Search

Aim: to evaluate the efficacy and safety of the new prokinetic drug acotiamide in the treatment of functional dyspepsia.Key findings. Acotiamide is an antagonist of inhibitory muscarinic receptors of type 1 and 2 and a reversible inhibitor of acetylcholinesterase activity. In patients with functional dyspepsia acotiamide normalizes the accommodation of the fundal part of the stomach and accelerates delayed gastric emptying. The conducted studies have confirmed the higher efficacy of acotiamide compared to placebo in reducing the severity of such symptoms of functional dyspepsia as a feeling of epigastric postprandial fullness and bloating, early satiation. The advantage of acotiamide in comparison to other prokinetics (in particular, metoclopramide and domperidone) is the high safety of use and the absence of influence on the duration of the Q-T interval.Conclusion. The high efficacy and safety of the application makes it advisable to use acotiamide in the treatment of patients with functional dyspepsia.

Abstract Background Since the previous network meta-analysis assessing the efficacy of prokinetics for functional dyspepsia (FD), there have been a number of new studies and cinitapride is a new prokinetic agent for FD. This updated meta-analysis aimed to explore the efficacy and safety of prokinetics for FD. Methods An updated study search in Pubmed, EMBASE, Cochrane Library and Web of Science was conducted in literatures published from July 2015 to March 2023. Randomized controlled trials investigating the use of prokinetics in adult FD patients were included. The primary outcome was the total efficacy rate and the secondary outcome was adverse events. A Bayesian network meta-analysis was performed using R software. Results A total of 28 studies were included. Network meta-analysis showed that metoclopramide had a higher total efficacy rate than mosapride (OR: 3.53, 95%CI: 1.70–7.47), domperidone (OR: 2.29, 95%CI: 1.16–4.63), itopride(OR: 2.77, 95%CI: 1.41–5.59), acotiamide(OR: 2.63, OR: 1.33–5.36), and placebo(OR: 5.68, 95%CI: 2.98–11.10), however similar to cinitapride (OR: 1.62, 95%CI: 0.75–3.53). Cinitapride had a higher total efficacy rate than mosapride (OR: 2.18, 95%CI: 1.16–4.14) and placebo (OR: 3.52, 95%CI: 2.01–6.24). Cinitapride had lower risk of total adverse events than domperidone. There was no difference in the risk of drug-related adverse events between the prokinetics. Conclusions Metoclopramide and cinitapride may have a better efficacy than other prokinetics in the treatment of FD, and cinitapride may have a lower risk of total adverse events. Further studies using uniform definitions or validated tools to measure the total efficacy rate are needed.

Acotiamide is a prokinetic with a novel mechanism of action an antagonist of muscarinic M1 and M2 receptors and an acetylcholinesterase inhibitor. Acetylcholine is the central mediator of the tone of the muscular components of the gastrointestinal tract, increasing its motor activity. Blockade of presynaptic M1 and M2 receptors neutralizes the inhibitory effect of the feedback mechanism on the acetylcholine synthesis, while inhibition of acetylcholinesterase in the synaptic cleft reduces the acetylcholine degradation. Currently, the clinical efficacy of acotiamide in the population of patients with functional dyspepsia is demonstrated in more than 10 clinical studies in different regions of the world, demonstrating a reduction of the symptoms of the disease during treatment with this agent and an improvement in the quality of life of patients. In addition, the combination of acotiamide with proton pump inhibitors optimizes the management of patients with gastroesophageal reflux disease.

Background: Since the previous network meta-analysis assessing the efficacy of prokinetics for functional dyspepsia (FD), there have been a number of new studies and cinitapride is a new prokinetic agent for FD. This updated meta-analysis aimed to explore the efficacy and safety of prokinetics for FD. Methods: An updated study search in Pubmed, EMBASE, Cochrane Library and Web of Science was conducted in literatures published from July 2015 to March 2023. Randomized controlled trials investigating the use of prokinetics in adult FD patients were included. The primary outcome was the total efficacy rate and the secondary outcome was adverse events. A Bayesian network meta-analysis was performed using R software. Results: A total of 28 studies were included. Network meta-analysis showed that metoclopramide had a higher total efficacy rate than mosapride (OR: 3.53, 95%CI: 1.70–7.47), domperidone (OR: 2.29, 95%CI: 1.16–4.63), itopride(OR: 2.77, 95%CI: 1.41–5.59), acotiamide(OR: 2.63, OR: 1.33–5.36), and placebo(OR: 5.68, 95%CI: 2.98–11.10), however similar to cinitapride (OR: 1.62, 95%CI: 0.75–3.53). Cinitapride had a higher total efficacy rate than mosapride (OR: 2.18, 95%CI: 1.16–4.14) and placebo (OR: 3.52, 95%CI: 2.01–6.24). Cinitapride had lower risk of total adverse events than domperidone. There was no difference in the risk of drug-related adverse events between the prokinetics. Conclusions: Metoclopramide and cinitapride may have a better efficacy than other prokinetics in the treatment of FD, and cinitapride may have a lower risk of total adverse events. Further studies using uniform definitions or validated tools to measure the total efficacy rate are needed. [ABSTRACT FROM AUTHOR]

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain or burning sensation in the epigastrium, a feeling of fullness or early satiety) in the absence of diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

Functional dyspepsia is one of the most common functional disorders of the gastrointestinal tract, which resulted from impaired motor skills, visceral hypersensitivity, increased mucosal permeability, disorders of the autonomic nervous system, etc. There is no specific therapy for this disease, which often leads to the irrational use of various groups of drugs. Drug therapy is recommended only during periods of symptoms. The main options of pharmacotherapy include the use of proton pump inhibitors, phytotherapeutic drugs, eradication therapy of Helicobacter pylori. Against the background of possible motor disorders, prokinetics are also one of the possible treatment options, but cisapride has long been withdrawn from sale due to cardiotoxicity, the use of domperidone and metoclopramide is limited due to side effects, especially with long-term therapy, so currently the only prokinetic that can be used in everyday clinical practice is itopride. In refractory cases, tricyclic antidepressants and psychotherapeutic approaches are another effective treatment option.

Functional dyspepsia (FD) is one of the dysregulatory lesions of the upper digestive tract. This syndrome has fairly well-defined clinical manifestations that include borderline psychopathological disorders. Its diagnosis becomes a method for ruling out organic gastrointestinal and mental illnesses. Treatment for FD is complex and includes a behavioral component, prokinetics, myotropic spasmolytics, antisecretory drugs, and tricyclic antidepressants. The efficiency of therapy directly depends on a physician's ability to choose an individualized regimen.

Aim. To present the materials of an Expert Council, which was held on September 23, 2019 in Istanbul (Turkey) under the auspices of a World Gastroenterology Organisation congress and the support of the Abbott company.General provisions. During the work of the Expert Council, the role of motility disorders of the stomach and duodenum, intestines, gall bladder and the sphincter of Oddi in the development of functional diseases of the digestive system, such as functional dyspepsia (FD), irritable bowel syndrome (IBS), biliary dyskinesia (BD) was discussed, and the effectiveness of antispasmodics and prokinetics in their treatment was shown. At the same time, the advantages of the mebeverin antispasmodic drug, as well as the high efficiency and safety of the itopride hydrochloride prokinetic drug were noted. It is emphasized that, at the stage of a diagnostic search in the absence of “alarm symptoms” in patients with suspected FD, IBS, and BD, these drugs can be prescribed empirically.Conclusions. When selecting pharmacotherapy for patients with motor impairment, it is extremely important to consider the nature of these disorders. The use of modern medical preparations, which are characterized by a high level of safety and the targeted action towards a specific motility disorder, allows optimal therapy results to be achieved with minimal risks for the patient.

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. The article presents modern views on the pathogenesis of the disease. It is shown that disorders of motor skills (retardation of voiding function, disturbance of relaxation accommodation) and stomach sensitivity (visceral hypersensitivity to stretching) are considered to be one of the main pathophysiological mechanisms of FD. The authors present a modern algorithm of treatment of patients with FD, based on the clinical recommendations of the Rome Consensus IV revision (2016) and the Russian Gastroenterological Association (2017). The strategy of differentiated use of pharmaceuticals for different variants of FD is considered.

The article presents a current algorithm for treating patients with functional dyspepsia, which is based on the clinical guidelines of the Rome IV Revision (2016), the Russian Gastroenterological Association (2017), and the American and Canadian Associations of Gastroenterologists (2017). It provides evaluation of the options for eradication of Helicobacter pylori infection as one of the stages of management of patients with this functional disorder. It also discusses the strategy for differentiated use of proton pump inhibitors and prokinetics for various variants of functional dyspepsia.

Functional gastrointestinal disorders are currently being considered as the most common pathology of the gastrointestinal tract. Symptoms that may be related to the gastroduodenal region, represent one of the major subgroups among functional gastrointestinal disorders, in which the functional dyspepsia rightly maintains leading positions syndrome. Pathogenetic factors of functional dyspepsia and other functional gastrointestinal disorders, which can be regarded as proven at the moment, are the dysmotility of the gastrointestinal tract, which determines the feasibility of using in the basic treatment of these diseases medications that affect motor function of the gastrointestinal tract and preventing anastaltic contractions of the smooth muscles, which are combined into a group of prokinetic. With comorbidity positions, clinical efficacy and drug safety is a priority itopride hydrochloride prokinetics in treatment of functional dyspepsia and other related functional gastrointestinal disorders.

Functional dyspepsia (FD) is a disease with different prevailing pathogenetic mechanisms. The prevalence of FD varies widely from 10 to 30 % of the population, depending on the country and the surveyed cohort. There are two forms of FD: postprandial distress syndrome manifested by a fullness/early satiety after eating, and epigastric pain syndrome — pain/burning in the epigastrium, which may worsen after eating. In a significant part of patients with FD, there are manifestations of both syndromes, the so-called overlap, or a mixed type. In the Ukrainian population, all patients with dyspepsia should be diagnosed and, if found, — undergo mandatory eradication of H.pylori. In patients with persistent symptoms or in those initially not infected with H.pylori, in our opinion, it is advisable to use the combination of proton pomp inhibitor and prokinetic as starting treatment. In our country, a fixed combination of omeprazole and domperidone is available in two dosages. This is Omez D containing 10 mg of both components and a more highly dosed Omez DSR containing 20 mg of omeprazole and 30 mg of domperidone in the form of sustained-release pellets.

Abstract Background Controversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD. Methods Randomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL. Results In total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27–6.06), mosapride (OR: 1.99, 95% credible interval: 0.87–4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92–4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29–6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43–6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07–1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04–2.18). Conclusions Metoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD.

The adolescence is characterized by high rates of gastroenterological morbidity due to physiological characteristics of the body and social and psychological status of the teenager. Dyspepsia takes the leading position in the structure of functional pathology. Studies have shown the role of family, unhealthy habits and addictions in the development of this disorder. One should also bear in mind that the adolescence is characterized by an increase in organic pathology. There is a close association of the functional dyspepsia and the premorbid background, such as autonomous dysfunction and vertebral abnormalities. The use of cholinolytics, prokinetics, opioid receptor antagonists, antacids and anti-secretory agents seems rational for treatment of dyspepsia. If the above mentioned groups of agents lack efficacy, the second line therapy is proposed, which includes tricyclic antidepressants.

1. The pharmacokinetics (PKs) analysis of compounds absorbed after the oral administration of Si-Ni-San (SNS) decoction to functional dyspepsia (FD) patients was designed to detect whether the effects were similar to prokinetics administered to healthy rats, without ethical limitation. 2. First, the absorbed compounds, liquiritigenin (L), naringenin (N) and hesperitin (H) in the plasma were identified by UPLC-MS/MS following the oral administration of SNS decoction to subjects with FD. Next, the natural ratio of LNH in the SNS decoction was determined by UPLC. Third, gastric emptying and intestinal transit after the oral administration of LNH, in combination or alone, was compared with those observed after SNS administration in healthy rats. Additionally, the clinical PKs of LNH was studied. 3. The prokinetic efficacy of LNH administered at their natural ratios (7.5:5:1) increased dose-dependently and was better than the observed efficacy when administered alone in rats. Analysis of the clinical PK parameters, calculated using a one-compartment model, showed that the Cmax parameters of LNH in 3, 4 and 4 h were 639.17, 410.00 and 181.67 μg/L, respectively. 4. The clinical herbal PK analysis of the absorbed LNH preclinical prokinetic compounds, in their natural ratio from SNS, highlights the impact of an herbal translational pharmacology study. [ABSTRACT FROM AUTHOR]

The aim of review. To demonstrate that esophageal and stomach motility disorders play one of basic roles in pathogenesis of gastroesophageal reflux disease (GERD).Key points. Gastroesophageal reflux disease is related to the group of acid-related diseases, however esophageal and stomach motility disorders play important role in its development. In patients with GERD disorders of primary and secondary peristalsis of the esophagus, increase of frequency of transient lower esophageal sphincter relaxations and pathologic bile refluxes are common.Conclusion. Numerous studies are devoted to investigation of gastroesophageal reflux disease. The role of motility disorders of the esophagus and the stomach in its pathogenesis, and origin of symptoms of reflux disease and other gastro-intestinal functional diseases, in particular the functional dyspepsia is actively discussed. At upper gastro-intestinal motility disorders application of prokinetics is effective, e.g. itopride hydrochloride, that reduces frequency of transient lower esophageal sphincter relaxations due to decrease of intragastric pressure, activates propulsive stomach motility and eliminates duodenogastric and duodenogastroesophageal refluxes.

The aim of review. To present modern data on the pathophysiological mechanisms causing functional dyspepsia (FD) syndrome.Key points. Nowadays FD is considered to be a complex multifactor process which cause and effect relationships are under continuous active study. Disorders of stomach motility (delay of evacuation, disorders of relaxation accommodation) and sensitivity (visceral hypersensitivity to distention) are considered to be the basic pathophysiological mechanisms of FD. These changes develop approximately in 40% of FD patients. Besides that, alteration of duodenal sensitivity to hydrochloric acid and lipids can play significant role in genesis of FD.Conclusion. Mechanisms of FD are based on multiple heterogenous disorders of motor and sensitive functions of the stomach and duodenum. Due to major role of stomach motility disorders prokinetics are the priority drugs for treatment of FD.

The aim of review. To present modern approach to treatment of functional dyspepsia (FD).Key points. Treatment of FD should be comprehensive and include general recommendations, application of drugs and psychotherapeutic methods. At a choice of specific drug clinical variant of disease should be taken into account. At pain-predominant (ulcer-like) variant antisecretory agents (first of all — proton pump inhibitors) are the drugs of choice, at postprandial distress syndrome (dysmotility-like variant) - prokinetics. In resistant cases psychotropic drugs and psychotherapeutic methods are indicated.Conclusion. Investigation of FD pathogenesis should be continued that will provide more differentiated treatment approach and improve the results.

The aim of review. To present literature data on application of prokinetics at gastroesophageal reflux disease and functional dyspepsia.Summary. Gastroesophageal reflux disease and functional dyspepsia are considered to be the most common gastroenterological diseases. Motility disorder of gastroesophageal zone plays a leading part in pathogenesis of these diseases that assumes application prokinetics as a baseline therapy. Itopride hydrochloride has advantage over other prokinetics by three key parameters: double mechanism of action, absence of drug interactions and serious side effects.

Introduction: Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions. Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs. Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There are a number of predisposing factors and pathophysiological mechanisms including stressful events, child maltreatment, visceral hypersensitivity, altered gastrointestinal motility and change in intestinal microbiota. It is possible that the environmental risk factors intricately interact with genes through epigenetic mechanisms to contribute to the pathophysiology. The diagnosis mainly depends on clinical evaluation. Commonly used pharmacological interventions do not play a major role in relieving symptoms. Centrally directed, nonpharmacological interventions such as hypnotherapy and cognitive behavioral therapy have shown both short and long term efficacy in relieving pain in children with FAPDs. However, these interventions are time consuming and need specially trained staff and therefore, not currently available at grass root level. Clinicians and researchers should join hands in searching for more pragmatic and effective therapeutic modalities to improve overall care of children with FAPDs. [ABSTRACT FROM AUTHOR]

The article deals with is one of the most common symptoms, faced by general practitioners or gastroenterologists — functional dyspepsia. Its clinical manifestations are described, attention is paid to the treatment issues. It is emphasized that the primary treatment of functional dyspepsia in most cases is an empirical, based on clinical assessment of predominance of acid-dependent or dysmotor symptoms, for which proton pump inhibitors, prokinetics, or combination drugs containing proton pump inhibitors and prokinetics, such as Omez D or Omez DCR, are administered, respectively.

The article tells about current diagnostic criteria for the syndrome of functional dyspepsia; major clinical variants of the disease and the process; modern algorithm revealing the main stages of diagnosis and treatment of patients with functional dyspepsia in clinical practice. The role of eradication of Helicobacter pylori infection in multimodal treatment of functional dyspepsia is highlighted.

Functional dyspepsia is relatively common yet poorly understood. The best accepted diagnostic criteria are the Rome III criteria. The epidemiology, healthcare seeking rates, impact and pathophysiology are reviewed with a focus on women. Treatment is limited with no clearly established regimen currently recommended. Duodenal eosinophilia may be found in a subset. Proton pump inhibitors and prokinetic agents represent the standard therapeutic regimen after Helicobacter pylori infection has been eliminated. Some novel agents such as the prokinetic acotiamide appear promising; however, the need for a safe and efficacious treatment remains largely unmet. This review also describes the currently available management options for functional dyspepsia. [ABSTRACT FROM AUTHOR]

Functional dyspepsia (FD) and gastroparesis (GP) are the two most prevalent gastric neuromuscular disorders. These disorders are frequently confused, have more similarities than differences, and can be thought of as two ends of a continuous spectrum of gastric neuromuscular disorders (Fig. 1). FD is currently defined by the Rome III criteria; it is now subdivided into a pain-predominant subtype (epigastric pain syndrome) and a meal-associated subtype (post-prandial distress syndrome). GP is defined by symptoms in conjunction with delayed gastric emptying in the absence of mechanical obstruction. Symptoms for both FD and GP are similar and include epigastric pain or discomfort, early satiety, bloating, and post-prandial nausea. Vomiting can occur with either diagnosis; it is typically more common in GP. A patient suspected of having either FD or GP should undergo upper endoscopy. In suspected FD, upper endoscopy is required to exclude an alternative organic cause for the patient's symptoms; however, most (70 %) patients with dyspeptic symptoms will have FD rather than an organic disorder. In suspected GP, upper endoscopy is required to rule out a mechanical obstruction. A 4-hour solid-phase gastric emptying scan is recommended to confirm the diagnosis of GP; its utility is unclear in patients with FD, as it may not change treatment. Once the diagnosis of FD or GP is made, treatment should focus on the predominant symptom. This is especially true in patients with GP, as accelerating gastric emptying with the use of prokinetics may not necessarily translate into an improvement in symptoms. Unfortunately, no medication is currently approved for the treatment of FD and, thus, technically, all treatment options remain off-label, including medications for visceral pain (e.g., tricyclic antidepressants) and nausea. This review focuses on treatment options for FD and GP with an emphasis on new advances in the field over the last several years. [ABSTRACT FROM AUTHOR]

Although abdominal bloating is one of the most bothersome symptoms experienced by patients with functional dyspepsia (FD), therapeutic drugs to relieve abdominal bloating have not been established. We investigated the Kampo (Chinese herbal) medicine, Hangekobokuto (Banxiahoupo- tang, HKT) for patients with FD from the standpoint of bowel gas retention. The bowel gas volume calculated from a plain abdominal radiogram (gas volume score, GVS) in FD patients was significantly higher than that in healthy subjects. Two week administration of HKT in the FD patients showed a significant decrease of GVS. Furthermore, gastrointestinal symptoms, especially symptoms of abdominal pain, indigestion and constipation, all of which are closely related to abdominal bloating, improved significantly in FD patients after the administration of HKT. These results suggest that HKT improves abdominal bloating accompanied by the reduction of bowel gas in FD patients. [ABSTRACT FROM AUTHOR]

Abstract: To develop a therapeutic for functional dyspepsia (FD), a prokinetic agent, DA-9701 has been newly formulated with Pharbitis Semen and Corydalis Tuber and we evaluated the gastroprokinetic effects of DA-9701 in comparison with conventional prokinetics. Oral administration with DA-9701 not only significantly accelerated gastric emptying in normal rats but also restored the delayed gastric emptying caused by apomorphine and cisplatin up to almost normal levels. For gastrointestinal transit, DA-9701 caused FITC-dextran to travel a significantly longer distance than the control, and in the delayed GI transit models induced by laparotomy and atopine, DA-9701 considerably increased the values of mean geometric center (MGC), while the conventional prokinetics rarely showed significant effects. Furthermore, DA-9701 drastically increased the gastric accommodation in Beagle dogs, shifting the pressure–volume curve toward considerably higher volume compared to the control, which was comparable to that of cisapride. These results indicate that DA-9701 has potential as a safe and effective therapeutic for FD patients with abnormalities in GI motor function. [Copyright &y& Elsevier]

Background: Functional dyspepsia (FD) is often treated with serotonin agonists; however, the efficacy of such agents has recently been questioned. The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) comparing serotonin agonists with other types of prokinetics in patients with FD. Methods: Included studies were RCTs that compared serotonin agonists, including cisapride and mosapride, with dopamine antagonists, including metoclopramide and domperidone, and an opiate agonist, trimebutine, in patients with FD. Studies were identified by searching the Medline database (January 1951 – January 2005) and Cochrane Library (Issue 4, 2004), and by manual searches. The difference in the probability of patients' responses between the serotonin agonists and control agents was used as a summary statistic for the treatment effect. Meta-regression analysis was used to detect sources of heterogeneity. Results: Five studies were identified. In total, 467 subjects were assigned to a serotonin agonist arm, and 322 subjects were assigned to a control arm. In the overall analysis, the summary statistic was 0.019 (95% confidence interval [CI]: −0.055 to 0.093; P = 0.612), indicating that the patients' responses to serotonin agonists were similar to those to control agents. However, in the stratified meta-analysis of cisapride and mosapride, mosapride had a 6.7% greater probability of producing a response compared with control agents (summary statistic: 0.067; 95% CI: 0.010–0.124; P = 0.021), whereas no significant effect was observed with cisapride. Conclusion: The data suggest that mosapride may be more effective than cisapride for the treatment of FD. Although FD is a chronic condition, efficacy was assessed over short periods in the studies used for the present meta-analysis. Long-term RCTs are needed to confirm the effect. [ABSTRACT FROM AUTHOR]

This randomized, double-blind study compared the efficacy of Helicobacter pylori eradication against prokinetics in H. pylori-infected functional dyspepsia patients. Patients with moderately severe or severe dyspepsia fulfilling the Rome II criteria were randomized to either H. pylori eradication for 1 week and 6 weeks of placebo prokinetics or 6 weeks of prokinetics and placebo H. pylori eradication in the first week. Symptoms were assessed at baseline and at 6 and 12 months using the Glasgow Dyspepsia Severity Score (GDSS). Global response to treatment was assessed at 12 months. Altogether 130 patients were enrolled ( H. pylori eradication, 71; prokinetics, 59). The mean baseline GDSS was 9.3 for the H. pylori eradication group and 8.9 for the prokinetic group. At 6 months, the score was 3.6 and 4.1, respectively, and it remained at 3.5 and 3.8, respectively, at 12 months. With H. pylori eradication, 31.0% had complete symptom resolution (GDSS 0 or 1) at 12 months compared with 23.7% with prokinetics (a nonsignificant difference). At 12 months, global symptomatic improvement was seen in 62.0% of the H. pylori eradication group compared with 67.8% of the prokinetics group. Both H. pylori eradication and prokinetic therapy resulted in symptom improvement in two-thirds of dyspeptic patients at 1 year. More patients tended to achieve complete symptom relief with H. pylori eradication. [ABSTRACT FROM AUTHOR]

The management of functional dyspepsia ( FD) is a challenge for gastroenterologists in clinical practice. The eradication of Helicobacter pylori ( H. pylori) and the utility of antacids, prokinetics and antidepressants are recommended as treatment choices for FD by consensus. Unlike in Europe and the USA, H. pylori eradication in Asia can lead to a higher proportion of FD patients with symptom relief and a higher symptom response rate to prokinetics. Moreover, response rates to anti-secretory drugs such as proton pump inhibitors deviate considerably from those in the Western world. Digestive enzymes and probiotics have also been reported to be used for the treatment of FD but evidence of their effectiveness is not adequate. Anti-anxiety drugs and antidepressants are reported to have peculiar effects on FD, especially in refractory FD, in which tricyclic antidepressants and selective serotonin reuptake inhibitors at small doses are most often recommended. When these drugs are selected to treat FD, clinicians should also consider their roles in treating mental disorders as well as the direct effects of neurotransmitters on gastroenterological disorders. However, their effects need to be further verified by prospective double-blinded randomized clinical trials with a large sample size. Distinguishing among different symptom subtypes has limited significance in guiding the medical choice for FD and individualized drug treatment should be recommended in its management. [ABSTRACT FROM AUTHOR]

Background: Pharmacotherapy, including prokinetics and proton pump inhibitors for functional dyspepsia (FD) have limited effectiveness, and their safety has been recently questioned. Chinese herbal medicine (CHM) could be considered as an alternative. A systematic review (SR) of SRs was performed to evaluate the potential effectiveness and safety of CHM. Method: We conducted a comprehensive literature search for SRs with meta-analyses in eight international and Chinese databases. Pooled effect estimation from each meta-analysis was extracted. The AMSTAR instrument was used to assess the methodological quality of the included SRs. Results: A total of 14 SRs of mediocre quality assessing various CHMs, alone or in combination with conventional pharmacotherapy, were included. Meta-analyses showed that CHM was more effective than prokinetic agents for the alleviation of global dyspeptic symptoms. Three specific CHM formulae appeared to show superior results in the alleviation of global dyspeptic symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun Zi decoction. No significant difference in the occurrence of adverse events in using CHM or pharmacotherapy was reported. Conclusion: CHM can be considered as an alternative for the treatment of FD symptoms when prokinetic agents and proton pump inhibitors are contraindicated. Future trial design should focus on measuring changes in individual dyspeptic symptoms and differentiate the effectiveness of different CHM for postprandial distress syndrome and epigastric pain syndrome. A network meta-analysis approach should be used to explore the most promising CHM formula for FD treatment in the future. [ABSTRACT FROM AUTHOR]