Document Detail

Role of chemical stimulation of the duodenum in dyspeptic symptom generation.
MedLine Citation:
PMID:  20234343     Owner:  NLM     Status:  MEDLINE    
The response to chemical stimuli such as acid, nutrients, and capsaicin at the level of the duodenum is increasingly recognized as important in the etiology of dyspeptic symptoms. Increased duodenal acid exposure has been reported for patients with dyspeptic symptoms. Duodenal hypersensitivity to acid and the enhancing effect of duodenal acid on gastroduodenal mechanosensitivity may also contribute to dyspeptic symptom generation. Serotonergic signaling pathways may be involved in acid-induced dyspeptic symptoms. As for nutrients, lipid has been unequivocally shown to have a function in the pathogenesis of dyspeptic symptoms. Cholecystokinin (CCK) is an important mediator of the effects of duodenal lipid on gastroduodenal sensorimotor activities. It is unclear whether CCK hypersecretion or hypersensitivity to CCK is responsible for symptoms in dyspeptic patients. The presence of capsaicin in the duodenum evokes symptoms and affects gastric sensorimotor function. In patients with dyspepsia, capsaicin-induced symptoms appeared to occur earlier and to be more severe, however the effects of duodenal infusion and putative consequent gastric sensorimotor abnormalities have not been examined. Capsaicin activates transient receptor potential ion channel of the vanilloid type I, which can also be activated and sensitized by acid. The interaction between the different chemical stimuli is complex and has not yet been studied in patients with dyspeptic symptoms. In conclusion, the mechanisms underlying an enhanced response to duodenal chemical stimulation in patients with dyspeptic symptoms are partially understood. At the level of the duodenum, abnormalities may exist in stimulus intensity, mucosal mRNA expression, biosynthesis, release, or inactivation of mucosal mediators, or receptor expression on afferent nerve endings. Elucidation of the abnormalities involved will provide a basis for rational treatment of dyspeptic symptoms.
O S van Boxel; J J M ter Linde; P D Siersema; A J P M Smout
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-03-16
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  105     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-07     Completed Date:  2010-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  803-11; quiz 802, 812     Citation Subset:  IM    
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Capsaicin / adverse effects
Dietary Carbohydrates / adverse effects
Duodenum / drug effects*,  physiopathology
Dyspepsia / chemically induced*,  classification,  physiopathology
Gastric Acid
Lipids / adverse effects
Reg. No./Substance:
0/Dietary Carbohydrates; 0/Lipids; 404-86-4/Capsaicin

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