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Capsaicin hypersensitivity test identifies patients with functional dyspepsia
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A noninvasive test using a simple capsaicin pill effectively identified patients with functional dyspepsia, according to research published in the American Journal of Gastroenterology.
Johann Hammer, MD, of the departments of gastroenterology and hepatology at the Medical University of Vienna, Austria, wrote that his findings could lead to new diagnostic options for a disorder that is often difficult to diagnose due to a lack of biological markers.
He wrote that previous research has shown that a large portion of patients with functional dyspepsia are hypersensitive to capsaicin because it can agitate TRPV1 receptors, which are distributed throughout the GI tract and upregulated in functional dyspepsia.
“A simple capsule-based test to study chemosensitivity has recently been developed that was able to confirm functional dyspepsia in approximately half of patients,” he wrote. “The test had encouraging test characteristics, good reproducibility and a negligible placebo response, but its application in routine practice that would clarify its clinical use was pending.”
Hammer conducted a single-center cohort study of 224 patients to assess the relevance of the test. Each patient — referred for gastrointestinal symptoms without any alarm symptoms — received a capsule containing 0.75 mg of capsaicin. He assessed the severity of the patients’ symptoms before and after they took the capsule using a graded questionnaire. He then determined the difference using aggregate symptom scores (delta).
The test had a positive predictive value for the diagnosis of functional dyspepsia of 70% to 71% with a sensitivity between 0.51 and 0.59 and a specificity of 0.84 to 0.89. Patients with functional dyspepsia had significantly higher median delta symptom scores (10) compared with patients with inflammatory bowel disease (2.5; P = .003), peptic ulcer disease (0; P < .001), irritable bowel syndrome (3; P = .001) and patients classified with “other disease” (2.5; P < .001).
Patients with GERD had significantly lower symptoms scores if they did not also have functional dyspepsia (2) vs. GERD patients with functional dyspepsia (10).
Hammer said his findings could lead to even more tests for functional dyspepsia, and could help develop potential therapies that target the TRPV1 capsaicin receptor.
“The test provides reliable results and might be a helpful adjunct in the diagnostic work-up for the reassurance of patients and doctors,” he wrote. “It has its possible application as a diagnostic tool in the work-up of upper abdominal symptoms, as well as a tool to evaluate therapeutic interventions and to stratify patients with functional dyspepsia for clinical trials into groups of those with and without visceral hypersensitivity.” – by Alex Young
Disclosures: The author report no relevant financial disclosures.
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