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Background: Psychological factors contribute to the pathogenesis of functional dyspepsia (FD). Antidepressant agents are beneficial in treatment of refractory FD. However, their efficacy is greatly hindered by the poor treatment adherence. Stigma is present in patients with chronic diseases or mental disorders and could affect adherence. The present study was aimed to evaluate stigma prevalence in FD patients and to explore the impact of stigma on treatment adherence to antidepressants. Methods: Functional dyspepsia patients unsatisfied with the regular first‐line treatment and received newly initiated antidepressant medicine were recruited and subjected to antidepressant treatment for 8 weeks. Stigma scales and symptom scores of dyspepsia, depression, and anxiety were analyzed before and after treatment. Associations between stigma and medication adherence were evaluated. Key results: One hundred and ten of the enrolled 138 participants reported minimal disease‐related internalized stigma, and 28 reported mild stigma before antidepressant therapy. Male gender, lower education, and higher scores of dyspepsia, depression, and anxiety were predictors of stigma before treatment. The mean stigma scores increased after 8‐week antidepressant treatment. A proportion (36.4%‐89.9%) of patients showed stigma attached to antidepressant therapy in the 4‐question survey. Post‐treatment stigma scores negatively correlated with treatment adherence and efficacy. Patients with decreased post‐treatment stigma scores displayed better medication adherence and symptom improvement compared to those with elevated or unaltered post‐treatment stigma scores. Conclusions: Patients with refractory FD report stigma attached to the disease and antidepressants. It is an obstacle to treatment adherence and efficacy of antidepressant medication in FD therapy. [ABSTRACT FROM AUTHOR]

Introduction: The mucosa-associated microbiota (MAM) is not as frequently studied in diarrhea-predominant irritable bowel syndrome (IBS-D) compared with the fecal microbiota. In this study, we examined the MAM in the terminal ileum and its correlation with bowel symptoms in IBS-D., Methods: Mucosal biopsies of the terminal ileum from 25 patients with IBS-D and 25 healthy controls were collected for 16S ribosomal RNA gene sequencing. Correlation analysis was performed., Results: Compared with healthy controls, the MAM in the terminal ileum showed a decreased alpha diversity in the IBS-D cohort (Chao1 and Shannon indexes, P < 0.05). And the overall MAM profile clustered separately into 2 groups (ADONIS [PERMANOVA, permutational multivariate analysis of variance], P < 0.05). At the phylum level, the relative abundance of Proteobacteria was significantly higher in the ileal MAM of patients with IBS-D while that of Firmicutes was significantly lower. At the genus level, the relative abundance of Pseudomonas was significantly higher in the IBS-D cohort, with lower Bacteroides and Ruminococcus . Moreover, 40.0% of patients with IBS-D had multiple small nodules (nodular lymphoid hyperplasia) on the mucosal surface of the terminal ileum, which indicated a low-grade inflammation. In patients with IBS-D with nodular lymphoid hyperplasia, the changes of Pseudomonas and Bacteroides were more overt. Correlation analysis revealed that the relative abundance of Pseudomonas positively correlated with abdominal pain and the severity of IBS., Discussion: Patients with IBS-D showed a dysbiosis of MAM in the terminal ileum, which may be associated with bowel symptoms. Moreover, 40.0% of them displayed mucosal low-grade inflammation, with a more severe mucosal microbial disturbance., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Increased colonic bile acid (BA) exposure, frequent in diarrhea-predominant irritable bowel syndrome (IBS-D), can affect gut function. Nerve growth factor (NGF) is implicated in the development of visceral hypersensitivity (VH). In this study, we tested the hypothesis that BAs cause VH via mucosal mast cell (MMC)-to-nociceptor signaling, which involves the farnesoid X receptor (FXR)/NGF/transient receptor potential vanilloid (TRPV)1 axis. BAs were intracolonically administered to rats for 15 d. Visceral sensitivity to colorectal distention and colonic NGF expression were examined. BAs caused VH, an effect that involved MMC-derived NGF and was accompanied by enhanced TRPV1 expression in the dorsal root ganglia. Anti-NGF treatment and TRPV1 antagonism inhibited BA-induced VH. BAs induced NGF mRNA and protein expression and release in cultured mast cells. Colonic supernatants from patients with IBS-D with elevated colonic BA content transcriptionally induced NGF expression. In FXR -/- mice, visceral sensitivity and colonic NGF expression were unaltered after BA treatment. Pharmacological antagonism and FXR silencing suppressed BA-induced NGF expression and release in mast cells. Mitogen-activated protein kinase kinase (MKK) 3/6/p38 MAPK/NF-κB signaling was mechanistically responsible for FXR-mediated NGF expression and secretion. The findings show an MMC-dependent and FXR-mediated pronociceptive effect of BAs and identify the BA/FXR/NGF/TRPV1 axis as a key player in MMC-to-neuron communication during pain processing in IBS.-Li, W.-T., Luo, Q.-Q., Wang, B., Chen, X., Yan, X.-J., Qiu, H.-Y., Chen, S.-L. Bile acids induce visceral hypersensitivity via mucosal mast cell-to-nociceptor signaling that involves the farnesoid X receptor/nerve growth factor/transient receptor potential vanilloid 1 axis.

Aim: To assess the potential benefits of mosapride plus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease., Methods: A literature search was performed through MEDLINE, EMBASE, and the ISI Web of Knowledge. The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed. The rate of responders was evaluated by the pooled relative risk (PRR) and improvement in symptom scores was assessed by single effect size of a standardized mean, while Hedges'g was used as the effect size. Pooled effect sizes with 95%CIs were calculated using a fixed-effects model. Between-study heterogeneity was assessed using Q test and I (2) analyses. In addition, studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed., Results: This systematic review included information on a total of 587 patients based on 7 trials. Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy. The statistical analysis for the effect of additional mosapride showed equivocal results (PRR = 1.132; 95%CI: 0.934-1.372; P = 0.205; Hedges'g = 0.24; 95%CI: 0.03-0.46; P = 0.023). No heterogeneity and publication bias were found among the studies. Three open-labeled trials assessed the additional efficacy of mosapride in PPI-resistant patients. However, since these trials did not set the control group, the results may be considerably biased., Conclusion: Mosapride combined therapy is not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.

Objective: To study the correlation between single nucleotide polymorphism (SNP) of monoamine oxidase A gene (MAOA) and anger regulation., Methods: Enrolled were healthy students from some college, including 225 of the high trait anger and 221 of the low trait anger. Subjects were recruited referring to the state-trait anger expression inventory 2 (STAXI-2) and their blood sampled. The DNA was extracted using phenol-chloroform method, 4 tag SNPs of MAOA (rs5906957, rs2235186, rs1181275, and rs5905613) were genotyped by PCR-based ligase detection reaction (PCR-LDR). The scores for trait anger expression inventory and the scores for trait anger expression control at the 4 tag SNPs of MAOA in the different sexes groups of the high and the low trait anger were statistical analyzed., Results: There was statistical difference in anger control score of locus rs2235186 of MAOA gene group (P = 0.037). There was no significant difference in anger expression or anger control score of different genotypes of the other three tag SNPs (P > 0.05)., Conclusion: MAOA gene tag SNP rs2235186 was correlated with anger control traits of healthy female college students of the low trait anger in China.

Objective: To understand the epidemiological characteristics and the influencing factors of Japanese encephalitis (Abbreviated JE) at different periods in Hainan province, and to provide evidence for JE control strategies., Methods: Data on JE had been collected since 1952 and related incidence, mortality, fatality rates of JE and the rate of JE vaccination were calculated for four periods: the natural epidemic period (1952-1978), period for inactivated JE vaccine promotion (1979-1986), national immunization program period (1987-1990) and the promotion of live-attenuated JE vaccine period (1991-2007). History on the immunity of JE and data from the monitoring programs on cases and insect vectors were also analyzed., Results: The average annual incidence in natural epidemic period was 7.12/100,000, which was also the highest among the 4 periods with the mortality rate as 0.89/100,000. The average annual incidence was 0.11/100,000 which was the lowest while the mortality rate was 0.01/100,000 in the period when live-attenuated JE vaccination was under promotion. Since the establishment of JE surveillance system was set up in Hainan province in 2002, the specimen collection rate of JE reported suspected cases had reached 92.8%, while the incidence of confirmed JE cases fluctuated between 0.05/100,000 and 0.2/100,000. Of the confirmed cases, 86% did not have clear history of JE vaccination. The annual average protective rate reached 95.69% in 2004-2007. The density of insect vectors was high in Hainan province. The infection rate of JE in host animal swine, kept rising from April to October, and in some surveillance points, the rate reached 99.3%. The density of insect vector plotted in trans-curve with the infection of host animals., Conclusion: The application of live-attenuated JE vaccine was found to have had significant protective effect on JE in susceptible children. It helped reducing the incidence and controlling the epidemics of JE. It appears feasible to include live-attenuated JE vaccine into the expanded immunization program.