Questions evaluating these symptoms were vali date d in 15 cognitive interviews . CONCLUSIONS & INFERENCES This focus group study confirms symptoms corresponding to postpr and ial fullness and early satiation as the key items for developing a PRO for PDS BACKGROUND Disordered gastric antral motor activity may be induced by mental stress . The effect of cisapride on these abnormalities has previously not been investigated . METHODS Ten healthy subjects and 19 patients with functional dyspepsia ( FD ) and erosive prepyloric changes participated in the study .  Antral motility was recorded with real-time ultrasonography after ingestion of 500 ml meat soup during i ) a 4-min rest period , ii ) 2.5 min of mental stress , and iii ) a 4-min recovery period . Patients and controls were studied after 3 days of treatment with 10 mg cisapride three times daily and placebo in a double-blind crossover design . RESULTS Mean postpr and ial amplitude of antral contractions was lower in patients than controls ( p < 0.001 ) . Antral amplitude was reduced by mental stress in healthy persons ( p < 0.001 ) but not in patients . Both fasting and postpr and ial antral areas were larger in FD patients than controls ( p < 0.001 and p = 0.02 , respectively ) . Cisapride reduced the fasting ( p < 0.001 ) and the postpr and ial ( p = 0.05 ) antral area in the FD group but not in controls . The soup meal produced dyspeptic symptoms in 90 % of the patients and in only 10 % of the controls ( p < 0.001 ) . Cisapride had no significant effect on symptoms or antral contractions . CONCLUSIONS Mental stress induced antral hypomotility in healthy subjects but not in patients with FD who had reduced motility at base line . Cisapride reduced the enlarged fasting and postpr and ial antral areas in the patients but had no effect on amplitudes of antral contractions or symptoms OBJECTIVES To conduct a pilot study examining whether adding biofeedback-assisted relaxation training ( BART ) to medication treatment results in better clinical outcomes than medication treatment alone for children with functional dyspepsia ( FD ) associated with duodenal eosinophilia , a subgroup of children with recurrent abdominal pain . METHODS Twenty children were r and omly assigned to receive a st and ardized medication treatment or medication plus 10 sessions of BART . Children and parents completed psychosocial functioning and quality of life measures at baseline , posttreatment , and 6 months . Children rated pain daily via PDA . Physicians provided biweekly assessment s of clinical improvement . RESULTS Children receiving medication plus BART demonstrated better outcomes on pain intensity , duration of pain episodes , and clinical improvement than children receiving medication alone . CONCLUSIONS BART is a promising adjunctive treatment for pediatric FD associated with duodenal eosinophilia . Electronic daily diaries appear to be a useful approach to assessing changes in self-reported pain ratings in this population Background and aims : Patients with functional dyspepsia who have hypersensitivity to gastric distension have more prevalent pain , suggesting the presence of hyperalgesia . It is unclear whether this reflects activation of pain specific afferent pathways or multimodal afferent pathways that also mediate non-painful sensations . In the former case , hyperalgesia should occur when intensity of non-painful sensations is still low . The aim of the study was to analyse whether the symptom profile during gastric dissentions in functional dyspepsia patients with hyperalgesia reflects sensitisation of pain specific or multimodal pathways . Methods : Forty eight consecutive dyspeptic patients ( 35 female ) underwent gastric sensitivity testing with a barostat balloon using a double r and om staircase protocol .  At the end of every distending step , patients scored perception of upper abdominal sensations on a graphic 0–6 rating scale and completed visual analogue scales ( VAS 0–100 mm ) for pain , nausea , satiety , and fullness . The end point was a rating scale of 5 or more . Results : Hypersensitivity was present in 20 patients ( 40 % ) ; gastric compliance did not differ between normo- and hypersensitive patients . At maximal distension ( score 5 or more ) , hypersensitive patients had significantly lower distending pressures and intra-balloon volumes , but similar VAS scores for pain , nausea , satiety , and fullness compared with normosensitive patients . In both normosensitive and hypersensitive patients , elevation of pain VAS scores with increasing distending pressures paralleled the elevation in VAS scores for nausea , satiety , and fullness . Conclusions : Hypersensitive dyspeptic patients reach the same intensity of painful and non-painful sensations as normosensitive patients but at lower distending pressures . Hyperalgesia occurs in hypersensitive dyspeptic patients at distending pressures that also induce intense non-painful sensations . These findings argue against isolated upregulation of pain specific afferents in functional dyspepsia patients with visceral hypersensitivity Background : Functional dyspepsia ( FD ) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen , where no structural explanation for the symptoms is found . The role of drug treatment remains controversial . The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily ( b.i.d ) and to test methods for symptom assessment . Methods : 197 patients fulfilling the criteria for FD were r and omly allocated to double-blind treatment with omeprazole 20 mg b.i.d ( n = 100 ) or placebo ( n = 97 ) for 14 days . Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded . Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before r and omization . The patients recorded dyspeptic symptoms on diary cards . Results : A stringent endpoint , ' complete symptom relief on the last day of treatment ' , was the primary efficacy variable . For the APT cohort , this was achieved in 29.0 % and 17.7 % on omeprazole and placebo , respectively ( 95 % CI of difference ( 11.3 % ) : -0.4%-23.0 % , P = 0.057 ) . Similar figures in the PP cohort were 31.0 % and 15.5 % , respectively ( 95 % CI of difference ( 15.5 % ) : 3.2%-27.7 % , P = 0.018 ) . The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as , no dyspeptic symptoms on the last 2 days of treatment and overall treatment response . H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy . Conclusion : A subset of patients with FD will respond to therapy with omeprazole
However , benefit was limited to antipsychotics and tricyclic antidepressants .
Conclusions Psychotropic drugs may be an effective treatment for FD , but the effect appears to be limited to antipsychotics and tricyclic antidepressants with fewer trials for other agents , meaning that firm conclusions for efficacy can not be made .
Objective Functional dyspepsia ( FD ) is a chronic gastroduodenal disorder .
Individuals with FD demonstrate visceral hypersensitivity , abnormal central pain processing , and low mood , but it is unclear whether psychotropic drugs are an effective treatment for the condition .