Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The significance of the human immunodeficiency virus (HIV) in the small intestinal lamina propria in patients with the acquired immune deficiency syndrome or conditions related to that syndrome who have chronic diarrhea and malabsorption is unclear. To investigate this issue, upper endoscopy (after a 12- to 16-hour fast) with duodenal biopsy and aspirate was performed in 20 HIV-infected seropositive homosexual men referred for diarrhea of more than 8 weeks duration (Group 2) and in 9 HIV-infected homosexual men referred for dysphagia or dyspepsia with no symptoms of malabsorption (Group 1). All biopsy specimens were examined by light microscopy and immunochemical staining with monoclonal antibody against HIV glycoprotein gp41. Electron microscopy was performed in 18 patients in Group 2 and in all patients in Group 1. Immunogold electron microscopy was used as a confirmatory test for identified HIV particles. In addition, D-xylose absorption was measured in all patients after a 25-g dose of D-xylose with measurement of serum D-xylose concentration 1 hour after the dose and measurement of 5-hour urinary D-xylose excretion. Mean serum D-xylose was 35.4 +/- 4.5 mg/dL in Group 1 and 15.8 +/- 2.3 mg/dL in Group 2 (P less than 0.001), whereas mean urine D-xylose was 5.5 +/- 0.6 g in Group 1 and 2.0 +/- 0.4 g in Group 2 (P less than 0.001). Immunoperoxidase for gp41 was positive in 5 (56%) patients in Group 1 and in 12 (60%) patients in Group 2. Lamina propria HIV viral particles were identified by electron microscopy in both patient groups. Viral particles were seen within and adjacent to the cytoplasm of mononuclear cells and were not present in enterocytes or neuroendocrine cells. There were no significant differences in serum or urine D-xylose tests between patients with and without lamina propria HIV. In addition, lipid accumulation in intercellular spaces near the basolateral membrane of adjacent enterocytes was seen in 33% of patients with chronic diarrhea. These findings suggest that lamina propria HIV is not a direct cause of enteropathy in HIV-infected patients and that lymphatic obstruction may be one pathophysiologic mechanism producing this malabsorptive state.
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PMID:Histopathologic findings of duodenal biopsy specimens in HIV-infected patients with and without diarrhea and malabsorption. 141 28

T cell subsets in the gut mucosa are distinct populations and their imbalance in HIV has specific implications in infection. Alterations in T cell subsets in duodenal biopsies were investigated in 17 asymptomatic HIV patients, 24 AIDS patients and 10 controls with non-ulcer dyspepsia. Immunohistochemistry and immunofluorescence using MoAbs to CD3, CD4, CD8, CD68, CD45RA, CD45RO and gp120 were performed on frozen sections. In the lamina propria, there was a significant depletion of CD4+ cells at all stages of HIV, but the density of CD8 lamina propria cells was increased. Intraepithelial lymphocytes were decreased in AIDS patients. There was a significant correlation between cellular density and mucosal CD3+ lymphocytes, and between mucosal CD3+ and CD8+ lymphocytes. Although mucosal CD4,CD45RO+ 'memory' cells were decreased, CD8,CD45RO+ 'memory' cells were increased. Mucosal CD4+ lymphocyte depletion occurred early in HIV, and thus their role in mucosal protection against opportunistic infection should be revised. Mucosal CD8+ lymphocytes initially increased, but decreased when CD4 blood counts were depleted, perhaps contributing to loss of host protection against infection. Intraepithelial lymphocyte depletion may also contribute to opportunistic infection.
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PMID:Loss of mucosal CD4 lymphocytes is an early feature of HIV infection. 809 58

Our purpose in conducting this descriptive study was to assess the health-related concerns and experiences of a sample of employed perimenopausal women in Alexandria, Egypt. In addition, we explored their help-seeking behavior and their perception of symptoms. We interviewed two hundred working women ages 40-60 years, 42% of whom were nurses, using a semistructured interview form as well as Koos's list of symptoms. The commonly mentioned concerns, in order of frequency, were chronic headaches, chronic fatigue, transportation and phone communication problems, financial problems, job dissatisfaction, backaches, hypertension, kidney disease and gall bladder disease, gastritis/indigestion, menstrual disturbances, arthritis, AIDS, and hepatitis B. With respect to the problems experienced by the women in the past 6 months, there was a high self-reported prevalence of headaches, fatigue, transportation and communication problems, backaches, job dissatisfaction, dissatisfaction with health insurance, financial problems, menstrual disturbances, gastritis/indigestion, gall bladder disease, anxiety, disturbed sleep, and hypertension. Women attempted to manage their problems mainly by taking over-the-counter drugs and self-prescribing (75.5%), doing nothing or using traditional remedies (56.5%), and going to a doctor or health insurance office (40%). Symptoms perceived by the majority of the women as not needing medical attention included loss of appetite, persistent backache, bleeding gums, chronic fatigue, persistent headaches, and loss of weight. The influence of education and occupation on women's perceptions and practices is discussed.
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PMID:Health-related concerns and experiences of employed perimenopausal women in Alexandria, Egypt. 885 19

A survey of 72 patients at an AIDS clinic regarding self-medication with recreational drugs for medical or psychological conditions related to their illness disclosed that marijuana was the primary drug used. The perceived benefit was for gastrointestinal conditions such as nausea, vomiting, indigestion and appetite improvement. Use of other "recreational" drugs as self-medication was reported to usually be ineffective or to worsen the condition they sought to help. Fifty-eight percent of patients reported some attempt to self-medicate. Thirty-two percent were currently using marijuana, and most admitted to pre-AIDS marijuana use. Fifty-seven percent of the sample reported some pre-AIDS drug use, primarily alcohol and marijuana. Results are discussed in terms of potential clinical problems arising from continued recreational drug use among AIDS patients.
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PMID:Medical use of recreational drugs by AIDS patients. 924 37

Several serotonin (5-HT) receptor subtypes have been defined by pharmacological responses to selective agonists and antagonists and by pathways of receptor-effector coupling. Using molecular techniques, additional receptor subtypes have been described. 5-HT receptors are prevalent in the central nervous system and gut and participate in induction of emesis. 5-HT3 antagonists are used to prevent emesis from cancer chemotherapy and also demonstrate efficacy in radiation-induced nausea, postoperative nausea, hyperemesis gravidarum, and nausea and vomiting with the acquired immunodeficiency syndrome. 5-HT4 agonists exhibit prokinetic properties in nauseated patients with gastroparesis and functional dyspepsia. Conversely, 5-HT4 antagonists have antiemetic activity in some experimental models. The 5-HT1D receptor agonist sumatriptan reduces emesis with migraine headaches and in cyclic vomiting syndrome, most likely via action on central nervous system sites. In other models, 5-HT1A and 5-HT2A/5-HT2C agonists exhibit antiemetic properties. The utility of 5-HT receptor ligands in treating emesis is the subject of active investigation.
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PMID:Serotonin receptor physiology: relation to emesis. 1049 49

The objectives of this study were to describe the clinical presentations and outcomes of all HIV+ patients who presented to the Emergency Department (ED) with a chief complaint of abdominal pain and to compare the outcomes of those with advanced disease (CD4 < 200/mm(3)) to those with early or middle stage disease (CD4 >or= 200/mm(3)). We conducted a retrospective chart review in an urban municipal hospital ED and included subjects if they were HIV+ and had a chief complaint of abdominal pain. Demographic and clinical data were entered into a standardized database; patients with advanced disease were compared with those with early or middle stage disease. One hundred eight patient visits were reviewed. The mean age was 37 +/- 7.6 years with mean CD4 count of 263/mm(3); 44% had CD4 counts <200/mm(3). Abdominal pain of unknown etiology, gastroenteritis/diarrhea, and ulcer disease/gastritis/dyspepsia were the three most common diagnostic categories for all patients. With the exception of disseminated mycobacterial disease, there were no statistically significant differences between the two groups. AIDS-associated opportunistic infections represented only 10% of the ED diagnosis of those patients with advanced disease. Only 8% of patients required intra-abdominal surgical procedures, however, 37% were admitted compared with 18% of patients without HIV disease (p < 0.001). Patients infected with HIV presenting with abdominal pain most often have a non-HIV related cause of abdominal pain and infrequently require surgery. However, HIV+ patients are admitted at twice the rate of the non-HIV infected population.
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PMID:Abdominal pain in the HIV infected patient. 1235 77

Helicobacter pylori is a causative organism for chronic gastritis and associated with peptic ulcer disease. Infection may be asymptomatic as well. Human immuno-deficiency virus infection predisposes to a multitude of opportunistic infections, many of them resulting in gastrointestinal symptoms. We studied the prevalence of H pylori co-infection with HIV and its correlation with gastrointestinal symptoms in HIV infected patients. Seventy-three consecutive HIV infected patients presenting to the medical out patient department of Postgraduate Institute of Medical Education & Research, Chandigarh, India, were included in the study. Antibodies (IgG) to H pylori were tested by ELISA. There were 43 males, 30 females; mean age 26.1 +/- 4.7 years. Risk factors for acquiring HIV infection was predominantly heterosexual exposure. Eleven patients presented with gastrointestinal symptoms. Thirty-five of the 73 (47.9%) patients had serological evidence of H pylori infection. Six of them had gastrointestinal symptoms. These were odynophagia in 5, dyspepsia in 4 and recent diarrhoea in 2. Twenty-four patients with H pylori infection had AIDS. There was no difference in the prevalence of H pylori infection between patients with and without AIDS.
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PMID:Helicobacter pylori in Indian HIV infected patients. 1263 75

This study aimed to estimate the incidence of gastrointestinal symptoms (GIS) and associated factors in an outpatient cohort of people living with HIV/AIDS (PLWHA) followed between October 2009 and July 2011. We evaluated nausea and/or vomiting, dyspepsia, heartburn, diarrhea, constipation, and flatulence. The outcome variable was the presence of three or more GIS. Sociodemographic (sex, skin color, age, income, years of schooling), lifestyle (smoking status, alcohol consumption, physical activity level), clinical (antiretroviral therapy, time of HIV infection, CD4 lymphocyte count, viral load), and anthropometric (nutritional status and waist circumference) variables were investigated. Data on sociodemographic and lifestyle variables were collected through a pre-tested and standardized questionnaire. CD4 count was determined by flow cytometry and viral load by branched DNA (bDNA) assays for HIV-1. All variables were analyzed at a p<0.05 significance level. Among 290 patients, the incidence of three or more GIS was 28.8% (95% CI 23.17 to 33.84) and 74.48% presented at least one symptom. Female gender (IR 2.29, 95% CI 1.63 to 3.22) and smoking status (IR 1.93, 95% CI 1.30 to 2.88) were risk factors for the presence of three or more GIS after multivariate Poisson regression. A high incidence of gastrointestinal symptoms was found among PLWHA, and it was significantly associated with female sex and tobacco use. Those results reinforce the relevance of investigating the presence of GIS in PLWHA as it may affect treatment adherence.
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PMID:Gastrointestinal Symptoms in HIV-Infected Patients: Female Sex and Smoking as Risk Factors in an Outpatient Cohort in Brazil. 2774 31