Abteilung fìr Gastroenterologie und Hepatologie, Universitätsklinik fìr Innere Medizin 3, Vienna, Austria.
Am J Gastroenterol. 2018 Apr;113(4):584-592. doi: 10.1038/ajg.2018.16. Epub 2018 Mar 13.
The diagnosis of functional dyspepsia (FD) is challenging due to the lack of reliable biological markers to support the diagnosis. We assessed the relevance of a previously validated simple test for chemical hypersensitivity in the setting of a gastrointestinal outpatient department.
A total of 224 outpatients who were referred for evaluation of gastrointestinal symptoms in the absence of alarm symptoms swallowed a capsule containing 0.75 mg capsaicin. Severity of symptoms before and after capsule ingestion was assessed by a graded questionnaire and the difference in aggregate symptom scores (delta) was calculated.
Sensitivity of the test was between 0.51-0.59, specificity was 0.84-0.89 and positive predictive value for the diagnosis of FD 70-71%. FD patients had significantly higher median delta symptom scores (10.0; 25% quartile: 3.0; 75% quartile: 16.0) as compared to inflammatory bowel disease (2.5; 1.0/8.5)(P=0.003), peptic ulcer disease (0.0; -1.5/4.5) (P<0.001), irritable bowel syndrome (3.0;0.5/8.5)(P=0.001), and patients classified with "other disease" (2.5;0.0/5.0)(P<0.001). Patients with gastroesophageal reflux disease had significantly lower symptom scores if FD was not concomitantly diagnosed (2.0; 0.0/6.0) than if FD was present (10.0; 4.0/15.0).
Hypersensitivity for capsaicin discriminates functional dyspepsia from patients with other GI disorders. The capsaicin test is a simple and non invasive method to detect a large subgroup of functional dyspepsia with chemical hypersensitivity. These findings might open new diagnostic options in functional dyspepsia and possibly new therapeutic options by targeting the specific capsaicin receptor TRPV1.
由于缺乏可靠的生物学标志物来支持诊断，功能性消化不良（FD）的诊断具有挑战性。我们评估了先前验证的用于化学超敏反应的简单测试在胃肠门诊环境中的相关性。
共有 224 名因胃肠道症状就诊且无警报症状的门诊患者吞下了含有 0.75mg 辣椒素的胶囊。在胶囊摄入前后通过分级问卷评估症状的严重程度，并计算总症状评分的差异（delta）。
该测试的灵敏度在 0.51-0.59 之间，特异性在 0.84-0.89 之间，FD 的阳性预测值为 70-71%。与炎症性肠病（2.5；1.0/8.5）（P=0.003）、消化性溃疡病（0.0；-1.5/4.5）（P<0.001）、肠易激综合征（3.0；0.5/8.5）（P=0.001）和归类为“其他疾病”的患者（2.5；0.0/5.0）（P<0.001）相比，FD 患者的中位 delta 症状评分明显更高（10.0；25%四分位数：3.0；75%四分位数：16.0）。如果 FD 不伴发，胃食管反流病患者的症状评分明显较低（2.0；0.0/6.0），如果 FD 存在，则症状评分较高（10.0；4.0/15.0）。
辣椒素超敏反应可将功能性消化不良与其他 GI 疾病区分开来。辣椒素测试是一种简单且非侵入性的方法，可用于检测具有化学超敏反应的功能性消化不良的大亚组。这些发现可能为功能性消化不良提供新的诊断选择，并通过靶向特定的辣椒素受体 TRPV1 提供新的治疗选择。
