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

A questionnaire was used to study the choice and use of gastric function tests by members of the British Society of Gastroenterology.Pentagastrin has largely replaced older drugs as the stimulant of choice for evoking maximal acid secretion. Insulin tests are being used in situations where they are unlikely to provide useful clinical information. Fewer physicians than surgeons measure gastric secretion, and they use tests less often. The reluctance of physicians to test patients with uninvestigated dyspepsia or gastric ulcer seems justified, but in patients having dyspepsia with negative x-ray films, or after gastrectomy or vagotomy, the greater investigative keenness of surgeons seems commendable. Only half the surgeons ever try to assess the completeness of their vagotomies, and in only one-third of this half is it their usual practice. Criticism is made of the practice of routine measurement of acid in patients with duodenal ulcer, and of the use of acid measurements to decide whether a patient should have surgery or which type of operation should be performed.
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PMID:Use of gastric function tests by British gastroenterologists. 554 Dec 30

Of 19 patients with chronic non-specific lung disease, chosen without reference to dyspeptic symptoms, 17 (89%) exhibited duodenogastric reflux of barium indicating pyloric incompetence. In the one patient who proved to have a gastric ulcer the amount of reflux diminished when the ulcer healed. The degree of pyloric incompetence was not found to be related to the severity of arterial blood gas or pH disturbance or to the presence of right heart failure. All patients who exhibited reflux had evidence of obstructive airways disease and most were receiving bronchodilators.We believe that reflux of detergent bile into the stomach may explain the high incidence of dyspepsia and acute gastric ulceration in chronic non-specific lung disease.
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PMID:Pyloric incompetence in chronic non-specific lung disease. 554 53

Peak acid outputs in normal subjects and patients with duodenal and gastric ulcer were significantly (and similarly) correlated with body weight and calculated lean body mass. Expression of measurements of peak acid output as a function of body weight or lean body mass lessened but did not abolish the significance of the situation that men with no dyspepsia or gastric ulcer secreted more acid than women; the significant sex difference in duodenal ulcer was, however, abolished. Data for peak acid output have been tabulated, not only as m-equiv/hr but also as mu-equiv/kg body weight/hr and mu-equiv/kg lean body mass/hr. On the basis of the present data no change is suggested in the current expression of peak acid output as m-equiv/hr since expression of acid output as a function of body weight or lean body mass improves neither the variability nor the diagnostic discrimination of measurement of peak acid output.
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PMID:Lean body mass, gastric acid, and peptic ulcer. 581 Sep 74

Technetium-99m pertechnetate is known to concentrate in the stomach following intravenous injection, but there is controversy on the cellular site of this uptake, with evidence for both the mucous and parietal cells being primarily responsible. Gastric uptake following intravenous pertechnetate has been studied in patients with non-ulcer dyspepsia and peptic ulcer, using a gamma camera and computer processing with regions of interest. Under identical conditions in any one patient, quantification of uptake at 20 min is reproducible to an accuracy of +/- 6%. Six patients with gastric ulcer were studied before and 3 weeks after starting treatment with carbenoxolone. There was a rise in uptake in 5 subjects with a mean percentage increase of 25%. The effect of cimetidine was studied in six patients with either gastric or duodenal ulcer. There was little change in uptake (mean 6%). These preliminary data would support the hypothesis that concentration of pertechnetate occurs primarily in the mucous cell.
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PMID:Carbenoxolone and gastric Technetium-99m pertechnetate uptake in patients with gastric ulceration. 625 14

Seventy-two patients with endoscopically proven gastric ulcers were entered into a prospective controlled trial to assess the efficacy of ranitidine and cimetidine in ulcer healing. All patients were biopsied on entry and at subsequent endoscopies. After exclusion of 7 patients during the first month of treatment, the remaining 65 patients, 47 males and 18 females, mean age 48.2 +/-1.5 years, at 1 month had a healing rate of 47% and 52% respectively. The non-healers continued their treatment for a further 4 weeks. This increased the healing rate to 77% and 76% respectively. If the defaulters and poor compliers are withdrawn the healing rate rises to 58% and 57% at 4 weeks and to 91% and 79% at 8 weeks respectively. There was no significant difference between the two groups as regarded initial ulcer size and severity of dyspepsia. Antacid tablet consumption during the study was comparable. The initial size of the ulcers which failed to heal after 4 weeks of treatment tended to be larger than those which healed (P less than 0.05), but smoking did not appear to influence ulcer healing. No obvious side-effects or evidence of dysplasia were found. The study shows that ranitidine is at least as effective as cimetidine in gastric ulcer healing.
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PMID:Ranitidine in the treatment of gastric ulceration. 627 19

Hepatic artery infusion chemotherapy is a recognized treatment of unresectable hepatic neoplasms. Because the arterial supply to the stomach and duodenum originates from the celiac and hepatic arteries, unavoidable infusion of the gastroduodenal and right gastric arteries may result in gastrointestinal complications. Of 174 patients (266 infusions) treated with hepatic artery infusion chemotherapy during a 12 month period, 18 developed severe dyspepsia. Ten of these 18 patients had gastrointestinal pathology documented by either endoscopy or upper gastrointestinal series; six had gastric ulcer and gastritis, two had duodenal ulcer, one pyloroduodenitis, and one pancreatitis. Endoscopically, the hepatic artery infusion chemotherapy-induced ulceration and gastritis were located in the distribution of the infused arteries. Radiographically, the gastric abnormalities ranged from typical benign ulcers to a pattern of multiple ulcerations with nodular fold mimicking malignancy. Angiographic correlation could be made on eight of the 10 patients. Vascular trauma, observed in five of these eight patients, seemed to contribute to gastrointestinal complications in hepatic artery infusion chemotherapy.
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PMID:Hepatic artery infusion chemotherapy: gastroduodenal complications. 645 49

A consecutive series of 2,277 patients presenting for upper gastrointestinal endoscopy was analysed. The following groups of patients were studied with reference to sex, race and dialect groups: those presenting with dyspepsia but no haemorrhage, those presenting with upper gastrointestinal haemorrhage, those with non-ulcer dyspepsia, gastric ulcer and duodenal ulcer. Males out-numbered females in all diagnostic groups. Male and female Malays were under-represented in all diagnostic groups when compared to the Singapore population. Amongst female Chinese, there was an excess of Cantonese patients and an under-representation of Teochew patients in most diagnostic groups. These dialect differences were not remarkable amongst male Chinese. The possible reasons for these differences and their significance are discussed.
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PMID:The influence of sex, race and dialect on peptic ulcer and non-ulcer dyspepsia in Singapore. 661 Nov 5

In order to ascertain the role of gastric carcinoembryonic antigen (CEA) determination in detecting patients with a risk for gastric cancer, 69 subjects were studied; 23 were referred for endoscopy because of dyspepsia but without obvious macroscopic lesions, 27 with duodenal ulcer, 11 with benign gastric ulcer, 8 with gastric cancer. The following results were obtained by subdividing the material according to the histologic interpretation of the results of gastric mucosal biopsies: (1) in the presence of minor histologic abnormalities of the gastric mucosa, CEA in gastric juice was under 100 ng/ml in all but five cases; and (2) in moderate or severe chronic atrophic gastritis (associated or otherwise with intestinal metaplasia or dysplasia), and in gastric cancer, gastric CEA ranged between 224 and 3120 ng/ml in all but two cases. Although not diagnostic for gastric cancer, gastric CEA is a promising test in detecting patients at risk, including those with dysplasia of the gastric mucosa.
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PMID:Carcinoembryonic antigen in gastric juice collected during endoscopy. Value in detecting high-risk patients and gastric cancer. 664 May 4

Dyspepsia is a common problem in ambulatory care. While many authorities recommend ordering upper gastrointestinal x-ray series (UGI) before therapy, there is evidence that clinicians frequently treat dyspepsia without diagnostic procedures. Decision analysis was performed to select optimal management based on probabilities and outcome values from the published literature. The choices evaluated were Symptomatic Therapy (low dose antacids or anticholinergics), Ulcer Therapy (high dose antacids or cimetidine), or UGI followed by further tests or therapy. Our model indicates that mortality is minimized if UGI is performed prior to selection of therapy, and if endoscopy is performed when the x ray shows gastric ulcer. Weeks of pain are minimized if Ulcer Therapy is begun immediately, but direct health care costs are minimized by beginning with Symptomatic Therapy. The marginal cost per additional life saved by performing a UGI rather than beginning with Ulcer Therapy was +1.6 million to +2.3 million, depending on whether endoscopy followed the finding of gastric ulcer. Mortality advantages of the strategies beginning with UGI were sensitive to assumptions regarding the incidence of gastric cancer and the benefits of early diagnosis. With slight reductions in these base case values, the Ulcer Therapy strategy appeared to minimize all outcomes except dollar cost.
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PMID:Diagnosis and treatment of dyspepsia. A cost-effectiveness analysis. 682 Jun 78

Between 1970 and 1979, 140 patients aged between 19 and 84 years with endoscopically confirmed gastric ulcer (GU), were treated with Biogastrone in reducing doses for 6 months. They received a daily dose of 300 mg for one week, 150 mg for 5 weeks, 100 mg for 6 weeks and 50 mg for the remainder of the 6 months. All the patients were reviewed at 2, 4, 6, 8, 12, 16, 20, 32, and 38 weeks and thereafter every 3 months or earlier in the event of significant dyspepsia. The anticipated recurrence rate of GU of approximately 42% at 2 years (3) was nearly halved to 26.7% over a median follow-up of 36 months in 140 cases completing the full six months course of treatment. The incidence of side effects was as follows: (i) A weight gain of 3.5 kg or more was seen in 23% of the patients at 2 weeks; this effect was maintained through the 6 month period. (ii) Oedema was noted in 14% of the patients at 2 weeks but declined to a 2% incidence by the end of the study. (iii) Elevated diastolic blood pressure in 14--18% of patients below 60 years and 20--27% patients above 60 years of age was noted throughout the study period. A high proportion of patients (38%) receiving other therapy had hypertension prior to the trial period; Carbenoxolone treatment had little further effect on blood pressure in these patients. (iv) Hypokalaemia was noted in the early stages of treatment especially in those over 60 years (43%). The incidence declined with the reduction in dosage through the 6 month treatment period. All side effects were successfully treated by diuretics and potassium supplements.
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PMID:Long-term therapy with carbenoxolone in the prevention of recurrence of gastric ulcer. Natural history and evolution of important side-effects and measures to avoid them. 693 41


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