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

Ninety-three consecutive patients referred to a gastroenterology unit with unexplained dyspeptic symptoms were sent a postal questionnaire 6-12 months after endoscopy. It inquired into their current physical symptoms and subjective improvement since investigation, satisfaction with treatment, past history and current psychological well-being. A comparison group of 47 patients with peptic disease were similarly surveyed. Those with unexplained dyspepsia reported more current physical symptoms, more dissatisfaction with their treatment and less subjective improvement than those with peptic disease. The two groups were similar in terms of psychological distress but previous consultation for abdominal and other somatic complaints were more common in those with unexplained dyspepsia. The implications for management of dyspeptic patients are discussed.
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PMID:The outcome of unexplained dyspepsia. A questionnaire follow-up study of patients after endoscopy. 143 65

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2-5% during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6-10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.
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PMID:Symptoms of gallstone disease. 148 6

The importance of personality traits in nonulcer dyspepsia and irritable bowel syndrome is a controversial issue. We wished to assess the distribution of abnormal personality traits in nonulcer dyspepsia and the irritable bowel syndrome, define any relation among personality and symptoms, and determine whether personality factors discriminate among patients with functional, psychiatric, or organic gastrointestinal diseases. Patients with nonulcer dyspepsia (n = 31), irritable bowel syndrome (n = 67), organic gastrointestinal disease (n = 64), somatoform disorder (n = 36) and healthy controls (n = 128) were studied. Before diagnostic evaluation by an independent physician, all patients completed the Minnesota Multiphasic Personality Inventory and a symptom questionnaire. Symptom scores for abdominal pain and the Manning criteria, which is considered to be diagnostic for the irritable bowel syndrome, were evaluated. Personality scales in patients with nonulcer dyspepsia, irritable bowel syndrome, and organic disease were very similar. However, patients in the other groups differed from somatoform disorder on nearly all scales. In nonulcer dyspepsia, irritable bowel syndrome, and organic disease, hypochondriasis weakly correlated with pain. Subgroups of irritable bowel syndrome patients with predominant constipation and those with predominant diarrhea had similar personality traits, although hypomania was minimally increased in constipation. Patients who fulfilled the Manning criteria for irritable bowel syndrome had more psychological distress than those who did not. The Minnesota Multiphasic Personality Inventory correctly classified somatoform disorder and health 81% and 75% of the time, respectively, but it classified nonulcer dyspepsia and irritable bowel syndrome correctly in only 32% and 34% of cases. Our results suggest that psychopathology may not be the major explanation for functional gastrointestinal disorders.
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PMID:Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome. 200 21

Patients with duodenal ulcer or functional dyspepsia do not differ on dyspeptic symptoms. The aim of the present study was to test the hypothesis that functional dyspepsia and duodenal ulcer are two different diagnostic entities by examining the discriminating power of several anamnestic, biological, and psychosocial variables. Ninety-four patients with duodenal ulcer and 86 patients with functional dyspepsia were included. Anamnestic data, global assessment, Helicobacter pylori status, blood group, Lewisa+ phenotype, and several measures of psychological distress and somatic complaints were registered. Compared to patients with functional dyspepsia, the duodenal ulcer patients were more often infected by Helicobacter pylori and had their stomach discomfort more often relieved by eating. Compared to patients with duodenal ulcer, patients with functional dyspepsia had higher scores of depression, trait anxiety, general psychopathology and different somatic complaints (called somatization). They were also less satisfied with the health care system, their disorder had a greater negative impact on their quality of life, and their global assessment of own health was poorer. Discriminant analysis including age, smoking, Helicobacter pylori status, global assessment, and somatic complaint classified 86.1% of the patients correctly (77.9% of the patients with functional dyspepsia and 93.6% of the patients with duodenal ulcer). It is concluded that duodenal ulcer and functional dyspepsia are two separate diagnostic entities. Patients with duodenal ulcer are older, smoke more often, and almost all are infected with Helicobacter pylori, while patients with functional dyspepsia are characterized by somatization and a negative assessment of their own health.
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PMID:Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer. Significance of somatization. 772 72

Increased numbers of psychiatric diagnoses and increased levels of psychological distress are seen in the majority of medical clinic patients with gastrointestinal motility disorders. In IBS, psychological symptoms are believed to be comorbid conditions, which do not cause the motility disorder but which do influence the patient's decision to consult a physician. In functional dyspepsia, psychological symptoms are present in many patients, but their role is not known; the available data suggest that psychological symptoms do not predict which patients will consult a physician. Among constipated patients, anxiety is believed to contribute to the development and course of pelvic floor dyssynergia by increasing pelvic floor muscle tension. Constipated patients without physiologic abnormalities to explain their constipation appear to have more psychological symptoms than those with delayed colonic transit, but there is significant psychological distress even in patients with slow transit constipation. Psychological symptoms do not seem to predict which constipated patients will consult a physician. There is an increased incidence of psychiatric diagnoses in patients with esophageal motility disorders as well, but the role that these psychological symptoms play in the course of the disorder is not known. Patients with the most common gastrointestinal motility disorders, IBS and dyspepsia, report experiencing more stressful life events, and IBS patients appear to show a greater increase in gastrointestinal symptoms when exposed to stressors. Laboratory studies document that acute psychological stressors do alter gastric, small bowel, and colonic motility, and patients with IBS appear to show a greater change in colonic and ileal motility with stress than healthy controls. Greater reactivity has not been demonstrated for the esophagus or stomach, however, and it has not been demonstrated for other gastrointestinal motility disorders. A characteristic of many patients who consult gastroenterologists for IBS and other motility disorders is a tendency to report multiple somatic complaints (including many nongastrointestinal complaints) and to overuse medical resources. This pattern of behavior is referred to as somatization or abnormal illness behavior. One source of abnormal illness behavior is childhood social learning, which occurs (1) when parents provide gifts or special privileges to a child who reports somatic symptoms or (2) when parents model abnormal illness behaviors themselves.
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PMID:Psychosocial aspects of functional gastrointestinal disorders. 868 74

Patients with symptoms of GERD and dyspepsia are among the most common consulters in general practice and are different from their counterparts in the community who choose not to consult although they suffer from similar symptoms. They represent a heterogeneous group with considerable symptom overlap. They have a relatively poor quality of life and endoscopic findings can only explain symptoms in about half of these patients. Thus psychosocial factors which could contribute to their morbidity should be explored. While some studies have methodological shortcomings, main findings are that key psychological factors are anxiety, tension, neuroticism, somatization, fears of malignancy, negative assessment of health, depression, a poor social network and less effective coping strategies. Physical illness is likely to bring on psychological distress due to discomfort or threat of ill health. Cognizance of psychosocial factors will facilitate an understanding of the underlying problems and will improve diagnosis and selection of optimal treatment.
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PMID:Psychosocial factors and their role in symptomatic gastroesophageal reflux disease and functional dyspepsia. 889 45

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

Visceral hypersensitivity was shown in patients with functional gastrointestinal disorders (FGID). The mechanisms underlying this sensory dysfunction remain undetermined. The initial hypothesis of a generalized reduction in pain tolerance was rejected by further studies that suggested a normal tolerance to somatic stimuli and led to the generally accepted assumption that pain intolerance is specific and exclusive for visceral stimuli in these patients. We wanted to revisit this theory by examining whether patients with FGID reported perception and tolerance to somatic pain differently from normal subjects and whether the response to somatic pain stimulus was correlated to gastrointestinal symptoms or psychological status or distress. Thirty-three patients with FGID (Rome II criteria)(F/M: 26/7; mean age 48+/-9.9) and 33 normal controls (F/M: 24/9; mean age 44.1+/-6.8) were asked to immerse their nondominant hand into 4 degrees C water for as long as possible (maximum 120 sec). Time before appearance of: (1) discomfort, (2) pain, and (3) withdrawing of the hand were noted. The intensity of pain was rated on a visual analog scale from 0 to 100. Self-report questionnaires were used to assess the severity of gastrointestinal symptoms (St-Luc GI index) and the psychological distress (SCL-90) in the patient group. Data are expressed in seconds as mean +/- SEM. Discomfort sensory thresholds were similar in controls and FGID patients (28+/-3 and 24+/-2, respectively; NS) whereas pain and withdrawing were significantly lower in FGID (41+/-3 and 76+/-6 sec) than in controls (62+/-6 and 102+/-4; P < 0.05). Pain intensity was similar in both groups (64+/-4 vs 67+/-3; NS). Female patients showed lower sensory thresholds than male patients and control females (pain thresholds: 39.8+/-3.4 vs 67.8+/-16.7 and vs 56.8+/-8.7; P < 0.05). Sensory thresholds were not different in subgroups of patients with FGID (irritable bowel syndrome and functional dyspepsia). No correlation was shown between sensory thresholds and gastrointestinal index or SCL 90-test. In conclusion, FGID patients showed a threshold to painful somatic stimulus that was lower than in normal subjects. These findings suggest that patients with FGID may have hyperalgesia and low pain tolerance that is not limited to the viscera, but that is part of a systemic general condition.
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PMID:Pain hypersensitivity in patients with functional gastrointestinal disorders: a gastrointestinal-specific defect or a general systemic condition? 1171 67

Little is known about the prevalence and risk factors for development of irritable bowel syndrome (IBS) in Japan. In the United States, it is reported that heredity and social learning contribute to the development of IBS. Our aims were (1) to estimate the prevalence of IBS, (2) to confirm that subjects with IBS are more likely to have parents with a history of bowel problems, (3) to confirm that gastroenteritis is a risk factor for IBS, and (4) to determine whether these two risk factors interact with psychological distress. Prevalence was estimated from a sample of 417 young adults seen for annual health screening examinations. To evaluate risk factors related to consulting physicians, the 46 subjects who fulfilled Rome II diagnostic criteria for IBS but denied ever having seen a physician about these symptoms (IBS non-consulters) were compared to the 317 subjects who did not meet the criteria for IBS (controls) and to a group of 56 patients diagnosed with IBS by gastroenterologists (IBS patients). All subjects completed the Gastrointestinal Symptoms Rating Scale, the State-Trait Anxiety Inventory, the Self-Rating Depression Scale, the Perceived Stress Scale, and the SF-36 quality of life scale. Fourteen and two-tenths percent (15.5% of females and 12.9% of males) of the community sample met the criteria for IBS diagnosis, of whom 22% consulted physicians. IBS patients and IBS nonconsulters were more likely than controls to have a parental history (33.9 vs. 12.6%, P < 0.001, for patients and 26.1 vs. 12.6%, P < 0.01, for nonconsulters) and were more likely to report an infective history compared to controls (44.6 vs. 16.1%, P < 0.001, for patients and 32.6 vs. 16.1%, P < 0.01, for nonconsulters). Two-way analysis of variance showed that the parental history was associated with a significantly greater impact on symptoms of indigestion, diarrhea, constipation, state and trait anxiety, and the SF-36 scales for social functioning and role emotional and that an infective history was associated with a greater impact on bodily pain. Both a parental history of bowel problems and a history of acute gastroenteritis are significant risk factors for development of IBS in Japan, as reported for the United States. Moreover, patients with such a family history show more psychological distress than other patients.
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PMID:Patients and nonconsulters with irritable bowel syndrome reporting a parental history of bowel problems have more impaired psychological distress. 1530 99

Functional dyspepsia represents a heterogeneous group of gastrointestinal disorders marked by the presence of upper abdominal pain or discomfort. Although its precise definition has evolved over the last several decades, this disorder remains shrouded in controversy. The symptoms of functional dyspepsia may overlap with those of other functional bowel disorders including irritable bowel syndrome and non-erosive reflux disease. There may be coexistent psychological distress or disease complicating its presentation and response to therapy. Given the prevalence and chronicity of functional dyspepsia, it remains a great burden to society. Suspected physiological mechanisms underlying functional dyspepsia include altered motility, altered visceral sensation, inflammation, nervous system dysregulation and psychological distress. Yet the exact pathophysiological mechanisms that cause symptoms in an individual patient remain difficult to delineate. Numerous treatment modalities have been employed including dietary modifications, pharmacological agents directed at various targets within the gastrointestinal tract and central nervous system, psychological therapies and more recently, complementary and alternative treatments. Unfortunately, to date, all of these therapies have yielded only marginal results. A variety of emerging therapies are being developed for functional dyspepsia. Most of these therapies are intended to normalize pain perception and gastrointestinal motor and reflex function in this group of patients.
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PMID:Review article: current and emerging therapies for functional dyspepsia. 1688 13


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