BACKGROUND： It has been demonstrated that patients with functional dyspepsia have experiences social life stress events, and accompanied by psychological disorders, mainly manifested as depression and anxiety.Mental ...BACKGROUND： It has been demonstrated that patients with functional dyspepsia have experiences social life stress events, and accompanied by psychological disorders, mainly manifested as depression and anxiety.Mental factors can lead to excessive gastrointestinal consensual reaction, and result in different brain-gut axis disturbance, and then cause the gastrointestinal sensorimotor abnormality and endocrine changes.OBJECTIVE： To observe the effect of antidepressant treatment on the changes of water load and serum cortisol in patients with functional dyspepsia, and analyze the therapeutic mechanism.DESIGN： A comparative observation.SETTING： The First Affiliated Hospital o Zhengzhou University.PARTICIPANTS： Forty-five patients with functional dyspepsia accompanied by depression were selected from the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University from July 2004 to July 2006, and they were 25 - 65 years of age, and their disease courses ranged 1 - 10 years. They were all accorded with the diagnostic standards for Rome Ⅱ functional dyspepsia functional dyspepsia. As the patients＇ will, they were divided into treatment group （n =30, 12 males and 18 females） and control group （n =15, 6 males and 9 females）, and there were no significant differences in the data between the two groups （P 〉 0.05）. The programs were discussed and agreed by the committee of medical ethics of the First Affiliated Hospital of Zhengzhou University. Informed contents were obtained from all the patients.METHODS： In the treatment group, the patients were treated with venlafaxine sustained release capsule （75 mg per day）, and those with sleep disorder were added by benzodiazepines （alprazolam）. In the control group, the patients were given routine treatments of antacid, prokinetics, etc. Before and after 8-week treatment, the following examinations were performed： ① The gastrointestinal symptoms were assessed according to the symptoms; ② The severity of depression was evaluated with Hamilton depression scale （HAMD）; ③The relaxation of proximal stomach was observed using water load test; ④ The serum level of cortisol was detected.MAIN OUTCOME MEASURES： ① Symptom score; ② HAMD score; ③ Water load amount; ④Serum level of cortisol.RESULTS： All the 45 patients were involved in the analysis of results. ① Symptom score： The scores of gastrointestinal symptoms were decreased as compared with those before treatment in both the treatment group and control group （P 〈 0.05）. ② HAMD scores： The scores of HAMD were decreased as compared with those before treatment in both the treatment group and control group （P 〈 0.05）. ③ Water load amount：The total effective rate was significantly higher in the treatment group than the control group （P 〈 0.05）. ④The serum levels of cortisol after treatment were significantly lower than those before treatment in the patients with severe gastrointestinal symptoms in the treatment group and control group （P 〈 0.05）.CONCLUSION： Antidepressants can normalize the cortisol level of patients with functional dyspepsia, and then decrease gastric sensitivity and ameliorates the receptive relaxation of proximal stomach, also increase the water load amount correspondingly, and finally control the gastrointestinal symptoms of functional dyspepsia.展开更多
AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD ...AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD patients and controls in a Mexican population. METHODS: Twenty FD-Rome Ⅱ patients were matched by age and gender with 20 healthy controls. All underwent both drinking tests at a 15 mL/min rate, randomly, 7 d apart. Every 5 min within each test, four symptoms were evaluated (satiety, bloating, nausea and pain) by Likert scales. Maximum tolerated volume (MTV) was defined as the ingested volume when a score of 5 was reached for any symptom or when the test had to be stopped because the patients could not tolerate more volume. Sensitivity and specificity were analyzed. RESULTS: FD patients had higher symptom scores for both tests compared to controls (water: t= 4.1, P= 0.001 ＜0.01; Nutren(R): t= 5.2, P= 0.001＜0.01). The MTV forwater and Nutren(R) were significantly lower in FD (water: 1014±288 vs 1749±275 mL; t = 7.9, P = 0.001＜0.01;Nutren(R): 652±168 vs 1278±286 mL; t= 6.7, P = 0.001＜0.01). With the volume tolerated by the controls, the percentile 10 was determined as the lower limit fortolerance. Sensitivity and specificity were 0.90, 0.95 for water and 0.95, 0.95 for Nutren(R) tests.CONCLUSION: A drinking test with water or a nutritional beverage can discriminate between FD patients and healthy subjects in Mexico, with high sensitivity and specificity. These tests could be used as objective, noninvasive, and safe diagnostic approaches for FD patients.展开更多
文摘BACKGROUND： It has been demonstrated that patients with functional dyspepsia have experiences social life stress events, and accompanied by psychological disorders, mainly manifested as depression and anxiety.Mental factors can lead to excessive gastrointestinal consensual reaction, and result in different brain-gut axis disturbance, and then cause the gastrointestinal sensorimotor abnormality and endocrine changes.OBJECTIVE： To observe the effect of antidepressant treatment on the changes of water load and serum cortisol in patients with functional dyspepsia, and analyze the therapeutic mechanism.DESIGN： A comparative observation.SETTING： The First Affiliated Hospital o Zhengzhou University.PARTICIPANTS： Forty-five patients with functional dyspepsia accompanied by depression were selected from the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University from July 2004 to July 2006, and they were 25 - 65 years of age, and their disease courses ranged 1 - 10 years. They were all accorded with the diagnostic standards for Rome Ⅱ functional dyspepsia functional dyspepsia. As the patients＇ will, they were divided into treatment group （n =30, 12 males and 18 females） and control group （n =15, 6 males and 9 females）, and there were no significant differences in the data between the two groups （P 〉 0.05）. The programs were discussed and agreed by the committee of medical ethics of the First Affiliated Hospital of Zhengzhou University. Informed contents were obtained from all the patients.METHODS： In the treatment group, the patients were treated with venlafaxine sustained release capsule （75 mg per day）, and those with sleep disorder were added by benzodiazepines （alprazolam）. In the control group, the patients were given routine treatments of antacid, prokinetics, etc. Before and after 8-week treatment, the following examinations were performed： ① The gastrointestinal symptoms were assessed according to the symptoms; ② The severity of depression was evaluated with Hamilton depression scale （HAMD）; ③The relaxation of proximal stomach was observed using water load test; ④ The serum level of cortisol was detected.MAIN OUTCOME MEASURES： ① Symptom score; ② HAMD score; ③ Water load amount; ④Serum level of cortisol.RESULTS： All the 45 patients were involved in the analysis of results. ① Symptom score： The scores of gastrointestinal symptoms were decreased as compared with those before treatment in both the treatment group and control group （P 〈 0.05）. ② HAMD scores： The scores of HAMD were decreased as compared with those before treatment in both the treatment group and control group （P 〈 0.05）. ③ Water load amount：The total effective rate was significantly higher in the treatment group than the control group （P 〈 0.05）. ④The serum levels of cortisol after treatment were significantly lower than those before treatment in the patients with severe gastrointestinal symptoms in the treatment group and control group （P 〈 0.05）.CONCLUSION： Antidepressants can normalize the cortisol level of patients with functional dyspepsia, and then decrease gastric sensitivity and ameliorates the receptive relaxation of proximal stomach, also increase the water load amount correspondingly, and finally control the gastrointestinal symptoms of functional dyspepsia.
文摘AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD patients and controls in a Mexican population. METHODS: Twenty FD-Rome Ⅱ patients were matched by age and gender with 20 healthy controls. All underwent both drinking tests at a 15 mL/min rate, randomly, 7 d apart. Every 5 min within each test, four symptoms were evaluated (satiety, bloating, nausea and pain) by Likert scales. Maximum tolerated volume (MTV) was defined as the ingested volume when a score of 5 was reached for any symptom or when the test had to be stopped because the patients could not tolerate more volume. Sensitivity and specificity were analyzed. RESULTS: FD patients had higher symptom scores for both tests compared to controls (water: t= 4.1, P= 0.001 ＜0.01; Nutren(R): t= 5.2, P= 0.001＜0.01). The MTV forwater and Nutren(R) were significantly lower in FD (water: 1014±288 vs 1749±275 mL; t = 7.9, P = 0.001＜0.01;Nutren(R): 652±168 vs 1278±286 mL; t= 6.7, P = 0.001＜0.01). With the volume tolerated by the controls, the percentile 10 was determined as the lower limit fortolerance. Sensitivity and specificity were 0.90, 0.95 for water and 0.95, 0.95 for Nutren(R) tests.CONCLUSION: A drinking test with water or a nutritional beverage can discriminate between FD patients and healthy subjects in Mexico, with high sensitivity and specificity. These tests could be used as objective, noninvasive, and safe diagnostic approaches for FD patients.
