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

Since Helicobacter pylori (Hp) was first isolated in 1983, much work has been carried out on the pathogenic effects of this organism. Hp infection is common in humans and currently is the most important etiologic agent in the development of chronic active gastritis, gastric and duodenal ulcers, carcinoma and Malt-lymphoma of the stomach. Moreover Hp infection has also been associated with various extradigestive diseases. At present, a role of Hp infection in dyspepsia is discussed. Dyspepsia is defined by persistence of pain, burning or discomfort localised to the upper abdomen; some authors include in dyspepsia symptoms such as belching, bloating, alitosis, nausea, postprandial repletion, vomiting and regurgitation. In absence of any underlying pathologies, such as peptic ulcer, gastroesophageal reflux, pancreatitis, biliary tract disease or others, dyspepsia is defined as functional or idiopathic dyspepsia. Functional dyspepsia may be distinct in ulcer, reflux or dysmotility-like dyspepsia and unspecified dyspepsia. Hp infection is common in dyspeptic patients and a role of this bacterium has been postulated mostly in ulcer-like dyspepsia. Mechanisms by when Hp induces dyspeptic symptoms are uncertain; bacterial cytotoxins, phlogosis mediators, activity of chronic gastritis Helicobacter-related and host immune response probably play an important role in pathogenesis of functional dyspepsia. However, dyspepsia is not present only in infected patients; therefore other pathogenic factors may be implicated in expression of dyspeptic symptoms in uninfected subjects, such as gastric dysmotility, modifications of gastric output or altered visceral sensibility, psychological factors, gastroesophageal reflux and irritable bowel.
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PMID:[Dyspepsia and Helicobacter pylori]. 1036 46

Helicobacter pylori is now considered a major pathogen of the upper gastrointestinal tract. It is seen as an important cause of peptic ulceration not associated with NSAID use. It is also increasingly linked to other diseases of the GI tract, although the relationship between the organism and conditions such as gastric cancer, non-ulcer dyspepsia and gastroesophageal reflux disease is not as clear as is the case in peptic ulcer disease. This is probably because of a lack of well-performed, statistically powerful, prospective therapeutic trials that indicate that H. pylori eradication is of benefit in these diseases. The high infection rate without overt disease seen in many populations, especially from developing countries, probably contributes to this "credibility gap." While we have excellent therapeutic regimens available at this time, rational targeting requires that the objective evidence in favor of therapeutic intervention in upper GI disease, as well as the local H. pylori epidemiology, needs to be considered.
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PMID:Helicobacter pylori: therapeutic targets. 1037 56

Antacids are commonly used self-prescribed medications. They consist of calcium carbonate and magnesium and aluminum salts in various compounds or combinations. The effect of antacids on the stomach is due to partial neutralisation of gastric hydrochloric acid and inhibition of the proteolytic enzyme, pepsin. Each cation salt has its own pharmacological characteristics that are important for determination of which product can be used for certain indications. Antacids have been used for duodenal and gastric ulcers, stress gastritis, gastro-oesophageal reflux disease, pancreatic insufficiency, non-ulcer dyspepsia, bile acid mediated diarrhoea, biliary reflux, constipation, osteoporosis, urinary alkalinisation and chronic renal failure as a dietary phosphate binder. The development of histamine H2-receptor antagonists and proton pump inhibitors has significantly reduced usage for duodenal and gastric ulcers and gastro-oesophageal reflux disease. However, antacids can still be useful for stress gastritis and non-ulcer dyspepsia. The recent release of proprietary H2 antagonists has likely further reduced antacid use for non-ulcer dyspepsia. Other indications are still valid but represent minor uses. Antacid drug interactions are well noted, but can be avoided by rescheduling medication administration times. This can be inconvenient and discourage compliance with other medications. All antacids can produce drug interactions by changing gastric pH, thus altering drug dissolution of dosage forms, reduction of gastric acid hydrolysis of drugs, or alter drug elimination by changing urinary pH. Most antacids, except sodium bicarbonate, may decrease drug absorption by adsorption or chelation of other drugs. Most adverse effects from antacids are minor with periodic use of small amounts. However, when large doses are taken for long periods of time, significant adverse effects may occur especially patients with underlying diseases such as chronic renal failure. These adverse effects can be reduced by monitoring of electrolyte status and avoiding aluminum-containing antacids to bind dietary phosphate in chronic renal failure. Antacids, although effective for discussed indications of duodenal and gastric ulcer and gastro-oesophageal reflux disease, have been replaced by newer, more effective agents that are more palatable to patients. Antacids are likely to continue to be used for non-ulcer dyspepsia, minor episodes of heartburn (gastro-oesophageal reflux disease) and other clear indications. Although their wide-spread use may decline, these drugs will still be used, and clinicians should be aware of their potential drug interactions and adverse effects.
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PMID:Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. 1040 Apr 1

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

The annual prevalence of dyspepsia in the UK is about 25%. Dyspepsia is one of the most common reasons for a patient to visit a primary care physician (PCP), accounting for between 3 and 4% of all PCP consultations. Antisecretory drugs prescribed by PCPs to relieve dyspepsia consume over 7% of the annual UK National Health Service drugs budget. In patients < 45 years old and in the absence of sinister symptoms (weight loss, anorexia or gastrointestinal blood loss) or treatment with non-steroidal anti-inflammatory drugs, three conditions account for the majority of cases of dyspepsia, namely functional (non-ulcer) dyspepsia (up to 60%), gastroesophageal reflux (5-15%) and peptic ulcer disease (15-25%). The discovery of Helicobacter pylori and its association with peptic ulcer disease led to a reevaluation of the management strategies used for dyspepsia. It became possible, using non-invasive testing, to determine whether a patient with dyspepsia was colonized with H. pylori and if not, it made peptic ulcer disease most unlikely. There are four main strategies for the management of patients with dyspepsia: empiric treatment, 'test and treat', 'test and investigate', or simply 'investigate'. The advantages, disadvantages and possible outcomes using each of these strategies are discussed using an evidence-based approach.
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PMID:Dyspepsia and Helicobacter pylori: test, treat or investigate? 1044 10

Dyspepsia, according to the internationally accepted Rome criteria, refers to pain or discomfort centred in the upper abdomen; patients with predominant heartburn are excluded from this group, although minor or infrequent heartburn is commonly associated with dyspepsia. It is an important condition not only because it is common and costly, but because it may indicate the presence of serious disease such as peptic ulcer or gastric cancer. However, the most frequent causes of dyspepsia are functional dyspepsia and gastro-oesophageal reflux disease. The discovery of Helicobacter pylori has resulted in important advances in the management of dyspepsia. The clinician faced with a patient who has persistent or recurrent dyspepsia needs to differentiate clearly those patients who have not been previously investigated from patients documented to have functional dyspepsia after investigation (fig 1). Here, the management of H pylori positive dyspeptic patients who have and have not been fully investigated will be reviewed.
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PMID:How should Helicobacter pylori positive dyspeptic patients be managed? 1045 33

Dyspepsia is a digestive syndrome distinct from (although frequently overlapping with) gastro-oesophageal reflux disease (GORD) and irritable bowel syndrome (IBS), which is characterised by various combinations of painful and non-painful symptoms arising from the epigastrium. Dyspepsia can be secondary to a variety of diseases, but in most instances it is idiopathic. Helicobacter pylori infection is responsible for the majority of peptic ulcers and of other diseases potentially associated with dyspepsia. Nevertheless, a causal role for H pylori infection in symptom occurrence has not been established. Experimental data indicate that H pylori eradication does not improve symptoms in the majority of dyspeptic patients. It has been proposed recently that H pylori negative patients should be managed according to their clinical presentation. Some reports suggest that taking into consideration the most relevant or "predominant" symptom may help to identify distinct subgroups among dyspeptic patients with different underlying pathophysiological abnormalities and different responses to treatment. Well designed and conducted prospective studies are needed to verify whether treatment of H pylori negative dyspeptic patients based on the predominant symptom actually is a cost effective approach.
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PMID:How should Helicobacter pylori negative patients be managed? 1045 34

Helicobacter pylori is a worldwide infection. In gastro-duodenal ulcer disease no doubt remains about the necessity of H. pylori eradication. Controversies subsisting in other pathologies such gastro-esophageal reflux, dyspepsia, gastritis, gastric adenocarcinoma or MALT lymphoma are reviewed. Multiple drug combinations have been proposed to cure the infection. These are discussed in the clinical setting of Belgian practice.
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PMID:[Controversies in the treatment of Helicobacter pylori]. 1049 76

Gastric diverticular are rare and usually are diagnosed incidentally on radiographic examination. Surgical treatment, consisting of simple excision or inversion of the diverticulum, has been reserved for patients with proven symptoms or complications. These procedures have typically required laparotomy, but with the development of advanced endoscopic techniques, a minimally invasive approach may be appropriate. The authors report two cases of gastric diverticula managed laparoscopically and review the literature related to this entity. Between 1993 and 1996, two patients were evaluated for dyspepsia-like gastrointestinal complaints. Both patients were found to have a gastric diverticulum on a contrast study, and one diverticulum was also seen on upper endoscopy. Laparoscopic resection was undertaken in both cases. Flexible gastroscopy was performed intraoperatively to help localize the diverticulum, which was resected with an endoscopic stapling device. Nissen fundoplication was performed in conjunction with the diverticulectomy in the second patient for gastroesophageal reflux. Both procedures were completed laparoscopically without complications. The postoperative course was uneventful in both patients. At long-term follow-up, the patients are asymptomatic. This experience indicates that laparoscopic resection of symptomatic gastric diverticula is a feasible alternative to laparotomy. A prospective analysis to verify the safety and efficacy of this procedure should be done.
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PMID:Laparoscopic management of gastric diverticula. 1052 35

Dyspepsia, often defined as chronic or recurrent discomfort centered in the upper abdomen, can be caused by a variety of conditions. Common etiologies include peptic ulcers and gastroesophageal reflux. Serious causes, such as gastric and pancreatic cancers, are rare but must also be considered. Symptoms of possible causes often overlap, which can make initial diagnosis difficult. In many patients, a definite cause is never established. The initial evaluation of patients with dyspepsia includes a thorough history and physical examination, with special attention given to elements that suggest the presence of serious disease. Endoscopy should be performed promptly in patients who have "alarm symptoms" such as melena or anorexia. Optimal management remains controversial in young patients who do not have alarm symptoms. Although management should be individualized, a cost-effective initial approach is to test for Helicobacter pylori and treat the infection if the test is positive. If the H. pylori test is negative, empiric therapy with a gastric acid suppressant or prokinetic agent is recommended. If symptoms persist or recur after six to eight weeks of empiric therapy, endoscopy should be performed.
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PMID:Evaluation and management of dyspepsia. 1089 31


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