Enfoque diagnóstico y terapéutico de dispepsia y dispepsia funcional: ¿qué hay nuevo en el 2019? / Diagnostic and therapeutic approach to dyspepsia and functional dyspepsia: what's new in 2019?

La dispepsia abarca un conjunto de síntomas que se originan en la región gastroduodenal. Se caracteriza por dolor o ardor epigástrico, saciedad precoz y llenura pos-prandial. Según la relación de los síntomas con las comidas se divide en síndrome de dolor epigástrico y síndrome de malestar pos-prandial. Sin embargo, en la práctica clínica, frecuentemente se sobreponen. En los últimos años se ha cambiado el paradigma de las alteraciones fisiológicas gástricas y han aumentado las evidencias que apoya a la eosinofilia duodenal, como una alteración primaria que altera la fisiología gástrica y puede inducir la sintomatología. Así mismo, cada día hay mayor interés en la alteración de la microbiota. El tratamiento se basa en la supresión de ácido, procinéticos, neuromoduladores, psicoterapia, terapias alternativas y complementarias. Ningún tratamiento es universalmente eficaz en todos los pacientes.

Dyspepsia encompasses a set of symptoms that originate in the gastroduodenal region. It is characterized by pain or epigastric burning, early satiety and post-prandial fullness. According to the relationship of symptoms with meals, it is divided into epigastric pain syndrome and postprandial distress syndrome. However, in clinical practice, they frequently overlap. In recent years the paradigm of gastric physiological alterations has been changed and evidence supporting duodenal eosinophilia has increased, as a primary alteration that alters gastric physiology and can induce symptomatology. Every day there is more interest in the alteration of the microbiota. The treatment is based on the suppression of acid, neuromodulators, prokinetics, psychotherapy, alternative and complementary therapies. No treatment is effective in all patients.

Patologías funcionales post-infecciosas: epidemiología, factores de riesgo y tratamiento / Post-infectious functional gastrointestinal disorders: epidemiology, risk factors and treatment

Infectious gastroenteritis is a risk factor for developing post-infectious functional gastrointestinal disorders (PI-FGDs), mainly irritable bowel syndrome (IBS) and functional dyspepsia (FD). It is a significant subgroup of patients due to frequent episodes of gastrointestinal infections. Symptoms in PI-FGD patients can prevail for more than twelve months, especially if infective agents are bacteria or parasites. Symptoms are indistinguishable from their non-infective equivalents (IBS and FD). Risk factors for developing PI-FGD are: female gender, type and severity of the gastrointestinal infection, high anxiety levels and younger age. Main pathogenic mechanisms are alteration of permeability and immunity. Mucosa inflammation prevails only at early stage; however, with follow-up it can be reduced or normalized. Nevertheless, certain alterations prevail, such as hypersensitivity. These events are treated in the same way as IBS or FD.

La gastroenteritis infecciosa es un factor de riesgo para desarrollar un trastorno digestivo funcional postinfeccioso (TDF-PI), principalmente síndrome de intestino irritable (SII) y dispepsia funcional (DF). Es un subgrupo de pacientes relevante debido a lo frecuente que son las infecciones gastrointestinales. Los síntomas en los pacientes con TDF-PI se pueden prolongar por más de un año, especialmente cuando los agentes infecciosos son bacterias o parásitos. Los síntomas son indistinguibles con respecto a los de sus equivalentes no infecciosos (SII y DF). Los factores de riesgo para desarrollar TDF-PI son el sexo femenino, el tipo y la severidad de la infección gastrointestinal, los niveles altos de ansiedad, y la menor edad. Los principales mecanismos patogénicos son la alteración de la permeabilidad y de inmunidad. La inflamación de la mucosa predomina solo al principio pero con el seguimiento esta disminuye o se normaliza, a pesar de lo cual ciertas alteraciones como la hiperensibilidad permanecen. Estos cuadros se tratan de la misma manera que un SII o DF.

Probing the Utility of Ultrasonography for Assessing Degree of Functional Dyspepsia / 대한소화기학회지

No abstract available.

Effect of Gongronema latifolium ethanol leaf extract on gastric acid secretion and cytoprotection in streptozotocin-induced diabetic rats / Efecto del extracto de etanol de las hojas de Gongronema latifolium sobre la secreción del ácido gástrico y la citoprotección en ratas con diabetes inducida por estreptozotocina

OBJECTIVES: Gongronema latifolium leaves have been used in folklore medicine to manage diabetes mellitus and alleviate dyspepsia. This study aimed to provide a pharmacological basis to the medicinal use of Gongronema latifolium as an antidiabetic and antiulcerogenic agent in diabetes mellitus. METHODS: Ethanol extract from the leaf (200 mg/kg bodyweight) of Gongronema latifolium was administered to both streptozotocin-induced diabetic and control groups orally for 14 days. Gastric acid secretion was measured and ulcer was induced using ethanol and fourhour pyloric ligation. RESULTS: The mean bodyweight was significantly lower (p < 0.01), while the mean weight of the stomach, liver and small intestine to bodyweight ratio was increased significantly (p < 0.05) in the two diabetic groups compared to control. Extract significantly (p < 0.01) reduced the blood glucose level similar to the nondiabetic control. Basal and stimulated acid secretion in diabetic control rats was significantly (p < 0.01) decreased when compared to control. Extract administration increased the stimulated gastric acid secretion to a level significantly (p < 0.05) higher than control while reduction in gastric secretion by ranitidine was similar compared with control. Gongronema latifolium treatment significantly (p < 0.05) reduced ulcer scores in both ulcer models and increased mucus weight in the diabetic group. CONCLUSION: These results suggest that Gongronema latifolium antiulcerative activity is due to its prevention of chemicalinduced stomach injury.

OBJETIVOS: Las hojas de la gongronema latifolium han sido usadas en la medicina tradicional para tratar la diabetes mellitus y aliviar la dispepsia. Este estudio estuvo dirigido a proporcionar una base farmacológica al uso medicinal de la gongronema latifolium como agente antidiabético y antiulcerogénico en la diabetes mellitus. MÉTODOS: El extracto de etanol de la hoja (200 mg/kg peso corporal) de la Gongronema latifolium se administró oralmente durante 14 días a grupos con diabetes inducida por estreptozotocina, y grupos de control. La secreción ácida gástrica fue moderada y la úlcera fue inducida usando etanol, y ligazón pilórica de cuatro horas. RESULTADOS: El peso corporal promedio fue significativamente más bajo (p < 0.01), mientras que el peso promedio del estómago, el hígado y el intestino delgado con respecto a la proporción del peso corporal aumentó significativamente (p < 0.05) en los dos grupos diabéticos comparados con los controles. El extracto redujo significativamente (p < 0.01) el nivel de glucosa de la sangre, de manera similar al control no diabético. La secreción ácida basal y estimulada en las ratas diabéticas control disminuyó significativamente (p < 0.01) en comparación con el control. La administración del extracto aumentó la secreción ácida gástrica estimulada a un nivel significativamente (p < 0.05) superior al control, en tanto que la reducción de secreción gástrica mediante ranitidina fue similar comparada con el control. El tratamiento con Gongronema latifolium redujo significativamente (p < 0.05) las puntuaciones de las úlceras, tanto en los modelos de la úlcera como en el peso de mucosidad aumentado en el grupo diabético. CONCLUSIÓN: Estos resultados sugieren que la actividad antiulcerosa de la Gongronema latifolium se debe a que previene las lesiones de estómago inducidas por medios químicos.

Dispepsia funcional: diagnóstico e tratamento / Functional dispepsy: diagnosis and treatment

Dispepsia Funcional é a causa mais frequente das dispepsias. Sua fisiopatologia permanece obscura e ainda não dispomos de um método diagnóstico específico. Além disso, há uma ampla lista de diagnósticos diferenciais de doenças as quais também cursam com dispepsia. O tratamento muitas vezes tem benefícios discretos, e deve ser individualizado sempre que possível, juntamente com uma boa abordagem psicossocial, a qual pode auxiliar na terapêutica e no manejo destes pacientes.

Funcional Dyspepsia is the most frequent cause of dyspepsia. Its pathophysiology remains unclear and there is not still a specific diagnostic method. Moreover, there is an extensive list of differential diagnosis of diseases which also presents with dyspepsia. The treatment often has discrete benefits and must be individually whenever possible, with good psychosocial, which can aid in the treatment and the management of these patients.

Dispepsia funcional: revisão de diagnóstico e fisiopatologia / Functional dyspepsia: review of diagnosis and pathophysiology

Dispepsia funcional é definida como um distúrbio da digestão caracterizado por um conjunto de sintomas relacionados ao trato gastrointestinal superior. É um distúrbio gastrointestinal comum observado na população geral.Sintomas observados: saciedade precoce, empachamento pós-prandial, náuseas, vômitos, timpanismo, distensão abdominal.Vários medicamentos, associados ou não, podem ser empregados.Corresponde a mais de 25% do atendimento no ambulatório de especialidade.

Detection of patients with functional dyspepsia using wavelet transform applied to their electrogastrogram

The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25 percent of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6 percent sensitivity, 92.9 percent specificity, and an error of 17.9 ± 6 percent (with a 95 percent confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

Dispepsia funcional: nuevos conocimientos en la fisiopatogenia con implicaciones terapéuticas / Functional dyspepsia: new pathophysiologic knowledge with therapeutic implications

La dispepsia funcional (DF) es un complejo sintomático, heterogéneo y altamente prevalente en la comunidad y en la práctica general. La DF se define como la presencia de síntomas que se piensan originados en la región gastroduodenal, en ausencia de enfermedad orgánica, sistémica o metabólica que pueda explicarlos. Entre los factores fisiopatogénicos se incluyen los trastornos de la acomodación y del vaciamiento gástrico, dismotilidad duodenal, sensibilidad aumentada, factores psicosociales y una asociación con un estado postinfeccioso. Se han hecho numerosos esfuerzos para aumentar los conocimientos en la etiopatogenia del síndrome, incluyendo nuevos aspectos moleculares y genéticos. Sin embargo, el mecanismo etiopatogénico exacto que causa los síntomas en un paciente individual sigue siendo difícil de identificar. Los nuevos criterios de Roma III redefinen y subclasifican la DF basándose en sus síntomas principales, lo cual es de gran valor para la investigación, el desarrollo y el control estandarizados de nuevas estrategias terapéuticas así como la formulación de recomendaciones para la práctica clínica. Las modalidades terapéuticas que se han empleado incluyen: modificaciones dietéticas, agentes farmacológicos dirigidos a actuar sobre distintos blancos dentro del aparato gastrointestinal, del sistema nervioso central y periférico, y terapias psicológicas incluyendo la hipnoterapia. Desafortunadamente, hasta la fecha, todas estas terapias han rendido solamente resultados marginales. Después de excluir enfermedad orgánica, es esencial que el paciente esté informado sobre la naturaleza y el pronóstico benignos de su enfermedad, y esto puede ser, a veces, la inversión más provechosa tanto para el paciente como para su médico.

Functional dyspepsia (FD) is a heterogeneous, highly prevalent symptom complex in the community and general practice. FD is defined as the presence of symptoms considered as originated in the gastroduodenal region, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Pathogenetic features include disturbed gastric accommodation and emptying, duodenal dysmotility, heightened sensitivity, notably psychosocial disturbances and an association with a postinfective state. Increasing efforts are made to determine the etiopathogenesis of the disease, including new molecular and genetic aspects. However, the exact etiopathologic mechanism that causes the symptoms in an individual patient remains to be identified. The new Rome III criteria redefine and sub-characterize FD patients according to their main symptoms and this can be of value for standardized research, development and control of new therapeutic strategies and calculated therapeutic recommendations in the clinical practice. Various treatment modalities have been employed including dietary modifications, pharmacological agents directed at different targets within the gastrointestinal tract and central nervous system and psychological therapies including hypnotherapy. Unfortunately, to date, all of these therapies have yielded only marginal results. After excluding organic diseases, it is essential that the patient be assured about the benign nature and prognosis of the disease, and this can be sometimes the most helpful inversion for the patient and his/her physician.

Postprandial gall bladder contraction seen under ultrasound to rule out non functioning gall bladder in patients of flatulent dyspepsia

Thirty patients with flatulent dyspepsia selected. Ultrasound examination pre and postprandial done. 26 had normal postprandial gall bladder contraction. 4 patients found to be having non functional gall bladder as it did not show postprandial contraction. They were advised to have oral cholecystography and one of these 4 patients was found to have stone impacted in neck of gall bladder

Initial ligguistic and psychometric validation of the Arabic version of nepean dyspepsia index

To report the initial evaluation of the linguistic and psychometric validation of the Nepean Dyspepsia Index [NDI], as part of the ongoing research of quality of life among dyspeptic patients. The Arabic version of the NDI was administered to 158 subjects [54 with non-ulcer dyspeptic [NUD]], 50 with gastro-esophageal reflux disease [GERD] and 54 with no history of gastroenteritis disease], with a mean age of 46.6 and SD 10.7. All subjects answered the Arabic versions of the General Health Questionnaire [GHQ], the Self-Report Questionnaire [SRQ], and the Short Form-12 Quality of Life [QOL] scale. We administered the final translation of the NDI by consensus. The study was conducted in King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between December 2002 and January 2004. The NDI has shown adequate internal consistency. Cronbach Alpha coefficient ranged between 0.88 to 0.93, and Split-half correlation reliability ranged between 0.82 and 0.94. Correlations between NDI subscales and total scores were high and significant. Adequate Face and content validity was demonstrated by consultation with gastroenterologists and clinical psychologists. Convergent validity was shown in the moderate and significant correlation of the NDI subscales and global index with the indices of the SF-12. Divergent validity was shown in that subscales of the NDI revealed low correlation with scales which measure other dimensions; thus, both QOL subscales and symptom checklist have discriminated patients from non-patients groups [p>0.01]. The factorial structure of the NDI was also examined, and it revealed 4 factors, which is similarly the same with other studies. The initial validation of the Arabic version of the NDI has shown that this scale has adequate psychometric and linguistic property and can represent a good addition to health outcome measures in dyspepsia research. Further validation studies are recommended

Noninvasive Measurement of Gastric Accommodation by SPECT

No abstract available.

Effect of portal hypertensive gastropathy on electrogastrographic changes and gastric emptying time

Dyspepsia is a frequent symptom in cirrhotic patients. Congestive gastropathy or portal hypertensive gastropathy [PHG] was detected as a possible cause of sustained dyspepsia in 40% of these patients, and prolonged gastric emptying time [GE] with decrease gastric wall compliance were detected in cirrhoric patients. Electrogastrography [EGG] is a non-invasive method to study gastric myoelectrical activity from the body surface by electrodes. whereas, an ultrasonographic method can be used for the estimation of gastric emptying by measuring what so called half emptying and full emptying times with other parameters. Aim of this work is to study patterns of EGG and ultrasnographic GE. In cirrhotic patients with or without PHG. 45 patients were chosen for this study and were divided into 3 groups ; group 1 is cirrhotic patients with PHG negative upper gastrointestinal [U.G.I.T.] endoscopy and group 2 is cirrhotic patients with PHG positive and group 3 is healthy subjects taken as control. We found significant delay in GE in gp. 2 in relation to group 3 [p < 0.05]. EGG reveiled power ratio lower in gp. 1, 2 [2.01 - 1.93] respectively compared to group. 3 [2.63]. Also there was highly significint increase in "Dominant frequency" at rest [DF] in group.1 campared to group. 2 and 3 [p>0.01] where mean of group 1 was 2944.9, in group 2 was 2477 and in group 3 was 1934 and the power meal at DF was higher in group 1 than 2 , 3 but siatistically insignificant where the mean in group 1 was 5922.5 and in group. 2 was 4804.8 and was 5087.8 in group 3 [p>0.05]. Delayed gastric emptying by U.S, and changes in EGG records of cirrohotic patients especially in presence of portal hypertensive gastropathy may explain dyspepsia frequently occurring with portal hypertensive gastropathy

Dispepsia funcional / Functional dyspepsia

Functional dyspepsia is a digestive alteration, characterized by pain or discomfort, localized in upper abdome, with-out evidence of organic or morphological alterations. This is a review on dyspepsia, its classification, etiology, physiopathology, with emphasis ondiagnosis and treatment