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)

This cross-sectional psychiatric and cardiological study compared patients with and without coronary artery disease (CAD) with respect to psychiatric morbidity, psychological factors, pain characteristics, medical morbidity and the prevalence of coronary risk factors. The 199 participants had been referred to cardiological outpatient clinics for the investigation of chest pain and had no history of heart disease. Current panic disorder occurred significantly more often in non-CAD patients (41% vs. 22%). No significant differences were found for other psychiatric disorders and psychological variables. Non-CAD patients reported significantly longer histories of pain and a higher prevalence of atypical chest pain. In other respects, there were surprisingly few differences between the groups. High morbidity of both psychiatric disease (pain disorder, 19%; any current psychiatric disorder, 72%) and somatic conditions (musculoskeletal disease, 33%; dyspepsia, 23%) was found with no significant differences between the groups. In these patients, multifactorial complaints may explain chest pain in both patient groups. The physicians should attend to psychiatric disorders in non-CAD as well as in CAD patients.
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PMID:Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. 1556 12

Eosinophilic esophagitis and eosinophilic gastroenteritis is being recognized more frequently among the adult patients. The disease is characterized by massive infiltration of the wall of gastrointestinal tract by sheets of eosinophils. The clinical features depend upon the site of involvement. They include dyspepsia, dysphagia, nausea, vomiting, chest pain, diarrhea and protein-losing enteropathy. Eosinophilic esophagitis may present as chest pain, dysphagia or dyspepsia. The characteristic endoscopic feature of eosinophilic esophagitis is the formation of fine concentric mucosal rings (corrugated esophagus). Regarding the pathogenesis of these mucosal rings our hypothesis is that mast cells in the esophageal wall in response to allergens release histamine, eosinophilic chemotactic factor and platelet activating factor, etc. which activate eosinophils to release toxic cationic proteins. Activation of acetyl choline by histamine may cause contraction of the muscle fibers in the muscularis mucosae resulting in the formation of esophageal rings. This hypothesis can be tested by demonstrating the contraction of muscle layers of muscularis mucosae with the use of high frequency endoscopic ultrasonic probe introduced via the biopsy channel of an endoscope.
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PMID:Pathogenesis of esophageal rings in eosinophilic esophagitis. 1561 59

The clinical and socioeconomic burden of gastro-esophageal reflux disease (GERD) is considerable. The primary symptom of GERD is heartburn, but it may also be associated with extraesophageal manifestations, such as asthma, chest pain and otolaryngologic disorders. The objective of the study was to describe the impact of heartburn on patients' Health-Related Quality of Life (HRQL) in Poland, using validated generic and disease-specific instruments to measure patient-reported outcomes. Patients with symptoms of heartburn completed the Polish versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), the Short Form-36 (SF-36) and the Hospital Anxiety and Depression (HAD) scale. Frequency and severity of heartburn during the previous 7 days were also recorded. 135 patients completed the assessments (mean age of 44 years, SD = 15; 61% female). 55% of patients had moderate symptoms and nearly two thirds (64%) had symptoms on 5 or more days in the previous week. Patients were most bothered by symptoms of reflux (mean GSRS score of 4.1, on a scale of 1 [not bothered] to 7 [very bothered]), indigestion (3.5) and abdominal pain (3.2). As a result of their symptoms, patients experienced impaired vitality (mean QOLRAD score of 3.8, on a scale of 1 to 7, where 1 represents the most severe impact on daily functioning), problems with food and drink (3.9), emotional distress (4.1) and sleep disturbance (4.7). Using HAD, 32% of heartburn patients were anxious and 10% were depressed. In conclusion it should be stated that there is consistent evidence that GERD substantially impairs all aspects of health-related quality of life.
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PMID:[Burden of illness in Polish patients with reflux disease]. 1601 13

The available evidence from randomized clinical trials or meta-analyses on the therapeutic efficacy of psychotropic drugs and, specifically, of antidepressants, in functional gastrointestinal disorders (FGD), are recent and still fairly limited. The use of these drugs is based on the frequent association of anxiety and depression or neurosis in patients with FGD who seek medical care and on the demonstrated efficacy of these drugs in relieving chronic pain, whatever its origin or localization, for more than 30 years. Antidepressants, even in doses under the antidepressant range, are antinociceptive due to their central and peripheral neuromodulatory effect, which is completely independent of anticholinergic, spasmolytic or antidepressant effects. This has been demonstrated in both animals and humans and, as occurs with another antinociceptive drugs such as clonidine, is mediated by alpha-adrenoreceptors. The choice of antidepressant depends both on the evidence of its analgesic activity (in general greater with tricyclic antidepressants than with the more modern selective serotonin reuptake inhibitors) and on the presence of drug-related adverse effects, which include not only anticholinergic adverse effects but also the possibility of hypotension or cardiotoxicity, which should be avoided. The main selection criteria are demonstrated efficacy and safety. Antidepressants have been shown to be effective in the specific field of non-coronary chest pain probably originating in the esophagus unrelated to gastroesophageal reflux disease, especially mianserin and trazodone, and the effect is maintained in the long term in nearly three-quarters of treated patients. Tricyclic antidepressants have also been shown to be effective in the treatment of abdominal pain in patients with irritable bowel syndrome, with an OR of 4.2 and an NNT of 3.2 in comparison with placebo. In contrast, there is insufficient evidence to recommend the use of antidepressants in functional dyspepsia.
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PMID:[Antidepressant therapy in functional gastrointestinal disorders]. 1618 84

Obesity has been associated with increased reporting of gastrointestinal (GI) symptoms, but whether weight gain or loss causes symptoms is unclear. We studied the association between changes in body weight and changes in upper GI symptoms. Prospective cohort study on random samples of Olmsted County, MN residents. Distinct upper GI symptom complexes [gastro-oesophageal reflux disease (GERD), chest pain, dyspepsia- pain predominant, dyspepsia-dysmotility] were defined. Subjects with persistent, new-onset or disappearing symptoms were identified as cases, subjects with no reported symptoms in any of the surveys served as controls. Associations were studied in a logistic regression model, using age, gender, baseline Body Mass Index and somatic symptom score as covariates. Participants for whom baseline and follow-up data were available (n = 637) had a median time between surveys of 10.5 years. Baseline body weight was associated with GERD, chest pain and dyspepsia-pain predominant symptom complexes. An increase in body weight >10 lb between surveys was associated with new onset of dyspepsia-dysmotility (OR 5.57, 95% CI 1.91, 16.2). No association was found between weight loss >10 lb and the studied symptom complexes. Moderate body weight increases and decreases are generally not associated with upper GI symptom changes over time in the general population.
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PMID:Relationship between upper gastrointestinal symptoms and changes in body weight in a population-based cohort. 1704 Apr 9

Visceral hypersensitivity (perception of gastrointestinal sensory events at a lower-than-normal threshold) is considered to be an important pathophysiological mechanism in the development of functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, non-cardiac chest pain and functional dyspepsia. These disorders are associated with significant health care and socioeconomic costs due to factors such as repeated visits to consultants, hospitalizations and work absenteeism. Despite the presence of extensive evidence linking visceral hypersensitivity and FGIDs, the mechanism(s) underlying visceral hypersensitivity has not been fully elucidated. Suggested hypotheses include sensitization of afferent neurones, both at the level of the enteric and the (afferent) autonomic nervous system (peripheral sensitization), sensitization of spinal cord dorsal horn neurones (central sensitization) and psychosocial factors/psychiatric comorbidity influencing the processing of afferent signals at the level of the brain. Importantly, these hypotheses may be complementary rather than mutually exclusive. However, the degree to which each of these mechanisms contributes to the overall perception of visceral pain, and therefore the generation of symptoms, still remains unclear. This article discusses the mechanisms that may underlie visceral hypersensitivity, with reference to FGIDs. Understanding these mechanisms is essential in order to improve the diagnosis and treatment of patients with these disorders.
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PMID:Peripheral and central mechanisms of visceral sensitization in man. 1728 May 84

"Nutcracker esophagus" (NE) is a primary esophageal motor disorder, first described in patients with noncardiac chest pain. In recent years NE has been associated with gastroesophageal reflux disease (GERD). In this study we compare patients with NE with and without GERD, as defined by pHmetry or endoscopy, with respect to clinical, endoscopic, radiologic, and manometric findings. Fifty-two patients with NE were studied. They were divided in two groups: GERD (17-32.6%) and non-GERD (35-67.4%) patients. Females predominated in both groups, with no significant difference in age (p>0.05). Chest pain was the chief complaint in both groups (p>0.05). Clinical findings in patients with and without reflux included chest pain (52.9% and 51.4%), dysphagia (58.8% and 42.8%), and heartburn (64.7% and 42.8%), followed by regurgitation, dyspepsia, ear, nose, and throat (ENT) complaints, respiratory symptoms, and odynophagia (p>0.05). Erosive esophagitis was found in three patients (5.7%). There were no differences between groups in the findings of barium swallow studies and all manometric findings were similar for both groups (p>0.05). We conclude that there were no differences in patients with NE with or without associated reflux disease. It is important to diagnose reflux properly so patients can be treated adequately.
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PMID:Are there any differences between nutcracker esophagus with and without reflux? 1745 46

An 89-year-old woman was seen for indigestion, light chest pain, and melanotic stools. Endoscopic examination revealed 2 submucosal gastric masses. A subtotal gastrectomy showed 2 submucosal masses in the stomach: one infiltrating through the muscularis propria into the serosa, the second one, a well-circumscribed submucosal nodule. Histologic examination showed large tumor cells infiltrating diffusely through the muscularis propria into the subserosa. On higher magnification, numerous signet ring cells were present against a myxoid stroma, in addition to large vacuolated epithelioid cells. There was no evidence of invasion, necrosis, nuclear pleomorphism, or mitotic activity. Initial diagnostic considerations based on the histology included signet ring cell carcinoma, malignant melanoma, and a myxoid mesenchymal tumor, including gastrointestinal stromal tumor. A panel of immunohistochemical stains showed diffuse strong positivity for S-100 protein and negative reaction for CD117, bcl-2, cytokeratin AE1/AE3, Melan-A, HMB45, smooth muscle antigen, and other differentiation markers. Electron microscopic examination revealed elongated, complex, and interdigitating cell processes covered by a thin layer of continuous basement membrane material characteristic of peripheral nerve sheath differentiation. The presentation of this tumor was significant in that it was multifocal and infiltrative, mimicking a malignant neoplasm. The extensive myxoid/signet ring cell change represents a heretofore-unreported histologic variant of gastric schwannoma.
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PMID:Signet ring cell gastric schwannoma: report of a new distinctive morphological variant. 1832 78

The prevalence of gastroesophageal reflux disease (GERD) ranges from 2.5% to 7.1% in most population-based studies in Asia. There is evidence that GERD and its complications are rising, coinciding with a decline in Helicobacter pylori (H. pylori) infection. Asian GERD patients share similar risk factors and pathophysiological mechanisms with their Western counterparts. Possible causes for the lower prevalence of GERD include less obesity and hiatus hernia, a lesser degree of esophageal dysmotility, a high prevalence of virulent strains of H. pylori, and low awareness. Owing to the lack of precise translation for 'heartburn' in most Asian languages, reflux symptoms are often overlooked or misinterpreted as dyspepsia or chest pain. Furthermore, a symptom-based diagnosis with a therapeutic trial of the proton pump inhibitor (PPI) may be hampered by the high prevalence of H. pylori-related disease. The risk stratification for prompt endoscopy, use of a locally-validated, diagnostic symptom questionnaire, and response to H. pylori'test and treat' help improve the accuracy of the PPI test for diagnoses. PPI remain the gold standard treatment, and 'on-demand' PPI have been shown to be a cost-effective, long-term treatment. The clinical course of GERD is benign in most patients in Asia. The risk of progression from non-erosive reflux disease to erosive esophagitis is low, and treatment response to a conventional dose of PPI is generally higher. Although H. pylori eradication may lead to more resilient GERD in a subset of patients, the benefits of H. pylori eradication outweigh the risks, especially in Asian populations with a high incidence of gastric cancer.
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PMID:Gastroesophageal reflux disease: an Asian perspective. 1912 Aug 71

There is increasing evidence for involvement of the immune system in functional gastrointestinal disorder (FGID), including onset after acute gastrointestinal infections, genotypes resulting in altered cytokine expression and abnormal presence of immune cells. Our aim was to assess cellular and humoral immune responses in (i) FGIDs, compared to healthy subjects and (ii) acute vs unspecified onset FGIDs. Lymphocytic [interleukin (IL)-5, IL-10, IL-13 and interferon gamma (IFN-gamma)] and monocytic [IL-10, IL-12, tumour necrosis factor (TNF)-alpha] cytokine production was characterized at baseline and after stimulation with phytohemagglutinine and anti-CD28 or lipopolysaccharide (LPS) in controls (n = 32), irritable bowel syndrome (IBS) (n = 30), functional dyspepsia (FD) (n = 23) and non-cardiac chest pain (NCCP) (n = 15). Serum IL-6 and IL-10 concentrations were compared, and the immunophenotype was assessed using fluorescent-activated cell sorter. Findings were compared for acute vs unspecified onset FGID. Compared to controls, stimulated lymphocyte expression of IL-5 and IL-13 was enhanced in IBS, FD and NCCP (all P < 0.05). Conversely, the stimulated monocytic IL-12 and lymphocytic IL-10 expression were reduced in IBS and FD, while IFN-gamma expression was also reduced in FD patients. Except for an increase in the numbers of CD3(+)CD45RA(+)CD45RO(+) cells, no distinct cellular profile was detected. Patients with a presumed acute onset of their symptoms had higher serum IL-10 levels and more CD3(+)CD45RA(+)CD45RO(+) cells, while TNF-alpha levels following stimulation with LPS were higher in FD patients reporting an acute onset. A shift towards a Th2 cytokine profile is present in FGID, while the cellular immunophenotype remains largely unchanged. Further research is indicated and could provide new therapeutic strategies for these disorders.
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PMID:Immune dysfunction in patients with functional gastrointestinal disorders. 1912 84


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