Controversies in dyspepsia

Abstract

Even in the absence of visible lesions like an ulcer, cancer or oesophagitis, patients with functional dyspepsia may complain of severe dyspeptic symptoms and have a poor quality of life. Characteristically, these patients also often have a low estimate of their own health and have complaints from several organ systems. The cause of the disease is not known. Both central nervous system and gastric disturbances appear to be involved, and their relative importance is controversial. There is no clear beneficial effect of acid suppression or H. pylori eradication although effects of such therapy may be seen in minor subgroups. New findings emphasise the importance of distinguishing between functional dyspepsia and gastro‐oesophageal reflux disease, which exhibit completely different gastric accommodation patterns to a meal and have very different therapeutic potential. The effect of drugs like glyceryl trinitrate, glucagon, sumatriptan and buspirone which all concomitantly improve symptoms and gastric accommodation support the important role of abnormal gastric accommodation to meals in patients with functional dyspepsia. A hypothetical model for the pathogenesis of functional dyspepsia is presented. It incorporates four established abnormalities: various psychological abnormalities, low vagal tone, impaired gastric relaxation, and visceral hypersensitivity, in a logical interplay along the brain‐gut axis. Copyright © 2001 Taylor and Francis Ltd.

Wistar Kyoto rats have impaired gastric accommodation compared to Sprague Dawley rats due to increased gastric vagal cholinergic tone

“…Since both emotional and cognitive factors modulate stomach functions, it is not surprising that several studies have reported high scoring for anxiety and depression in some patients with FD [14Á16]. However, it is unclear whether central neural mechanisms cause the dyspeptic symptoms and reduced accommodation, or vice versa [17].…”

Alterations in Antral Cytokine Gene Expression in Peptic Ulcer Patients During Ulcer Healing and After Helicobacter pylori Eradication

“…Although Helicobacter pylori infection cannot explain all symptoms or ulcer cases in the upper gastrointestinal system [1], it is generally accepted that H. pylori is the most important etiologic factor leading to ulcers in the duodenum and to some extent in the stomach [2]. Furthermore, the chronic stimulation of the local immune response in H. pylori infection may lead to atrophic gastritis and even development of cancer [3].…”

Modelo Procesual del estrés de la Dispepsia Funcional : implicaciones para la evaluación y el tratamiento

“…El diagnóstico de la DF implica, por lo tanto, descartar otras enfermedades del sistema digestivo que frecuentemente tienen síntomas similares tales como la úlcera péptica, la enfermedad por reflujo gasfro-esofágico, el síndrome de colon irritable, y el cán-cer gástrico, entre otras (Berstad et al 2001;Talley et al 2000;Tack et al 2001).…”