 Hi there, welcome back to my YouTube channel. This is Daniel Rosal here. I want to do another video on the subject of functional dyspepsia better known as FD. And what I want to talk about today is how there is actually a treasure trove of information out there on the internet from the medical research community. Now, if you're like me struggling with FD and you're getting kind of frustrated by the symptoms and the fact that your doctors don't have answers and you're trying perhaps different medications and not getting tremendous success, then I think it can be very helpful to read some of these. Now, these are intended for doctors basically. So what I'm talking about is finding journal articles and other sort of literature that is basically intended for medical professionals but can be very, very information dense for patients. And if you're working with a family doctor that maybe has never heard of FD or the current treatment approaches in use, then I think that finding these reading them for yourself, perhaps if your doctor is amenable to such an idea, printing them out or your gastroenterologist could be something useful. I've definitely been having a hard time recently getting doctors to understand what FD is and that it's not sort of a basket, whatever the word is, a waste basket diagnosis. That's been tricky and some medical professionals are dismissive, I find particularly psychiatry who think that FD is a purely mental disorder whereas the research is pretty clear that they're understanding a lot more about the fact what's wrong with FD patients. Now, there's two types of functional aspepsia, epigastric pain disorder and a post-prandial syndrome and depending what type you have, you might want to set up alerts. Now that's actually one of the things I just want to sort of give a quick recommendation for also is setting up a Google alert. Google alert, I find this very helpful. If you don't know how to do that, let me just drag over my notepad. Go on to google.com for slash alert. Now, caveat is you're going to need a Google account whether that's a G suite or a Gmail account to sign up for those. Second tip I have is it's very helpful to use exact match parameters for Google. It'll just make it sort of a little bit easier to zone in on information that's actually talking about FD. So I'm pretty sure my Google alert is simply functional dyspepsia in quotation marks to get exact match results and that is how I get it and I check the alerts basically once a week and see if anything looks interesting that people are finding out about it. Second tip is to use file type PDF. Now, this is another Google operator that will basically just return PDFs matching your keyword. You can also go on to Google scholar to find that more academic or practitioner oriented research but the PDF file type operator is what I've been using for I don't know how long probably 10 or 15 years whenever I'm looking for more kind of heavyweight material that's just kind of out there on the internet. It works really nicely for the most part. So just to give you a flavor for what's out there here's just one I randomly stumbled upon. It's a journal article from Australian prescriber and it's by lead author Nicholas Talley. Now, if you get into the strange habit of reading articles about functional dyspepsia you'll start to recognize a recurrence among the researchers. I guess the gastroenterology research community isn't colossal. Now, one thing I always do recommend doing is just checking when the research originated from because hopefully at least things move quickly in medical research and something that's 10 years old might be quite outdated where something that's recently published could be a lot more updated. So this article, for instance, just to give you just to explain why I think these things are really useful, they're written for doctors. So they're gonna use medical language and as a non-doctor myself, I'm not a researcher I'm not a doctor, I'm just somebody with a strong vested interest in figuring out my own functional dyspepsia. You just kind of have to get used to the language a bit. Ideopathic means that the origin isn't known or isn't understood, little things like this but I find I was able to sort of pick apart the main things in this paper at least, the differential diagnosis, trying to figure out what other conditions they rule out. This section is particularly interesting. So I presume this is intended for family doctors, I'm not exactly sure, but pathophysiology describing what they know about what actually causes FD. I'm just gonna read some bits of it here. Functional dyspepsia has been considered an ideopathic disorder, but this view is changing. In some cases FD develops after acute infectious gastroenteritis suggesting blah, blah, blah, hate pylori. You just pick up these very interesting tidbits reading this, so here's one of them. Gastric and duodenal motility disturbances have been observed in functional dyspepsia. Gastric emptying is often normal but maybe slow in 25% of patients. However, symptoms have generally not correlated with slow gastric emptying, that's quite interesting. Other abnormalities, and this is what I have, now my gastro, my problems all basically began after I had my gallbladder surgery and my gastro says there is some kind of possibility of nerve damage, he calls it impaired gastric accommodation which is another term I've come across in the research about functional dyspepsia which means that your stomach just doesn't really open up and they talk about this in this paper here. Other abnormalities include failure of the gastric fundus to relax normally after eating. This occurs in up to 40% of patients and is linked to early seity. Patients, people, this is interesting for me because I have the postprandial type of this problem. People with postprandial distress have unique duodenal pathology, namely increased duodenal esonophils that may degranulate. Now, esonophils, I know this because I have asthma. Esonophils, it's a type of white blood cell that I believe is associated with allergies. When you take drugs like singular, they're supposed to reduce your esonophilic levels. But you can pick these little things up. Psychological distress is common in patients with FD but may begin after the gut symptoms manifest and I kind of think that this is what happened to me. I was definitely always had maybe a touch of anxiety and maybe also depression but it just got so much worse since this started mostly because the things that keep you mentally healthy like exercising and jogging are a lot harder to do when you're feeling like bloated all the time. So that's what I pick up from all this research about this is that doctors are like, well, yeah, definitely psychological factors can make this worse but I don't really see in the papers I read about FD a general consensus that this is a somatic disorder and that's always annoying when you walk into a doctor's office and you get that feeling. So when I presented to a psychiatrist to say, I think this thing is making me depressed and I probably need to get some help for that. They were insistent that their drugs would sort the problem 100% and I did not find that that occurred. So yeah, it can be frustrating to try to battle for help for this disease. Proposed disease model interesting has been proposed. Now, this stuff is beyond me. I'm just, as a lay person, I'm just trying to pick out the tidbits that I can understand. There's a lot of depth here that just goes way beyond what I can wrap my head around but you might be the same and if you have a background in medical research or you're a medical professional yourself, you're probably gonna understand 10 times as much as I do. Typical diagnosis and then it gives about what kind of helps, some dietary tips. This was really useful. There's a little breakdown here by the two types of FD rating which, how the evidence is for each type, EGS and post-prandial distress syndrome and talks about fundiculaccers, antidepressants. I just want to zoom in on this because there's so much discussion in FD communities about amytryptolin and nortryptolin and the other tricyclics. So, now this is a 2017 journal article so it's from four years ago now and what they say in their section about antidepressants is that low dose tricyclics are superior to placebo for FD but they are probably most helpful for those with epigastric. So, that is interesting. That's kind of what I've always figured because when I looked up amytryptolin, what are these older antidepressants? I got stuff about pain and migraines and for my type of FD, post-prandial, I do not have any pain whatsoever. So, it was kind of had a suspicion that was gonna be the case and just give some dosing recommendations. SSRIs and SNRIs are reported to be better than placebo, FN27 and blah, blah, blah, blah, blah, and lots and lots more info there. Now, another paper that I find really, really interesting mentioned this drug and this one came from, again, this researcher, Nicholas Talley, an Australian gastroenterologist, is one of the co-authors of this paper that's available on the internet. This is from Expert Opinion and it's from, let's see, it does say that it's fine for personal use only which is why I'm feeling comfortable enough to screencast these videos. Emerging drugs expert, I was looking for the name of the journalist, not just called Expert Opinion, it's Expert Opinion on emerging drugs or something of that nature. Anyway, this is a longer document and it does talk about a drug called Acoteamide and this is the only drug in reading these papers that I've come across that I say, oh, that sounds like it's actually really intended for FD and sounds actually very promising. The rest kind of don't really sound that way or they're saying for these drugs like Amitriplein, well, yeah, we're using it but the evidence is kind of mixed. So this is currently, I never thought I would utter this sentence in my life. I wrote to the FDA and the EMA this week, the European Medical Authority, just asking them if they have any information on where those drugs stand currently in the regulatory process. I know that in America, it does seem as if they're undergoing Acoteamide is doing the late-sale clinical trials. They're currently being used in India and Japan so more developing world healthcare systems have already approved and people are posting on the internet on personal Facebook groups and Reddit and medical websites from these countries saying they're having great success with it. So it's a drug I would love to try and therefore I am trying my best to figure out when that might be a possibility. They said it'll diagram here of the stomach with other drugs being used. Finally, I came across this little treatment chart from the Lancet that basically for doctors provides almost a diagnostic pathway in terms of just kind of summarizes everything, actually a really nice little PDF here. Talking about the two different syndromes in FD, post-prandial and epigastro pain syndrome. Gives a little bit of info about what we know about its pathophysiology, the immune dysfunction, alterations in the gut microbiome, gut brain access dysfunction, and then management. If you're under 55, like me, have an endoscopy. Sorry. Yeah, have an endoscopy, test for H. pylary, PPI's, I've been on those things for many years and it hasn't improved or made this worse. Then a trial of a tricyclic or a prokinetic. If your symptoms resolved, you're in business and you can be discharged and continue monitoring. And if they persist, consider psychological therapy for, and that's kind of basically where it ends over there. So how did I find this info? I just typed functional dyspepsia, file type PDF into Google. I also think that setting up a keyword alert would be very valuable because this is only gonna catch PDFs. And if you do set up a Google alert, you're gonna be kind of drinking from the fire hose as they say in terms of just getting in all the info. It can be a bit overwhelming. So I personally have mine running once a week and I just go through it and I try to see what people are saying about FD and what researchers are figuring out, et cetera. And anything that looks vaguely interesting or promising, I will be reporting back upon on this channel because I've received a very enthusiastic response to the couple of videos so far. People also struggling with this. People also trying to figure out this condition just reached out to me through various means, a lot of emails and it's good to know that these videos are connecting with people. I am not providing medical advice. I'm just a patient trying to help other patients to join this collective pursuit because it's kind of a shared mission really of sourcing information from anywhere we can source it from. That may be helpful. And I think this is kind of where you see the internet at its best when people are just trying to help one another because ultimately we all want to either get our FD under control or get our FD completely better. And we're all trying to search for these glimmers of information from wherever we can get them. Hope this video was useful and if you would like to get more videos, please feel free to subscribe. Again, I emphasize this is not the medical information, not a substitute for that in any way, shape or form. If you have FD or suspect you have FD, then the obvious thing to do is to go to your doctor and tell him what your symptoms are and let the professionals handle it. Hope this video was helpful again and thank you for watching.