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

Nonulcer dyspepsia (NUD) is an enigmatic disorder which likely has heterogeneous etiologies. Helicobacter pylori-associated gastritis has been identified in a large number of patients with NUD, raising speculation that chronic infection with this organism may cause dyspepsia in some patients. Prospective case-control and cohort studies however do not suggest that H. pylori prevalence is greater in NUD than in asymptomatic controls. Limited therapeutic trials of H. pylori-eradication therapy have not shown a convincing symptomatic improvement compared with placebo treatment. Definition of the role of H. pylori in NUD awaits further well-designed, well-controlled epidemiologic and therapeutic studies. Until such information is available, routine endoscopic gastric biopsies looking for H. pylori in patients with NUD should be abandoned.
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PMID:Endoscopy-negative dyspepsia. Hold those forceps! 840 11

Although dyspeptic symptoms are very common, the vast majority of patients have modest symptoms and rarely seek medical advice. The major organic causes of dyspepsia are chronic peptic ulcer disease, gastro-oesophageal reflux disease and malignancy. Functional dyspepsia is very common. In the fit elderly patient, prompt investigation may be more appropriate than empirical treatment in view of the higher proportion of patients with organic disease and the likelihood of malignancy. The symptoms of peptic ulceration and gastro-oesophageal reflux disease are often atypical in the elderly population. Frail patients, especially those with multiple pathology, should be treated empirically in the first instance. Empirical treatment should be with histamine H2-receptor antagonists or prokinetic agents. Drug treatment is not always required in dyspepsia and should be avoided where possible, especially given the increased risk of drug interactions and poor compliance in the elderly. For those patients with documented non-malignant organic disease, the advent of the H2-receptor antagonists, proton pump inhibitors, prokinetic drugs and regimens which eradicate Helicobacter pylori means that treatment is almost always successful.
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PMID:Diagnosis and treatment of dyspepsia in the elderly. 857 90

Non-ulcer dyspepsia is a common disorder in clinical practice. The pathogenesis and predisposing factors that lead to the development of Helicobacter pylori infection are still unclear. The aim of the present study was to evaluate the prevalence of H. pylori infection in non-ulcer dyspepsia patients with delayed gastric emptying and those with normal gastric emptying, and to determine if delayed gastric emptying predisposes to H. pylori infection. A total of 70 patients (29 males, 41 females) aged 18-59 years (mean +/- S.D. 40.5 +/- 11.2 years) took part in the study. A solid-phase scintigraphic gastric emptying study and 14C urea breath test were performed on each patient. There was no statistically significant difference in age between those patients with and without delayed gastric emptying (40.8 +/- 11.9 vs 40.4 +/- 10.5 years), or between those with and without H. pylori infection (40.5 +/- 12.6 vs 40.5 +/- 9.8 years). Of the 70 patients, 45 (64.3%) had delayed gastric emptying and 25 (35.7%) had normal gastric emptying. The overall incidence of H. pylori infection was 58.6%. The incidence of H. pylori infection among patients with delayed gastric emptying was 60% (27/45 patients) and among patients with normal gastric emptying 56% (14/25) patients). The incidence of H. pylori infection in the two groups was not significantly different. The incidence of H. pylori infection in the non-ulcer dyspepsia patients in this study was similar to that of age-matched asymptomatic volunteers in Taiwan. In conclusion, based on the results of this study, delayed gastric emptying does not lead to a predisposition to H. pylori infection in non-ulcer dyspepsia patients.
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PMID:Delayed gastric emptying does not predispose to Helicobacter pylori infection in non-ulcer dyspepsia patients. 871 89

Functional dyspepsia (FD) includes a heterogeneous group of patients suffering from a variety of different conditions. The Dyspepsia Project has been implemented in 14 GI Units since 1984, in order to epidemiologically test the discriminating power of the Working Teams definitions and of standardized questionnaires. Five per cent of admitted subjects were subclassified as sphincter of Oddi dysfunction or biliary dyspepsia (BD), defined as biliary pain associated or not to bilirubin or alkaline phosphatase elevation, in the abscence of ultrasonographic evidence of gallstone disease or bile duct dilatation. The more useful symptoms in favour of the diagnosis of biliary dyspepsia were found to be pain in the right hypochondrium, radiating to the shoulder, or to the back, initiated by food, and eventually associated with constipation, or epigastric postprandial discomfort. Interestingly, symptoms suggesting biliary dyspepsia are partially shared by dysmotility-like dyspepsia. The placebo response in functional dyspepsia is variable, between 6 and 80% of patients, reflecting variations in the kind and severity of the diseases in different studies. That represents a considerable difficulty in evaluating drug efficacy, even in the case of biliary dyspepsia. A therapeutic double-blind trial in functional dyspepsia using tauro-ursodeoxycholic acid is discussed.
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PMID:Functional dyspepsia: how could a biliary dyspepsia sub-group be recognized? A methodological approach. 884 44

Many patients with liver cirrhosis have dyspeptic complaints. Peptic ulcer, gallstones and oesophagitis are the most common causes of dyspepsia. Functional dyspepsia is infrequently investigated in liver cirrhosis. Sixty-two patients with liver cirrhosis and dyspepsia were submitted to endoscopic and sonographic investigation. In 28 of them no organic finding was detected. These cases were considered as having functional dyspepsia. 36% were of dysmotility-like type, 28% were ulcer- and reflux-like, each, and 7% were of idiopathic type. Aerophagia could not be taken in consideration as functional dyspepsia, due to portal hypertension. In comparison with a group of 30 patients with functional dyspepsia without liver cirrhosis, functional dyspepsia in liver cirrhosis is more frequent in men than in women and occurs about a decade later. In 12 subjects the gastric emptying of a semifluid meal estimated by sonography was normal. Functional dyspepsia is a reality in liver cirrhosis. Gastric emptying seems not to have a major role in the etiopathogenesis of such complaints.
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PMID:[Functional dyspepsia in liver cirrhosis]. 896 53

Functional dyspepsia is a common disorder with a diverse pathophysiological background, but the role of motility disorders in functional dyspepsia remains unclear. We aimed to quantify the relationship between disturbed gastric emptying and functional dyspepsia, using a meta-analytic approach. Through a structured literature search of Medline and Embase from 1983 to 1996, we selected all studies in which scintigraphic solid-phase gastric emptying was measured in both functional dyspeptic patients and controls. Seventeen studies involving 868 dyspeptic patients and 397 controls were pooled. Gastric emptying in patients with functional dyspepsia was 1.46 (1.23-1.69) times slower than controls; the proportion of patients with abnormally slow emptying was either 37% (34-40%, simple numeric pooling) or 39% (29-49%, weighted pooling). We conclude that gastric emptying of solids in patients with functional dyspepsia is 1.5 times slower than in healthy controls and that a significant delay of emptying is present in almost 40% of patients with functional dyspepsia.
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PMID:Disturbed solid-phase gastric emptying in functional dyspepsia: a meta-analysis. 975 69

Nonulcer dyspepsia or chronic dyspepsia (defined as upper gastrointestinal symptoms of at least 3-weeks duration) is a common problem in Western countries. Up to 30% of the general population suffer from dyspepsia and the dyspepsia-related work-load of the general practitioner is considerable. The general practitioner has to formulate a management approach: what therapy, if any, and which patient should be investigated? A considerable overlap of symptoms make a precise diagnosis without additional investigations difficult, but empirical acid inhibition is an attractive option. Disturbances of gastrointestinal motility and, perhaps, Helicobacter gastritis are additional possible pathogenetic mechanisms. At present, conclusive, controlled clinical trials are lacking and it remains controversial which strategy is most cost-effective but at the same time optimal for the patient.
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PMID:[Nonulcer dyspepsia]. 978 56

Functional dyspepsia is a chronic disorder of unknown aetiology. The lack of endoscopic abnormalities in patients with this disorder has led many physicians to believe that gastro-oesophageal reflux disease may be responsible for most symptoms. Our group has addressed this issue, by pathophysiological studies in a large cohort of Dundee patients with persistent dyspeptic symptoms. Peptic ulcer and gallstones were excluded in all patients by appropriate tests. Ambulatory pH monitoring showed oesophageal acid reflux that lay above the conventional diagnostic threshold in approximately 20% of patients. This subset was diagnosed as having gastro-oesophageal reflux disease. In the remainder, moderate or severe reflux-like symptoms were reported by approximately 44% patients, who were categorized as reflux-like functional dyspepsia. Reflux symptoms were mild or absent in 36% patients, who were categorized as non-reflux-like dyspepsia. While oesophageal pH profiles lay within the conventional normal range in both of these functional dyspepsia subgroups, patients with reflux-like functional dyspepsia had significantly greater acid exposure values, including total oesophageal acid exposure time, percentage time at a pH of less than 4.0, DeMeester scores and pain reflux event correlation. Hence patients with reflux-like functional dyspepsia have oesophageal acid exposure that lies below the diagnostic threshold for gastro-oesophageal reflux disease but exceeds that of patients with non-reflux dyspepsia. The high pain/reflux event correlation in reflux-like functional dyspepsia suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
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PMID:Is functional dyspepsia largely explained by gastro-oesophageal reflux disease? 989 82

Pathological processes and diseases of the upper gastrointestinal tract have become increasingly recognized over recent years as childhood entities responsible for a variety of upper gastrointestinal symptoms previously labelled as functional or non-organic. The term 'dyspepsia' is an adult one whose definition requires clarification before use in the paediatric context, but it encompasses age-dependent symptoms such as feed-associated irritability in the infant, peri-umbilical pain in the younger child, and heart-burn, nausea, and indigestion in the older child as in adults. The possible organic conditions giving rise to such symptoms are multiple and multiorgan and include: gastro-oesophageal reflux; peptic ulcer disease; upper gastrointestinal Crohn's disease; antroduodenal motility disorders; pancreatitis; cholecystitis; cholelithiasis; biliary dyskinesia; and abdominal migraine. However, Munchausen syndrome by proxy must not be forgotten. Non-ulcer dyspepsia, it is now clear, has a basis in altered gastroduodenal motility and may be amenable to propulsion agents. In many individuals the dyspeptic symptoms of recurrent abdominal pain may be altered by psychotherapeutic intervention. Indeed there remains a proportion of children who undoubtedly have a behavioural or psychological base to their complaint. Nevertheless, with the recent increase in diagnostic yield from improved technical investigative aids available to paediatrics in the last 5-10 years, it is clear that the responsibility of the paediatrician to the child to find a cause of their symptoms is paramount. The variety of presenting features, possible causes of these symptoms, and appropriate investigation and treatment will be discussed, and management algorithms based on published literature and personal practice will be offered.
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PMID:Dyspepsia in infants and children. 989 91

Functional dyspepsia and the irritable bowel syndrome (IBS) are amongst the most widely recognised functional gastrointestinal disorders. Symptom based diagnostic criteria have been developed and refined for the syndromes (the Rome criteria) and these are now widely applied in clinical research. Both functional dyspepsia and IBS are remarkably prevalent in the general population, affecting approximately 20% and 10% of persons, respectively. The prevalence is stable from year to year because the onset of these disorders is balanced by their disappearance in the population. Clinically useful predictors of the course of these disorders have not been identified. Approximately one third of persons with functional dyspepsia concurrently have IBS. In most studies from Western countries, it has been shown that only a minority with functional dyspepsia and IBS present for medical care; the factors that explain consultation behaviour remain inadequately defined although fear of serious disease and psychological distress may be important. The majority of patients diagnosed as having functional dyspepsia or IBS continue to have symptoms long term with a significant impact on quality of life. The indirect costs of the functional gastrointestinal disorders greatly outweigh the direct costs but overall these conditions are responsible for a major proportion of health care consumption. Rational management of the functional gastrointestinal disorders will only follow a better understanding of the natural history of these conditions.
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PMID:Scope of the problem of functional digestive disorders. 1002 63


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