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

Dyspepsia can be defined as the presence of upper abdominal pain or discomfort; other symptoms referable to the proximal gastrointestinal tract, such as nausea, early satiety, and bloating, may also be present. Symptoms may or may not be meal related. To be termed chronic, dyspepsia should have been present for three months or longer. Over half the patients who present with chronic dyspepsia have no evidence of peptic ulceration, other focal lesions, or systemic disease and are diagnosed as having non-ulcer (or functional) dyspepsia. Non-ulcer dyspepsia is a heterogeneous syndrome. It has been proposed that this entity can be subdivided into a number of symptomatic clusters or groupings that suggest possible underlying pathogenetic mechanisms. These groupings include ulcer-like dyspepsia (typical symptoms of peptic ulcer are present), dysmotility (stasis)-like dyspepsia (symptoms include nausea, early satiety, bloating, and belching that suggest gastric stasis or small intestinal dysmotility), and reflux-like dyspepsia (heartburn or acid regurgitation accompanies upper abdominal pain or discomfort). The aetiology of non-ulcer dyspepsia is not established, although it is likely a multifactorial disorder. Motility abnormalities may be important in a subset of dyspepsia patients but probably do not explain the symptoms in the majority. Epidemiological studies have not convincingly demonstrated an association between Helicobacter pylori and non-ulcer dyspepsia. Other potential aetiological mechanisms, such as increased gastric acid secretion, psychological factors, life-event stress, and dietary factors, have not been established as causes of non-ulcer dyspepsia. Management of non-ulcer dyspepsia is difficult because its pathogenesis is poorly understood and is confounded because of a high placebo response rate. Until more data are available, it seems reasonable that treatment regimens target the clinical groupings described above. Antacids are no more effective than placebo in non-ulcer dyspepsia, although a subgroup of non-ulcer dyspepsia patients with reflux-like or ulcer-like symptoms may respond to H2-receptor antagonists. However, there is no significant benefit of these agents over placebo in many cases. Bismuth has been shown to be superior to placebo in patients with H. pylori in a number of studies, but these trials had several shortcomings and others have reported conflicting findings. Sucralfate was demonstrated in one study to be superior to placebo, but this finding was not confirmed by another group of investigators. Prokinetic drugs appear to be efficacious, and may be most useful in patients with dysmotility-like and reflux-like dyspepsia.
 ...
PMID:Non-ulcer dyspepsia: myths and realities. 188 33

The irritable bowel syndrome is characterized by the presence of abdominal pain associated with disturbed defecation; certain symptoms are able to discriminate the irritable bowel syndrome from organic disease. Functional dyspepsia is also common in patients with symptoms otherwise compatible with the irritable bowel syndrome. Approximately one-third of patients with functional dyspepsia have symptoms thought to be of colonic origin. Despite this, functional dyspepsia can be distinguished from the irritable bowel syndrome on the basis of symptom criteria. A generalized motility disturbance may explain the presence of dyspepsia in patients with the irritable bowel syndrome. Whether a specific type of dyspepsia occurs in this syndrome is not established.
 ...
PMID:Spectrum of chronic dyspepsia in the presence of the irritable bowel syndrome. 189 32

Nonulcer dyspepsia with or without duodenitis and duodenal ulcer disease are often considered to be a spectrum of the same acid-peptic process. Some reports evaluating basal gastric acid secretion in nonulcer dyspepsia and duodenal ulcer disease have supported that impression; however, results from different studies have been mixed. In order to compare basal gastric secretory profiles in nonulcer dyspepsia and duodenal ulcer disease, we determined basal acid outputs in 66 consecutive patients with the diagnosis of nonulcer dyspepsia. All patients with nonulcer dyspepsia had at least a three-month history of epigastric abdominal pain, and all had negative upper gastrointestinal endoscopies except for 14 with duodenitis. The 66 patients with nonulcer dyspepsia were compared to 40 asymptomatic normal subjects and 114 patients with endoscopically documented duodenal ulcer disease. There was no significant difference in mean basal acid output among all 66 patients with nonulcer dyspepsia (2.9 +/- 2.7 meq/hr), the group of normal subjects (3.2 +/- 2.7 meq/hr), the 14 patients with nonulcer dyspepsia with duodenitis (3.0 +/- 2.1 meq/hr), and the 52 patients with nonulcer dyspepsia without duodenitis (2.9 +/- 2.9 meq/hr). However, mean basal acid output of the patients with duodenal ulcer disease (9.1 +/- 7.6 meq/hr) was significantly higher than all the other groups (P less than 0.001). The gastric acid secretory profiles determined in this study do not appear to support the view that nonulcer dyspepsia with or without duodenitis and duodenal ulcer disease are a spectrum of the same acid-peptide process.
 ...
PMID:Basal gastric acid secretion in nonulcer dyspepsia with or without duodenitis. 291 46

Nonulcer dyspepsia remains a difficult disorder to treat because it is a heterogeneous syndrome. Once patients with the irritable bowel syndrome, esophagitis, and other organic diseases are excluded, there remain patients with dyspepsia of unknown cause (termed "essential dyspepsia") and patients with dyspepsia plus symptoms of gastroesophageal reflux without esophagitis. The aim of this study was to determine whether cimetidine or pirenzepine is efficacious in relieving the symptoms of these latter subgroups. Sixty-two consecutive patients were studied who had chronic upper abdominal pain or nausea where endoscopy had shown no evidence of peptic ulceration, esophagitis, or malignancy; 47 had essential dyspepsia, and 15 had dyspepsia plus gastroesophageal reflux. They were initially randomized to either cimetidine or placebo, or pirenzepine or placebo. Patients continued each medication for 1 mo, and, after a washout period, crossed over when again symptomatic; 51 patients completed cimetidine and placebo, and 50 completed pirenzepine and placebo. The results showed that cimetidine was superior to placebo in decreasing the number of upper abdominal pain episodes weekly and the severity of pain, but the absolute improvement was small. Pirenzepine was not superior to placebo in decreasing symptoms.
 ...
PMID:Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia. 351 48

Dyspepsia or indigestion is one of the most common disorders that is managed by general practitioners and gastroenterologists. Non-ulcer dyspepsia can be defined as upper abdominal pain or nausea in patients in whom endoscopy reveals no evidence of peptic ulceration or gastric cancer. Non-ulcer dyspepsia is a heterogeneous disorder and can be the result of such diverse entities as the irritable bowel syndrome, duodenitis or gastro-oesophageal reflux, or may be idiopathic ("essential" dyspepsia). This review traces the development of modern thought on dyspepsia and non-ulcer dyspepsia, from the 16th century to the present.
 ...
PMID:Dyspepsia and non-ulcer dyspepsia: an historical perspective. 354 May 42

Functional dyspepsia is defined as persistent or recurrent upper abdominal pain or discomfort not explained by structural or biochemical abnormalities. In about half of the patients who present to their practitioner with chronic dyspepsia, no underlying disease is established after clinical investigation. Many clinical trials have been performed to demonstrate a certain relationship between functional dyspepsia and several pathogenic mechanisms like dysmotility, Helicobacter pylori infection, acid output and hypersensitivity to distension. Unfortunately, the conclusions of those studies are conflicting. Short-term follow-up, lack of consensus about diagnostic criteria for functional dyspepsia and unvalidated symptom measures make it difficult to interpret their results.
 ...
PMID:Functional dyspepsia. 776 Sep 72

It was investigated whether central pain mechanisms including the endogenous antinociceptive system were involved in functional dyspepsia defined as: abdominal pain without abnormal findings. Pain sensitivity was measured by an ischaemic pain test comparing 21 functional dyspepsia patients with two control groups: 1) 24 patients with organic abdominal pain, and 2) 13 healthy pain-free controls. The endogenous opioids beta-endorphin, met-enkephalin immunoreactivity, and dynorphin immunoreactivity were measured in cerebrospinal fluid (CSF) from nine patients with functional dyspepsia and pain-free controls undergoing minor surgery while under spinal analgesia. There was no significant difference between the groups in pain sensitivity, but subdivision of the functional dyspepsia group showed that individuals with pain and no symptoms of irritable bowel syndrome (IBS) were significantly more sensitive to ischaemic pain than functional dyspepsia patients with IBS. The CSF beta-endorphfin concentration was significantly decreased in the functional dyspepsia group as compared with the controls. There were no significant group differences regarding met-enkephalin immunoreactivity and dynorphin immunoreactivity. Because of post-lumbar-puncture headache, this part of the investigation was suspended after nine patients. Functional dyspepsia is probably a pain syndrome with decreased central antinociceptive activity.
 ...
PMID:[Reduced concentration of beta-endorphin in cerebrospinal fluid and reduced pain tolerance in patients with functional dyspepsia]. 783 29

Non-ulcer dyspepsia (NUD) means the presence of upper abdominal pain and discomfort and also nausea, vomiting, flatulence, heartburn and belching. It is estimated, that about 20-30% of all patients refer to a doctor because of dyspeptic symptoms. Helicobacter pylori (Hp) infections are diagnosed in about 60% of persons with NUD and in 80-100% of patients with clinical, endoscopic and histological diagnosis of gastritis. The authors decided to investigate a correlation between gastritis and Hp infection and a relationship between the influence of antibacterial therapy and Hp eradication from gastric mucus and to observe gastric mucosa condition. We examined 73 patients (range age 16-73): 40 females and 33 males. We employed the Sydney System for evaluation of gastric mucosa condition. The patients were divided into two groups: Hp-positive 50 persons and Hp-negative-23 persons. Hp infected subjects were treated with antibacterial drugs (bismuth + metronidazol + amoxycillin or bismuth + metronidazol + tetracycline) and Hp-negative only with bismuth. Hp eradication was obtained in 72.7% of patients treated with bismuth + metronidazol + amoxycillin and 76.4% of persons treated with bismuth + metronidazol + tetracycline. A statistically significant difference between these two kinds of antibacterial therapy was not noted. Both methods are equally effective. We observed also and improvement of the histological state of antrum and corpus gastric mucosa after therapy in comparison to changes before treatment. We noticed a decrease of dyspeptic complaint in 89.2% of Hp infected persons in whom Hp had been eradicated. Among Hp-negative 23 patients gastric mucosa was normal in 30% and chronic gastritis was found in 70% of subjects. Based upon the present results it seems very important and suitable to detect Hp organisms in gastric mucus of all dyspeptic patients who are endoscopically examined and biopsied at the same time. We would suggest to do an urease test and to take histological samples together with full endoscopic examination according to the Sydney System guidelines.
 ...
PMID:Non-ulcer dyspepsia and Helicobacter pylori infection--morphological analysis according to the Sydney system--changes before and after treatment. 885 27

Pathological processes and diseases of the upper gastrointestinal tract have become increasingly recognized over recent years as childhood entities responsible for a variety of upper gastrointestinal symptoms previously labelled as functional or non-organic. The term 'dyspepsia' is an adult one whose definition requires clarification before use in the paediatric context, but it encompasses age-dependent symptoms such as feed-associated irritability in the infant, peri-umbilical pain in the younger child, and heart-burn, nausea, and indigestion in the older child as in adults. The possible organic conditions giving rise to such symptoms are multiple and multiorgan and include: gastro-oesophageal reflux; peptic ulcer disease; upper gastrointestinal Crohn's disease; antroduodenal motility disorders; pancreatitis; cholecystitis; cholelithiasis; biliary dyskinesia; and abdominal migraine. However, Munchausen syndrome by proxy must not be forgotten. Non-ulcer dyspepsia, it is now clear, has a basis in altered gastroduodenal motility and may be amenable to propulsion agents. In many individuals the dyspeptic symptoms of recurrent abdominal pain may be altered by psychotherapeutic intervention. Indeed there remains a proportion of children who undoubtedly have a behavioural or psychological base to their complaint. Nevertheless, with the recent increase in diagnostic yield from improved technical investigative aids available to paediatrics in the last 5-10 years, it is clear that the responsibility of the paediatrician to the child to find a cause of their symptoms is paramount. The variety of presenting features, possible causes of these symptoms, and appropriate investigation and treatment will be discussed, and management algorithms based on published literature and personal practice will be offered.
 ...
PMID:Dyspepsia in infants and children. 989 91

Nonulcer dyspepsia is a description of persistent or recurrent upper abdominal pain or discomfort with no structural or biochemical explanation for the patient's symptoms. The exact cause of nonulcer dyspepsia is not known, but many myths have evolved regarding its etiology and treatment. The goal of this review is to evaluate the potential causes of nonulcer dyspepsia. By determining what it is and what it is not, we can be more selective in our approach to diagnosis and our choice of empiric therapies.
 ...
PMID:Nonulcer dyspepsia: what it is and what it is not. 1091 66


1 2 3 Next >>