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)

From a computerized database comprising 28 pertinent items in each of a consecutive series of 664 patients with cholelithiasis, differences were studied between men and women. In 52 patients there was a documented attack of acute pancreatitis (7.8%). Twenty-five of 174 men had pancreatitis, compared with 27 of 490 women (p less than 0.0001). Men developed gallstones later in life than women, but suffered gallstone pancreatitis earlier in life and in the course of their gallstone-related disease. A history of flatulent dyspepsia, chronic cholecystitis, and biliary colic was less common in men than in women with pancreatitis (p less than 0.0001). Men with pancreatitis had fewer stones in their gallbladders than did women (p = 0.0002). The cystic duct and the common bile duct in the pancreatitic patient were more likely to be dilated (p less than 0.0001). In the nonpancreatic group, these ducts were larger in men. Pancreatic duct reflux on operative cholangiography was more common both in patients with pancreatitis 62% cf 14% (p less than 0.0001), and in men (p less than 0.001). Predisposition to pancreatitis relates to duct size rather than stone size per se. Men are more susceptible to gallstone migration at an early stage of their disease. In addition they have a larger diameter duct system and possibly a different anatomic disposition of the sphincter of Oddi, which predisposes them to a higher incidence of pancreatitis than women. The data suggest that it is cystic duct size that is critical in the pathogenesis of gallstone pancreatitis.
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PMID:Sex differences in gallstone pancreatitis. 144 54

The term "postcholecystectomy syndrome" indicates etiologically and pathogenetically various lesions of the organism related to variably expressed symptoms of pain and dyspepsia. The author has performed endoscopic retrograde cholangiopancreatography (ERCP) to 60 patients with "postcholecystectomy syndrome" to find out what underlies this syndrome. In 34 (56%) of the patients the biliary ducts were dilated. The most frequent cause of this was Vater's papilla stenosis, which was found in 26 patients (43%). The author is of the opinion that this stenosis preceded the cholecystectomy and was the result of inflammatory processes related to cholelithiasis. In 20 patients stones were found in the biliary ducts, single or multiple. In most cases the stones in the biliary duct had been missed during the cholecystectomy. In some patients the stones in the biliary duct were formed after the operation. In 26.6% of the patients ERCP helped in discovering other diseases such as chronic pancreatitis, duodenal ulcer and peripapillary diverticulum which are in the basis of the "postcholecystectomy syndrome". The author recommends to every patients with persistent complaints after cholecystectomy ERCP to be performed in order to find out the cause of the complaints and determine the correct treatment--medicamentous or surgical.
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PMID:[The so-called postcholecystectomy syndrome in light of the results of endoscopic retrograde cholangiopancreatography]. 189 12

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

60 patients with symptomatic gallstone disease were asked about their abdominal symptoms and food intolerance. Equally a healthy control group was investigated. Preoperatively, 72% of patients with gallstones suffered from right upper quadrant pain. Additionally all patients complained of associated dyspeptic symptoms (100% vs. 8% of the control group). 51% of patients with gallstone disease vs. 15% of the control group avoided flatulent and fatty food. 4 months after cholecystectomy, 90% were painfree, 82% were free of dyspeptic symptoms and 84% were not complaining of any food intolerance. 6% developed new food intolerances. Thus cholecystectomy seems to be an effective treatment, not only for typical gallstone related symptoms, but also for associated symptoms, such as dyspepsia and food intolerance. Different therapeutic regimens have to compete with these results.
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PMID:[Dyspepsia and food intolerance in symptomatic gallstone disease. Does cholecystectomy help?]. 191 43

Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder will relieve only these symptoms. Making this determination is a challenge, however, because the classic picture of biliary colic may be inaccurate and the connection between gallstone disease and flatulent dyspepsia is questionable at best. Descriptions of both these conditions are based on anecdotal evidence or reports of uncontrolled surgical series. A review of recent controlled trials suggests that the pain of biliary colic is constant and infrequent, comes in episodes lasting 1 to 5 hours, is located in the epigastrium or right upper quadrant of the abdomen, and characteristically occurs at night. There are few additional symptoms other than nausea or vomiting, and colic is not induced by eating fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the right upper quadrant, fatty-food intolerance, and bloating--is probably not related to the presence of gallstones in the majority of patients.
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PMID:Gallstone symptoms. Myth and reality. 192

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

We studied the prevalence of gallstones in patients with upper abdominal pain, heaviness, or discomfort by ultrasound examination of the gallbladder. The actual ultrasound examination was performed by a clinical gastroenterologist blinded to the symptoms. Of 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The gallbladder was contracted in 450 (91.2%), normal-size in 36 (7.2%), and distended in 8 (1.6%). Biliary colic was more frequently the presenting complaint in patients with a contracted gallbladder than in those with normal size gallbladder (p less than 0.001). Dyspepsia was more frequent in the presence of a normal size gallbladder than a contracted one (p less than 0.001). We conclude that ultrasonography of the gallbladder by the clinician has a high diagnostic yield, and the symptom complex has an excellent correlation with the sonographic appearance.
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PMID:Gallstone disease in north India: clinical and ultrasound profile in a referral hospital. 222 98

Cholecystectomy is standard treatment for symptomatic cholelithiasis. Long term relief from symptoms, however, has not been reported. We reviewed 671 elective cholecystectomies performed between 1982 and 1987 for biliary colic (group 1, 91 per cent), dyspepsia associated with gallstones (group 2, 5 per cent) and atypical pain syndromes (group 3, 4 per cent), to define precisely important variables for comparison with alternate methods of gallstone treatment. Cholecystectomy resulted in a mortality rate of zero per cent and an over-all morbidity rate of 4.5 per cent. The procedure-related morbidity rate was 2.2 per cent. Long term follow-up period for 81 per cent of these patients (mean of 45 months) showed that 88 per cent were free of symptoms. Patients in groups 1 and 3 were more likely to obtain relief from symptoms than those in group 2 (p = 0.10). We concluded that cholecystectomy is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of relief from symptoms. Alternative treatments for gallstones must compare favorably with these results of modern cholecystectomy prior to acceptance and widespread use.
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PMID:Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. 229 28

27 patients with radiolucent biliary stones in normofunctioning gall bladder were treated with a combination of CDCA and UDCA (CDCA doses = 7.7 mg/kg/day; UDCA--6.5 mg/kg/day); only 23 continued in the study for at least one year. The reasons for leaving were in one case the necessity of a cholecystectomy and treatment interruption in 3 cases. The rate of complete dissolution was of 39%, being of 17% the partial dissolution rate. The only biochemical alteration was the increase of HDL cholesterol at 9 and 12 months of treatment (p less than 0.05 and p less than 0.01 respectively). Transient diarrhea was seen in 17% of the patients and it did not require treatment. The incidence of liver colic during the year before treatment was 26% and it decreased during the 1st year of treatment to 4%. The non-specific dyspepsia observed during the year before treatment was of 48%, and decreased to 17% during the first year of treatment. Only one patient developed calcification of the gallstone, 12 months after treatment.
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PMID:[Combined therapy with chenodeoxycholic acid and ursodeoxycholic acid of radiolucent biliary lithiasis]. 249 Nov 84

Two hundred and fifty cases of biliary tract disease were studied as regards case history, physical and laboratory investigations, surgery and follow-up. It was found that females especially multipara were frequently affected; majority of cases were in 3rd to 5th decade of their life, rise in age showing decline in incidence. Majority of cases (82.4%) were vegetarians and had used vegetable fats (oriental diet). Most of the cases (98.8%) belonged to middle and poor class and were lean and thin. Pain in the right upper quadrant of the anterior abdominal wall had been the commonest symptom, in about half the cases it got aggravated by fatty meals. A mass was felt in the right hypochondrium in 29.6% and Murphy's sign was positive in 55.5% of cases. Radio-opaque calculi were present in 8% of cases, in another 10.8% the calculi were demonstrated by oral cholecystography, radiography could detect calculi in 47 (25.4%) cases and its overall diagnostic success rate has been low (56.8%). Ultrasonography proved more valuable tool for diagnosis; bile culture was positive in 8.8% of cases only for Esch coli, proteus, klebsiella, staphylococci or paracolon. Right subcostal incision gave the best results. Chronic cholecystitis with cholelithiasis (74%) was more common than acalculus cholecystitis (26%), incidence of carcinoma was 2.8%, and in 5 out of 7 cases malignancy was associated with cholelithiasis. Early diagnosis and cholecystectomy for gallstones can prevent malignancy. Surgery on the whole proved beneficial and it can be more rewarding if pre-operatively other causes of dyspepsia are either excluded or confirmed. Excluding cases of malignancy, the mortality has been quite low and thus acceptable.
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PMID:Gall bladder disease: an analytical report of 250 cases. 263


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