Endoscopy-Guided Evaluation of Duodenal Mucosal Permeability in Functional Dyspepsia

Ishigami, Hideaki; Matsumura, Tomoaki; Kasamatsu, Shingo; Taida, Takashi; Okimoto, Kenichiro; Saito, Keiko; Maruoka, Daisuke; Nakagawa, Tomoo; Katsuno, Tatsuro; Arai, Makoto

doi:10.1016/s0016-5085(17)30879-x

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…In the last few years, there has been an increasing interest in duodenal alterations in patients with FD. 2–4,14 In the present paper, we report decreased total duodenal BS concentrations during fasting and increased duodenal VDR expression in FD compared to controls.…”

Section: Discussionsupporting

confidence: 59%

“…19 This finding of a decreased primary to secondary BS ratio in patients with FD may contribute to impaired duodenal barrier function. 3,14 In addition, we report no effect of gender and age on BS levels. Conflicting data have been reported on male and female plasma BS concentrations.…”

Section: Discussionmentioning

confidence: 48%

“…Therefore, the hydrophobic nature of the BS pool is linked with pathological conditions 19 . This finding of a decreased primary to secondary BS ratio in patients with FD may contribute to impaired duodenal barrier function 3 , 14 . In addition, we report no effect of gender and age on BS levels.…”

Section: Discussionmentioning

confidence: 58%

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Altered duodenal bile salt concentration and receptor expression in functional dyspepsia

et al. 2018

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Background: Functional dyspepsia is a common functional gastrointestinal disorder in which a variety of pathophysiological mechanisms such as increased intestinal permeability and low-grade inflammation are involved. The factor causing these alterations, however, has not been identified. Objective: We aimed to evaluate the luminal bile salt content and receptor expression in patients with functional dyspepsia and healthy volunteers. Methods: Gastroduodenoscopy was performed to obtain duodenal biopsies from 25 healthy volunteers and 25 patients with functional dyspepsia (Rome III) to measure duodenal bile salt receptor expression with Western blot. Duodenal fluid aspirates were collected at fixed time points during fasted and fed state conditions and bile salt composition analysis was performed by liquid chromatography-mass spectrometry/mass spectrometry. Results: Patients (N ¼ 17) displayed decreased fasted bile salt concentrations compared to healthy volunteers (N ¼ 20) over time (1.8 AE 0.3 mM vs 3.6 AE 0.5 mM; p ¼ 0.03). In addition, an increased expression of duodenal bile salt sensor vitamin D receptor was found in patients (3.7 AE 1.0-fold; p < 0.0005; N ¼ 24 for both groups). Conclusion: Patients with functional dyspepsia are characterized by a decreased duodenal bile salt concentration in fasted state and an increased duodenal vitamin D receptor expression.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 48%

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Altered duodenal bile salt concentration and receptor expression in functional dyspepsia

et al. 2018

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“…Our study therefore does not provide a correlation between duodenal baseline impedance and in vitro measurements of duodenal mucosa in using chambers. However, previous studies have already described that impaired duodenal mucosal integrity and permeability using biopsy sample [10] in patients with FD, and increased mucosal admittance through endoscopic technique [40] in FD compared to HC. This study did not show a significant statistical correlation between baseline impedance and severity of dyspeptic symptoms.…”

Section: Discussionmentioning

confidence: 90%

Patients with dyspepsia have impaired mucosal integrity both in the duodenum and jejunum: in vivo assessment of small bowel mucosal integrity using baseline impedance

et al. 2019

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Background Recent studies reported that impaired proximal duodenal mucosa, assessed by duodenal biopsy, could play an important role in the development of dyspeptic symptoms. The aims of this study were (a) to develop a method to measure ''in vivo'' duodenal and jejunal baseline impedance (BI) and (b) to assess small bowel mucosal integrity in patients with functional dyspepsia (FD) and healthy controls (HC). Methods We recruited 16 patients with FD and 15 HC. All subjects underwent ambulatory duodeno-jejunal manometry combined with impedance (HRM/Z), BI were determined by measuring impedance immediately after the passage of nocturnal migrating motor complex (MMC) phase IIIs. Results The number of MMC phase IIIs in FD was significantly lower than that in HC (2.6 ± 1.4 vs 4.8 ± 1.7, p \ 0.001). The BI in patients was significantly lower than that in HC in D1(164.2 ± 59.8 X in FD and 243.1 ± 40.5 X in HC, p = 0.0061), D2 (191.2 ± 34.1 and 256.5 ± 91.4 X, p = 0.01), D3 (214.0 ± 76.9 and 278.1 ± 45.3 X, p = 0.009), D4 (270.8 ± 54.2 and 351.8 ± 50.2 X, p \ 0.001), and J1 (312.2 ± 55.4 and 379.3 ± 38.3 X, p = 0.001). Conclusions This is the first study reporting the duodenal and jejunal BI in vivo. The results have shown significantly lowered BI in the proximal small intestine in patients with FD compared to HC. Furthermore it suggests that measurements of small bowel BI could be used as a biomarker for diagnosis and follow up of patients with FD.

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“…Investigation during endoscopy revealed increased mucosal permeability in EPS, PDS and functional dyspepsia with concomitant IBS 85 . This finding confirmed earlier studies on biopsy samples that demonstrated decreased transepithelial resistance and increased paracellular permeability together with immune cell infiltration 86 .…”

Section: Gastroduodenal Inflammationmentioning

confidence: 98%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

254

247

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Endoscopy-Guided Evaluation of Duodenal Mucosal Permeability in Functional Dyspepsia

Cited by 5 publications

References 20 publications

Altered duodenal bile salt concentration and receptor expression in functional dyspepsia

Altered duodenal bile salt concentration and receptor expression in functional dyspepsia

Patients with dyspepsia have impaired mucosal integrity both in the duodenum and jejunum: in vivo assessment of small bowel mucosal integrity using baseline impedance

Functional dyspepsia

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