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      Menthacarin for long-term treatment of functional dyspepsia – Results from a clinical trial follow-up Translated title: Menthacarin zur Behandlung der funktionellen Dyspepsie – Ergebnisse eines Langzeit-Follow-ups

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          Abstract

          Background Menthacarin was shown to be effective and safe in clinical trials in patients with functional dyspepsia (FD). Long-term treatment results have not been reported yet.

          Methods An open-label, 11-month follow-up (FU) was offered to FD patients who had undergone treatment with Menthacarin (1 gastro-resistant capsule b.i.d. vs. placebo (PL)) in a 4-week, double-blind, clinical trial. During FU, all patients (former verum and PL) were treated with 1 gastro-resistant capsule Menthacarin b.i.d. Main outcomes were the changes in pain intensity and severity of sensation of pressure, heaviness, and fullness from original baseline and global improvement.

          Results 70 patients were included in the analyses (former Menthacarin group: 36, former PL group: 34). At the end of the PL-controlled study phase, all 3 main efficacy variables were statistically significantly improved in the Menthacarin group compared to PL. In the FU phase, former PL patients started to improve under Menthacarin treatment towards the outcomes seen in the former Menthacarin group (alignment at approximately 6 months), while former Menthacarin patients showed sustained or even continuously improved outcomes by month 12. At study end, more than 90% of patients were “much or very much improved" in both groups. Menthacarin treatment was well tolerated.

          Conclusions The favorable effects seen in the FU period suggest that Menthacarin is a valuable treatment option in FD patients who require symptomatic treatment also in the longer term for up to 12 months.

          Zusammenfassung

          Hintergrund Menthacarin hat sich in klinischen Studien bei Patienten mit funktioneller Dyspepsie (FD) als wirksam und sicher erwiesen. Langzeitergebnisse einer Behandlung wurden bisher nicht berichtet.

          Methodik FD-Patienten, die in einer 4-wöchigen klinischen Doppelblindstudie mit Menthacarin (1 gastroresistente Kapsel b.i.d. vs. Placebo [PL]) behandelt worden waren, wurde ein offenes, 11-monatiges Follow-up (FU) angeboten. Während des FU erhielten alle Patienten (sowohl ehemalige Verum- als auch PL-Patienten) 1 magensaftresistente Kapsel Menthacarin b.i.d. Wichtigste Zielparameter waren die Veränderung der Schmerzintensität und des Schweregrads des Druck-, Schwere- und Völlegefühls sowie die globale Verbesserung.

          Ergebnisse Die Analyse umfasste insgesamt 70 Patienten (36 ehemals Menthacarin, 34 ehemals PL). Alle 3 Hauptwirksamkeitsvariablen waren in der Menthacarin-Gruppe am Ende der PL-kontrollierten Studienphase im Vergleich zu PL statistisch signifikant verbessert. In der FU-Phase begannen sich die vormaligen PL-Patienten unter Menthacarin-Behandlung zu verbessern und sich den Ergebnissen der vormaligen Menthacarin-Gruppe anzunähern (Angleichung nach etwa 6 Monaten), während die letztere Gruppe bis Monat 12 eine anhaltende oder fortschreitende Besserung zeigte. Am Studienende waren über 90% der Patienten beider Gruppen stark oder sehr stark verbessert. Die Menthacarin-Behandlung war gut verträglich.

          Schlussfolgerungen Die in der FU-Periode beobachteten günstigen Effekte legen nahe, dass Menthacarin eine wertvolle Therapieoption bei FD-Patienten ist, welche eine symptomatische Behandlung benötigen, auch bei einer längerfristigen Einnahme über bis zu 12 Monate.

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          Most cited references33

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          Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV.

          Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology are recognized by morphological and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing. Research on these gut-brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: 1) updating the basic and clinical literature, 2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the use of imprecise and occassionally stigmatizing terms when possible, 4) uses updated diagnostic algorithms, 5) incorporates information on the patient illness experience, and physiological subgroups or biomarkers that might lead to more targeted treatment. This introductory article sets the stage for the remaining 17 articles that follow and offers an historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, provides a biopsychosocial pathophysiological conceptualization of FGIDs, and offers an approach to patient care.
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            Factors affecting therapeutic compliance: A review from the patient’s perspective

            Objective To explore and evaluate the most common factors causing therapeutic non-compliance. Methods A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.
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              Gastroduodenal Disorders.

              Symptoms that can be attributed to the gastroduodenal region represent one of the main subgroups among functional gastrointestinal disorders. A slightly modified classification into the following 4 categories is proposed: (1) functional dyspepsia, characterized by 1 or more of the following: postprandial fullness, early satiation, epigastric pain, and epigastric burning, which are unexplained after a routine clinical evaluation; and includes 2 subcategories: postprandial distress syndrome that is characterized by meal-induced dyspeptic symptoms and epigastric pain syndrome that does not occur exclusively postprandially; the 2 subgroups can overlap; (2) belching disorders, defined as audible escapes of air from the esophagus or the stomach, are classified into 2 subcategories, depending on the origin of the refluxed gas as detected by intraluminal impedance measurement belching: gastric and supragastric belch; (3) nausea and vomiting disorders, which include 3 subcategories: chronic nausea and vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; and (4) rumination syndrome.
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                Author and article information

                Journal
                Z Gastroenterol
                Z Gastroenterol
                10.1055/s-00000094
                Zeitschrift Fur Gastroenterologie
                Georg Thieme Verlag KG (Rüdigerstraße 14, 70469 Stuttgart, Germany )
                0044-2771
                1439-7803
                13 June 2022
                March 2023
                1 June 2022
                : 61
                : 3
                : 257-267
                Affiliations
                [1 ]Zentrum für Endoskopie, Starnberg, Germany und Medizinische Klinik und Poliklinik II, Klinikum Großhadern, München, Germany
                [2 ]Global Medical Affairs, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
                Author notes
                Correspondence Martin Storr Zentrum für Endoskopie Oßwaldstr. 182319 StarnbergGermany Martin.Storr@ 123456med.uni-muenchen.de
                Article
                10.1055/a-1823-1333
                9998233
                35697065
                5c26d7b7-92f0-4deb-b697-978c1bb84e24
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 September 2021
                : 15 March 2022
                Funding
                Funded by: Dr. Willmar Schwabe GmbH & Co. KG
                Categories
                Originalarbeit

                funktionelle dyspepsie,follow-up-studie,kümmelöl,pfefferminzöl,menthacarin,functional dyspepsia,follow-up study,caraway oil,peppermint oil

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