Jan Tack

..This review summarizes recent progress in our understanding of normal and pathologic gastric sensory and motor function...

..Selective serotonin reuptake inhibitors (SSRIs) are frequently used in the treatment of irritable bowel syndrome (IBS) although evidence of their efficacy is scarce...

..To determine the efficacy, impact on quality of life (QOL) and safety of prucalopride, a selective, high-affinity 5-HT(4) receptor agonist, in patients with chronic constipation...

..Buspirone, a 5-hydroxytryptamine 1A receptor agonist, relaxes the proximal stomach in healthy individuals. We studied the effects of buspirone on symptoms and mechanisms of FD...

..Although the cornerstone of treatment is a gluten-free diet, some patients may still have persisting symptoms and warrant further investigations...

..Diagnostic work-up aims at exclusion of underlying organic disease. Treatment starts with dietary adjustments, aiming at decreasing nutrients that enhance transit and stool and at identifying precipitating food items...

..There is also the possibility that prucalopride might be of benefit to other disorders of gastrointestinal motility with a number of studies currently in progress, which are evaluating alternative applications...

..This review summarizes the current understanding of the role of visceral hypersensitivity in the pathogenesis of NERD symptoms and the mechanisms implicated in the pathogenesis of esophageal hypersensitivity...

..Recently studied drugs include drugs under investigation including nitrates, serotonin reuptake blockers, 5-HT(1A) receptor agonists (buspirone and R137696), and muscarinc M1/M2 receptor antagonists (acotiamide or Z-338)...

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..Future studies might aim at the development of non-invasive test that identify relevant pathophysiological mechanisms, at refining assessment of symptom pattern and at the development of short-term therapeutic trials...

..Adverse events were similar for drug and placebo. A 4-week administration of the fundus-relaxing 5-HT(1A) agonist R-137696 failed to significantly improve symptoms, VH or gastric accommodation compared to placebo...

..There is a lack of outcomes studies addressing the issue of reflux inhibitors and surgery for weakly acidic reflux that persists in patients on PPIs...

..The main limitation to a greater clinical usefulness of gastroduodenal function testing is the lack of therapeutic alternatives...

..4 and 2.5 kg, respectively). In tertiary care FD, weight loss is strongly associated with two early satiety associated symptom clusters...

..In patients with treatment-refractory dumping syndrome, surgical reintervention or continuous enteral feeding can be considered, but the outcomes of such approaches are variable...

..To determine current opinions of clinical experts on the appropriate management of symptomatic GORD in primary care, and to compare these opinions with those from a similar study conducted in 2001...

..It is unclear whether decreased serotonin transporter function contributes to sensorimotor abnormalities in irritable bowel syndrome...

..Disorders of gastric motor function include impaired accommodation, gastroparesis and dumping syndrome. This review summarises current knowledge on the pathophysiology, diagnostic approach and treatment for these disorders...

..Ghrelin, the endogenous ligand of the growth hormone secretagogue receptor, is released from the stomach. Animal studies suggest that ghrelin stimulates gastrointestinal motor activity...

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..The proposed classification requires further research and careful validation but the criteria should be of value for clinical practice; for epidemiological, pathophysiological, and clinical management studies; and for drug development...

..Surgical decompression or resection is necessary in case of refractoriness or perforation, respectively...

..The therapeutic options for the non-acid component of the refluxate, including acid suppression, prokinetics, baclofen and surgery, are discussed...

..It has been proposed that treatments for irritable bowel syndrome with constipation (IBS-C) should provide rapid symptomatic relief, be intermittent, and effective upon repeated use...

..The aim of the present study was to study 24 hour pH monitoring in consecutive functional dyspepsia patients...

..Although delayed gastric emptying is often found in functional dyspepsia, a causal role for delayed emptying in inducing symptoms has not been demonstrated...

..This review summarizes recent progress in our understanding of the pathophysiology and treatment of gastroesophageal reflux disease...

..Thus, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using some type of pathophysiologic testing will be required...

..This review summarizes recent progress in our understanding of gastric sensory and motor function in health and in disease...

..Dyspeptic patients are often treated with the prokinetic drug cisapride...

..To study the effect of the 5-HT(4) agonist tegaserod on sensitivity to gastric distention and gastric accommodation in FD...

..This review summarizes the recent progress in the epidemiology, pathophysiology and treatment of functional dyspepsia...

..Psychotherapy can be considered for refractory patients. Several novel drug therapies are under evaluation...

..AST-120 (spherical carbon adsorbent) is a non-absorbed, carbon-based adsorbent with extensive adsorbing capability for histamine, serotonin and other substances implicated in IBS pathogenesis...

..Selective 5-hydroxytryptamine re-uptake inhibitors act both centrally and peripherally to enhance the availability of physiologically released 5-hydroxytryptamine...

..Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted...

..The aim of this study was to identify and characterize patients with presumed postinfectious dyspepsia (PD) compared with unspecified-onset dyspepsia (UD)...

..In animals, accommodation involves activation of gastric nitrergic neurones. Our aim was to study involvement of nitric oxide in gastric accommodation and in meal induced satiety in humans...

..The aim of this study was to define hypersensitivity to gastric distention and its association to specific symptoms in functional dyspepsia...

..Impaired gastric accommodation is a major pathophysiological mechanism in functional dyspepsia. The aim of the present work was to assess a satiety drinking test in the evaluation of accommodation in health and dyspepsia...

..Hence serotonergic modulation of upper gut sensitivity appears to be promising for the development of novel approaches to the treatment of functional disorders of the upper gastrointestinal tract...

..g. tricyclic antidepressant agents) may prove beneficial...

..This review summarizes recent progress in our understanding of gastroduodenal motility and sensitivity in health and in disease...

..Tegaserod, a 5-hydroxytryptamine-4 receptor agonist, enhances gastric emptying, but its effects on proximal stomach function have not been studied...

..The aim of this study was to test the hypothesis that impaired gastric accommodation causes early satiety...

..However, a direct relationship between duodenal acid exposure and symptom severity is lacking...

..Our aim was to investigate regional cerebral blood flow during painful proximal gastric distention in hypersensitive FD...

..ATD alters gastric postprandial motor function and distension-induced nausea. These findings confirm involvement of 5-HT in the control of gastric accommodation and sensitivity...

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..Experimentally induced anxiety in healthy volunteers is associated with changes in sensorimotor function of the proximal stomach...

..Through these mechanisms, increased duodenal acid exposure may be involved in the pathogenesis of dyspeptic symptoms...

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..We compared the efficacy of subcutaneous octreotide with that of the long-acting repeatable (LAR) octreotide formulation, which is administered monthly, in patients with dumping syndrome...

..The aim of the study was to examine postprandial phasic contractility in functional dyspepsia in relation to pathophysiological, clinical, and demographic variables...

..Therefore, we aimed to determine the influence of gastric sensitivity and abuse history on gastric sensation scores and brain activity in homeostatic-afferent, emotional-arousal, and cortical-modulatory brain regions in FD...

..The aims of this study were to study the long-term evolution of symptoms in a clinical FD population and to identify factors associated with outcome...

..We aimed to assess the effect of oesophageal perfusions with acid and weakly acidic solutions on 'exposed' and 'non-exposed' oesophageal mucosa and its relationship to symptoms in healthy subjects...

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..Psychosocial factors and altered response to duodenal lipids or acid have also been identified as pathophysiologic mechanisms...

..Severe erosive oesophagitis is associated with low impedance baseline. We hypothesised that impedance baseline measurements could be used to evaluate changes in oesophageal mucosa integrity in man...

..The effect of sildenafil on gastric fundus suggests a therapeutic potential for phosphodiesterase inhibitors in patients with impaired gastric accommodation...

..Delayed gastric emptying of solids was constantly associated with postprandial fullness and with vomiting. Delayed emptying for liquids was also associated with postprandial fullness and with severe early satiety...

..CONCLUSIONS: Experimentally induced anxiety alters gastric sensorimotor function, suggesting that psychological factors may play a causal role in the pathogenesis of some dyspeptic symptoms and mechanisms...

..The effect of motilin is atropine-resistant and involves a direct muscular pathway or a non-cholinergic neural pathway...

..FD + IBS is more prevalent in female patients and is associated with a higher weight loss, with greater overall symptom severity, and with hypersensitivity to distention...

..These findings suggest that reducing meal volumes and early postprandial physical activity might contribute to decrease proximal extent of reflux and postprandial GERD symptoms...

..CONCLUSIONS: In a tertiary care population, functional dyspepsia is a heterogeneous condition characterized by 4 major dimensions differentially associated with psychopathological and physiopathological mechanisms...

..To determine the role of duodenogastro-esophageal reflux (DGER) in the pathogenesis of refractory gastro-esophageal reflux disease (GERD) in children...

..The aim of the present study was to investigate the role of acid and DGER in patients with reflux disease poorly responsive to PPIs...

..1217 +/- 115 kcal, NS). CONCLUSION: Administration of a lipase inhibitor does not affect gastric compliance, sensitivity to distension and accommodation to an orally ingested meal, and does not influence meal-induced satiety...

..CONCLUSIONS: In a setting where desensitisation played no role, erythromycin enhanced gastric emptying was not associated with a beneficial effect on meal related symptom severity...

..5 +/- 70.9 vs 637.5 +/- 56.2 mL, ns). Ghrelin administered during the meal significantly inhibits gastric accommodation in health, but this is not associated with early satiation...

..The therapeutic options for the non-acid component of the refluxate, including acid suppression, prokinetics, baclofen, surgery and mucosal protective agents like alginates, are discussed...

..However, patients with GERD have more acid reflux and less nonacid reflux. Differences in the air-liquid composition of the refluxate may contribute to the higher rate of acid reflux observed in these patients...

..Although delayed gastric emptying is traditionally considered the mechanism underlying the symptoms in these patients, poor correlations with symptom severity have been reported...

..These observations suggest that endogenous opioids are involved in the control of gastric accommodation and phasic contractility but not in the control of sensitivity to gastric distension or gastric emptying in healthy volunteers...

..Unexplained excessive throat phlegm is a sign suggestive of GER and GEPR, and unexplained yellow throat phlegm a sign suggestive of duodenogastroesophagopharyngeal reflux (DGEPR)...

..This cytokine could be implicated in the motility disturbances observed during gastrointestinal inflammation...

..The aim of the present study was to establish the time-course of symptoms in relation to meal ingestion, and to assess the relationship between self-reported meal-related symptoms and pathophysiological mechanisms in FD...

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..It is unknown whether DGOR exposure is an independent risk factor for oesophageal lesions. A multivariate analysis was performed on the relationship between oesophageal lesions and demographics and acid and DGOR exposure...

..Previous studies have suggested involvement of 5HT(1) receptors in the control of gastric tone...

..Through these mechanisms, increased duodenal acid exposure may play a role in the pathophysiology of FD symptoms...

..CONCLUSIONS: Symptom episodes in patients with presumed GERD are more related to acid reflux than to DGER. DGER does not play a major role in producing typical esophageal symptoms...

..Symptoms induced by gastric distension are not region specific and no spatial summation occurred. Meal induced relaxation occurs both in the proximal and distal stomach...

..7) to 5.8 (1.3) (p<0.01). Four patients reported mild side effects of nausea or drowsiness. CONCLUSIONS: The GABA(B) receptor agonist baclofen improves duodenal reflux and associated reflux symptoms that persist during PPI therapy...

..Therefore, tonic contractile activity in the oesophageal body is mainly caused by a continuous cholinergic excitatory input. A nitric oxide inhibitory mechanism may have a complementary role in the regulation of oesophageal tone...

..Symptoms, oesophageal pHmetry and proton pump inhibitor treatment are used for diagnosing gastro-oesophageal reflux-related cough. Weakly acidic reflux is now increasingly associated with reflux symptoms such as regurgitation or chest pain...

..Intraluminal impedance allows non-radiological monitoring of movement of oesophageal liquids...

..The Ca2+-sequestering components might also have been compensating for each other, as most drugs only delayed and not inhibited Ca2+ removal...

..The actions of sumatriptan on gastric motility seem to be attributable to a direct action on enteric neurones...

..02) compared with before the infusion. In conclusion, duodenal acid enhances mechanical sensitivity in the duodenum, affects gastroduodenal motor function, and might be of importance for dyspeptic symptoms...

..The present article provides an overview of pathogenetic factors, pathophysiologic mechanisms and their potential roles in FD...

..In conclusion, in patients with functional dyspepsia the presence of HP infection does not seem to affect significantly the overall prevalence of symptoms or the gastric sensory-motor functions...

..Hypersensitivity to distension of the stomach is a frequent finding in functional dyspepsia. During gastric distension studies both wall tension and elongation are increased...

..These findings indicate that nitrergic enteric neuropathy may be a primary dysfunction in diabetes, independent from vagal dysfunction...

..Pretreatment with capsaicin does not desensitize the oesophagus to acid perfusion or to balloon distention...

..The involved mechanism could at least in part depend on an effect on meal-induced accommodation. 100 mg Acotiamide exhibited the potential to improve FD symptoms and QOL. Further studies are indicated...