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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to correlate the effects of different coffees on esophageal acid contact, heartburn, and regurgitation in patients with coffee-sensitivity. Twenty volunteers with coffee-sensitivity were studied in a double-blind, 3 period, crossover study examining the effect of three regular (caffeinated) coffees (a coffee from the USA--"A"; a "treated" coffee from Europe--"B"; and an "untreated" coffee from Europe--"C") before and after a high-fat test meal. The median acid contact times for coffees A, B, and C were 6.5%, 9%, and 10.5%, respectively (A vs. C, p = 0.005). Significantly fewer patients reported any symptoms with coffee A compared with coffee C (p < 0.05). Symptoms were usually more frequent and severe after the test meal. There was a trend toward fewer and less severe symptoms with the treated coffee (B) compared with its untreated counterpart (C). Our conclusions are as follows: (a) Different coffees induce variations in gastroesophageal reflux in coffee-sensitive individuals. (b) Coffee can be treated in a manner which decreases heartburn symptoms by 75% while decreasing acid contact by only 14%. (c) Gastroesophageal reflux and symptoms of coffee sensitivity increase with the concomitant ingestion of food. (d) Symptoms of dyspepsia appear to be influenced by variations in both the coffee itself and characteristics of susceptible individuals. (e) Although gastroesophageal reflux is important in the genesis of coffee-sensitivity, there must be other factors which act in concert with reflux to produce symptoms of coffee-sensitivity.
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PMID:Effect of different coffees on esophageal acid contact time and symptoms in coffee-sensitive subjects. 775 95

The relation between symptom severity in gastro-oesophageal reflux disease (GORD) and quantitated oesophageal acid reflux is variable. Furthermore, when oesophageal acid exposure lies within the conventional normal range, the cause of the symptoms is unknown. This prospective study evaluated 24 hour ambulatory oesophageal pH profiles in relation to objective symptom scores in 100 dyspeptic patients who were free from ulcer and gall stones. Twenty patients had raised oesophageal acid exposure and reflux symptoms consistent with GORD, and 80 had oesophageal pH profiles within the conventional normal range. Forty four of the 80 had severe or moderate reflux symptoms and were classified as having reflux like functional dyspepsia (RFD); 36 had minimal or absent reflux symptoms, and were categorised as having non-reflux dyspepsia (NFD). While oesophageal pH profiles lay within the conventional normal range in both functional dyspepsia subgroups, patients with RFD had consistently greater acid exposure values as follows: mean (SEM) total oesophageal acid exposure time, RFD 16.2 (2.56) min v NFD 9.05 (2.0) min (p < 0.03); percentage of time with pH < 4, RFD 1.4 (0.2) v NFD 0.8 (0.2) (p < 0.03); DeMeester scores, RFD 12.8 (0.5) v NFD 11.4 (0.4) (p < 0.03). The RFD group had a pain/reflux event correlation of 23.8 (5.3)% v 8.1 (3.7)% for the NFD group (p < 0.01). This study shows that patients with RFD have oesophageal acid exposure that lies below the diagnostic threshold for GORD, but exceeds that of patients with NFD. The high pain/reflux event correlation in RFD, suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
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PMID:Importance of reflux symptoms in functional dyspepsia. 788 15

The aim of the present study was to determine the pattern of structural and functional disorders encountered in an Asian gastroenterological clinic and to compare this pattern with findings from Western centres. Consecutive new patients (totalling 2384) attending the clinics of two consultant gastroenterologists were studied. Of these, 2141 suffered from gastroenterological problems. One thousand and sixty-three (49.6%) had structural diseases, the commoner ones being liver disease, peptic ulcer, malignancy, haemorrhoids and gallstones. The remainder who were found to have no structural disease (n = 1078; 50.4%) were deemed to have functional disorders including non-ulcer dyspepsia, irritable bowel, simple constipation and functional diarrhoea. The proportions of functional and structural disease were similar to those in the West. Major differences included a higher frequency of hepatoma and a lower frequency of inflammatory bowel disease and gastro-oesophageal reflux in the present series.
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PMID:The pattern of functional and organic disorders in an Asian gastroenterological clinic. 800 43

In children with vomiting, dyspepsia, and feeding problems, gastroesophageal reflux (GOR) and altered gastric emptying are common. We have used electrical impedance tomography (EIT) to study children with suspected gastric emptying disorders. Abnormalities of the gastric emptying curve suggestive of GOR were seen in some, with marked negative or positive shifts related to sharp increases or decreases in intragastric resistance. These findings could represent fluid leaving or entering the stomach, as might occur in GOR. To confirm the origin of the abnormal EIT curves, we devised and in vitro tank test system, and we performed simultaneous 2-h EIT and intraoesophageal pH monitoring after a glucose meal on six patients. In vitro, reflux of > or = 25 ml produced clearly detectable changes on the emptying curves. In vivo, the overall correlation between the times of 42 GOR episodes lasting > or = 1 min detected by pH study and the times of 38 negative peaks due to > or = 15% changes of the maximum intragastric resistivity detected by simultaneous EIT was significant; the correlation was highly significant in four of six patients. When the peaks were used to define GOR episodes on EIT gastric emptying curves, the two methods still showed good agreement. Retrospective examination of 50 patients who had undergone both EIT and 24-h intraoesophageal pH study during their diagnostic workup showed that EIT had a sensitivity of 94.6% and a specificity of 76.9% (with positive and negative predictive values of 0.92 and 0.83, respectively) for the detection of pathological GOR.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Detection of gastroesophageal reflux by electrical impedance tomography. 801 69

Upper endoscopy is currently one of the most frequently performed procedures. The most common indications for diagnostic EGD include dyspepsia unresponsive to medical therapy or associated with systemic signs, dysphagia or odynophagia, persistent gastroesophageal reflux symptoms, occult gastrointestinal bleeding, and surveillance for malignancy. These guidelines, however, are largely based on consensus opinion, and few controlled trials have evaluated the effect of endoscopy on patient outcome, medical expenditures, and management. It appears that the benefits of therapeutic upper endoscopy for such conditions as acute gastrointestinal bleeding, foreign-body removal, and stricture dilatation are more well defined. Future studies should be directed at the most cost-effective and beneficial management strategies for many of these common conditions.
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PMID:Indications and contraindications for upper gastrointestinal endoscopy. 806 70

Functional dyspepsia covers various symptoms associated by the physician with the upper gastrointestinal tract without an identifiable organic cause. The existence of dyspepsia subgroups according to different symptom complexes, e.g. so-called "ulcer-like dyspepsia", has not been proved. Gastro-esophageal reflux disease is a distinguishable independent entity. Little is known about the pathogenesis of this common syndrome. Disturbances of gastric motility, especially postprandial antral hypomotility, are found in 50% of these patients but offer no explanation of the dyspeptic symptoms. Neither abnormal gastric acid secretion nor abnormal acid sensitivity has been proved in these patients. Furthermore, no relation between the symptoms and a Helicobacter pylori infection or a functional disturbance of the biliary tract has been established. In some cases fatty foods can provoke dyspeptic symptoms. Unfavorable psychosocial factors can influence the decision to consult a physician for dyspepsia. Recently, a lowered threshold of perception of stomach and small intestine distension in dyspepsia has been demonstrated. This disturbance of perception offers a new basis for further understanding and for possible treatment. Prokinetic agents can be of help in the treatment of functional dyspepsia. H2-receptor antagonists are most effective in patients presenting symptoms of gastro-esophageal reflux disease. Empiric therapeutic trials in this disease entity, which shows a high placebo response rate (between 30% and 60%), are not of proven value.
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PMID:[Functional dyspepsia. Old wine in new bottles?]. 815 99

Antacids have for long been regarded as the mainstay of pharmacologic therapy in patients with dyspepsia. The advent of the histamine H2-antagonist and of proton pump inhibitors has provided simpler and overall more efficient therapeutic modalities for severe forms of dyspepsia. This relates especially to aggressive forms of peptic ulcer disease and severe reflux oesophagitis, where even high dose histamine H2-antagonist therapy has its clear limitations. Antacids nevertheless continue to be widely used in less severe forms of dyspepsia, especially in patients suffering from heartburn. In such patients self medication of antacids as first therapeutic measure is still very common. This is well exemplified by an American nd British survey. Out of 6760 randomly selected British general practice patients 875 suffered from reflux-like symptomatology without having consulted their physician for the symptomatology for minimum one year. Antacids were taken by 61% of them. The advent of controlled endoscopic trials and the emergence of the H2-receptor blockers as a yardstick of ulcer therapy, however, facilitated reappraisal of the value of antacids in various conditions. This has given a clear-cut answer in well defined entities such as peptic ulcer disease and stress ulcer prophylaxis but has left many open questions in heterogeneous conditions especially in and around gastroesophageal reflux disease.
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PMID:Clinical use of antacids. 826 Jul 36

Cholecystokinin (CCK) belongs to the group of substances known as brain-gut peptides: it functions both as a neuropeptide and a gut hormone. The peptide and its synthetic derivatives (like for instance CCK-8 and the amphibian counterpart caerulein) significantly delay emptying of gastric contents in both animals and humans. The fact that CCK, in doses mimicking postprandial plasma levels, strongly affects emptying rate suggests the peptide to be a physiologic regulator of gastric emptying. Unfortunately, clear definition of the role of CCK in the physiology of gastric motor activity has long been hampered by the lack of specific and potent non-peptide antagonists of CCK-receptors. The availability of such compounds has stimulated a broad array of investigations into the physiological actions of this hormone and examination of its putative role in certain diseases. This paper summarizes the available data concerning the effect of CCK and its antagonists on gastric emptying. The use of selective CCK-antagonists has allowed to establish that the gastric motor effect of the peptide is direct and mediated through the stimulation of CCK-A receptors. As a consequence, CCK-A antagonism results in acceleration of emptying rate under certain experimental and clinical conditions. This peculiar pharmacologic effect of CCK-A antagonists, which could be useful in the treatment of functional dyspepsia (idiopathic or diabetic), gastroparesis and gastro-esophageal reflux disease (where patients often display a delayed emptying rate of solid food) needs to be further investigated, in order to fully explore their potential as gastrokinetic drugs.
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PMID:Effect of CCK and its antagonists on gastric emptying. 829 6

Thirty-three consecutive patients with idiopathic gastric acid hypersecretion (defined as a basal acid output > 10.0 meq/hr with a normal fasting serum gastrin level and negative secretin stimulation test) who were being treated for duodenal ulcer disease and other acid-peptic disorders were evaluated for the presence of Helicobacter pylori by means of a rapid urease test. Fourteen patients had duodenal ulcer and 19 had other acid-peptic disorders (gastroesophageal reflux in 14, including six with Barrett's esophagus; four with nonulcer dyspepsia; and one with erosive gastritis). Helicobacter pylori was present in 12 of the 14 ulcer patients (86%) compared to only two of the 19 nonulcer patients (11%) (P < 0.0001). The distribution of basal acid output for patients with duodenal ulcer was similar to that for nonulcer patients, and no significant difference in the mean basal acid output was found among Helicobacter pylori-positive compared to Helicobacter pylori-negative patients. Seven of the duodenal ulcer patients with a basal acid output greater than 15.0 meq/hr were Helicobacter pylori-positive, suggesting that the organism can withstand even extreme levels of gastric acidity. In conclusion, this study demonstrates that the prevalence of Helicobacter pylori infection in patients with duodenal ulcer disease associated with idiopathic gastric acid hypersecretion is not different from a majority of ulcer patients with normal acid secretory profiles and offers additional evidence that extreme levels of gastric acid are not bactericidal for the organism.
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PMID:Helicobacter pylori in duodenal ulcer patients with idiopathic gastric acid hypersecretion. 842 Jul 45

The first aim of the present study was to determine the cause of dyspepsia after negative conventional diagnostic work-up. In such patients, an extended diagnostic work-up was performed including esophageal pH monitoring and manometry, gastric and hepatobiliary scintigraphy, and lactose tolerance test. In 88 of 220 dyspeptic patients (mean age 49 years, range 17-87; 114 women) presenting to our gastroenterological outpatient department, a cause for dyspepsia was found by conventional work-up. Thirty-one of the remaining patients did not enter extended work-up because of minor symptoms. In 47 of 101 patients entering extended work-up, a diagnosis was established (21 endoscopy-negative gastroesophageal reflux disease, 11 gastric stasis, 6 biliary dyskinesia, and 5 lactase deficiency among them). A second aim of the study was to determine whether clusters of symptoms such as "gastroesophageal reflux-like," "dysmotility-like," and "dyspepsia of unknown origin" reliably predict the groups of diseases suggested by these terms. This was not the case. In conclusion, in 40% of dyspeptic patients, a conventional diagnostic work-up led to a diagnosis that explained a patient's symptoms. After a negative conventional diagnostic work-up, an extended diagnostic work-up with functional tests yielded a possible explanation for their symptoms in 47% of patients. In such patients symptomatology was of little help for predicting the diagnosis.
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PMID:What is behind dyspepsia? 842 Jul 48


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