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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

While widely used in research, the 1991 Rome criteria for the gastroduodenal disorders, especially symptom subgroups in dyspepsia, remain contentious. After a comprehensive literature search, a consensus-based approach was applied, supplemented by input from international experts who reviewed the report. Three functional gastroduodenal disorders are defined. Functional dyspepsia is persistent or recurrent pain or discomfort centered in the upper abdomen; evidence of organic disease likely to explain the symptoms is absent, including at upper endoscopy. Discomfort refers to a subjective, negative feeling that may be characterized by or associated with a number of non-painful symptoms including upper abdominal fullness, early satiety, bloating, or nausea. A dyspepsia subgroup classification is proposed for research purposes, based on the predominant (most bothersome) symptom: (a) ulcer-like dyspepsia when pain (from mild to severe) is the predominant symptom, and (b) dysmotility-like dyspepsia when discomfort (not pain) is the predominant symptom. This classification is supported by recent evidence suggesting that predominant symptoms, but not symptom clusters, identify subgroups with distinct underlying pathophysiological disturbances and responses to treatment. Aerophagia is an unusual complaint characterized by air swallowing that is objectively observed and troublesome repetitive belching. Functional vomiting refers to frequent episodes of recurrent vomiting that is not self-induced nor medication induced, and occurs in the absence of eating disorders, major psychiatric diseases, abnormalities in the gut or central nervous system, or metabolic diseases that can explain the symptom. The current classification requires careful validation but the criteria should be of value in future research.
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PMID:Functional gastroduodenal disorders. 1045 43

Functional dyspepsia (FD) is the most common condition in patients consulting with upper gastrointestinal tract symptoms, resulting in up to 5% of visits to family physicians. By definition, patients with FD have no clinical, biochemical or endoscopic evidence of an organic disease that is likely to explain their symptoms. The process to be used in a structured interview for establishing a clinical diagnosis of FD is presented. The steps are as follows: determine the duration and the course of the disease; characterize the current syndrome and review the alarm symptoms; elicit the patient-perceived dominant symptom and/or condition; and identify the patient's reason for consulting and address the psychosocial factors. According to the clinical characteristics of the three most frequent causes of dyspepsia (peptic ulcer, gastroesophageal reflux and FD) and acknowledging that these conditions may coexist rather than overlap in some patients, an algorithm is suggested for establishing a working diagnosis of FD and indications for investigation, and initiating a management strategy.
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PMID:Systematic approach toward the clinical diagnosis of functional dyspepsia. 1054 52

This study examined the prevalence of functional gastrointestinal (FGI) disorders, and the association between FGI disorders and measures of affective distress, among a sample of 127 university students. Subjects completed a questionnaire battery including Research Diagnostic Questions for Functional Gastrointestinal Disorders, the Beck Anxiety Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, and a medical utilization questionnaire. FGI disorders were diagnosed in 51.2% of the sample. Functional dyspepsia (22.8%), dyschezia (20.5%), functional heartburn (19.7%), functional chest pain (18.1%), and globus (12.6%) were the most frequently diagnosed disorders. Participants experiencing globus, functional dyspepsia, or functional heartburn showed significant differences in terms of anxiety, anxiety sensitivity, depression, and/or physician visits, when compared with participants without these disorders. Our results suggest that FGI disorders are strikingly prevalent among young adults, and specific FGI disorders are associated with affective distress. Implications of the observed association between psychological factors and FGI disorders are discussed.
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PMID:Neurotic butterflies in my stomach: the role of anxiety, anxiety sensitivity and depression in functional gastrointestinal disorders. 1057 72

Nonulcer dyspepsia is a description of persistent or recurrent upper abdominal pain or discomfort with no structural or biochemical explanation for the patient's symptoms. The exact cause of nonulcer dyspepsia is not known, but many myths have evolved regarding its etiology and treatment. The goal of this review is to evaluate the potential causes of nonulcer dyspepsia. By determining what it is and what it is not, we can be more selective in our approach to diagnosis and our choice of empiric therapies.
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PMID:Nonulcer dyspepsia: what it is and what it is not. 1091 66

Functional dyspepsia is a heterogeneous disorder in which distinct pathophysiological abnormalities are present in subgroups of patients. Accommodation of the proximal stomach to a meal is impaired in 40% of patients with functional dyspepsia. This is associated with symptoms of early satiety and weight loss. The presence of early satiety as a relevant or severe symptom is a good predictor of impaired accommodation. Gastric barostat or proximal gastric ultrasound may confirm the presence of impaired accommodation after a meal. Sophisticated analysis of scintigraphic gastric emptying images or a simple caloric drinking test are under investigation in the diagnosis of impaired accommodation. It seems logical to have patients eat more frequent, smaller sized meals. Cisapride is the only well-evaluated form of pharmacological treatment for this condition, and has been withdrawn from the US market (see Important Note under Treatment, below). Small or preliminary studies suggest some benefit from buspirone or selective serotonin reuptake inhibitors (SSRIs).
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PMID:Functional Dyspepsia: Impaired Fundic Accommodation. 1109 89

Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub-groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history-taking will be of pivotal importance in management strategies for functional dyspepsia.
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PMID:Review Article: pain versus discomfort--is differentiation clinically useful? 1114 30

Does it make sense to diagnose functional dyspepsia? In 1998, a committee gathered in Rome recommended to diagnose functional dyspepsia in patients with persistent or recurrent pain or discomfort centered in the upper abdomen but no disease likely to explain the symptoms, which are not exclusively relieved by defecation or associated with changed stool frequency or form. Careful history taking, physical examination and upper endoscopy during a symptomatic period off anti-secretory therapy are recommended as minimum workup. Functional dyspepsia thus is a diagnosis of exclusion. The term is unfortunate: It suggests the presence of a manifest or yet covert organ dysfunction and also a fundamental difference between disorders with defined and with unknown cause, only the former being serious. However, that a limited number of investigations failed to reveal a cause does not mean that there is no cause. Further, functional often is used synonymous with vague and ideology-ridden terms such as "organ neurosis", "vegetative dystonia" and "psychosomatic disorder". There are no unequivocal data showing that patients with functional dyspepsia share pathophysiological, psychosocial or psychopathological characteristics or that there is a specific therapy. In the individual patient, therapy has to be tailored according to the symptoms. It thus seems doubtful whether the diagnosis functional dyspepsia can, for a patient's treatment or otherwise, be of value. If a categorization is deemed inevitable, the term idiopathic dyspepsia would be preferable, as it unequivocally makes clear that the symptoms' cause is unrevealed.
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PMID:[Functional dyspepsia: philosopher's stone or much noise about nothing?]. 1150 36

Gastroenterologists frequently encounter patients who report vague epigastric discomforts or sensations of fullness, bloating, and distention in the upper abdomen. The discomfort is neither burning in character nor severe in intensity; there is no nocturnal pain. The epigastric location of discomfort and lack of radiation may help to exclude biliary tract and pancreatic diseases. Nausea may be present, but there is little or no vomiting. After these patients ingest liquids or solid foods, the symptoms of easy filling or early satiety and increasing discomfort and nausea are almost always present. The patient may only report "indigestion," but a specific chief complaint, such as pain, discomfort, nausea, or bloating may be elicited with further inquiries. Solid foods usually provoke more symptoms than do liquids. Symptoms of early satiety, nausea, bloating, and abdominal discomfort may culminate in the vomiting of undigested food. These vague upper gastrointestinal (GI) symptoms have been termed "dyspepsia." When peptic diseases of the stomach are excluded, the symptom complex has been called "nonulcer" dyspepsia, a vague syndrome with symptoms attributed to stomach dysfunction. Nonulcer dyspepsia has been reviewed recently. Such symptoms, commonly attributed to a "functional" disorder, are very common in clinical practice, with an incidence of 30% of patients. In this review, we will discuss an approach to the evaluation and treatment of patients with symptoms of nausea, early satiety, bloating, and vague epigastric discomfort--dyspeptic symptoms associated with functional stomach disorders. We will review the anatomy and motility of the stomach and suggest potential neuromuscular malfunctions of the stomach that may result in epigastric symptoms. The potential role of stress and other brain-gut interactions, which may underlie these symptoms, will also be reviewed.
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PMID:Functional disorders of the stomach. 1153

Functional dyspepsia is a clinical syndrome defined by upper abdominal symptoms without identifiable cause by conventional diagnostic means. Recent studies have established that functional dyspepsia is a heterogeneous disorder in which different pathophysiologic disturbances underlie different symptom profiles. Delayed gastric emptying is associated with postprandial fullness, nausea, and vomiting; impaired accommodation is associated with early satiety and weight loss; and hypersensitivity to gastric distention is associated with epigastric pain, belching, and weight loss. The pathogenesis of functional dyspepsia is unknown but may be postinfectious in a subgroup of patients. The role of psychological disturbances and of duodenal hypersensitivity requires further study. Treatment of the underlying pathophysiologic abnormality seems logical, but options for pharmacotherapy are limited to acid suppression, prokinetic drugs, and antidepressants. Psychotherapy can be considered for refractory patients. Several novel drug therapies are under evaluation.
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PMID:Causes and treatment of functional dyspepsia. 1169 88


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