Abstract
Disorders of digestive tract functions, secretion, digestion, propagation, absorption, and metabolism, can easily lead to abdominal symptoms of meal-related diseases such as functional dyspepsia (FD). Pancreatic exocrine function also exerts an important role in digestion and absorption after meal. Therefore, pancreatic exocrine must be a significant function associated with the pathogenesis of FD as well as acid secretion and gastroduodenal motility. However, it is unclear which dysfunction or organ is an origin of abdominal symptoms of FD, because symptoms felt at the epigastrium are complicatedly caused by dysfunction of both the gastroduodenum and the adjacent organ (e.g., pancreas). In addition, it is known that a mismatch in the perception site and expression between the general epigastric symptoms and FD-specific symptoms often appears in most FD patients. This issue may cause poor understandings of the accurate pathogenesis of FD.
In this chapter, first of all, we introduce what kind of upper abdominal symptoms general Japanese subjects felt and where they felt FD-like symptoms using a questionnaire with an illustration divided into eight parts of the abdomen including the sternum, and then give the information about roles of pancreatic exocrine function and usual nutrition in the pathogenesis of FD.
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References
Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150:1380–92.
Kaji M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol. 2010;25:1151–6.
Tack J, Carbone F, Holvoet L, Vanheel H, Vanuytsel T, Vandenberghe A. The use of pictograms improves symptom evaluation by patients with functional dyspepsia. Aliment Pharmacol Ther. 2014;40:523–30.
Fujikawa Y, Tominaga K, Tanaka F, Kamata N, Yamagami H, Tanigawa T, et al. Postprandial symptoms felt at the lower part of the epigastrium and a possible association of pancreatic exocrine dysfunction with the pathogenesis of functional dyspepsia. Intern Med. 2017;56:1629–35.
Wilmer A, Van Cutsem E, Andrioli A, Tack J, Coremans G, Janssens J. Ambulatory gastrojejunal manometry in severe motility-like dyspepsia: lack of correlation between dysmotility, symptoms, and gastric emptying. Gut. 1998;42:235–42.
Iwakiri R, Tominaga K, Furuta K, Inamori M, Furuta T, Masuyama H, et al. Randomised clinical trial: rabeprazole improves symptoms in patients with functional dyspepsia in Japan. Aliment Pharmacol Ther. 2013;38:729–40.
Matsueda K, Hongo M, Tack J, Aoki H, Saito Y, Kato H. Clinical trial: dose-dependent therapeutic efficacy of acotiamide hydrochloride (Z-338) in patients with functional dyspepsia: 100 mg t.i.d. is an optimal dosage. Neurogastroenterol Motil. 2010;22:618–e173.
Pandol SJ. The exocrine pancreas. San Rafael, CA: Morgan & Claypool Life Sciences; 2010.
Kuhn RJ, Gelrud A, Munck A, Caras S. CREON (Pancrelipase Delayed-Release Capsules) for the treatment of exocrine pancreatic insufficiency. Adv Ther. 2010;27:895–916.
Miwa H, Kusano M, Arisawa T, Oshima T, Kato M, Joh T, et al. Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol. 2015;50:125–39.
Detlefsen S, Sipos B, Feyerabend B, Klöppel G. Pancreatic fibrosis associated with age and ductal papillary hyperplasia. Virchows Arch. 2005;447:800–5.
Torigoe T, Ito K, Yamamoto A, Kanki A, Yasokawa K, Tamada T, et al. Age-related change of the secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP using spatially selective inversion recovery pulse. Am J Roentgenol. 2014;202:1022–6.
Yasokawa K, Ito K, Tamada T, Yamamoto A, Hayashida M, Tanimoto D, et al. Noninvasive investigation of exocrine pancreatic function: Feasibility of cine dynamic MRCP with a spatially selective inversion-recovery pulse. J Magn Reson Imaging. 2015;42:1266–71.
Rothenbacher D, Löw M, Hardt PD, Klör HU, Ziegler H, Brenner H. Prevalence and determinants of exocrine pancreatic insufficiency among older adults: results of a population-based study. Scand J Gastroenterol. 2005;40:697–704.
Herzig KH, Purhonen AK, Räsänen KM, Idziak J, Juvonen P, Phillps R, et al. Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatr. 2011;11:4.
Tominaga K, Fujikawa Y, Tsumoto C, Kadouchi K, Tanaka F, Kamata N, et al. Disorder of autonomic nervous system and its vulnerability to external stimulation in functional dyspepsia. J Clin Biochem Nutr. 2016;58:161–5.
Pilichiewicz AN, Feltrin KL, Horowitz M, Holtmann G, Wishart JM, Jones KL, et al. Functional dyspepsia is associated with a greater symptomatic response to fat but not carbohydrate, increased fasting and postprandial CCK, and diminished PYY. Am J Gastroenterol. 2008;103:2613–23.
Tominaga K, Tsumoto C, Ataka S, Mizuno K, Takahashi K, Yamagami H, et al. Regional brain disorders of serotonin neurotransmission are associated with functional dyspepsia. Life Sci. 2015;137:150–7.
Levine ME, Koch SY, Koch KL. Lipase supplementation before a high-fat meal reduces perceptions of fullness in healthy subjects. Gut Liver. 2015;9:464–9.
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Fujikawa, Y., Tominaga, K. (2018). Pancreatic Exocrine Function. In: Tominaga, K., Kusunoki, H. (eds) Functional Dyspepsia. Springer, Singapore. https://doi.org/10.1007/978-981-13-1074-4_16
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DOI: https://doi.org/10.1007/978-981-13-1074-4_16
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