Since the publication of the Rome III criteria for functional dyspepsia (FD), the evidence about the efficacy of half-dose of proton pump inhibitors for dyspepsia symptoms have been limited.
To examine the efficacy of lansoprazole for functional dyspepsia (FD) diagnosed with the Rome III criteria by the multicentre, double-blind, randomized, placebo-controlled study in Japan.
A total of 54 FD participants were randomized to lansoprazole 15 mg once daily or placebo for a 4-week double-blind treatment period. The primary efficacy endpoint was an overall dyspeptic symptom relief rate evaluated by 5-point Likert scale scores. The alteration of dyspeptic symptom scores during the study period was also assessed.
At week 4, the overall dyspeptic symptom relief rates were higher in the lansoprazole group (30.4%) than in the placebo group (6.7%) (p = 0.045). The scores for epigastric pain (p = 0.045) and epigastric burning (p = 0.03) were significantly improved in the lansoprazole group compared to the placebo group, whereas the improvement of the scores for postprandial fullness (p = 0.81) and early satiation (p = 0.33) was not different between lansoprazole and placebo groups.
Lansoprazole 15 mg ameliorates dyspeptic symptoms, particularly the epigastric pain syndrome-related symptoms of FD.
Functional dyspepsia; lansoprazole; proton pump inhibitor; Rome III
ROS (reactive oxygen species) play an essential role in the pathophysiology of diabetes, stroke and neurodegenerative disorders. Hyperglycaemia associated with diabetes enhances ROS production and causes oxidative stress in vascular endothelial cells, but adverse effects of either acute or chronic high-glucose environments on brain parenchymal cells remain unclear. The PPP (pentose phosphate pathway) and GSH participate in a major defence mechanism against ROS in brain, and we explored the role and regulation of the astroglial PPP in response to acute and chronic high-glucose environments. PPP activity was measured in cultured neurons and astroglia by determining the difference in rate of 14CO2 production from [1-14C]glucose and [6-14C]glucose. ROS production, mainly H2O2, and GSH were also assessed. Acutely elevated glucose concentrations in the culture media increased PPP activity and GSH level in astroglia, decreasing ROS production. Chronically elevated glucose environments also induced PPP activation. Immunohistochemical analyses revealed that chronic high-glucose environments induced ER (endoplasmic reticulum) stress (presumably through increased hexosamine biosynthetic pathway flux). Nuclear translocation of Nrf2 (nuclear factor-erythroid 2 p45 subunit-related factor 2), which regulates G6PDH (glyceraldehyde-6-phosphate dehydrogenase) by enhancing transcription, was also observed in association with BiP (immunoglobulin heavy-chain-binding protein) expression. Acute and chronic high-glucose environments activated the PPP in astroglia, preventing ROS elevation. Therefore a rapid decrease in glucose level seems to enhance ROS toxicity, perhaps contributing to neural damage when insulin levels given to diabetic patients are not properly calibrated and plasma glucose levels are not adequately maintained. These findings may also explain the lack of evidence for clinical benefits from strict glycaemic control during the acute phase of stroke.
astrocyte; diabetes mellitus; ER (endoplasmic reticulum) stress; glucose metabolism; Kelch-like enoyl-CoA hydratase-associated protein 1 (Keap1)/nuclear factor-erythroid 2 p45 subunit-related factor 2 (Nrf2); pentose phosphate pathway (PPP); 6-AN, 6-aminonicotinamide; [14C]deoxyglucose, 2-deoxy-d-[1-14C]glucose; AGE, advanced glycation end-product; Ara-C, cytosine arabinoside; BiP, immunoglobulin heavy-chain-binding protein; CMRglc, cerebral metabolic rate of glucose; CMRoxy, cerebral metabolic rate of oxygen; DAPI, 4′,6-diamino-2-phenylindole; DBSS, Dulbecco's balanced salt solution; DMEM, Dulbecco's modified Eagle's medium; ER, endoplasmic reticulum; G6PDH, glyceraldehyde-6-phosphate dehydrogenase; H2DCFDA, 2′,7′-dichlorodihydrofluorescein diacetate; Keap1, Kelch-like enoyl-CoA hydratase-associated protein 1; MCB, monochlorobimane; Nrf2, nuclear factor-erythroid 2 p45 subunit-related factor 2; PERK, double-stranded-RNA-dependent protein kinase-like endoplasmic reticulum kinase; PFA, paraformaldehyde; PLL, poly-l-lysine; PPP, pentose phosphate pathway; ROS, reactive oxygen species; sulforaphane, 1-isothiocyanato-(4R,S)-(methylsulfinyl)butane