Symptoms and Subtypes in Pediatric Functional Dyspepsia: Relation to Mucosal Inflammation and Psychological Functioning

Schurman, Jennifer Verrill; Singh, Meenal; Singh, Vivekanand; Neilan, Nancy A; Friesen, Craig A.

doi:10.1097/mpg.0b013e3181d1363c

Cited by 68 publications

(76 citation statements)

References 23 publications

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“…A significant correlation with antral MC densities with anxiety, depression and somatisation has been reported in children with FD 67. Moreover, the degranulation of MCs in the duodenum appears to be highly sensitive and specific for the identification of adult patients with FD as shown by 100% sensitivity and specificity indicated by an area under the receiver operating characteristic curve of 1.0 for the optimal degranulation rate cut-off values of 30.2% at the duodenal bulb and 36.8% at the descending part of the duodenum 66…”

Section: Linking MC Infiltration and Activation In The Gi Tract With mentioning

confidence: 88%

“…While there is discrepancy in IBS, available studies in FD reveal that MC numbers are significantly increased in the antrum and corpus of Helicobacter pylori -negative FD,64 65 and in the duodenum of patients with FD (table 2). 9 61 66 67 Moreover, increased MCs have been recently reported in the oesophagus of patients suffering from non-cardiac chest pain 68. Even so, it is hard to dismiss the physiological relevance of such ‘modest’ increases because, on the one side, similar incremental changes in leucocyte counts in circulating blood occur in infectious and inflammatory conditions, and on the other side, the magnitude of cell change is enormous if we consider the total mucosal surface of the GI tract.…”

Section: Infiltration In the Gi Tract In Fgidsmentioning

confidence: 99%

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The role of mast cells in functional GI disorders

Wouters

Vicario

Santos

2015

Gut

268

237

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Functional gastrointestinal disorders (FGIDs) are characterized by chronic complaints arising from disorganized brain-gut interactions leading to dysmotility and hypersensitivity. The two most prevalent FGIDs, affecting up to 16-26% of worldwide population, are functional dyspepsia and irritable bowel syndrome. Their etiopathogenic mechanisms remain unclear, however, recent observations reveal low-grade mucosal inflammation and immune activation, in association with impaired epithelial barrier function and aberrant neuronal sensitivity. These findings come to challenge the traditional view of FGIDs as pure functional disorders, and relate the origin to a tangible organic substrate. The mucosal inflammatory infiltrate is dominated by mast cells, eosinophils and intraepithelial lymphocytes in the intestine of FGIDs. It is well established that mast cell activation can generate epithelial and neuro-muscular dysfunction and promote visceral hypersensitivity and altered motility patterns in FGIDs, postoperative ileus, food allergy and inflammatory bowel disease. This review will discuss the role of mucosal mast cells in the gastrointestinal tract with a specific focus on recent advances in disease mechanisms and clinical management in irritable bowel syndrome and functional dyspepsia.

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Section: Linking MC Infiltration and Activation In The Gi Tract With mentioning

confidence: 88%

Section: Infiltration In the Gi Tract In Fgidsmentioning

confidence: 99%

The role of mast cells in functional GI disorders

Wouters

Vicario

Santos

2015

Gut

268

237

View full text Add to dashboard Cite

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“…Tryptase protein expression was higher in both postinfectious FD and nonspecific FD than in healthy controls, and mast cell numbers in antral mucosa were significantly increased in both types of FD [27]. A significant link with antral mast cell density and psychological functioning in children with FD has been described with anxiety, depression, and somatisation showing correlation with mast cell densities in gastric mucosa [28]. These studies therefore implicate gastric mast cells having a possible role in FD, although the data are not as yet as robust as that for duodenal eosinophilia.…”

Section: Functional Dyspepsia Eosinophils and Mast Cellsmentioning

confidence: 90%

The Role of Eosinophils and Mast Cells in Intestinal Functional Disease

Walker

Warwick

Ung

et al. 2011

Curr Gastroenterol Rep

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Functional gastrointestinal disorders (FGIDs) are common and currently defined by a symptom-based classification with no discernable pathology. In functional dyspepsia (FD), the duodenum is now implicated as a key area where symptoms originate.This is attributed to immune activation with increasing evidence indicating a role for duodenal eosinophilia. In irritable bowel syndrome (IBS), mastocytosis has been documented throughout the small and large intestine. Eosinophils and mast cells are an important link between innate and adaptive immunity, and are important in allergic type TH2 inflammation. Eosinophils may give rise to symptoms due to release of preformed cytokine proteins, which trigger neural excitation, muscle spasm, and pain. The close relationship of mast cells to nerves in IBS may similarly give rise to symptoms. Genetic studies also support of the role of innate immunity in FGIDs. The data supporting a prime role for eosinophils and mast cells in subsets of FD and IBS has become credible, and these data should be used to implement advances in diagnosis and therapeutic trials.

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“…The participants in the one adult FD study previously noted consisted of patients with symptoms of EPS. EPS is rare in pediatric FD and, in fact, none of the subjects in our study had pain localized only to the epigastrium [15] . Most of the participants in the current study would have met adult criteria for PDS.…”

Section: Clinical Responsementioning

confidence: 91%

Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

Zybach

Friesen

Schurman

2016

WJGPT

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AIM:To study the effectiveness of melatonin vs placebo in children with functional dyspepsia (FD). METHODS:The study was conducted as a double blind, randomized, placebo controlled crossover trial. Subjects were aged 8-17 years and diagnosed with FD based on Rome Ⅲ criteria. All subjects had failed to respond to 4 wk of acid suppression. Subjects receive a continuous two weeks of placebo and a continuous two weeks of melatonin in an order blinded to the participant and the study team. A Global Clinical Score was obtained to assess changes in abdominal pain. Pain was self-reported to be worse (grade 1), no change (grade 2), moderate improvement (grade 3), good (grade 4; minimal pain and not interfering with daily activities), or excellent (grade 5; no pain), respectively. A positive clinical response was defined as a grade 3 or greater response. Subjects wore an actigraph to assess sleep during a one week baseline period and during each treatment period. Subjects' sleep latency and total sleep time were recorded throughout the duration of the study. RESULTS:Fourteen subjects were enrolled and 12 completed the study. One withdrew prior to starting both melatonin and placebo and the other before starting melatonin. A positive clinical response (grade 3-5) was achieved in 42% of subjects on melatonin vs 50% of subjects on placebo (NS). Effect size was calculated

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Symptoms and Subtypes in Pediatric Functional Dyspepsia: Relation to Mucosal Inflammation and Psychological Functioning

Cited by 68 publications

References 23 publications

The role of mast cells in functional GI disorders

The role of mast cells in functional GI disorders

The Role of Eosinophils and Mast Cells in Intestinal Functional Disease

Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

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