Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia

Abstract

Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets. Visceral sensitivity and intestinal electromechanical function both are demonstrated to be altered in some FD patients and are potential targets for treatment. Limited studies in pediatric FD are available, but available evidence supports adult data that targeting visceral hypersensitivity and electromechanical dysfunction is warranted, particularly in the context of the biopsychosocial model. Future studies in pediatrics are needed to determine optimal therapy and appropriate patient application.Rosen JM, Cocjin JT, Schurman JV, Colombo JM, Friesen CA. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World

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

“…It is a common diagnosis in children with population prevalence estimates of 3.5% to 27% [1,2] . A number of biologic contributors to the generation of FD have been identified and include inflammation, electromechanical dysfunction (e.g., altered gastric emptying) and visceral hyperalgesia [3,4] . Melatonin, a hormone produced, in part, by the pineal gland, has a well-known role in regulation of sleep-wake cycles through its sleep promoting effects.…”

Plasma ghrelin and liquid gastric emptying in children with functional dyspepsia consistent with post‐prandial distress syndrome

“…There are a number of other possible mechanisms through which ghrelin physiology might influence FD symptoms. A defect in gastric accommodation has been implicated in FD and may be more associated with the symptom of early satiety . However, this seems unlikely to be a mechanism for symptom improvement because ghrelin infusion results in the inhibition of gastric accommodation in healthy adults …”

“…The model suggests that FD occurs as a result of interactions between biological, psychological, and social factors. Delayed gastric emptying (GE) is one of the biological factors which have been implicated . Delayed GE has been documented in up to 66% of children with FD .…”

“…Delayed GE has been documented in up to 66% of children with FD . Most previous studies in children have evaluated solid GE; however, delayed liquid GE also has been reported …”

Gastrointestinal symptoms in children: Primary care and specialist interface

“…Most patients with FD have meal‐related symptoms . Physiologic, genetic, environmental and psychological factors are involved; some subtle structural abnormalities have been linked to FD, such as gastric abnormalities (impaired accommodation, delayed emptying and hypersensitivity), Helicobacter pylori gastritis, erosive prepyloric changes, duodenal inflammation and increased eosinophil counts …”