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)

Sucralfate is an unabsorbed antiulcer drug that binds to gastrointestinal tissue and protects it from acid and pepsin. Twenty-two arthritic patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) were given sucralfate concomitantly for two weeks in an attempt to lessen gastrointestinal side effects. Changes from baseline in abdominal discomfort were assessed after 2, 7, 10 (or 11), and 14 days of treatment. Sucralfate administration was accompanied by the disappearance of heartburn, epigastric pain, epigastric distress, or epigastric burning in 42 of 59 occurrences, and by statistically significant reductions in bloating. There was a trend toward significance in decreased nocturnal abdominal pain and in belching. Overall improvement, assessed at the completion of each patient's treatment, also was statistically significant.
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PMID:Sucralfate in the relief of gastrointestinal symptoms associated with nonsteroidal anti-inflammatory drugs. 383

This paper reports a family in which idiopathic megaduodenum occurred. The index case was a 17 year old male with lifelong steatorrhea, episodic vomiting of food consumed days before, offensive belching, and recurrent abdominal pain and distention. The diagnosis was made by a barium meal examination, but only after a failed small bowel biopsy suggested some anatomical abnormality. Direct questioning about family members then revealed that his father, aged 43 years, had similar symptoms and a subsequent barium meal confirmed the diagnosis. Screening of the family revealed megaduodenum in the 20 year old sister who was totally asymptomatic and had normal fecal fat levels but an abnormal breath test. The remainder of the family members were asymptomatic and had normal radiology. This family, in which idiopathic megaduodenum occurred in three of six members, is reported because it illustrates some of the features of idiopathic megaduodenum and chronic idiopathic intestinal pseudo-obstruction. It also demonstrates the need to investigate the families of apparent sporadic cases. Such investigation may uncover additional symptomatic and asymptomatic individuals who may be presenting diagnostic difficulty, and who, by virtue of an early diagnosis, may be spared unnecessary surgery.
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PMID:Chronic idiopathic megaduodenum in a family. 385 57

The efficacy and safety of the peripheral kappa-receptor agonist fedotozine was investigated in a double-blind, placebo-controlled, dose-ranging study involving 146 patients with nonulcer dyspepsia (NUD). After a two-week washout, patients were assigned to one of four groups to receive either placebo or fedotozine three times a day at doses of 10, 30, or 70 mg for six weeks. Analysis of mean symptom intensity scores showed that the 30-and 70-mg doses of fedotozine were superior to placebo in relieving postprandial fullness, bloating, abdominal pain, and nausea. Eructation and early satiety were marginally affected. The 30-mg dose was significantly more effective than placebo in reducing the total symptom score. Eight-two mostly minor adverse effects were recorded, but no significant differences in distribution emerged between placebo and treatment groups. The number of withdrawals declined significantly as a function of increasing dose. These results indicate that 30 mg three times a day is the minimal effective dose of fedotozine in the treatment of NUD symptoms and that this treatment is safe.
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PMID:Double-blind dose-response multicenter comparison of fedotozine and placebo in treatment of nonulcer dyspepsia. 817 19

The authors examined 48 children of Helicobacter pylori positive parents: 52% were serologically positive for Helicobacter pylori using the Orion Diagnostics Pyloriset Latex agglutination test. Of these children 10 had upper abdominal pain, heartburn and acid eructation and osesophagogastroscopy was performed; seven were found to be Helicobacter pylori positive histologically. These results draw attention to the transmission of Helicobacter pylori infection within families. They suggest that these children should be reviewed regularly, and the diagnostical examinations need to perform if the clinical picture is suspicious of Helicobacter pylori infection.
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PMID:[Helicobacter detected in children of Helicobacter pylori-positive parents]. 842 29

Medical treatment of duodenogastroesophageal reflux in postgastrectomy patients has been disappointing. Using ambulatory esophageal bilirubin monitoring, we evaluated the efficacy of cisapride in this disorder. Ten chronically symptomatic partial gastrectomy patients (5 Billroth I, 5 Billroth II; 8 men; average age 57) with duodenogastroesophageal reflux were randomized to four weeks of either placebo or cisapride (20 mg four times a day) in a double-blind crossover study. Significantly improved patients continued to take cisapride for an additional four months. Duodenogastroesophageal reflux was assessed at baseline and after four weeks on each therapy. Daily diary recorded symptoms and mean monthly scores were determined. Global symptom improvements were assessed at the end of each treatment period. Compared to placebo, cisapride significantly (P < 0.05) decreased duodenogastroesophageal reflux. Overall symptom improvements were assessed at the end of each treatment period. Compared to placebo, cisapride significantly (P < 0.05) decreased duodenogastroesophageal reflux. Overall symptoms improved in 70% of patients on cisapride compared to 10% on placebo (P < 0.01). Mean monthly scores significantly (P < 0.05) improved for abdominal pain, regurgitation, and belching. These symptoms remained improved after four months of chronic therapy. We conclude that cisapride significantly reduces duodenogastroesophageal reflux and results in short- and long-term symptom improvements in postgastrectomy patients and that cisapride offers the first successful medical therapy for duodenogastroesophageal reflux in postgastrectomy patients.
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PMID:Placebo-controlled trial of cisapride in postgastrectomy patients with duodenogastroesophageal reflux. 867 97

Helicobacter pylori-like organisms (Hp) and polymorphonuclear leucocytes (PMNs) in 2614 gastroduodenal biopsies from 602 patients with dyspepsia, in Al Ain, United Arab Emirates, between October 1990 and October 1992, were histologically graded to determine the prevalence of Hp gastritis and their utilization in the evaluation of treatment efficacy in these patients. Symptoms of functional dyspepsia included, in order of frequency, abdominal pain or discomfort, flatulence, burning sensation, regurgitation, fullness, nausea, vomiting, bloating and belching. The biopsies were paraffin embedded, sectioned and stained with hematoxylin and eosin (H and E) to grade the inflammation. In addition to H and E, several special stains including modified Giemsa (MG), Wharthin-Starry silver and cold Ziehl-Neelsen stains were utilized to clearly identify Hp organisms. Giemsa method was found to be superior to other special stains in visualizing the Hp organisms in paraffin sections, and was utilized in every case. Two immunohistochemical markers for B cells (CD20) and T cells (CD45RO) were utilized for labeling lymphocytes infiltrating the lamina propria of the gastroduodenal biopsies in formalin-fixed paraffin-embedded sections. H and E and MG stained sections were utilized to count PMNs and Hp, and were graded 0, 1, 2, and 3, corresponding to none, mild, moderate, and severe grades of the Sydney system for classification of gastritis, respectively. Of the total initial 2318 endoscopic biopsies, 98.8% of the patients had suitable biopsies for histologic evaluation. Unsuitable biopsies were recovered from patients with gastric carcinoma. Inflammation was seen in 98.5% of 595 patients with suitable biopsies. In 74.5% of these patients the inflammation was active; 37.5, 32.5 and 4.5% had mild, moderate and severe active inflammation, respectively. In the remaining 24% of the 595 patients, the gastritis was chronic without activity or atrophic changes. As many as 73.6% of the patients with suitable biopsies were Hp positive; 39.8, 29.1 and 4.7% had grades 1, 2 and 3 Hp, respectively. Intestinal metaplasia was found in 28.9% of the 602 patients, and was seen more often in Hp positive than Hp negative patients (34.5 vs 14%, P < 0.005, for d.f. = 1; chi 2 = 10.35). Of the Hp positive patients, 172 and 46 patients attended the first and second follow-up endoscopy visits, respectively. The triple treatment was composed of one dose of tinidazole (2gm), doxycycline, 200 mg initial dose and 100 mg daily for two weeks, and bismuth subcitrate (Gist-Brocades nv, Delft, The Netherlands), 2 tablets twice daily for 4 weeks. After triple drug treatment, eradication of Hp was accomplished, histologically, in 38.4 and 45.7% of the patients on first and second follow-up visits, respectively. Thus, the Sydney system-based grading scale provides an objective histological evaluation of Hp gastritis for accurate prevalence studies, and may prove to be of value in estimating treatment efficacy.
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PMID:Grading Helicobacter pylori gastritis in dyspeptic patients. 881 77

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.
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PMID:Non-ulcer dyspepsia and Helicobacter pylori infection--morphological analysis according to the Sydney system--changes before and after treatment. 885 27

Abnormalities in gastrointestinal motility have been reported in a substantial proportion of patients with functional dyspepsia, supporting the use of prokinetic drugs for treatment of dyspeptic symptoms. To evaluate efficacy and safety of levosulpiride in short-term treatment, 1298 patients were enrolled in a double-blind multicentric study carried out in 45 Italian Gastroenterology Departments. Patients were randomly assigned to either levosulpiride (25 mg tid), domperidone (10 mg tid), metoclopramide (10 mg tid) or placebo (1 tablet tid) for 4 weeks. Patients were selected on the basis of: a) occurrence in the last 4 weeks of at least 5/10 selected symptoms (anorexia, nausea, vomiting, upper abdominal pain, postprandial bloating, abdominal fullness, early satiety, belching, heartburn, regurgitation), severity of which should reach/exceed a total score of 8, as assessed by a specific scale ranging from 0 (absent) to 3 (severe); b) normal results of routine biochemical, ultrasound and endoscopic examinations. In addition, each patient subjectively evaluated efficacy of treatment by a visual analogue scale. Significant improvement was recorded for all symptoms at days 10 and 28 in all groups (p < 0.001), but levosulpiride was significantly (p < 0.01) superior to domperidone, metoclopramide and placebo both in the overall clinical improvement scale as well as in a subgroup of symptoms (postprandial bloating, epigastric pain, heartburn). Active treatments and placebo were comparable as far as concerns occurrence of side-effects (12-20%) including galactorrhoea, breast tenderness and menstrual changes.
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PMID:Levosulpiride in functional dyspepsia: a multicentric, double-blind, controlled trial. 889 46

Helicobacter pylori has been associated with a number of upper gastrointestinal diseases. Treatment directed toward H. pylori promotes ulcer healing and decreases ulcer recurrence. This study reports a longer-term quality of life follow-up in a group of patients treated for H. pylori. Thirty patients who were treated for upper gastrointestinal symptoms at least 2 years (median 32 months) prior to the initiation of this study had the Gastrointestinal Symptom Rating Scale questionnaire mailed to them. 19 patients responded. This scale measures abdominal pain, heartburn, acid regurgitation, sucking sensations in the upper abdomen, nausea and vomiting, borborygmus, abdominal distention, and belching. Three groups of patients were studied: symptomatic patients without H. pylori infection, symptomatic patients with H. pylori infection and successful eradication, and symptomatic patients with H. pylori infections without eradication. The median symptom scores for each group were no more than 1.5. However, there were no statistically significant differences among these three groups in any of the eight items measured by the Gastrointestinal Symptom Rating Scale. The sample size of this study was sufficient to detect a difference between groups of 1.6. Patients treated for H. pylori have no to occasional upper gastrointestinal symptoms in more than 2 years' follow-up. There appears to be no difference in patients treated for the infection and those without the infection.
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PMID:Long-term quality of life outcome after treatment for Helicobacter pylori gastric infection. 916 72

The meaning and definition of dyspepsia continues to challenge clinical investigators and has led to the setting up of several international working teams. However, confusion continues to reign around this term. The effort to classify patients with dyspepsia into subgroups according to their most predominant symptoms has failed to provide clues to the underlying disease, or even to discriminate between functional and organic dyspepsia. With these limitations in mind, the question arises: is there any reason for putting further effort into developing a world-wide definition of dyspepsia when, in addition to the aforementioned shortcomings, further variables such as geographical region, ethnic background, culture and sanitary resources come into play? The answer is that only by establishing a reproducible methodology for individual symptom assessment using a well-defined protocol will comparisons of the prevalence of dyspepsia and the impact of different therapeutic interventions become possible around the world. The data on dyspepsia prevalence, nearly all arising from studies in a few developed geographical areas and countries, are of the order of 1-4% of all consultations in all primary care medicine. However, estimates of adults affected by dyspepsia are as high as 20-40%. The magnitude of these statistics underlines the necessity for further work on the concept of dyspepsia and its major functional subgroups, following the exclusion of any organic causes. Issues such as 'investigate dyspepsia before starting with any kind of treatment or treat dyspepsia before further investigation' or the debate about whether to 'eradicate or ignore Helicobacter pylori in functional dyspepsia' will remain unresolved unless studies performed throughout the world use widely comparable and acceptable definitions and criteria for these conditions. Since the first international working party report in 1988, definitions of dyspepsia have included the description of 'upper abdominal pain or discomfort' and, more recently, have specified 'pain or discomfort centered in the upper abdomen' in order to emphasise further the site of origin as the upper alimentary tract (stomach-duodenum). However, a major change was evident in the more recent Rome I and Rome II reports, in which the symptoms heartburn, acid regurgitation, and belching were excluded from the definition of dyspepsia because of their relation to gastroesophageal reflux disease (GERD) and aerophagia. The intention to define a set of symptoms for dyspepsia is good, but we continue to be faced with overlaps. How should the patient with epigastric pain and heartburn after endoscopic exclusion of duodenal ulcer and reflux esophagitis be classified: dyspepsia or GERD? In cases of abnormal gastroesophageal reflux, 24-h pH monitoring could help to resolve this dilemma, but what if this investigation turns out to be normal? In this field, we need to perform careful studies. In addition, we need to consider the lifestyle and cultural habits of people around the world when translating upper gastrointestinal symptoms into dyspepsia. A step forward in the definition of dyspepsia was attempted by the recent working party for the Rome II consensus on functional gastrointestinal disorders (N. Talley et al.). In this project, the symptoms of dyspepsia were individually described not by a single term, but by painting a 'word picture', to make it easier for patients to express their symptoms, and give doctors and clinical investigators a better understanding of the 'dyspeptic problem' of each individual. It is advisable to follow this approach, since a clear picture of a patient's symptoms, including their duration and intensity, in association with the modern technical approaches that allow investigation beyond organic causes of dyspepsia, will lead to progress in our understanding and better communication about this problem within the medical community, and ultimately to better treatment.
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PMID:Current concepts in dyspepsia: a world perspective. 1044 9


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