Effect of acute and chronic levosulpiride administration on gastric tone and perception in functional dyspepsia A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline Functional dyspepsia: outcome of focus groups for the development of a questionnaire for symptom assessment in patients suffering from postprandial distress syndrome (PDS). Regional cerebral blood flow during gastric balloon distention in functional dyspepsia. Selective gastric hypersensitivity and reflex hyporeactivity in functional dyspepsia. Dyspeptic patients with visceral hypersensitivity: sensitisation of pain specific or multimodal pathways? Effect of fluoxetine on symptoms and gastric dysrhythmia in patients with functional dyspepsia. Visceral and somatic sensory function in functional dyspepsia. Psychotherapy in functional dyspepsia. Personality traits predict treatment outcome with an antidepressant in patients with functional gastrointestinal disorder. [Randomized controlled trial of modified banxia houpo decoction in treating functional dyspepsia patients with psychological factors]. What are the real problems for patients with functional dyspepsia? Validation of a specific quality of life questionnaire for functional digestive disorders Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions Clinical Presentation and Personality Factors Are Predictors of the Response to Treatment in Patients with Functional Dyspepsia: A Randomized, Double-Blind Placebo-Controlled Crossover Study Cisapride in functional dyspepsia in general practice. A placebo‐controlled, randomized, double‐blind study
Altered visceral perception is common in functional dyspepsia ( FD ) . Dopaminergic pathways control gastrointestinal motility , but whether they modulate visceral sensitivity is unknown 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 : In functional gastrointestinal ( GI ) disorders including functional dyspepsia ( FD ) and irritable bowel syndrome ( IBS ) , there might be no small extent of contributions of psychosomatic factors . As a therapy for IBS patients , the effectiveness of antidepressants  has been reported 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 & 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 / AIMS We have previously shown that patients with functional dyspepsia are hypersensitive to gastric distention . The aim of this study was to establish whether this sensory disturbance was confined to the stomach and whether it was associated with gut reflex dysfunction . METHODS In 10 selected patients with dyspepsia and 12 healthy controls , perception and gut reflex responses to gastric distention , duodenal distention , and somatic stimulation were measured . St and ardized distentions at fixed pressures were performed by gastric and duodenal barostats . Perception was scored by a detailed symptom question naire ; gut reflex responses were measured as isobaric volume changes by each barostat . Somatic transcutaneous electrical nerve stimulation was produced on the h and . Individual stimuli ( 2-minute duration ) were r and omly applied at 10-minute intervals in stepwise increments in search of the respective threshold for discomfort . RESULTS Patients with dyspepsia had gastric hypersensitivity to distention ( discomfort threshold at 6.4 + /- 0.4 mm Hg vs. 8.3 + /- 0.6 mm Hg in controls ; mean + /- SE ; P < 0.05 ) , whereas duodenal and somatic sensitivity was normal . Furthermore , patients with dyspepsia explicitly recognized their clinical symptoms in all gastric but only in 58 % + /- 12 % of the duodenal distention trials . In addition , patients with dyspepsia showed defective gastric relaxatory responses to duodenal distention ( 68 + /- 30 mL gastric expansion vs. 239 + /- 12 mL in controls ; P < 0.05 ) . CONCLUSIONS Patients with dyspepsia are selectively hypersensitive to gastric distention ; this sensory dysfunction is associated with impaired reflex reactivity of the stomach 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 / AIMS Although antidepressants have been used for decades in treating patients with functional abdominal syndromes , how they influence gastrointestinal motility remains unclear . We aim ed to assess the role of depression in functional dyspepsia , and the effect of antidepressants on the functional dyspepsia patients ' symptoms and gastric myoelectrical activity . METHODOLOGY We conducted an open clinical trial with 40 functional dyspepsia patients .  Zung self-rating depression scale was used in evaluating the patients ' depression .  Cutaneous electrogastrography and evaluation of upper gastrointestinal symptoms  were performed before and after administration of a one-month course of fluoxetine . RESULTS In the baseline study , the depressed functional dyspepsia patients had higher symptom scores than non-depressed patients ( P < 0.05 ) . The depressed functional dyspepsia patients had higher percentages of tachygastria than healthy controls ( P < 0.05 ) , but the electrogastrography parameters of depressed and non-depressed functional dyspepsia patients were not different . After one-month fluoxetine treatment , the symptom scores improved significantly in the depressed functional dyspepsia patients ( P < 0.05 ) , but not in the non-depressed patients . Electrogastrography did not improve in either group . CONCLUSIONS Depressive functional dyspepsia patients had higher symptom scores and responded well to fluoxetine treatment . However , electrogastrography did not improve after the treatment . These findings suggest that depression is significant in the presentation of functional dyspepsia symptoms , but not correlated with gastric myoelectrical activity 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 Patients with functional dyspepsia were assigned at r and om to cognitive psychotherapy ( 10 sessions of 50 min duration , n = 50 ) or to a control group ( no treatment , n = 50 ) . Before treatment all patients were assessed on psychological , somatic and lifestyle factors . If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ( ' target complaints ' ) . The patients were evaluated at the end of therapy ( after 4 months ) and at 1 yr follow-up . Outcome measures were dyspeptic symptoms , scores on ' target complaints ' and psychological parameters . Both groups showed improvement in dyspeptic and psychological parameters after 1 yr . The improvement in the control group was attributed to a non- specific effect of increased interest and attention . The therapy group showed greater reduction than the control group on dyspeptic symptoms [ days of epigastric pain ( p = 0.050 ) , nausea ( p = 0.024 ) , heartburn ( p = 0.021 ) , diarrhoea ( p = 0.002 ) and constipation ( p = 0.047 ) ] ; and on scores on ' target complaints ' ( p = 0.001 ) BACKGROUND We investigated the relationship between personality traits and response to treatment with the tetracyclic antidepressant mianserin or placebo in patients with functional gastrointestinal disorder ( FGD ) without psychopathology . METHODS Forty-eight patients completed the Buss-Durkee Hostility Inventory , Neuroticism Extroversion Openness -Personality Inventory ( NEO-PI ) , and Eysenck Personality Question naire ( EPQ ) , neuroticism + lie subscales , before they were consecutively allocated to a 7-week double-blind treatment study with mianserin or placebo . Treatment response to pain and target symptoms were recorded daily with the Visual Analogue Scale and Clinical Global Improvement Scale at every visit . RESULTS A low level of neuroticism and little concealed aggressiveness predicted treatment outcome with the antidepressant drug mianserin in non-psychiatric patients with FGD . Inversely , moderate to high neuroticism and marked concealed aggressiveness predicted poor response to treatment . These findings were most prominent in women . Personality traits were better predictors of treatment outcome than serotonergic sensitivity assessed with the fenfluramine test . CONCLUSION Assessment of the personality traits negativism , irritability , aggression , and neuroticism may predict response to drug treatment of FGD even when serotonergic sensitivity is controlled for . If confirmed in future studies , the findings point towards a more differential psychopharmacologic treatment of FGD OBJECTIVE To observe the therapeutic effect of Modified Banxia Houpo Decoction ( MBHD ) in treating patients with functional dyspepsia ( FD ) accompanied with psychological factors , and to compare it with Domperidone , Neurostan , and Domperidone + Neurostan . METHODS Recruited were 89 FD patients accompanied with anxiety and /or depression , who were r and omly assigned to four groups , i.e. , the  MBHD group ( 23 cases ) , the  Domperidone group ( 22 cases ) , the  Neurostan  group ( 22 cases ) , and the Domperidone + Neurostan group ( 22 cases ) . Corresponding medication lasted for4 weeks . The psychological scoring was performed using Hamilton Depression Scale ( HAMD ) and Hamilton Anxiety Scale ( HAMA ) . The improvement rate of FD symptoms , the ratios of FD symptoms scoring < 2 , and the improvement rate of FD symptoms > 50 % were calculated by the scoring of FD symptoms . The gastric emptying rates of patients in each group were compared using the examinations of gastric emptying . RESULTS There was no statistical difference in pre-treatment HAMD , HAMA , FD symptoms scoring , and the gastric emptying rate among the 4 groups ( P > 0.05 ) . The psychological scoring and FD symptoms scoring significantly decreased in the 4 groups except the Domperidone group after 4-week treatment ( P<0.01 , P < 0.05 ) . The psychological scoring and FD symptoms scoring were obviously lower in the MBHD group than in the Domperidone group ( P < 0.05 ) . The improvement rate of FD symptoms , the ratios of FD symptoms scoring < 2 , and the improvement rate of FD symptoms > 50 % were the highest in the Domperidone + Neurostan group , followed by the MBHD group , and then the Domperidone group . After treatment the gastric emptying rate obviously increased in each treatment group when compared with before treatment in the same group ( P < 0 . 01 ) , and there was no statistical difference among these groups after treatment . CONCLUSIONS MBHD had certain therapeutic effects on FD patients accompanied with psychological factors . Its effect was associated with gastric emptying . Besides , its improvement of the psychological state and symptoms was superior to that of Domperidone BACKGROUND Patients with functional dyspepsia ( FD ) have more complaints than just the dyspepsia . METHOD One hundred FD patients were assessed with regard to psychologic , medical , and social factors , before r and omization , in a study of cognitive therapy . They were asked to list their main problem areas or ' target complaints ' . RESULTS Dyspepsia was the third most frequent target complaint ( 26 patients ) , and anxiety was the most frequent one ( 65 patients ) . Patients identifying dyspepsia as a target complaint differed from the other FD patients in several aspects . They had significantly more dyspeptic symptoms ( p < 0.05 ) and scored significantly higher on multiple somatic complaints ( p = 0.001 ) , depression ( p = 0.025 ) , general psychopathology ( p = 0.043 ) , the global assessment scale ( p = 0.001 ) , and the General Health Question naire ( p = 0.040 ) . However , they did not have more somatic predisposing factors like consumption of alcohol and coffee or infection with Helicobacter pylori than the patients with other target complaints . CONCLUSIONS Anxiety and not dyspepsia was the most frequent target complaint , and patients who identified dyspepsia as a target complaint did not have more somatic predisposing factors BACKGROUND Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life . Their similarities justify the elaboration of a single specific question naire for the two conditions . AIMS To examine the process leading to the validation of the psychometric properties of the functional digestive disorders  quality of life question naire ( FDDQL ) . METHODS Initially , the question naire was given to 154 patients , to assess its acceptability and reproducibility , analyse its content , and reduce the number of items . Its responsiveness was tested during two therapeutic trials which included 428 patients . The question naire has been translated into French , English , and German . The psychometric validation study was conducted in France , United Kingdom , and Germany by 187 practitioners . A total of 401 patients with dyspepsia or irritable bowel syndrome , defined by the Rome criteria , filled in the FDDQL and generic SF-36 question naires . RESULTS The structure of the FDDQL scales was checked by factorial analysis . Its reliability was expressed by a Cronbach ’s α coefficient of 0.94 . Assessment of its discriminant validity showed that the more severe the functional digestive disorders , the more impaired the quality of life ( p<0.05 ) . Concurrent validity was supported by the correlation found between the FDDQL and SF-36 question naire scales . The final version of the question naire contains 43 items belonging to eight domains . CONCLUSIONS The properties of the FDDQL question naire , available in French , English , and German , make it appropriate for use in clinical trials design ed to evaluate its responsiveness to treatment among patients with dyspepsia and irritable bowel syndrome Nonulcer dyspepsia ( NUD ) is a common syndrome , but the optimal treatments have yet to be established . This study was performed to determine the most effectivetreatment for NUD . Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms . When no organic lesions werefound , the patients were directed to consult ourdepartment ( Psychosomatic Medicine ) ; 194 consecutive NUD patients were studied . All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID ) . Patients with serious NUD were hospitalized , and r and omly divided into control(N = 42 ) and experimental groups ( N = 86 ) . The controlswere treated with physical treatment alone . Theexperimental group received psychiatric treatment inaddition , based on the results of SCID . The experimentalgroup showed a significant improvement compared with thecontrols ( P < 0.0001 ) . The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained ( functional ) dyspepsia is unknown . We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy , while psychological disturbances would be associated with a less favorable response to treatment . Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial . Patients were treated for 4 weeks in a double-blind , placebo-controlled crossover trial starting in r and om order with either active drug ( ranitidine , 150 mg b.d . ) or placebo . Every 7 days , medication was switched from active drug to placebo , or vice versa . At entry , patient characteristics were assessed utilizing a semistructured st and ardized interview and st and ardized question naires , and weekly intensity of symptoms was assessed utilizing a visual analogue scale . Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50 % at the end of the study period were categorized as responders . Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response . During treatment the symptom score decreased significantly , from 32.1 ± 1.44 ( SD ) to 21.3 ± 1.9 at the end of the trial ( P < 0.001 ) . Twenty of 75 were responders . High scores for somatization ( OR , 3.6 ; 95 % Cl , 1.2–11.4 ) , anxiety ( OR , 3.3 ; 95 % Cl , 0.9–11.8 ) , and reflux-like symptoms ( OR , 5.3 ; 95 % Cl , 1.7–16.7 ) were associated with response to treatment , while dysmotility-like symptoms were associated with an unfavorable response ( OR , 0.3 ; 95 % Cl , 0.1–0.9 ) . Symptom pattern and psychological disturbances are independent predictors of treatment response . Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound 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
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 .