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Review : Are Rice and Spicy Diet Good for Functional Gastrointestinal Disorders?
( Sutep Gonlachanvit ) 대한소화관운동학회 2010 Journal of Neurogastroenterology and Motility (JNM Vol.16 No.2
Rice- and chili-containing foods are common in Asia. Studies suggest that rice is completely absorbed in the small bowel, produces Little intestinal gas and has a Low allergenicity. Several clinical studies have demonstrated that rice-based meals are well tolerated and may improve gastrointestinal symptoms in functional gastrointestinal disorders (FGID). Chili is a spicy ingredient commonly use throughout Asia. The active component of chili is capsaicin. Capsaicin can mediate a painful, burning sensation in the human gut via the transient receptor potential vanilloid-1 (TRPV1). Recently, the TRPV1 expressing sensory fibers have been reported to increase in the gastrointestinal tract of patients with FGID and visceral hypersensitivity. Acute exposure to capsaicin or chili can aggravate abdominal pain and burning in dyspepsia and IBS patients. Whereas, chronic ingestion of natural capsaicin agonist or chili has been shown to decrease dyspeptic and gastroesophageal reflux disease (GERD) symptoms. The high prevalence of spicy food in Asia may modify gastrointestinal burning symptoms in patients with FGID. Studies in Asia demonstrated a Low prevalence of heartburn symptoms in GERD patients in several Asian countries. In conclusion rice is well tolerated and should be advocated as the carbohydrate source of choice for patients with FGID. Although, acute chili ingestion can aggravate abdominal pain and burning symptoms in FGID, chronic ingestion of chili was found to improve functional dyspepsia and GERD symptoms in small randomized, controlled studies.(J Neurogastroenterol Motil 2010;16:131-138)
( Satimai Aniwan ),( Sutep Gonlachanvit ) 대한소화기기능성질환·운동학회 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.3
Background/Aims Whether, chronic chili ingestion can desensitize transient receptor potential vanilloid type 1 receptors in gastrointestinal (GI) tract leading to decrease GI symptoms and sensation in diarrhea-predominant irritable bowel syndrome (IBS-D) patients has not been well explored. The aim of this study was to determine the effects of 6-week chili treatment on postprandial GI symptoms and rectal sensation in response to balloon distention in IBS-D patients. Methods Sixteen IBS-D patients received placebo or chili capsules before meals 3 times/day for 6 weeks in a randomized, double-blinded, crossover fashion with 4-week washout period. Postprandial GI symptoms were evaluated. All patients underwent a rectal barostat study to evaluate rectal sensory threshold at the end of each treatment. Results The maximum postprandial abdominal burning scores were similar between both treatments at baseline (1.4 [0.0-2.0] vs. 1.1 [0.0-2.8], P > 0.05) but were significantly decreased after chili (0.0 [0.0-0.5] vs. 0.3 [0.0-1.6], P < 0.05) at the end of treatment. The chili treatment significantly increased sensory threshold for the first rectal sensation (median [interquartile range]:16 [12-16] mmHg vs. 8 [8-16] mmHg, P < 0.05) however, there was no significant effect on rectal compliance (7.3 ± 1.0 vs. 7.1 ± 1.8 mL/mmHg). Other postprandial GI symptoms did not vary significantly between both treatments at baseline and the end of treatment. Conclusions In IBS-D patients, 6-week chili ingestion significantly decreased postprandial abdominal burning and increased the rectal sensory threshold. These findings suggest a desensitization effect of chili ingestion on transient receptor potential vanilloid type 1 receptors in the proximal gut and rectum. (J Neurogastroenterol Motil 2014;20:400-406)
( Tanisa Patcharatrakul ),( Sutep Gonlachanvit ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.3
Antroduodenal manometry is one of the methods to evaluate stomach and duodenal motility. This test is a valuable diagnostic tool for gastrointestinal motility disorders especially small intestinal pseudo-obstruction which is difficult to make definite diagnosis by clinical manifestations or radiologic findings. Manometric findings that have no evidence of mechanical obstruction and suggestive of pseudo-obstruction with neuropathy or myopathy can avoid unnecessary surgery and the treatment can be directly targeted. Moreover, among patients who have clinically suspected small intestinal pseudo-obstruction but with normal manometric findings, the alternative diagnosis including psychiatric disorder or other organic disease should be considered. The application of this test to the patients with functional gastrointestinal symptoms especially to find the association of motor abnormalities to the symptom has less impressive yield. Antroduodenal manometry is now readily available only in some tertiary care centers. The aim of this review is to describe the antroduodenal manometry technique, interpretation and clinical utility. (J Neurogastroenterol Motil 2013; 19:395-404)
Suriya Keeratichananont,Tanisa Patcharatrakul,Sutep Gonlachanvit 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.3
Background/AimsA high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching. MethodsTwenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative(pH–). ResultsForty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH– patients (P < 0.05). The difference in the number of refluxes between pH+ and pH– patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH– (P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05). ConclusionsIn patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.
( Veeravich Jaruvongvanich ),( Tanisa Patcharatrakul ),( Sutep Gonlachanvit ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.4
Background/Aims The correlation between the Bristol stool form scale (BSFS) and colonic transit time (CTT) has been reported in Western populations. Our study aims to study the relationship between BSFS, stool frequency, and CTT in Eastern patients with chronic constipation. Methods A total of 144 chronic functional constipation patients underwent colonic transit study by using radio-opaque markers, anorectal manometry, and balloon expulsion test. Stool diary including stool forms and frequency was recorded. Delayed CTT was defined as the retention of more than 20.0% of radio-opaque markers in the colon on day 5. Results Twenty-five patients (17.4%) had delayed colonic transit. Mean 5-day BSFS (OR, 0.51; 95% CI, 0.34-0.79; P = 0.021) and stool frequency (OR, 0.60; 95% CI, 0.44-0.83; P = 0.002) were independently associated with delayed CTT by logistic regression analysis. Mean 5-day BSFS (area under the curve [AUC], 0.73; 95% CI, 0.62-0.84; P < 0.001) and stool frequency (AUC, 0.75; 95% CI, 0.63-0.87; P < 0.001) fairly predicted delayed CTT. The optimal mean 5-day BSFS of ≤ 3 provided 68.0% sensitivity, 69.7% specificity, and 69.4% accuracy, and the optimal stool frequency ≤ 2 bowel movements in 5 days provided 64.0% sensitivity, 83.1% specificity, and 84.0% accuracy for predicting delayed CTT. Conclusions Both stool form and frequency were significantly associated with delayed CTT. Stool frequency ≤ 2 and BSFS 1-3 rather than BSFS 1-2 that was used in the Westerners could be used as surrogate for delayed CTT in Eastern patients with constipation. (J Neurogastroenterol Motil 2017;23:561-568)
( Chatchai Kriengkirakul ),( Tanisa Patcharatrakul ),( Sutep Gonlachanvit ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.2
Background/Aims To evaluate the value of a 2-week high dose proton pump inhibitor (PPI) treatment on patients with overlapping non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD). Methods Sixty overlapping NERD and FD patients with symptom onset > 3 months prior underwent 24-hour esophageal pH monitoring studies. All patients received rabeprazole 20 mg b.i.d. for 2 weeks. The reflux and dyspeptic symptoms were evaluated using a symptom questionnaire with 4-point Likert scales before and at the end of treatment. A positive PPI test was defined as score improvement in ≥ 50% from the baseline in the typical reflux symptoms. Results The prevalence of each reflux and dyspeptic symptom did not differ significantly between patients with positive and negative pH tests. After the PPI treatment, epigastric burning, acid regurgitation, heartburn, nausea, vomiting and chest discomfort scores were significantly improved compared to pretreatment values (P < 0.05), whereas postprandial abdominal fullness, early satiation, belching and food regurgitation were not. The proportion of patients who responded to the PPI treatment did not differ significantly between patients with positive and negative pH tests. The sensitivity, specificity, PPV, NPV and accuracy of 2-week high dose rabeprazole treatment for diagnosing gastroesophageal reflux disease were 47%, 38%, 50%, 35% and 43%, respectively. Conclusions The two-week high dose PPI treatment was not effective for early satiation, postprandial abdominal fullness, regurgitation or belching symptoms in patients with overlapping NERD and FD. Acid exposure in the distal esophagus could not predict the response of symptoms to PPI. In addition, the 2-week PPI test provided limited value for gastroesophageal reflux disease diagnosis in patients with overlapping NERD and FD.
Second Asian Consensus on Irritable Bowel Syndrome
Kok-Ann Gwee,Sutep Gonlachanvit,Uday C Ghoshal,Andrew S B Chua,Hiroto Miwa,Justin Wu,Young-Tae Bak,Oh Young Lee,Ching-Liang Lu,Hyojin Park,Minhu Chen,Ari F Syam,Philip Abraham,Jose Sollano,Chi-Sen Cha 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.3
Background/AimsThere has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely toupdate the Asian IBS Consensus. MethodsKey opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology,pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process wascarried out by using a modified Delphi method. ResultsThirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-braininteraction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and uppergastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet,probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. ConclusionsOur consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view toholistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
Asian Consensus Report on Functional Dyspepsia
( Hiroto Miwa ),( Uday C Ghoshal ),( Sutep Gonlachanvit ),( Kok-Ann Gwee ),( Tiing-Leong Ang ),( Full-Young Chang ),( Kwong Ming Fock ),( Michio Hongo ),( Xiaohua Hou ),( Udom Kachintorn ),( Meiyun Ke 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.2
Background/Aims Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.