Efficacy of the 5-HT1A Agonist Tandospirone Citrate in Improving Symptoms of Patients With Functional Dyspepsia: A Randomized Controlled Trial

Miwa, Hiroto; Nagahara, Akihito; Tominaga, Kazunari; Yokoyama, Tetsuji; Sawada, Yasuo; Inoue, Kentaro; Ashida, Kiyoshi; Fukuchi, Takumi; Hojo, Mariko; Yamashita, Hiroshi; Tomita, Toshihiko; Hori, Keiichi; Oshima, Tadayuki

doi:10.1038/ajg.2009.427

Cited by 117 publications

(96 citation statements)

References 26 publications

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“…Impaired gastric accommodation can be targeted by 5-HT1A agonists and the muscar inic auto-receptor antagonist and acetylcholinesterase inhibitor acotiamide 193 . Studies have shown symptomatic benefit in PDS of the 5-HT1A agonists buspirone and tandospirone 194,195 (in particular for symptoms of early satiety, whereas no relationship between symptom improvement and the patient's anxiety status was observed) and acotiamide 196 , a finding that led to the approval of acotiamide for functional dyspepsia treatment in Japan and India.…”

Section: Pharmacological Treatment Of Pdsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

260

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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Section: Pharmacological Treatment Of Pdsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

260

247

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“…63 In a double-blind, placebo-controlled study involving 144 patients, the response rate after 4 weeks of treatment with tandospirone was 31.5%, as compared with 12.7% with placebo (P = 0.002). 64 …”

Section: Prokinetic Agentsmentioning

confidence: 99%

Functional Dyspepsia

2015

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“…Recently, a review article described the basic science and clinical evidence for such use, and discussed future applications for various kampo medicines in the treatment of gastrointestinal tract disorders [62]. In Japan, an RCT was done on the efficacy of tandospirone citrate (a 5-HT1A agonist) in improving symptoms of patients with FD [63]. In addition, two meta-analyses have shown the efficacy of antidepressants and anxiolytics in the treatment of FD patients [64,65].…”

Section: Treatmentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for functional dyspepsia

et al. 2015

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General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list ''functional dyspepsia'' as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.

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Efficacy of the 5-HT1A Agonist Tandospirone Citrate in Improving Symptoms of Patients With Functional Dyspepsia: A Randomized Controlled Trial

Abstract: Despite a considerable placebo effect, the benefits of tandospirone were shown in terms of improvement in abdominal symptom scores.

Cited by 117 publications

References 26 publications

Functional dyspepsia

Functional dyspepsia

Functional Dyspepsia

Evidence-based clinical practice guidelines for functional dyspepsia

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