Advances in functional dyspepsia; traditional and beyond traditional

INTRODUCTION

Functional dyspepsia is a clinical syndrome defined by chronic, recurrent pain or discomfort in the upper abdomen of a variable origin. A general agreement exists on the irrelevant role played by H. pylori in the pathophysiology of most cases of functional dyspepsia.¹ Diagnosis of functional dyspepsia is based on the clinical symptoms and detection of H. pylori serum antibodies. The following clinical symptoms of functional dyspepsia are considered; upper gastrointestinal pain, burping, gastric distension, halitosis, hyperacidity and acid reflux. Specific sensitive diagnostic tests such as urea breath and H. pylori fecal antigen tests are available; H. pylori serum antibodies, though non-specific, is suggested as screening test because of being cost effective as the matter of H. pylori dyspepsia is a typical subject of cost-effectiveness.^2,3

Functional dyspepsia with or without reflux disease has been demonstrated lately to widely spread beyond medical limits and rules in both sexes among different age groups and social classes to the extent that it was found prevalent even among children.^2,4,5 It is necessary to effectively deal with H. pylori dyspepsia due to its associated discomfort and risk with many reasons of chronic illness through inflammatory, toxic, immune or other different reasons.²

The efficacy of antibiotic treatment for non-ulcer dyspepsia is controversial, different trails have given conflicting results. Overall, antibiotic eradication treatment for non-ulcer dyspepsia symptoms had no significant effect on quality of life compared with placebo and was found more costly if compared to antacid treatment.^6,7 Bio-organic acids; lactic, formic and acetic have been lately proved effective in symptomatic and clinical cure of dyspepsia.^4,8

Eradication of clinical symptoms of H. pylori dyspepsia could be considered a clinical cure; patients who are rendered asymptomatic after treatment do not need further investigation or treatment; they can just return for re-assessment if they develop further symptoms.

Evaluation of eradication after H. pylori treatment markedly increases cost with no clear improvement in results.⁸

Aim

Demonstration of different traditional and non-traditional etiologic reasons behind the frank phenomena of increasing symptoms of functional during latest decades.

METHODS

A prospective study carried out in Medina, Saudi Arabia between October 2023 and October 2024. An equal groups of 32 males and females, children and adults with clinical symptoms of epigastric discomfort, hyperacidity, indigestion and abdominal distension with or without reflux symptoms were randomly included in the study. The age of children ranged between 13-18 years while the adults between 39 and 54 years, they were screened for existence of H. pylori which was further confirmed by specific tests; urea breath test and H. pylori fecal antigen (Table 1).² Colon care and colon clear for natural eradications of H. pylori were employed for them in the form of vinegar therapy and the potent natural senna leaves extract purge. Vinegar therapy consisted of vinegar-mixed salad among principal meals, once or twice daily for 3-5 days/week.⁹ They were given natural probiotic supplements (acid butter milk) for 10 days in order to improve dyspeptic symptoms and they were followed up for 8-10 months after colon clear.

The statistical tool and method used in this study was descriptive statistics by SPSS to summarize the distributions of gender, age groups, and test outcomes through counts and percentages.

RESULTS

H. pylori fecal antigen test was proved positive in 90% of patients; 17 children and 12 adults. Urea breath test was positive in 25% of patients; 3 children and 5 adults (Figures 1-3). Dyspeptic and heart burn symptoms disappeared in all patients after the probiotic supplement, colon care and colon clear.

Majority of both children and adults tested positive for the fecal antigen test and negative results are minimal in both groups.

A larger proportion of adults tested negative for urea breath test compared to children. Positive results are relatively rare in both age groups.

The box plots above illustrate the age distribution for different test results: Fecal antigen results: Both positive and negative results are spread across a similar age range, with no significant outliers. Urea breath results: Positive results are slightly more concentrated among younger participants compared to negative results.

DISCUSSION

It was noticed during inclusion of patients in the study that symptoms of functional dyspepsia constitute frank constant finding among population living in a developing country which further indicates the influence of lifestyle in food habits upon these dyspeptic symptoms.^2,9

According to the results of this study, H. pylori should be responsible for most symptoms of functional dyspepsia. However, it seems also that normal-behaviour H. pylori strains are not pathologic by their own unless aroused by misbehaviour in food habits. A normal-behaviour H. pylori should not exist inside the gastric lumen during presence of food, it remains under the gastric mucus layer until travel of food from the stomach and drop of gastric acid to a residual level where it picks up its nutrition from remnants of food within the gastric lumen in a blink like momentum protected with a shield of ammonia around its immediate vicinity before it returns back to its natural habitat under the gastric mucus layer. Otherwise, and if the bacterium exists within the lumen during presence of food, there would be of course a vicious circle between ammonia of H. pylori and the gastric acid with consequent dilemma of heart burn inside the stomach.^2,4,5,9

Therefore; it could be rather clear why symptoms of functional dyspepsia constitute constant findings among developing population; that should be definitely due to the style of people’s life and misbehaviour in food habits that excite H. pylori forcing it to change behavior.^2,7,9

As the use of antibiotics in children is more than in adults due to the frequent incidence of throat and upper respiratory troubles, therefore; migration of H. pylori to the colon could occur in children rather frequent and could be responsible for many gastro-intestinal troubles in children to the extent that an investigator has advised to stop fighting the stomach bacterium H. pylori as oesophageal reflux was not as such before development of the anti- H. pylori antibiotics.^2,7,10 Hence; antibiotic use for children should be seriously restricted unless severely indicated.

Natural probiotics play an important role in human health by promoting nutrient supply, preventing pathogen colonization, shaping and maintaining normal mucosal immunity. Natural gut bacteria have been recently appreciated as having a true symbiotic relationship with the host; within this large pool of bacteria, probiotic supplements containing lactic acid-producing bacteria (LAPB) like Lactobacilli have been claimed to have some variety of beneficial effects on human health. LAPB also represent some of the most commonly used probiotic bacteria being extensively employed in food products generating large amounts of the healthy bio-organic lactic acid that helps to improve dyspeptic symptoms.^11-13

Bio-organic acids; lactic, formic and acetic acid, were lately recognised to control epigastric symptoms and discomfort developing due the abnormal behaviour of H. pylori via interference with the energy metabolism and respiratory chain metabolism of the bacterium.^7,9,14-21 Colon care with vinegar-mixed food and colon clear with the natural senna leave purge extract constitute ideal natural and safe measures to control most symptoms caused by the abnormal-behaviour H. pylori strains.^{4,8,9,14,22,23}

Disappearance of symptoms of dyspepsia and hyperacidity was considered in this study as clinical cure with no need for further confirmation or investigation as H. pylori is a typical subject of cost-effectiveness and evaluation of eradication after H. pylori treatment markedly increases cost with no clear improvement in results.⁸

Limitations

No follow up for colonic assessment: The study lack for follow up evaluations, such as urea breath tests or fecal antigen.

Small sample size: The study has a limited sample (32 participants, aged 13-54) restrict it’s generalizability to wider populations.

Absence of control group: The absence of a control group makes it hard to say if the intervention alone caused the improvements.

CONCLUSION

H. pylori has been lately constituting a frank reason of dyspepsia, as H. pylori is a typical subject of cost-effectiveness; hence disappearance of symptoms should be considered a clinical cure without any need for evaluation of eradication after H. pylori treatment.

ACKNOWLEDGEMENTS

Authors would like to thank to faculty of medicine, Al Rayan national college of medicine and Zaitona medical center in Medina, Saudi Arabia.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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