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

Functional dyspepsia or nonulcer dyspepsia, and nonerosive reflux disease (NERD) or endoscopy-negative reflux disease, are common reasons for referral to a gastroenterologist. Although there is much confusion with regard to definition, recent research would suggest that these 2 conditions are linked and may represent components in the spectrum of the same disease entity, in terms of both symptoms and pathophysiology. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and Helicobacter pylori infection.
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PMID:Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications. 1809 37

Functional dyspepsia is a highly prevalent disorder that accounts for 5% of visits to primary care clinicians. It frequently coexists with other gastrointestinal tract disorders, including irritable bowel syndrome and gastroesophageal reflux disease. Symptoms of functional dyspepsia, including epigastric pain, early satiety, and postprandial nausea, are nonspecific, making its diagnosis difficult. Functional dyspepsia is a heterogeneous disorder involving a number of different pathophysiologic processes, culminating in both gastrointestinal sensory and motor dysfunction. Although functional dyspepsia does not impart any increased risks to long-term health, it significantly affects both individuals and society. The economic burden of evaluating and treating functional dyspepsia is estimated to be at least $1 billion per year, and patients with functional dyspepsia experience a markedly reduced quality of life. Using the case of Ms C, we apply an evidence-based approach to highlight current knowledge in the diagnosis, evaluation, and treatment of functional dyspepsia.
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PMID:A 32-year-old woman with chronic abdominal pain. 1816 96

Functional gastrointestinal disorders including functional dyspepsia are highly prevalent. Their clinical course is benign without disease-associated mortality. On the other hand, the impact can be substantial for the affected patients with regard to the decrease of quality of life, and for society with regard to the economical implications. Functional dyspepsia is a clinical syndrome with various underlying pathophysiologies. Thus, it is understandable that there is no single cure available. Reassurance by ruling out relevant differential diagnoses, explanation, and general advice with regard to the underlying causes and dietary and life-style measures are important components of the management of these patients. Well established medical treatments include Helicobacter pylori eradication, acid inhibitory agents and prokinetics. The overall gain over placebo ranges from less than 5% for H. pylori eradication to 15% for antisecretory agents and prokinetics. Thus, even considering a substantial proportion of patients with spontaneous remissions (usually addressed as placebo response in clinical trials), there are 20 to 40% of patients who do not respond properly to these measures. In these patients, other treatment modalities need to be considered. These second- or third-line measures include herbal medicines and psychotropic agents. Some of the herbal preparations have been well studied in controlled clinical trials with sufficient scientific evidence to assume efficacy. Psychotropic drugs on the other hand have, as yet, not been specifically tested in functional dyspepsia. Medications such as clonidine, buspirone or octreotide can be helpful in few selected patients. However, a very careful assessment of potential risks and benefits needs to be undertaken on a case-by-case basis. Other evidence-based measures include psychological interventions such as psychotherapy and hypnotherapy.
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PMID:Failed therapy and directions for the future in dyspepsia. 1846 39

(1) Functional dyspepsia is extremely common, yet few if any treatments have been shown to be effective. This review examines the potential benefits and risks of using herbal products in treating symptoms of dyspepsia. (2) About forty plants have been approved in France in the composition of products traditionally used for dyspepsia. (3) The clinical efficacy of most of these plants has not been assessed. Some essential oils can cause severe adverse effects, including seizures. Herbal teas appear to be safe when used appropriately. (4) A few randomised controlled clinical trials suggest that peppermint essential oil is effective in reducing abdominal pain, flatulence and diarrhea in patients with "irritable bowel syndrome". Peppermint tea, containing essential oil, has no known adverse effects. (5) There is no sound reason to discourage patients from using herbal teas made from plants such as lemon balm, German chamomile or star anise.
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PMID:Herbal remedies for dyspepsia: peppermint seems effective. 1863 Mar 90

Functional dyspepsia belongs to functional disorders of the gastrointestinal tract. Its prevalence is estimated up to 25% of adult population of Western countries. On the contrary to irritable bowel syndrome, functional dyspepsia is slightly more frequent in men. The recent classification of functional dyspepsia includes its two subcategories: postprandial distress syndrome (DS, B1a) and epigastric pain syndrome (EPS, B1b). In the management of functional dyspepsia three strategies are taken into the consideration: 1. early gastroscopy performed in people over 45 years of age and independent of age in case of alarm symptoms. 2. Therapy based on noninvasive H. pylori testing: in young adults with dyspeptic symptoms, without alarm symptoms and not treated with nonsteroid antiphlogistic medications. 3. Empiric treatment: considered as an initial therapy in patients not diagnosed with dyspepsia, without alarm symptoms and in dyspeptic patients despite H. pylori eradication. In the treatment of functional dyspepsia the following treatments are applied: dietary treatment, farmacotherapy with antisecretory drugs, prokinetics, H. pylori eradication, antidepressants and psychotherapy. Directions of the further investigation in functional dyspepsia include: improvement of endoscopic methods, and searching for new groups of medications according to the new Rome III classification of functional dyspepsia, based on its pathophysiology.
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PMID:[Epidemiology, classification and management of functional dyspepsia]. 1944 80

The patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) questionnaire was recently developed and validated for the evaluation of therapeutic responsiveness in functional dyspepsia (FD). Functional dyspepsia is a heterogeneous disorder, with different pathophysiological mechanisms underlying the symptom pattern. The relationship between PAGI-SYM scores and putative pathophysiological mechanisms has not been studied. The aim of this study was to evaluate the relationship between PAGI-SYM subscales and gastric emptying, gastric sensitivity and gastric accommodation in FD. A total of 161 consecutive FD patients underwent Helicobacter pylori (HP), gastric barostat and standardized gastric emptying testing (n = 126), and completed the PAGI-SYM questionnaire. Relationships between scores for the six subscales (heartburn/regurgitation, nausea/vomiting, fullness/satiety, bloating, upper abdominal pain, lower abdominal pain) and gastric function were analysed using Pearson's linear correlation, multiple regression analysis, chi-square and Student's t-tests. Gastric emptying was significantly correlated with scores for heartburn/regurgitation (r = 0.26), nausea/vomiting (r = 0.19), fullness/satiety (r = 0.20), bloating (r = 0.21) and lower abdominal pain (r = 0.22; all P < 0.05). Patients with delayed emptying had significantly higher scores for each of these subscales (all P < 0.05). Discomfort volume during gastric distension was significantly correlated with scores for fullness/satiety (r = -0.27), bloating (r = -0.23), heartburn/regurgitation (r = -0.21), and upper abdominal pain (r = -0.20). Patients with hypersensitivity to distension had significantly higher scores for fullness/satiety (P < 0.05). At different cut-off levels of symptom severities, consistent associations were found between fullness/satiety and gastric discomfort volume, between preprandial volumes and upper abdominal pain, compliance and upper abdominal pain, and between bloating and gastric discomfort volume. Multiple regression analysis revealed that gastric emptying rate contributed significantly to models for the severity of these subscales. The importance of discomfort volume disappeared in favour of gender when sex was included in the model. No significant correlations were found with HP status or with gastric accommodation. PAGI-SYM scores are mainly correlated with gastric emptying rate and with gastric hypersensitivity. Multivariate analysis suggests that the questionnaire may be useful in the evaluation of gastroprokinetics. Its role in the evaluation of drugs that alter gastric sensitivity is less clear.
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PMID:Relationship between symptom pattern, assessed by the PAGI-SYM questionnaire, and gastric sensorimotor dysfunction in functional dyspepsia. 1966 3

Functional dyspepsia is a highly prevalent but heterogeneous disorder; multiple pathogenetic mechanisms are likely involved but the underlying causal pathways in functional dyspepsia remain obscure. The term functional dyspepsia was popularized by the famed Walter Alvarez at the Mayo Clinic early last century. Prominent Australian gastroenterologists who have contributed to our understanding of functional dyspepsia include Peter Baume, Barry Marshall, Douglas Piper, Nick Talley, John Kellow, and Gerald Holtmann. Specific dyspeptic symptoms have not generally correlated very well with any particular physiologic disturbance, although gastric disaccommodation and duodenal eosinophilia have been linked to early satiety in this condition. Genetic markers have been tentatively identified, and functional dyspepsia can follow bacterial gastroenteritis. No objective diagnostic tools for functional dyspepsia are currently agreed upon, although meal induction of symptoms appears reproducible and may have diagnostic utility. The symptomatic criteria for functional dyspepsia (Rome III criteria) are based on expert consensus and the exclusion of organic causes. Various therapeutic modalities for functional dyspepsia have been explored; however, empirical approaches are still employed for the treatment of functional dyspepsia. Better approaches for functional dyspepsia are likely to follow an improved understanding of the underlying pathophysiological abnormalities.
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PMID:Whither dyspepsia? A historical perspective of functional dyspepsia, and concepts of pathogenesis and therapy in 2009. 1979 94

Functional dyspepsia is a clinical syndrome that features abdominal symptoms centered in the upper abdomen without an organic basis. Three possible mechanisms of gastric dysfunction could be related to functional dyspepsia: 1) delayed gastric emptying, 2) impaired gastric accommodation to food intake, and 3) hypersensitivity to gastric distention. Delayed gastric emptying has been suggested to lead to prolonged antral distension that causes dyspeptic symptoms. Delayed gastric emptying is therefore a focal point of debate about anorexia caused by dyspepsia, and prokinetic agents are often administered in Japan for its treatment. Recently, we found that addition of monosodium L-glutamate (MSG) to a high-energy liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method to improve delayed gastric emptying could be enhancement of chemosensors that activate the autonomic nervous system innervating the gastrointestinal tract. In conclusion, enrichment with glutamate promoted gastric emptying after intake of a high-protein meal, suggesting that free glutamate is important for protein digestion and that MSG may be helpful for management of delayed gastric emptying in patients with functional dyspepsia.
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PMID:New frontiers in gut nutrient sensor research: monosodium L-glutamate added to a high-energy, high-protein liquid diet promotes gastric emptying: a possible therapy for patients with functional dyspepsia. 2009 86

Functional dyspepsia includes one or more of four cardinal symptoms: postprandial fullness, early satiety, pain or burning in the epigastrum. According to the Rome III diagnostic criteria for functional dyspepsia, these symptoms must be present for the last 3 months with symptom onset at least 6 months prior to diagnosis. Functional dyspepsia is not the result of an underlying structural abnormality, but rather the consequence of multiple pathophysiological mechanisms such as abnormal gastric motility, gastric and duodenal hypersensitivity to acid, Helicobacter pylori infection. Dyspeptic patients over 50 or those with alarm symptoms should be investigated to detect any structural abnormality such as cancer, peptic ulcer or esophagitis. After structural abnormalities and gastroesophageal reflux disease are excluded the management of functional dyspepsia consists of either a test and treat approach (non invasive detection of Helicobacter pylori infection followed by eradication therapy) or empirical therapy. Although endoscopy was traditionally reserved for those patients without symptom relief after 6-8 weeks of therapy, the significant percentage of patients with functional dyspepsia with symptom breakthrough or relapse after antisecretory or prokinetic therapy discontinuation makes an initial endoscopic study a logical choice. Therapy with proton pump inhibitors yields results especially in those patients with regurgitation and epigastric burning sensation, while prokinetic agents with no extrapyramidal side effects (such as Domperidone and Itopride) alleviate satiation, bloating and nausea by accelerating gastric emptying. Second-line drugs with encouraging results in clinical trials which can be used in functional dyspepsia are low-dose tricyclic antidepressants as well as selective serotonine reuptake inhibitors.
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PMID:Functional dyspepsia: a pragmatic approach. 2118 Feb 36

Dyspepsia is a common term used for a heterogeneous group of abdominal symptoms. Functional dyspepsia (FD) is the focus of this review. The 2006 Rome III criteria defined FD and its subgroups, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). FD is a very common condition with a high prevalence throughout the world, adversely affecting the quality of life of patients. The pathophysiology of FD has been under investigation during the past two decades. Multiple mechanisms such as abnormal gastric emptying, visceral hypersensitivity, impaired gastric accommodation, and central nervous system factors are likely involved. Several tests are available for the assessment of various physiologic functions possibly involved in the pathogenesis of FD, and some of these could be used in clinical practice, helping to understand the abnormalities underlining patients' complaints. Currently, the possibilities of pharmacological therapy for FD are still limited, however, experience of using prokinetics, tricyclic antidepressants, selective serotonin-reuptake inhibitors (SSRIs), proton-pump inhibitors (PPIs), and several alternative techniques has been accumulated. The different combinations of alterations in physiologic gastrointestinal and central nervous system functions result in the very heterogeneous nature of FD so combined approaches to these patients could be beneficial in challenging cases.
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PMID:Functional dyspepsia. 2118 May 97


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