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

Neurohormonal factors were investigated in 10 patients with functional dyspepsia who had normal or slow upper gut transit and 10 age- and sex-matched healthy controls. Gastric and small bowel motility and transit, jejunal responses to luminal distention and IM neostigmine, gut hormones, and vagal and sympathetic functions were studied. Slow upper gut transit was defined by a gastric emptying slope less than 0.3%/min or 10% small bowel transit time greater than 300 minutes. Four patients with slow transit had reduced postprandial antral motility and gut hormone responses. Two of the four patients had vagal and sympathetic dysfunction. In 6 patients with normal transit, balloon distention in the jejunum was perceived at a lower volume (32.7 +/- 5.9 mL) than in controls (46.6 +/- 3.0 mL). Pressure responses to balloon distention were reduced in 5 and exaggerated in 1 patient; abnormal efferent vagal (2 patients) and sympathetic (1 patient) function were also documented. In view of the normal transit, motility, and jejunal pressure responses to neostigmine in all 6 patients, the abnormal response to distention suggests afferent dysfunction. Functional dyspepsia is a heterogenous disorder. Abnormal transit is sometimes associated with disorders of extrinsic neural control, but the latter are also found in patients with normal transit. Increased perception of intraluminal stimuli in those with normal transit suggests a disturbance in afferent function.
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PMID:Neurohormonal factors in functional dyspepsia: insights on pathophysiological mechanisms. 167 58

Non-ulcer dyspepsia is common in Africa, yet there are few data on its possible cause. In this study 40 patients with strictly defined non-ulcer dyspepsia were matched with 40 asymptomatic volunteers. Both groups were questioned concerning their intake of alcohol, cola nut, non-steroidal anti-inflammatory drugs, and smoking. They then underwent upper gastrointestinal endoscopy with mucosal biopsy of the gastric mucosa: these biopsies were examined for gastritis and Helicobacter pylori. Ingestion of cola nut was the only statistically significant difference between the two groups. A high prevalence of gastritis and H. pylori infection was found in both groups, suggesting that these factors are not important in the aetiology of non-ulcer dyspepsia in northern Nigeria.
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PMID:Non-ulcer dyspepsia in Nigeria: a case-control study. 175 74

Non-ulcer dyspepsia (NUD) includes functional forms, related to secretory and/or motor disorders, but also refers to forms with gastritis and/or duodenitis (erosive or not, Helicobacter pylori positive or not), as well as to idiopathic forms. NUD pathophysiology is multifactorial. Secretory abnormalities, H. pylori infection and in particular digestive and interdigestive disorders of gastrointestinal motility are often detected in NUD patients, but psychological, social and environmental factors can be also involved in NUD pathogenesis. With regard to symptom genesis, there is still no convincing evidence as to whether and to what extent pathogenetic factors have a causal relationship with dyspeptic symptoms. Upper gastro-intestinal endoscopy with biopsies and abdominal ultrasonography must be performed in patients over 45 years complaining of sudden symptoms, in patients under 45 years suffering from symptoms suggestive of severe organic disease and in patients with unexplained worsening of chronic symptoms. Ex adjuvantibus therapy may be employed in the remainder of dyspeptics. Oligosymptomatic dyspepsia needs no pharmacological treatment and in most cases it is enough to advise modifications of dietary habits and life style. Many drugs are usually employed in the pharmacological treatment of severe NUD but only H2-antagonists, pirenzepine and prokinetics are reported to be more effective than placebo. Efficacy of therapy should be checked after 4 weeks of treatment. If no improvement occurs, combined or different therapy might be employed. Treatment should be checked again after 8 weeks: therapeutic failure at this time indicates the need for endoscopic examination.
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PMID:Non-ulcer dyspepsia. 184 Aug 14

Dyspepsia is one of the most common ailment that is managed by general practitioners and gastroenterologists worldwide and particularly so in Tropical Africa. Non-ulcer dyspepsia can be defined as the presence of classic ulcer symptoms or any combination of burning, bloating, indigestion or other abdominal symptoms which only sometimes have a relation to food intake with out any radiological or endoscopic evidence of peptic ulceration. Compared to peptic ulcer disease, the literature on Non-ulcer dyspepsia is relatively scanty and studies have been done mostly in populations non-negroid origin. The present study has reviewed Non-ulcer dyspepsia with particular reference to the Africans and has highlighted the intriguing areas of the disorder with the consequent dilemma posed to its management. Further research on this topic is indicated and would be fascinating but a challenging task.
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PMID:Non-ulcer dyspepsia and the dilemma posed to its management. 184 50

Non-ulcer dyspepsia is a frequent clinical entity characterized by chronic upper gastrointestinal symptoms without organic lesions by radiology, sonography or endoscopy. We studied simultaneously the rate of gastric emptying and gallbladder contraction in 10 patients with non-ulcer dyspepsia and in 10 healthy controls after ingestion of 500 cc of isotonic saline, and 500 cc of a liquid mixed meal, hypercaloric and hyperosmotic. The measurements were done by direct real-time ultrasonic imaging in fasting and were repeated at regular intervals (15-30 minutes) after the liquid meal, until complete gastric emptying was established. We found with the liquid mixed meal, the patients with non-ulcer dyspepsia had a significant delay in gastric emptying and gallbladder hypokinesis with faulty contraction and slow refilling. Dynamic ultrasonographic studies are useful in patients with non-ulcer dyspepsia.
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PMID:[Gastric emptying of fluids and gallbladder contraction in non-ulcer dyspepsia]. 184 49

Dyspepsia can be defined as the presence of upper abdominal pain or discomfort; other symptoms referable to the proximal gastrointestinal tract, such as nausea, early satiety, and bloating, may also be present. Symptoms may or may not be meal related. To be termed chronic, dyspepsia should have been present for three months or longer. Over half the patients who present with chronic dyspepsia have no evidence of peptic ulceration, other focal lesions, or systemic disease and are diagnosed as having non-ulcer (or functional) dyspepsia. Non-ulcer dyspepsia is a heterogeneous syndrome. It has been proposed that this entity can be subdivided into a number of symptomatic clusters or groupings that suggest possible underlying pathogenetic mechanisms. These groupings include ulcer-like dyspepsia (typical symptoms of peptic ulcer are present), dysmotility (stasis)-like dyspepsia (symptoms include nausea, early satiety, bloating, and belching that suggest gastric stasis or small intestinal dysmotility), and reflux-like dyspepsia (heartburn or acid regurgitation accompanies upper abdominal pain or discomfort). The aetiology of non-ulcer dyspepsia is not established, although it is likely a multifactorial disorder. Motility abnormalities may be important in a subset of dyspepsia patients but probably do not explain the symptoms in the majority. Epidemiological studies have not convincingly demonstrated an association between Helicobacter pylori and non-ulcer dyspepsia. Other potential aetiological mechanisms, such as increased gastric acid secretion, psychological factors, life-event stress, and dietary factors, have not been established as causes of non-ulcer dyspepsia. Management of non-ulcer dyspepsia is difficult because its pathogenesis is poorly understood and is confounded because of a high placebo response rate. Until more data are available, it seems reasonable that treatment regimens target the clinical groupings described above. Antacids are no more effective than placebo in non-ulcer dyspepsia, although a subgroup of non-ulcer dyspepsia patients with reflux-like or ulcer-like symptoms may respond to H2-receptor antagonists. However, there is no significant benefit of these agents over placebo in many cases. Bismuth has been shown to be superior to placebo in patients with H. pylori in a number of studies, but these trials had several shortcomings and others have reported conflicting findings. Sucralfate was demonstrated in one study to be superior to placebo, but this finding was not confirmed by another group of investigators. Prokinetic drugs appear to be efficacious, and may be most useful in patients with dysmotility-like and reflux-like dyspepsia.
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PMID:Non-ulcer dyspepsia: myths and realities. 188 33

The irritable bowel syndrome is characterized by the presence of abdominal pain associated with disturbed defecation; certain symptoms are able to discriminate the irritable bowel syndrome from organic disease. Functional dyspepsia is also common in patients with symptoms otherwise compatible with the irritable bowel syndrome. Approximately one-third of patients with functional dyspepsia have symptoms thought to be of colonic origin. Despite this, functional dyspepsia can be distinguished from the irritable bowel syndrome on the basis of symptom criteria. A generalized motility disturbance may explain the presence of dyspepsia in patients with the irritable bowel syndrome. Whether a specific type of dyspepsia occurs in this syndrome is not established.
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PMID:Spectrum of chronic dyspepsia in the presence of the irritable bowel syndrome. 189 32

A prospective multifactorial study of symptoms and disturbance of gastrointestinal function has been undertaken in 50 patients with non-ulcer dyspepsia. Objective tests including solid meal gastric emptying studies, gastric acid secretion, E-HIDA scintiscan for enterogastric bile reflux, and hydrogen breath studies were carried out in all patients and validated against control data. Gastroscopy and biopsy were carried out in non-ulcer dyspepsia patients only. Non-ulcer dyspepsia patients were categorised on the basis of predominant symptoms as: dysmotility-like dyspepsia (n = 22); essential dyspepsia (n = 14), gastro-oesophageal reflux-like dyspepsia (n = 11); and ulcer-like dyspepsia (n = 3). In the total non-ulcer dyspepsia population, solid meal gastric emptying was delayed (T50 mean (SEM) = 102 (6) minutes (patients) v 64 (6) minutes (controls), (p less than 0.01) and high incidences of gastritis (n = 26) and Helicobacter pyloridis infection (n = 18) were found. An inverse correlation was observed between solid meal gastric emptying and fasting peak acid output (r = -0.4; p less than 0.01). Indeed gastric emptying was particularly prolonged in eight patients (T50 mean (SEM) = 139 (15) minutes) with hypochlorhydria. In the non-ulcer dyspepsia population oral to caecal transit time of a solid meal was delayed (mean SEM = 302 (14) minutes (patients) v 244 (12) minutes (controls) (p less than 0.01]. Seven patients had a dual peak of breath hydrogen suggestive of small bowel bacterial overgrowth. No association was observed between symptoms and any of the objective abnormalities. This multifactorial study has shown that hypomotility, including gastroparesis and delayed small bowel transit, is common in non-ulcer dyspepsia and may be related to other disorders of gastrointestinal function. No relation between symptoms and disorders of function, however, has been shown.
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PMID:Evidence for hypomotility in non-ulcer dyspepsia: a prospective multifactorial study. 201 18

Nonulcer dyspepsia is a common clinical syndrome whose etiology is unknown. The sensitivity of the gastric mucosa to acid and duodenal contents in 18 patients with nonulcer dyspepsia was studied. The patients had a normal upper gastrointestinal endoscopy and biopsy specimens were obtained for determination of Helicobacter pylori status. Fifteen of the 18 patients were infected with H. pylori. All patients underwent intubation with double-lumen tube and collection of cholecystokinin-stimulated pancretico-biliary secretions. Subsequently, normal saline, 0.1N hydrochloric acid, and autologous duodenal secretions were infused into the stomach in a randomized blinded fashion. A positive response was defined as the production of epigastric pain by acid and/or bile but not by saline. By this definition, only 6 patients (33%) had a positive response and none had reproduction of their usual symptoms. In patients with a negative response, only 4 remained asymptomatic during all infusions. The remaining 8 had symptoms during infusion of saline, 7 of whom also had symptoms during infusion of acid and/or duodenal secretions. Two of these patients had reproduction of their usual symptoms. In conclusion, the gastric mucosa in patients with nonulcer dyspepsia is not abnormally sensitive to acid or duodenal contents.
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PMID:Sensitivity of the gastric mucosa to acid and duodenal contents in patients with nonulcer dyspepsia. 172 75

Functional dyspepsia is a clinical syndrome defined by upper abdominal symptoms, without identifiable cause by conventional diagnostic evaluation. New diagnostic tests, such as gastrointestinal manometry and gastric emptying, may help in a better characterization of these patients by demonstrating specific motor abnormalities, such as postprandial antral hypomotility and delayed gastric emptying of solids, or less frequently, intestinal dysmotility patterns indicating a visceral neuropathy. Nevertheless, a substantial proportion of dyspeptic patients have normal motility patterns. Interestingly, recent studies have shown that a gastric hypersensitivity to distension may be the cause of the postprandial symptoms in functional dyspepsia. These data indicate that functional dyspepsia may include an heterogeneous group of patients with different underlying disturbances.
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PMID:Functional dyspepsia: recent pathophysiological advances. 213 May 81


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