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 symptom complex of gallstone dyspepsia is defined and then analysed before and after cholecystectomy in 108 patients. Only 46% of patients were symptom-free after operation and 30% were no better. When pyloric function was studied patients with these symptoms before or after cholecystectomy and those with normal radiographs showed duodenogastric reflux, often precipitated by intraduodenal fat. Symptomless matched control subjects showed no reflux. Synchronous radiology and pressure recordings demonstrated that the pylorus in these patients failed to contract in response to a duodenal contraction, whereas the normal pylorus could prevent the reflux produced by an isolated duodenal contraction. The effect of metoclopramide on gastroduodenal contractions and in treating the symptoms was assessed. Gallstone dyspepsia is essentially a functional disease--a disorder of gastroduodenal motility.
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PMID:Cholecystectomy and gallstone dyspepsia. Clinical and physiological study of a symptom complex. 23 36

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

Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder will relieve only these symptoms. Making this determination is a challenge, however, because the classic picture of biliary colic may be inaccurate and the connection between gallstone disease and flatulent dyspepsia is questionable at best. Descriptions of both these conditions are based on anecdotal evidence or reports of uncontrolled surgical series. A review of recent controlled trials suggests that the pain of biliary colic is constant and infrequent, comes in episodes lasting 1 to 5 hours, is located in the epigastrium or right upper quadrant of the abdomen, and characteristically occurs at night. There are few additional symptoms other than nausea or vomiting, and colic is not induced by eating fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the right upper quadrant, fatty-food intolerance, and bloating--is probably not related to the presence of gallstones in the majority of patients.
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PMID:Gallstone symptoms. Myth and reality. 192

The author analyzes postcholecystectomic complaints in 513 patients cholecystectomized in 1981-1985. He mentions the relationship between postcholecystectomic syndromes and preoperative complaints, the peroperative diagnosis and surgical operation. He recommends diagnostic investigations to elucidate the dyspepsia; the doctor must not be satisfied with the finding of cholecystolithiasis. The author also compares postcholecystectomic syndromes in patients with a biliodigestive anastomosis with papillosphincterotomy. The author analyzes in more detail the experience with treatment of nine patients, i.e. 1.75% patients with the finding of residual concrements.
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PMID:[Postcholecystectomy syndromes]. 223 69

The term "technologism" is used for a phenomenon where inadequate evaluation of the patient's condition may lead to an excessive number of auxiliary examinations, with a possible incorrect interpretation of their results and a possible inadequate final solution. On analysis of ultrasonographic examinations of the gallbladder the author considered as inadequate evaluation of biliary dyspepsia on account of the high incidence of cholecystolithiasis - 55.6% in men and 48.7% in women, biliary colic in men because of the low incidence of cholecystolithiasis - 32.0% and abdominal colic in women on account of the high incidence of cholecystolithiasis - 52.4%. In the final surgical treatment this phenomenon was not observed. The author wants to draw attention to the fact that a similar phenomenon may occur not only in biliary-disease and in ultrasonography, but also in other medical disciplines.
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PMID:[Cholecystolithiasis and ultrasonography. Is "technologism" possible in medicine?]. 265 79

Ursodeoxycholic acid (ursodiol) is a naturally occurring bile acid that constitutes about 1-2% of the bile acids in human bile. Although well known for more than 20 years in Japan as a treatment for biliary distress and dyspepsia, ursodiol has been tested as a gallstone-dissolving agent only since 1976. Successful dissolution occurs in 30-80% of subjects with radiolucent gallstones, depending on the size and number of the stones. Calcified or pigment stones do not respond to this treatment. The current theory of the pathogenesis of gallstones is that lithogenic bile, which is supersaturated with cholesterol, is secreted by the liver and is not produced in the gallbladder. Thus, although stones form in the gallbladder, defective hepatic cholesterol and bile acid metabolism are responsible for the abnormal bile. Gallstone-prone individuals show increased hepatocholesterol formation and reduced bile acid synthesis. As the micellar solubility limit in bile is exceeded, cholesterol microcrystals precipitate. Four factors account for ursodiol's effectiveness in gallstone dissolution: (a) biliary cholesterol secretion is diminished markedly during therapy; (b) hepatic bile acid synthesis is not inhibited by ursodiol; (c) the 7 beta-hydroxy group of ursodiol resists bacterial dehydroxylation, which lowers the amount of lithocholic acid formed and the cholestasis and liver damage it can cause; and (d) ursodiol is virtually free of side effects and toxicity; less than 1% of subjects experience transient diarrhea, which does not require discontinuation of treatment, and liver function tests remain normal. In about 50% of subjects, stones may recur within 84 months, and can be retreated with ursodiol.
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PMID:Clinical perspective on the treatment of gallstones with ursodeoxycholic acid. 306 79

In many longitudinal studies it is desired to estimate and test the rate over time of a particular recurrent event. Often only the event counts corresponding to the elapsed time intervals between each subject's successive observation times, and baseline covariate data, are available. The intervals may vary substantially in length and number between subjects, so that the corresponding vectors of counts are not directly comparable. A family of Poisson likelihood regression models incorporating a mixed random multiplicative component in the rate function of each subject is proposed for this longitudinal data structure. A related empirical Bayes estimate of random-effect parameters is also described. These methods are illustrated by an analysis of dyspepsia data from the National Cooperative Gallstone Study.
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PMID:Mixed Poisson likelihood regression models for longitudinal interval count data. 335 88

Stenosis of the ampulla of Vater is encountered in as many as 10% of patients with biliary diseases. In general it is classified as tumourous, inflammatory of functional stenosis. In the clinical picture biliary dyspepsia associated with cholestasis predominates. The cause of functional stenosis of the ampulla of Vater is not known. In the development of inflammatory stenosis most frequently iatrogenic damage of the ampulla during revision of the biliary pathways participates or repeated passage of concrements in cholecystolithiasis. Treatment of tumours of the ampulla of Vater is surgical, treatment of inflammatory stenosis is endoscopic by endoscopic papillotomy. In the treatment of functional stenosis a useful drug is hymecromon, as a rule combined with metoclopramide.
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PMID:[Stenosis of the papilla of Vater--clinical picture and possibilities of therapy]. 807 50

Dyspepsia is a common complaint in patients presenting with gallstone disease. Since the stomach appears to be its site of origin, the present study was undertaken to assess gastric emptying in patients with gallstone disease and to find out its correlation with dyspeptic symptoms before and after cholecystectomy. Gastric emptying (t1/2) was prospectively assessed in 43 patients with symptomatic gallstones (29 with and 14 without dyspepsia). These data were compared with that of 20 healthy volunteers (control group). Delayed gastric emptying (> 112 min: mean + 2 s.d. of the control group) was observed in 18 patients (42%; P < 0.002), 10 of whom presented with dyspepsia and eight without (NS). Re-evaluation in 18 of the 29 patients with dyspepsia, 3 months after cholecystectomy, revealed complete disappearance of symptoms in three, improvement in 11 and no change in four patients. After 6 months, two patients had reverted back to their pre-operative dyspeptic status; resulting in three patients completely cured, nine partially cured and six without any change in their dyspeptic status at this time. Gastric emptying was delayed in nine of the 18 patients before cholecystectomy. After cholecystectomy, normal emptying was observed in all but one patient (P < 0.005). Dyspeptic symptoms, however, completely disappeared in one patient, improved in five and remained unchanged in three. In the remaining nine patients, gastric emptying was normal both before and after cholecystectomy. Gallstone disease is associated with delayed gastric emptying but this delay was not the cause of dyspepsia in these patients. Cholecystectomy normalizes gastric emptying, a finding that has not been reported previously.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gastric emptying in patients with gallstone disease with or without dyspepsia: effect of cholecystectomy. 814 75

Gallstones accompanied by dyspeptic symptoms, were long not considered to be silent. The complaints were thought to be caused by the gallstones, and were termed gallstone dyspepsia. Up to 47% of all cholecystectomies are performed for dyspeptic symptoms. Numerous control studies have, however, all demonstrated that dyspeptic symptoms in stone carriers and controls with no gallstones occur with equally frequency, and that it is not possible to differentiate gallstone-specific dyspepsia. The frequent concomitance of dyspepsia and gallstones, is coincidental, and there is no causality involved. Thus, gallstones accompanied by dyspepsia must be considered silent stones. Not the silent gallstone, but gallstone dyspepsia is the myth.
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PMID:[Gallstone dyspepsia--a myth?]. 850 3


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