Stanghellini, et al. (2003). New developments in the treatment of functional dyspepsia.

[Wise Young]

• Stanghellini V, De Ponti F, De Giorgio R, Barbara G, Tosetti C and Corinaldesi R (2003). New developments in the treatment of functional dyspepsia. Drugs 63:869-92. Summary: Functional dyspepsia is a clinical syndrome defined by chronic or recurrent pain or discomfort in the upper abdomen of unknown origin. Although generally accepted, investigators differently interpret this definition and clinical trials are often biased by inhomogeneous inclusion criteria.The poorly defined multifactorial pathogenesis of dyspeptic symptoms has hampered efforts to develop effective treatments. A general agreement exists on the irrelevant role played by Helicobacter pylori in the pathophysiology of functional dyspepsia. Gastric acid secretion is within normal limits in patients with functional dyspepsia but acid related symptoms may arise in a subgroup of them. Proton pump inhibitors appear to be effective in this subset of patients with dyspepsia. Non-painful dyspeptic symptoms are suggestive of underlying gastrointestinal motor disorders and such abnormalities can be demonstrated in a substantial proportion of patients. Postprandial fullness and vomiting have been associated with delayed gastric emptying of solids, and early satiety and weight loss to postcibal impaired accommodation of the gastric fundus. Prokinetics have been shown to exert beneficial effects, at least in some patients with dyspepsia. In contrast, drugs enhancing gastric fundus relaxation have been reported to improve symptoms, although conflicting results have also been published. An overdistended antrum may also generate symptoms, but its potential pathogenetic role and the effects of drugs on this abnormality have never been investigated formally. Visceral hypersensitivity plays a role in some dyspeptic patients and this abnormality is also a potential target for treatment. Both chemo- and mechanoreceptors can trigger hyperalgesic responses. Psychosocial abnormalities have been consistently found in functional digestive syndromes, including dyspepsia. Although useful in patients with irritable bowel syndromes (IBS), antidepressants have been only marginally explored in functional dyspepsia.Among the new potentially useful agents for the treatment of functional dyspepsia, serotonin 5-HT(4) receptor agonists have been shown to exert a prokinetic effect. Unlike motilides, 5-HT(4) receptor agonists do not appear to increase the gastric fundus tone and this may contribute to improve symptoms. 5-HT(3) receptor antagonists have been investigated mainly in the IBS and the few studies performed in functional dyspepsia have provided conflicting results. Also, kappa-opioid receptor agonists might be useful for functional digestive syndromes because of their antinociceptive effects, but available results in functional dyspepsia are scanty and inconclusive. Other receptors that represent potential clinical targets for antagonists include purinoceptors (i. e., P2X2/3 receptors), NMDA receptors (NR2B subtype), protease-activated receptor-2, the vanilloid receptor-1, tachykinin receptors (NK(1)/NK(2)) and cholecystokinin (CCK)(1) receptors. Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.

[rock1]

Hello,
I am very new in this forum and happy to see the discussion related to functional dyspepsia .What are the basic symptoms of this disorder?
well i got that this causes the digestion problem natuarally stomach problam.
Also the Itopride hydrochloride dosages (http://www.drugdelivery.ca/s33603-s-itopride-hydrochloride.aspx) are doing some very well work in this situation.
Please let me know about the side effects and the precautions for that.

[Wise Young]

Hello,
I am very new in this forum and happy to see the discussion related to functional dyspepsia .What are the basic symptoms of this disorder?
well i got that this causes the digestion problem natuarally stomach problam.
Also the Itopride hydrochloride dosages (http://www.drugdelivery.ca/s33603-s-itopride-hydrochloride.aspx) are doing some very well work in this situation.
Please let me know about the side effects and the precautions for that.

Many people have stomach and upper GI pains. Those who have it after spinal cord injury often do not realize that it may be aggravated by neuropathic pain. That was the reason why I posted this study.

Itopride is a drug that stimulates gastrointestinal mobility. Other than that, I don't know much about its side-effects or effectiveness.

Wise.

Jpn J Pharmacol. 1996 Jun;71(2):129-37. Related Articles, Links

Gastroprokinetic effect of a new benzamide derivative itopride and its action mechanisms in conscious dogs.

Iwanaga Y, Miyashita N, Saito T, Morikawa K, Itoh Z.

Research and Development Division, Hokuriku Seiyaku, Co., Ltd., Fukui, Japan.

The novel benzamide derivative itopride was assayed for its effect on gastrointestinal motility in conscious dogs when it was administered intraduodenally (i.d.). Gastrointestinal motility was measured by means of chronically implanted force transducers, and itopride at a dose of 10 mg/kg, i.d. or more increased the gastric contractile force during the digestive state. Intraduodenal cisapride, domperidone and metoclopramide also stimulated gastric motility, and their threshold doses were 1, 3 and 1 mg/kg, respectively. Dopamine infusion (1 mg/kg/hr, i.v.) caused the postprandial gastric motility to disappear, but it was immediately restored by itopride at a dose of 3 mg/kg, i.d. With itopride at 1 and 3 mg/kg, i.d., acetylcholine (0.05 mg/kg/min)-induced contractions were greatly enhanced. In addition to its gastric stimulation, itopride at doses of 10-100 mg/kg, p.o. inhibited apomorphine (0.1 mg/kg, s.c.)-induced vomiting in dogs. In conclusion, intraduodenal itopride stimulates gastric motility through both anti-dopaminergic and anti-acetylcholinesterase actions. Its gastroprokinetic threshold dose was as large as 3-10 times those of cisapride, domperidone and metoclopramide. These findings suggest that itopride is an orally active gastroprokinetic with a moderate anti-emetic action.

PMID: 8835639 [PubMed - indexed for MEDLINE]

Original Article · Originalarbeit

Randomized Clinical Trial of Itopride for the Treatment of Postoperative Ileus after Laparoscopic Cholecystectomy
R. Gürlich, R. Frasko, P. Maruna, I. Chachkhiani

Chirurgische Gastroenterologie 2004;20:61-65 (DOI: 10.1159/000078069)


Summary

Background. Postoperative ileus is a distressing and frequent adverse effect after laparoscopic cholecystectomy (LCE). The goal of this prospective study was to evaluate if the new prokinetic drug itopride hydrochloride (Ganaton®, Abbott GmbH Co. KG, Wiesbaden, Germany) may ameliorate the gastric motility in the early post-operative period after LCE. Transcutaneous electrogastrography (EGG), a noninvasive diagnostic method allowing a monitoring of gastric myoelectric activity, was used to evaluate changes of gastric motility. Methods. 50 patients undergoing LCE were observed for 3 days beginning with the day of surgery. The patients were perorally treated with itopride hydrochloride (50 mg per day) or placebo (sacharose) in a randomized double-blind manner. EGG records were done 6, 24, and 48 h after surgery. EGG was performed in a fasting state and after stimulation with a liquid bolus. The EGG data were recorded by a Microdigitrapper device and analyzed using spectral analysis and Fourier transformation. Results. When comparing both groups (itopride and placebo), nausea was found significantly more frequently in the placebo group at the day of surgery as well as on postoperative days 1 and 2. The incidence of vomiting did not differ between both groups. Moreover, there are some differences in the EGG records. On the day of surgery, 40 and 56% of the patients in the placebo and the itopride group showed a physiological EGG curve, respectively. On the 1st postoperative day it was 56 and 68% and on the 2nd postoperative day 80 and 88%. However, these differences failed to reach a significance level of p < 0.05, most likely because of the relative small group sizes. Conclusion. The perioperative use of itopride accelerates the normalization of the EGG curve after LCE. Itopride was well tolerated, and we did not observe serious adverse effects during therapy. Our data suggests that itopride can be a useful accelerator of postoperative ileus restoration after LCE. However, other studies will be necessary to unequivocally prove the beneficial effect of itopride after LCE also in comparison with other commonly used drugs.

Copyright © 2004 S. Karger GmbH, Freiburg

[mertbadur]

I want you to give me further details about the treatment of IBS with itopride. And also I was told that Otilionium Bromide is also effective for this treatment.Is it considerably important?

[soromned]

I'm a new sufferer of functional dyspepsia. So that I always try to find some good news for me. Unfortunately no good news. The postings of this thread are also very old. If there any new successful research, please let us know.