Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A group of 292 consecutive patients underwent cholecystectomy for gallstones with presumed biliary pain over a 4-year period and all completed a self-assessment questionnaire before operation. Over the following 2 years 18 patients died but no others were lost to follow-up. The remaining 274 patients completed a further questionnaire 1 and 2 years after operation. Demographic characteristics and abdominal symptoms have been compared with an age- and sex-matched control group using the same questionnaire. Before operation symptoms of flatulent dyspepsia were far more frequent in patients with gallstones but operation markedly reduced these symptoms to an incidence which almost matched that of the control group. However, 1 year after cholecystectomy 34 per cent of patients still suffered some abdominal pain and of 35 patients referred back to hospital for investigation none has been shown to have a retained bile duct stone at a minimum follow-up of 5 years. A multivariate analysis indicated that preoperative flatulence together with long duration of attacks of pain are risk factors for postoperative dissatisfaction as judged by a linear analogue scale. However, both these factors are common and neither is a good discriminator of a poor outcome. The prediction of a poor symptomatic outcome after cholecystectomy from preoperative symptoms or patient characteristics had only limited success and all patients should be warned of this risk.
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PMID:Influence of cholecystectomy on symptoms. 191 18

Ninety-one normal, healthy volunteers participated in a single-center, double-blind, placebo-controlled, randomized, parallel group study: 1) to compare the prostaglandin E1 analog, misoprostol, given at a dose of 200 micrograms bid, with the recommended dose of 200 micrograms qid in protecting the gastroduodenal mucosa against injury due to anti-inflammatory doses of aspirin (3900 mg/day); and 2) to determine whether the reduced dose was associated with a lesser incidence of gastrointestinal (GI) side effects, particularly diarrhea. All subjects received 975 mg of aspirin qid with meals and at bedtime. They were concurrently administered either misoprostol 200 micrograms qid, misoprostol 200 micrograms bid and placebo bid, or placebo qid. All subjects were endoscopically normal at the onset of the study and were re-endoscoped on the morning of the 7th day of therapy, 2 h after the morning dose of medications. Gastric and duodenal mucosa were assessed separately on a 0-7 scale which gave a greater weight to erosions than to hemorrhages. GI symptoms, especially bowel habits, were assessed by means of diary cards. Subjects in both misoprostol groups had significantly less gastric and duodenal mucosal injury than subjects who received placebo (p less than 0.007 for each pairwise comparison). There was no statistically significant difference between the two misoprostol groups (p less than 0.093). Subjects in the misoprostol 200 micrograms qid group had significantly more loose and watery bowel movements than the subjects in the misoprostol 200 micrograms bid group (p less than 0.013), whereas there were no significant differences in bowel habits between the misoprostol 200 micrograms bid and placebo groups (p less than 0.122). More subjects in the misoprostol 200 micrograms qid group reported abdominal pain, loose stools, watery stools, flatulence, dyspepsia, and nausea than in the misoprostol 200 micrograms bid and placebo groups. In conclusion, the adverse events in the misoprostol 200 micrograms bid group were not significantly different from those in the placebo group, and were significantly better than in the misoprostol 200 micrograms qid group. The lower dose retained mucosal protective activity that was statistically indistinguishable from that of misoprostol 200 micrograms qid.
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PMID:A double-blind, placebo-controlled, 6-day evaluation of two doses of misoprostol in gastroduodenal mucosal protection against damage from aspirin and effect on bowel habits. 196 19

Fibric acid derivatives (FADs) are a class of drugs that have been shown to reduce the production of very low-density lipoprotein (VLDL) while enhancing VLDL clearance due to the stimulation of lipoprotein lipase activity. The drugs can reduce plasma triglyceride levels while raising high-density lipoprotein (HDL) cholesterol levels. Their effects on low-density lipoprotein (LDL) cholesterol levels are less marked and more variable. There is evidence that oral gemfibrozil (Lopid, Parke-Davis, Morris Plains, NJ) can reduce the risk of serious coronary events, specifically in those patients who had elevations of both LDL cholesterol levels and total plasma triglyceride levels with lower HDL cholesterol levels. Newer FADs (bezafibrate, ciprofibrate, fenofibrate) have been shown to have greater efficacy in reducing LDL cholesterol than gemfibrozil but, in general, these drugs are not as effective as the other primary drugs used to lower LDL levels. The FADs are also used to treat adult patients with very high levels of triglycerides who have pancreatitis and whose disease cannot be managed with dietary therapy. The FADs are well tolerated, with dyspepsia and abdominal pain the most common adverse effects. A small risk of cholelithiasis exists with these drugs, and caution should be used when combining these drugs with HMG-CoA reductase inhibitors because the combination increases the incidence of hyperlipidemic myositis and rhabdomyolysis.
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PMID:Effects of gemfibrozil and other fibric acid derivatives on blood lipids and lipoproteins. 204 26

In the United States, early diagnosis and cure of gastric carcinoma remain elusive. Patients with this disease commonly have gastrointestinal symptoms that often go unexplained. Physicians give gastric carcinoma a low priority in their differential diagnosis and are unaware of the risk factors patients may have. Patients may have a normal upper gastrointestinal series, and fiberoptic gastroscopy is delayed. Patients with unexplained indigestion and abdominal pain, coupled with such risk factors for gastric carcinoma as national origin, diet, heredity, and previous subtotal gastrectomy for gastric ulcers, should be given the opportunity of esophagogastroduodenoscopy.
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PMID:Adenocarcinoma of the stomach: a plea for early diagnosis. 205 57

Safety data have been gathered in US clinical trials of nabumetone on 1912 patients from August 1981 to May 1988. Dosing in the double-blind trials was 100 mg at bedtime, but in open-label trials patients could increase the dosage of nabumetone to 1500 or 2000 mg if required. Adverse experiences reported in the double-blind and open-label studies that were considered related to nabumetone treatment, or of unknown origin, occurred most commonly in two body systems: the body as a whole, and the digestive system. Incidence rates greater than 10% for adverse experiences categorised by preferred term occurred in the 'body as a whole' category for abdominal pain, and in the digestive system for diarrhoea and dyspepsia. Dosage increases to 2000 mg appeared to cause a dose-related increase in diarrhoea. In the long term studies, gastrointestinal ulcers have been confirmed in 13 (0.7%) patients. Hepatic and renal function was well preserved in patients treated with nabumetone. Overall, only 7 nabumetone-treated patients (0.4%) showed a marked elevation in both ALT (SGPT) and AST (SGOT). Two nabumetone-treated patients showed marked elevations in renal parameters, serum creatinine and blood urea nitrogen. Overall, nabumetone was well tolerated, and the adverse experience profile was clinically acceptable and presented no unusual or unexpected patterns.
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PMID:An overview of the long-term safety experience of nabumetone. 208 90

Helicobacter (Campylobacter) pylori has been cultured from the antral biopsies of 85-90% of patients of gastritis, gastric ulcer and duodenal ulcer at different centres. Studies conducted all over the world have firmly implicated this organism in the aetiology of active superficial gastritis and recurrences of duodenal ulcer. Two hundred patients with upper abdominal pain, distension, vomiting and/or haemetemesis were subjected to OGD scopy. In 163 of these patients there was endoscopic evidence of gastritis; in 24 there was DU; in 3, GU and in 10 it was normal. Diagnosis of H pylori infection was made by the rapid biopsy urease test which is nearly 100% specific and 98% sensitive. 170 out of 200 patients were positive for H pylori. Among these were 138 patients of gastritis (84.6%); 22 cases of DU (91.6%); 2 cases of GU (66.6%) and 8 in whom endoscopy was normal. Histological examination of the antral biopsy specimens showed mild to severe infiltration of mucosa with lymphocytes and plasma cells. None of the 170 H pylori positive cases showed polymorphonuclear infiltration which has been stressed repeatedly by most Western authors to be characteristic of "active" superficial gastritis associated with H pylori infection. Even in those with a history of dyspepsia of barely 4 weeks duration or less there was no PMN infiltration in the mucosa. Thus the local response to infection by H pylori of the gastric mucosa is different in Indian patients.
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PMID:Unusual features of Helicobacter (Campylobacter) pylori--associated gastritis in India. A study of 200 cases. 209 22

One hundred and thirty-seven consecutive outpatients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) were randomly allocated to double-blind treatment with 400-micrograms misoprostol tablets twice daily or placebo for 4 weeks. Misoprostol had a significant worsening effect on epigastric pain, nausea, meteorism, lower abdominal pain, and diarrhoea, as compared with placebo. The fact that symptoms in patients with NUD and EPC were exacerbated by an antisecretory dose of misoprostol indicates that the symptoms are largely unrelated to gastric acid.
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PMID:Misoprostol treatment exacerbates abdominal discomfort in patients with non-ulcer dyspepsia and erosive prepyloric changes. A double-blind, placebo-controlled, multicentre study. 212 24

The safety of etodolac, a new nonsteroidal anti-inflammatory drug (NSAID), was reviewed by examining data from 3,302 patients enrolled in double-blind and open-label clinical trials and from 8,334 patients taking etodolac in post-marketing surveillance studies. The review determined that gastrointestinal disturbances are the most frequently reported side effects, followed by headache, dizziness, rash, and pruritus. The rate of abdominal pain and dyspepsia is similar to that observed with several other NSAIDs but is lower than that seen with aspirin. Gastrointestinal ulceration occurs in less than 0.3% of patients taking etodolac, and drug-related hepatic, renal, and hematologic dysfunctions are rare. The elderly appear to be no more at risk of experiencing adverse effects than the general population. Overall, the review confirmed the excellent safety profile of etodolac reported previously.
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PMID:An updated safety profile of etodolac in several thousand patients. 214 32

Prior to the 17th century, there was considerable confusion regarding the process of digestion. Although some physicians were certain that it was initiated by acid in the stomach, both the source and the nature of the acid were unclear. In the early 19th century, Prout confirmed the active secretion of hydrochloric acid by the stomach and related it to the symptoms of dyspepsia. Jacob Helm and, subsequently, Beaumont studied digestion in humans with gastric fistulas and each commented extensively on the physiologic manifestation of digestion. The role of the vagus nerves in the control of gastric acid secretion was identified in the early and mid-19th century by Brodie, and subsequently elaborated upon by Pavlov. By the early 20th century, Latarjet and Jaboulay in France, performing operations for abdominal pain and tabes, reported the effects of vagotomy on acid secretion and gastric motility. In 1943, Dragstedt, in the United States, reported the cure of duodenal peptic ulcer disease by supradiaphragmatic vagotomy. He later observed the substantial delays in emptying of the stomach, which necessitated the introduction of concomitant gastric drainage procedures, such as gastrojejunostomy and pyloroplasty. In 1902, Bayliss and Starling had described the existence of a chemical regulator of function--secretin--which they termed a hormone. Shortly thereafter, Edkins reported results of studies that supported the presence of an acid regulatory hormone, gastrin, in the antrum of the stomach. Unfortunately, controversy marred this observation, and the action of gastrin was for more than 30 years ascribed to histamine. Komarov, in 1938, confirmed the existence of gastrin and its stimulatory effects on acid secretion. Physiologic recognition of the roles of vagal stimulation and antral gastrin in the secretion of acid from the stomach resulted in the development of the operation of vagotomy and antrectomy for peptic ulcer disease. Studies of the pylorus and the motility of the stomach resulted in an appreciation of the genesis of the postgastrectomy syndromes. By the middle of the 20th century, a clear appreciation of the morphologic characteristics of the parietal cell and its ability to secrete hydrochloric acid was under way. The complex metabolic process of the cell was correlated with the major morphologic transformation necessary to generate secretion of hydrochloric acid. The development of sophisticated research technology allowed the appreciation of the complex intracellular processes necessary to allow the generation of a 2.5 million-fold gradient of hydrogen ion secretion.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:From Prout to the proton pump--a history of the science of gastric acid secretion and the surgery of peptic ulcer. 215 87

In a double-blind multicentre study to compare pirenzepine with placebo in non-ulcer dyspepsia, 71 patients were randomized to receive 50 mg pirenzepine or placebo given orally twice daily for 4 weeks. The trial was not completed by five patients in the pirenzepine group and six in the placebo group. There were no significant differences between the groups in respect to changes in total symptoms (upper abdominal pain, nausea and vomiting, early satiety and postprandial bloating, eructation and pyrosis) scores and outcome, although 27/35 (77%) patients receiving pirenzepine were cured or improved compared with 22/36 (61%) receiving the placebo. Adverse effects were reported by 13 (37%) patients treated with pirenzepine and by six (17%) treated with placebo, seven withdrawing due to adverse effects.
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PMID:Pirenzepine in non-ulcer dyspepsia: a double-blind multicentre trial. 218 62


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