ANMA Primary Care FGID Study Working Group
Asian Rome Working Team Proposal final
ASIAN FUNCTIONAL DYSPEPSIA CONSENSUS
Team 1. Definition & Diagnosis
Leader: Sutep Gonlachnavit, Thailand
Meiyun Ke, China
Hyojin Park, Korea
Ratha-korn Vilaichone, Thailand
Michio Hongo, Japan
Team 2. Epidemiology
Leader: Uday Chand Ghoshal, India
Full-Young Chang, Taiwan
Xiaohua Hou, China
Benjamin Chun Yu Wong, Hong Kong
Kwong Ming Fock, Singapore
Team 3. Pathophysiology
Leader: Hiroto Miwa, Japan
Kwok-Hung Lai, Taiwan
Kwang Jae Lee, Korea
Poong-Lyul Rhee, Korea
Team 4. Management
Leader: Kok Ann Gwee, Singapore
Tiing-Leong Ang, Singapore
Ching-Liang Lu, Taiwan
Sanjiv Mahadeva, Malaysia
Kentaro Sugano, Japan
Non-voting Coordinator: Young-Tae Bak, Korea
Preliminary schedule is as follows:
1. To collect Asian original papers on FD from 1999 to 2009: 267 papers were collected by the end of
2. To collect more papers, original & review, from Asia and the rest of world until the end of 2009
3. To develop crude consensus statements about 10 in number from each team until the end of April 2010
4. To modify the statements after receiving feedbacks from other members until the end of August 2010
5. The first consensus meeting on September 19, 2010 (Sunday) before APDW 2010 in Kuala Lumpur
6. The first e-mail voting in the early November 2010
7. The second e-mail voting in the early January 2011
8. The second consensus meeting on March 3, 2011 (Thursday) before ANMA 2010 Beijing
9. To submit the Consensus Report until the end of September 2011
10. Each team will write a review paper for JNM.
ANMA IBS Consensus
ANMA IBS Consensus has been completed. The Consensus document has been published in J Gastroenterol Hepatol. The Asian data have been reviewed in four review papers, two in J Gastroenterol Hepatol and two in J Neurogastroenterol Motil. The abstracts of these papers are given below:
J Gastroenterol Hepatol 2009; 24: 1601-7
Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed.
Gwee KA, Lu CL, Ghoshal UC.
In this review we have unearthed epidemiological data that; support the \\\'old\\\' concept of irritable bowel syndrome (IBS) as a disorder of civilization, build a \\\'new\\\' symptom profile of IBS for Asia, and persuade us against the use of \\\'borrowed\\\' Western diagnostic criteria and illness models by Asian societies. In the 1960s, IBS was described as a disorder of civilization. Early studies from Asia suggested a prevalence of IBS below 5%. Recent studies from Asia suggest a trend for the more affluent city states like Singapore and Tokyo, to have higher prevalence of 8.6% and 9.8%, respectively, while India had the lowest prevalence of 4.2%. Furthermore, there was a trend among the better educated and more affluent strata of society in several urban Chinese populations for a higher prevalence of IBS, as well as a trend for a higher consultation rate. Across Chinese and Indian predominant populations, a majority of patients with IBS criteria report upper abdominal symptoms such as epigastric pain relieved by defecation, bloating and dyspepsia. Bloating and incomplete evacuation appear to be more important determinants of consultation behavior, than psychological factors. The failure of the Rome criteria to recognize the relationship to meals, may have led to a substantial misclassification of IBS as dyspepsia. The relevance of the Western model of psychological disturbance as a determinant of consultation behavior is questionable because of the accessibility and acceptability of medical consultation for gastrointestinal complaints in many Asian communities.
J Gastroenterol Hepatol 2010; 25: 244-51
Bugs and irritable bowel syndrome: The good, the bad and the ugly.
Ghoshal UC, Park H, Gwee KA.
Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post-infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that \\\'bugs\\\' may play in IBS? To address this question, we have conducted an in-depth review, attempting where possible to draw lessons from Asian studies.
J Neurogastroenterol Motil 2010; 16: 131-38
Are rice and spicy diet good for functional gastrointestinal disorders?
Rice- and chili-containing foods are common in Asia. Studies suggest that rice is completely absorbed in the small bowel, produces little intestinal gas and has a low allergenicity. Several clinical studies have demonstrated that rice-based meals are well tolerated and may improve gastrointestinal symptoms in functional gastrointestinal disorders (FGID). Chili is a spicy ingredient commonly use throughout Asia. The active component of chili is capsaicin. Capsaicin can mediate a painful, burning sensation in the human gut via the transient receptor potential vanilloid-1 (TRPV1). Recently, the TRPV1 expressing sensory fibers have been reported to increase in the gastrointestinal tract of patients with FGID and visceral hypersensitivity. Acute exposure to capsaicin or chili can aggravate abdominal pain and burning in dyspepsia and IBS patients. Whereas, chronic ingestion of natural capsaicin agonist or chili has been shown to decrease dyspeptic and gastroesophageal reflux disease (GERD) symptoms. The high prevalence of spicy food in Asia may modify gastrointestinal burning symptoms in patients with FGID. Studies in Asia demonstrated a low prevalence of heartburn symptoms in GERD patients in several Asian countries. In conclusion rice is well tolerated and should be advocated as the carbohydrate source of choice for patients with FGID. Although, acute chili ingestion can aggravate abdominal pain and burning symptoms in FGID, chronic ingestion of chili was found to improve functional dyspepsia and GERD symptoms in small randomized, controlled studies.
J Neurogastroenterol Motil 2010; 16: 120-30
Asian motility studies in irritable bowel syndrome.
Altered motility remains one of the important pathophysiologic factors in patients with irritable bowel syndrome (IBS) who commonly complain of abdominal pain and stool changes such as diarrhea and constipation. The prevalence of IBS has increased among Asian populations these days. Gastrointestinal (GI) physiology may vary between Asian and Western populations because of differences in diets, socio-cultural backgrounds, and genetic factors. The characteristics and differences of GI dysmotility in Asian IBS patients were reviewed. MEDLINE search work was performed including following terms, \\\'IBS,\\\' \\\'motility,\\\' \\\'transit time,\\\' \\\'esophageal motility,\\\' \\\'gastric motility,\\\' \\\'small intestinal motility,\\\' \\\'colonic motility,\\\' \\\'anorectal function,\\\' and \\\'gallbladder motility\\\' and over 100 articles were categorized under \\\'esophagus,\\\' \\\'stomach,\\\' \\\'small intestine,\\\' \\\'colon,\\\' \\\'anorectum,\\\' \\\'gallbladder,\\\' \\\'transit,\\\' \\\'motor pattern,\\\' and \\\'effect of stressors.\\\' Delayed gastric emptying, slow tansit in constipation predominant IBS patients, rapid transit in diarrhea predominant IBS patients, accelerated motility responses to various stressors such as meals, mental stress, or corticotrophin releasing hormones, and altered rectal compliance and altered rectal accomodation were reported in many Asian studies regarding IBS. Many conflicting results were found among these studies and there are still controversies to conclude these as unique features of Asian IBS patients. Multinational and multicenter studies are needed to be performed vigorously in order to elaborate characteristics as well as differences of altered motililty in Asian patients with IBS.
They are a consensus, and should not become a straight- jacket to prevent scientific enquiry.
(Jones J, et al. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut 2000;(Suppl II)47:ii1-ii19)
Gastroenterologists clinicians or academics
Primary care physicians, managed care
Industry, regulators patient needs, primary endpoints
Patients education materials, website, support groups
Improve patient outcomes
Treatment satisfaction; improve QOL
Reduce risks from unnecessary surgery, unconventional treatments
Low rate of missed diagnosis; minimise negative workups
Systematic literature review
Evaluation of studies
Expert panel recommendations