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Biofeedback, Relaxation Training, and Cognitive Behavior Modification
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Ann L. Davidoff, William E. Whitehead
Although resembling PUD, functional dyspepsia is considered a distinct clinical syndrome that resembles IBS and is separate from peptic ulcer disease. It is characterized by “chronic or recurrent upper abdominal pain for at least 3 months, or discomfort without x-ray or endoscopic evidence of other disease (e.g., acid-peptic or neoplastic disease of stomach or esophagus, pancreas, or hepatobiliary system) to explain the symptoms” (1, p 164). Sensations of bloating and fullness, belching, boborygmi, nausea, and heartburn are other symptoms often associated with functional dyspepsia (100,48). Somewhere between 50 and 90% of the patients who consult physicians for symptoms suggestive of peptic ulcer disease have no ulcers (101,102); moreover, a prospective study suggests that only 3% of such patients will develop an ulcer within 6 year of initial assessment (103). Dyspepsia accounts for approximately 5% of consultations to internal medical practitioners (104). Prevalence of functional dyspepsia in the community is estimated at 30 to 38% (101,104), but only a minority of those with symptoms, estimated at 28% on the basis of one study (104), consult physicians.
The upper gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Functional dyspepsia is the commonest of the upper FGIDs, affecting about 10% of the population, and refers to upper abdominal symptoms that typically occur after eating, lasting for a variable period of time, and for which no ‘organic’ cause can be found on appropriate testing. These symptoms may include fullness, inability to finish a normal-sised meal, bloating, and nausea (postprandial distress syndrome) or pain (epigastric pain syndrome). There are no tests to diagnose functional dyspepsia (by definition, tests are all normal), and the cause of the condition has not been fully defined. Possible causes/contributors include hypersensitivity or low-grade inflammatory processes. Once other conditions have been excluded (testing required depends on symptoms, age, ethnicity, etc.), initial treatment focusses on diet, avoiding foods that aggravate symptoms whilst maintaining a healthy and balanced diet. This will usually involve reduction in fatty and spicy foods, and smaller meals. If Helicobacter pylori (see earlier) is present, this is usually treated with antibiotics, which leads to improvement in about 5% of cases, followed by acid suppression and medications to increase transit of food (prokinetics). If anxiety or depression is present, it should be treated, and in refractory cases low doses of neuromodulators (especially tricyclics – see later) are often used. For more information about functional dyspepsia see [17, 18].
Global prevalence and international perspective of paediatric gastrointestinal disorders
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Shaman Rajindrajith, Niranga Devanarayana, Marc Benninga
Functional dyspepsia is a disorder characterised by the presence of persistent or recurrent pain or discomfort that does not subside with defecation and which is localised to the central region of the abdomen above the umbilicus (Rasquin et al., 2006). Epidemiology of functional dyspepsia has not been adequately studied across the world. A school-based study in Italy of children aged 6–19 years using Rome II criteria noted ulcer-like dyspepsia in 3.4% of children and dysmotility-like dyspepsia in 3.7% (De Giacomo et al., 2002). A prospective survey from the same country and that included children of a much more diverse age range showed a prevalence of 0.3% (Miele et al., 2004). A study from Asia has evaluated prevalence of abdominal pain-predominant functional gastrointestinal diseases in children and shown a prevalence of functional dyspepsia in 2.5% (Devanarayana and Rajindrajith, 2012). The prevalence was higher among girls than boys. A detailed symptom analysis showed that the majority of children have pain several times a week and the pain is short-lasting (less than 1 hour). Furthermore, children with functional dyspepsia also suffer from a range of intestinal-related symptoms such as bloating, loss of appetite, nausea, burping and flatulence, as well as extra-intestinal symptoms such as headaches, limb pains, headache, sleeping difficulties and light-headedness (Devanarayana et al., 2011b).
Gastroparesis syndromes: emerging drug targets and potential therapeutic opportunities
Published in Expert Opinion on Investigational Drugs, 2023
Le Yu Naing, Matthew Heckroth, Prateek Mathur, Thomas L Abell
Although classical gastroparesis is defined by delayed gastric emptying, there are various syndromes with similar clinical presentations without delayed gastric emptying. This group of patients is commonly characterized as having functional dyspepsia or chronic nausea and vomiting syndrome. Functional dyspepsia, based on the Rome IV criteria, is defined as postprandial fullness, early satiety, and epigastric pain/burning for at least three months with symptom onset at least six months prior to diagnosis. There must also be an absence of organic cause to explain symptoms and a normal solid gastric emptying time[6]. Although functional dyspepsia and Gp have classically been viewed as distinct entities, recent studies have similar clinical presentations and pathophysiology. More recently the National Institute of Health (NIH) gastroparesis consortium proposed that disorders such as functional dyspepsia can be viewed as a spectrum that includes chronic unexplained nausea and vomiting (CUNV), gastroparesis-like syndrome (GLS), and classic Gp[7]. Under this new, broadened definition, the prevalence of patients with Gp symptoms in the US is approximately 10%. This spectrum of disorders is often referred to as gastroparesis syndromes (GpS). The pathophysiology of GpS is not discussed in great detail here but is included in the targets for therapy in the sections that follow with the goal of developing new therapies[8]. (Figures 1, 2 , and 3).
Impact of hypnotic safety on disorders of gut-brain interaction: A pilot study
Published in American Journal of Clinical Hypnosis, 2020
Louis F. Damis, M. Skyler Hamilton
PAGI, Safe/Warmth, and Relaxed mean scale scores were averaged across participants to provide a view of interactions among these variables. As seen in Figure 3, beginning at Week 4, participants were evidencing increases in their experience of safe/warmth and relaxed positive affect, and by Week 5 were experiencing reductions in functional dyspepsia symptoms. Moreover, as safe/warmth peaked at Week 6, functional dyspepsia symptoms reached their lowest level. The specificity of the impact on symptoms of safe/warmth positive affect in comparison to the relaxed positive affect is supported by the observation that changes in safe/warmth were consistently related to functional dyspepsia symptoms in a negative manner, i.e., as safe/warmth increased, symptoms decreased. In contrast, although increases in the relaxed positive affect generally paralleled the increases in safe/warmth, relaxed positive affect shot up on Week 2 (onset of participants’ Winter break from college) and peaked at Week 7, these elevations were not associated with reductions in symptoms at Week 2 and were associated with increases in symptoms at Week 7. Only increases in safe/warmth positive affect were consistently associated with decreases in functional dyspepsia symptoms.
Gastroparesis versus dyspepsia by intragastric meal distribution: new diagnostics and definitions ahead
Published in Scandinavian Journal of Gastroenterology, 2020
Per Grybäck, Hans Jacobsson, Lucyna Neuger, Per M. Hellström
This survey take aim on the typical challenges we meet and the new diagnostic possibilities we have achieved for patients with the functional dyspepsia and gastroparesis of the idiopathic type. Even if gastroparesis is more common as a complication to long-standing diabetes and imbalanced plasma glucose levels, the ‘idiopathics’ stand out as an unexplained disorder, the malfunction of which yet to be defined. Hence, many questions cannot be fully answered, but experience can be shared and we have today some insight into the occurrence and characteristics of the overlapping concepts of functional dyspepsia and gastroparesis, knowledge that may improve our diagnostic and therapeutic approach. Patients with functional dyspepsia and idiopathic gastroparesis often have a mixed constellation of symptoms including nausea, vomiting, early satiety on food intake, postprandial fullness, bloating, and upper abdominal pain. The clinical experience of this impression points out potential directions for future clinical studies. Hence, we have sought to outline the clinical characteristics and controversies of functional dyspepsia and idiopathic gastroparesis in order shape a basis for emerging treatment possibilities.