Functional Dyspepsia In Menopause Patients—A Clinical Study

Functional dyspepsia (FD) is a variable combination of unexplained, chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. FD patients may be an extremely difficult group to manage and cost a lot. The exact prevalence varies with definition, the population studied and its mean age, the intensity of investigation, and the length of follow-up. About 50% patients of out-patient clinic of digestive internal medicine were diagnosed FD. Some of patients presented severe symptoms and have lower quality of life. The high prevalence of FD was observed in menopause women. Although prokinetic agents have been presented benefits to most of patients with FD, these drugs often did not yield improvement in part of menopause women with FD. The different physiological status between the menopause and the child-bearing period suggest the diverse pathophysiological mechanisms behind those two groups. Sex hormone therapy such as tibolone has been widely used in menopause women to relieve psychological symptoms. However, the effects of tibolone on FD symptoms in menopause women and the corresponding mechanisms have largely been unevaluated. Aims of the study1. Is tibolone able to relieve the symptoms of menopause FD?2. The effects of tibolone on gastric emptying and fast serum motilin of menopause FD.3. The effect of tibolone on gallbladder emptying of menopause FD.4. Comparison of effects of tibolone and cisapride on dyspepsia symptoms and gastric motility in menopause patients with FD. 5. The optimal postprandial time for measurement of gallbladder emptying. 6. The relationship between dyspepsia symptoms and duodenogastric reflux detected by Bilitec 2000.Methods1. The well-structure questionnaires and discriminant indices were used to evaluate the changes of symptom. 2. Gastric ejection fraction at 30 minutes and half of gastric emptying time were determined with 99mTc-radionucleography. 3. Gallbladder volume was measured by ultrasonography and calculated by Dodds' equation. 4. Radioimmunoassay was used to detect fast serum motilin.5. Duodenogastric reflux was detect with Bilitec 2000 bile monitoring. Results and conclusions1. Postprandial 30 minutes was the optimal time for measurement of gallbladder emptying because the coefficient of variation (CV=0.24) at this time was minimal.2. 24 hour monitoring by Bilitec 2000 seems not necessary if only for diagnosis of duodenogastric reflux. The monitoring time may be decided according to the duration of obvious symptoms. This modification enhanced patients in obedience in the clinical study. 3. Tiblolne significantly relieved the symptoms in menopause patients with FD, such as epiabdominal pain, abdominal inflated after meal, early satiety and belching. The effect was better than using cisapride alone.4. The mechanisms of tibolone behind the improvement of symptoms in menopause patients with FD may related with increasing gastric and gallbladder emptying and reducing duodenogastric reflux. 5. Neither tibolone nor cisapride affected the level of fast serum motilin.