Regional brain disorders of serotonin neurotransmission are associated with functional dyspepsia

Tominaga, Kazunari; Tsumoto, Chikako; Ataka, Suzuka; Mizuno, Kei; Takahashi, Kei; Yamagami, Hirokazu; Tanigawa, Tetsuya; Kawabe, Joji; Watanabe, Toshio; Fujiwara, Yasuhiro; Shiomi, Susumu; Watanabe, Yasuyoshi; Arakawa, Tetsuo

doi:10.1016/j.lfs.2015.07.023

Cited by 35 publications

(33 citation statements)

References 52 publications

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“…In patients with FD, eating a high-fat meal strongly induces nausea, abdominal pain, and abdominal bloating, and both fasting and postprandial cholecystokinin (CCK) levels are high (7). We have also shown that the indigestion score of the Gastrointestinal Symptom Rating Scale was high in patients with FD (8). Therefore, the upper abdominal symptoms at the epigastrium may result from functional disorders of the adjacent pancreas as well as the stomach and duodenum.…”

Section: Introductionmentioning

confidence: 82%

Postprandial Symptoms Felt at the Lower Part of the Epigastrium and a Possible Association of Pancreatic Exocrine Dysfunction with the Pathogenesis of Functional Dyspepsia

et al. 2017

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Objective In symptom-dependent diseases such as functional dyspepsia (FD), matching the pattern of epigastric symptoms, including severity, kind, and perception site, between patients and physicians is critical. Additionally, a comprehensive examination of the stomach, duodenum, and pancreas is important for evaluating the origin of such symptoms. Methods FD-specific symptoms (epigastric pain, epigastric burning, early satiety, and postprandial fullness) and other symptoms (regurgitation, nausea, belching, and abdominal bloating) as well as the perception site of the above symptoms were investigated in healthy subjects using a new questionnaire with an illustration of the human body. A total of 114 patients with treatment-resistant dyspeptic symptoms were evaluated for their pancreatic exocrine function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid. Results A total of 323 subjects (men:women, 216:107; mean age, 52.1 years old) were initially enrolled. Most of the subjects felt the FD-specific symptoms at the epigastrium, while about 20% felt them at other abdominal sites. About 30% of expressed as epigastric symptoms were FD-nonspecific symptoms. At the epigastrium, epigastric pain and epigastric burning were mainly felt at the upper part, and postprandial fullness and early satiety were felt at the lower part. The prevalence of patients with pancreatic exocrine dysfunction was 71% in the postprandial fullness group, 68% in the epigastric pain group, and 82% in the diarrhea group. Conclusion We observed mismatch in the perception site and expression between the epigastric symptoms of healthy subjects and FD-specific symptoms. Postprandial symptoms were often felt at the lower part of the epigastrium, and pancreatic exocrine dysfunction may be involved in the FD symptoms, especially for treatment-resistant dyspepsia patients.

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Section: Introductionmentioning

confidence: 82%

Postprandial Symptoms Felt at the Lower Part of the Epigastrium and a Possible Association of Pancreatic Exocrine Dysfunction with the Pathogenesis of Functional Dyspepsia

et al. 2017

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“…In other words, this period was needed for rikkunshito to improve chronic dyspeptic symptoms, although rikkunshito was shown to affect gastric sensorimotor function in clinical and experimental studies within a few minutes or hours . These findings suggest a time lag between physiological improvement and symptom relief, possibly because the psychological factor (anxiety) is closely associated with the pathogenesis of FD . Interestingly, rikkunshito also improves psychological instability affecting various humoral factors under stress circumstances .…”

Section: Discussionmentioning

confidence: 99%

“…11,30 These findings suggest a time lag between physiological improvement and symptom relief, possibly because the psychological factor (anxiety) is closely associated with the pathogenesis of FD. 31,32 Interestingly, rikkunshito also improves psychological instability affecting various humoral factors under stress circumstances. 14,15 Recently, it has also been demonstrated that the active components of rikkunshito are distributed in the brain and have antagonistic activities for both 5-HT 2C receptor and corticotropinreleasing factor receptor 1.…”

Section: Discussionmentioning

confidence: 99%

Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: A randomized clinical trial (the DREAM study)

Tominaga

Sakata²,

Kusunoki

et al. 2018

Neurogastroenterology Motil

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“…Compared with healthy individ uals, patients with functional dyspepsia also reveal alterations in the functional connectivity of brain regions at rest 149 and different structural brain measures, including regional grey matter volume and white matter microstructure [150][151][152][153] . Finally, emerging evidence supports alterations in central neuro transmitter systems, including the serotoninergic and endo cannabinoid systems, in functional dyspepsia [154][155][156] . Of note, to date no study has compared functional dyspepsia with other functional gastrointestinal disorders or with psychi atric control groups.…”

Section: Psychosocial Factors and Brain Mechanismsmentioning

confidence: 98%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

253

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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Regional brain disorders of serotonin neurotransmission are associated with functional dyspepsia

Cited by 35 publications

References 52 publications

Postprandial Symptoms Felt at the Lower Part of the Epigastrium and a Possible Association of Pancreatic Exocrine Dysfunction with the Pathogenesis of Functional Dyspepsia

Postprandial Symptoms Felt at the Lower Part of the Epigastrium and a Possible Association of Pancreatic Exocrine Dysfunction with the Pathogenesis of Functional Dyspepsia

Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: A randomized clinical trial (the DREAM study)

Functional dyspepsia

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