Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to identify those patients who would benefit from eradication therapy for Helicobacter pylori and to understand the scale of service changes needed to implement eradication therapy. All general practices in Bradford Health Authority were invited to take part in the study. Patients who had received more than one repeat prescription for proton pump inhibitors or H(2) receptor antagonists in the previous twelve months were identified using the repeat prescription systems in the participating practices. Their case notes were examined and the relevant data items extracted by a trained project worker. Forty-four out of 100 practices agreed to take part and they accounted for a population of 262 647 people. Of that population, 2.3% (6037) of patients were on long-term acid suppressing treatment. Seventy-nine percent (n=4784) of patients on long-term acid suppression had a diagnosis recorded in the records; 17% (n=1028) had duodenal ulcer; 5% (n=278) gastric ulcer and the rest, 58% (n=3478), consisted of patients labelled as dyspepsia, heartburn, gastritis, and non-ulcer dyspepsia. Only 131 (10%) of those patients with peptic ulcer had been prescribed eradication therapy. Endoscopy and barium meal examinations had been used to confirm the diagnosis in 2715 patients. In the remaining patients there was no information in the case notes to suggest whether the diagnosis had been confirmed by investigations.A substantial proportion of patients previously diagnosed as having peptic ulcer have not been offered eradication therapy demonstrating a delay in getting research evidence into practice. To ensure all patients within a health district who may benefit from eradication therapy, do benefit, a systematic approach including access to additional investigative facilities is required.
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PMID:Do all patients in primary care who may benefit from eradication of Helicobacter pylori have access to effective care? 1146 1

Actually is considered that Helicobacter pylori play a major role in the genesis of peptic ulcer. Like in the gastric and duodenal ulcer. When we demonstrate the presence of Helicobacter pylori in the gastric antrum of patients with ulcer they must receive eradication treatment. Another indication for eradication treatment are the patients with malt lymphoma or patients with endoscopical resection of gastric carcinoma. The ideal treatment is the therapy that eradicate 90% of the cases. The most effective are the triple therapies with one proton pump inhibitor with two antibiotics like amoxycillin plus clarithromycin. In Mexico the therapies with metronidazole are not recommended because we have high rates of resistance to this drug 70%. Is not justified to treat patients with non ulcer dyspepsia. We still recommended the schemes of 14 days. A good alternative is the combination of ranitidine bismuth citrate plus two antibiotics. Is possible that in the future we can have a vaccine to eradicate and to prevent the infection.
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PMID:[Treatment of Helicobacter pylori infection. Whom to treat and with what?]. 1146 22

There is currently no effective treatment for patients with nonulcer dyspepsia. Helicobacter pylori eradication has no beneficial effect on dyspeptic symptoms. Proton pump inhibitors are superior to placebo in the subset of patients with epigastric pain as the predominant symptom. H(2 )Receptor antagonists have no effect. Patients with dysmotility-like dyspepsia should be treated first with prokinetics. Unfortunately, cisapride no longer can be used to treat patients with functional dyspepsia because of reports of serious cardiovascular side effects and subsequent withdraw from the US market. Therefore, metoclopramide (or domperidone, if available) should be given. Treatment with motilides has no use in the relief of symptoms, even in patients with delayed gastric emptying. If the initial therapy has no effect after 4 weeks, switch treatment (eg, from proton pump inhibitor to metoclopramide or vice versa). If both of these pharmacologic therapies fail, consider treatment with an antidepressant (or with buspirone, an anxiolytic agent) or psychotherapy.
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PMID:Nonulcer Dyspepsia. 1146 90

It is rather difficult to choose a drug to treat nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathies in patients with rheumatic diseases, which primarily makes it necessary to use antiulcerous treatment as part of continuous NSAID therapy. Detecting upper gastric ulcers or erosions in many patients admitted to a rheumatology hospital for exacerbation of the underlying disease cannot cause NSAID to be discontinued even temporarily as this may lead to a significant deterioration and progression of the joint syndrome. The aim of the study was to evaluate the efficiency of 2-week treatment with misoprostol (Cytotec), 800 micrograms/day, and omeprasole (Omez), 40 mg/day, for NSAID-induced gastropathy in 63 patients with rheumatic diseases. The study has indicated that the use of Omez seems to be more advisable than that of Cytotec in the treatment of NSAID-induced gastropathy if it is necessary to continue to treat the patient with a whole range of antirheumatic drugs. Equally effective in healing ulcers and erosions, Omez is much better tolerated and able to rapidly relieve gastralgias and dyspepsia. It seems that the use of Cytotec for NSAID-induced gastropathy with a great deal of side effects and relatively less efficiency borne in mind may be limited because of cases of inefficiency of proton pump inhibitors.
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PMID:[Omeprazole and misoprostol for NSAID-induced gastropathies: comparative efficiency of their short-term treatment]. 1151 Jan 88

In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.
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PMID:Helicobacter pylori therapy: first-line options and rescue regimen. 1154 23

Dyspepsia, and the issue of Helicobacter pylori status, can present significant controversies in clinical management. Both primary physicians and gastroenterologists should be aware of options for the treatment of patients with dyspepsia. This article reviews information gathered about the eradication of H. pylori in non-ulcer dyspepsia (NUD), therapy for NUD not associated with H. pylori, and whether H. pylori testing should replace routine endoscopy in uncomplicated dyspepsia. The benefits of eradicating H. pylori in NUD include superior, cost-effective resolution of symptoms, compared to placebo; reduction of ulcer and gastric cancer risk; and removal of risk of certain adverse effects should long-term proton pump inhibitor therapy become necessary. In patients with normal endoscopy and no evidence of H. pylori, proton pump inhibitor therapy is superior to placebo in controlling symptoms. This benefit is confined to patients with symptoms and/or oesophageal pH-metry indicative of GORD. Non-invasive H. pylori testing may be appropriate for younger dyspeptic patients with no alarm symptoms who are not taking non-steroidal anti-inflammatory drugs (NSAIDs). In conclusion, eradication of H. pylori is advisable in patients with NUD. Proton pump inhibitor therapy is superior to placebo in NUD patients without H. pylori, especially if symptoms indicate GORD. H. pylori testing may replace endoscopy in young dyspeptics with no alarm symptoms or NSAID use.
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PMID:Review article: tackling the "dyspeptic problem". 1155 75

Dyspepsia, a common disorder, can present some difficult clinical dilemmas. Physicians should explore some of the more challenging cases of dyspepsia in a setting that fosters interactive dialogue among colleagues, as was the case at the interactive discussion reported below. A panel of experts presented and discussed three case histories. The audience was able to choose from among several options for diagnosis or treatment and recorded their votes by means of an electronic handset. The first case concerned the relationship between continued non-steroidal anti-inflammatory drug (NSAID) use and recurrent upper gastrointestinal (GI) symptoms without ulcer or Helicobacter pylori infection. The second was a woman with complex upper GI symptoms including heartburn. The last featured a young man with dyspepsia and no alarm symptoms. The first case showed that a standard dose of proton pump inhibitor (PPI) is the best treatment for patients with gastritis who continue to use NSAIDs. The second case revealed that 24-h pH monitoring can be used to establish a relationship between symptoms and reflux episodes. The third case demonstrated that it can be difficult to make a definitive diagnosis based on clinical symptoms, and that patients with endoscopy-negative reflux disease usually respond well to PPI therapy.
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PMID:Review article: managing the dyspeptic patient--an interactive discussion. 1155 76

The mechanisms by which aspirin(ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal symptoms are poorly understood. They probably arise from several causes, including direct and indirect mucosal injury, exacerbation of underlying peptic ulcer disease or non-ulcer dyspepsia, exacerbation of Helicobacter pylori gastritis, and possibly motility disorders. No single form of therapy has been generally successful. Because, in most cases, symptoms abate fairly rapidly with continued treatment, there is little evidence that benefit associated with any symptom-directed drug therapy is superior to placebo beyond 4 weeks. Exceptions may be the subsets of patients with pre-existing ulcer disease or heartburn, exacerbated by the NSAID therapy, who usually benefit from acid-suppressive drug treatment. Different NSAIDs vary in the frequency with which their use leads to gastrointestinal(GI) complications such as haemorrhage, perforation, obstruction, or the symptomatic ulcers from which about 40% of the complications arise. Most gastroduodenal ulcers heal over time, albeit more slowly, with conventional doses of any of the available anti-ulcer drugs. Maintenance therapy may be needed in many patients who continue NSAID therapy. Anti-ulcer drugs have not, thus far, been shown to be more effective than placebo in preventing ulcer complications or their recurrence. The use of COX-2-selective inhibitors appears, in outcome studies, to reduce gastrointestinal bleeding, including bleeding from ulcers, but it is not established that the ulcers protected were caused by NSAIDs, as distinct from ulcers exacerbating or recurring from antecedent peptic ulcer disease. To-date, perforation or obstruction have not been shown to be affected by selective COX-2 inhibitor drugs. If the major problem giving rise to severe NSAID complications is pre-existing peptic ulcer disease, it may yet emerge that the most effective approach will be the use of proton pump inhibitor drugs, for the duration of NSAID therapy, in a small subset of high-risk patients. Most other low-risk patients may not need any special care. Co-morbid conditions have a major impact on outcome of NSAID therapy. Morbidity or even death attributable solely to NSAIDs is probably small in normal patients, and requires little in the way of prophylaxis.
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PMID:Prevention and treatment of gastrointestinal symptoms and complications due to NSAIDs. 1156 39

Helicobacter pylori (H. pylori) has been found to be associated with various gastrointestinal diseases. Confirmation of H. pylori infection includes invasive and non-invasive methods. There has been increasing interest in noninvasive tests recently. However, the geographical differences among H. pylori strains have been emphasized recently and the H. pylori strain in Taiwan showed a high cagA positive result and different vacA subtype when compared with those of Western countries. The aim of this study is to access and compare the reliability and the diagnostic accuracy of the stool H. pylori antigen tests by spectrophotometry and by the visual method, especially in Southern Taiwan. Thirty-two patients (18 men and 14 women; age range: 23-91 y/o, mean: 50.5 y/o) who underwent gastroendoscopy at Kaohsiung Medical University Hospital were enrolled in this study. H. pylori infection status was confirmed by culture or two positive test results on CLO test, histology and 13C-urea breath test (13C-UBT). The exclusion criteria included previous gastrointestinal tract surgery, use of antibiotics, proton pump inhibitor or compounds containing bismuth within 1 month of the study. Among them, 14 patients were with duodenal ulcer (DU), 4 with gastric ulcer (GU), 12 with non-ulcer dyspepsia, and 2 with GU and DU. Those patients had their stool collected for ELISA tests of H. pylori stool antigen (HpSA). The HpSA tests were positive in 16 of 18 patients diagnosed as H. pylori positive, and negative in 13 of 14 patients as H. pylori negative. The sensitivity and specificity were 88.9% and 92.9% respectively. The positive and negative predictive values were 94.1% and 86.7% respectively. The concordance of HpSA accessed by spectrophotometry and visual method is 100%, which makes this test even easier and cheaper. We concluded that stool HpSA test is a noninvasive, accurate, reliable, rapid and easy way to diagnose H. pylori infection in Southern Taiwan, either by spectrophotometry or by visual assessment.
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PMID:Diagnosis of Helicobacter pylori infection by stool antigen test in southern Taiwan. 1159 60

The National Institute for Clinical Excellence recently issued guidance on the use of proton pump inhibitors (PPIs) in the management of dyspepsia, including gastro-oesophageal reflux disease (GORD). GORD is a common disorder that reduces quality of life and can indicate serious disease such as reflux oesophagitis. The symptoms of GORD must be distinguished from those of other diseases, such as functional dyspepsia or cardiac problems. Furthermore, atypical alarm symptoms, such as bleeding or sudden weight loss, require urgent further investigation. Most GORD is uncomplicated and can be treated using management algorithms that make the best use of resources. Newer strategies such as 'step-down' or 'on-demand' therapy can cost-effectively improve the long-term management and quality of life of patients with recurrent GORD.
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PMID:Managing gastro-oesophageal reflux disease in primary care. 1159 57


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