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)

Esophagogastroduodenoscopy is most commonly performed for evaluation of epigastric pain, severe heartburn, chronic nausea and other dyspepsia syndromes that are not relieved by medical therapy. It should not be performed as an in-office procedure in patients with unstable angina, respiratory failure, active upper gastrointestinal bleeding or hemodynamic instability. Although office esophagogastroduodenoscopy is safe for low-risk patients, the risks associated with anesthesia and the need for postprocedure observation may require other patients to undergo the procedure in a hospital setting. Use of a local anesthetic throat spray reduces the gag response that occurs when the endoscope is swallowed. Sedation is commonly achieved with intravenous administration of a benzodiazepine plus a narcotic, and the effects of these drugs can be rapidly reversed. Complications are rare and most frequently result from medications rather than from the procedure itself.
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PMID:Esophagogastroduodenoscopy for the family physician. 827 10

The aim of this study was to evaluate some biochemical and histopathological aspects in a group of patients with a view to identifying any differences depending on whether the pathology was associated with previous cholecystectomy or idiopathic. The study involved 23 patients (8 post-cholecystectomy cases and 15 ulcer-free dyspeptic patients) with the diagnosis of duodenogastric reflux gastritis confirmed by endoscopic histopathological evaluation. The following parameters were considered: 1. pH and bile salt concentration in gastric juice; 2. histological classification of antral biopsies (Niemela's criteria); 3. dyspeptic symptoms (dyspepsia, pyrosis and epigastric pain, sense of repletion, foul-tasting mouth) graded on a scale from 0 to 4. All parameters were considered in relation to whether or not Helicobacter Pylori was found in the histological specimens. No significant differences were found between the two groups for pH and bile salt values or for Helicobacter Pylori positivity. No relationship was observed between the Helicobacter Pylori and either the severity of the histological picture, the features of the biochemical parameters or the severity of the clinical symptoms. Such findings confirm the common pathophysiological pattern of reflux gastritis regardless of any permanent biliary tract alterations and the low importance of Helicobacter Pylori infection in determining this syndrome.
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PMID:Biochemical and histopathological aspects in duodenogastric reflux gastritis patients with or without prior cholecystectomy. 836 47

During the waiting time for upper gastrointestinal endoscopy 165 patients with dyspepsia completed a questionnaire and a diary for daily measurements of the symptoms pain, heartburn, and global complaints. 23 patients (14%) had peptic ulcer disease (PUD), 18 oesophagitis (11%), and the rest were labelled nonulcer dyspepsia (NUD). NUD was further subdivided into ulcer-like, reflux-like, dysmotility, and essential NUD by means of predefined symptom profiles. 39 (24%) patients were on H2 receptor antagonist treatment. In general, the intensity of the daily symptoms was rather low, and except for a higher rating of heartburn in oesophagitis, there were no significant differences between PUD, oesophagitis, and NUD--treated or untreated. NUD patients with reflux-like dyspepsia had significantly more heartburn than the group with essential NUD; otherwise there were no differences between the subgroups of NUD. The individual daily ratings for abdominal pain, heartburn, and global symptoms varied by an average standard deviation of 64%, 97% and 47% of the mean values, respectively, and were independent of treatment or diagnoses. There was an approximately 40% probability that two successive days had different levels of symptoms. Only 10% of the patients showed stable symptoms, and the patients were completely symptom-free for 20% of the observation period. Symptoms in dyspepsia patients disclosed low intensity and high variability in this study. Such factors may be important sources of bias in clinical trials.
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PMID:The intensity and variability of symptoms in dyspepsia. 848 80

This paper identifies the symptom profile associated with the four main diagnoses of functional digestive disorders (dyspepsia, gastro-oesophageal reflux disease (GORD), gastritis, and constipation) made by general practitioners in Belgium. Results are also presented from a multicentre study in which the effects of cisapride, administered as an oral tablet or suspension, were evaluated in patients with these functional digestive disorders. Analysis of symptom patterns revealed that early satiety and postprandial abdominal bloating were the most prominent symptoms, followed by eructation (belching), heartburn, regurgitation, postprandial epigastric burning or discomfort, and nausea. These symptoms occurred in all diagnostic groups. However, different symptom patterns were associated with each of the disorders; for example, heartburn and regurgitation were the core symptoms in patients diagnosed as having GORD, early satiety and abdominal bloating were characteristic of patients diagnosed with dyspepsia, and fasting or postprandial pain were characteristic of patients given the diagnosis of gastritis. Therefore, it appears that these diagnoses used by general practitioners in Belgium closely correspond to reflux-like, dysmotility-like and ulcer-like dyspepsia, as defined by an international working party. Cisapride improved the core symptoms in about 80% of patients with GORD or dyspepsia, relieved all epigastric symptoms in about 80% of patients with gastritis, and significantly decreased the use of laxatives and increased stool frequency in constipated patients. Cisapride was well tolerated and thus appears to be a useful option in the treatment of functional digestive disorders in a general practice setting.
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PMID:Functional dyspepsia versus other functional gastrointestinal disorders: a practical approach in Belgian general practices. 851 55

An open prospective drug monitoring study was undertaken to assess the efficacy and tolerability of 5 mg cisapride three times daily in 37,925 general practice patients with functional dyspepsia. Short-term (mean, 4 weeks) cisapride treatment was associated with a significant reduction in overall dyspeptic symptom scores and improvements in scores of all eight individual dyspeptic symptoms (epigastric discomfort, fullness, nausea, bloating, heartburn, acid regurgitation, loss of appetite, and vomiting). Physician's and patient's subjective global evaluations of antidyspeptic efficacy were good or very good in 80% to 90% of cases. The tolerability of cisapride was judged to be satisfactory, good or very good in approximately 95% of patients, with adverse drug reactions being documented in 4.8% of patients. Of these, diarrhea/loose stools (2.5% of all patients) and headache (0.7%) were most frequent. Premature treatment withdrawal due to poor tolerability was necessary in only 0.35% of patients.
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PMID:A German drug-monitoring study in general practice patients receiving cisapride for functional dyspepsia. 851 60

H2-receptor antagonists have been widely prescribed in the last 20 years and are considered to rank among the safest drugs known. In several countries they have been switched to over-the-counter (OTC) status, and a similar move is under consideration in Canada. Some concerns have been raised as to the effectiveness of these drugs in the treatment of dyspepsia and heartburn, their safety when taken for self-diagnosed symptoms, and the potential for their use to delay diagnosis or mask serious disease. The author presents evidence to support the use of OTC H2-receptor antagonists in the treatment of dyspepsia. He argues that the safety record of these drugs is reassuring and that they are unlikely to mask gastric cancer. Finally, he describes the appropriate place of OTC H2-receptor antagonists in the overall management of acid-related disorders.
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PMID:Habit, prejudice, power and politics: issues in the conversion of H2-receptor antagonists to over-the-counter use. 854 66

Patients with pyrosis or regurgitation as the dominating symptoms have gastro-oesophageal reflux disease (GORD). However, patients with more atypical symptoms may also suffer from it. The disease is usually chronic and patients who have additional oesophagitis are at risk of developing complications. The therapeutic goals in GORD are symptom relief, healing of lesions, prevention of complications, and omittance of adverse effects at the lowest possible costs. Patients with functional dyspepsia usually have symptoms of less severe intensity and as, per definition, no organic substrate is demonstrable, complications do not develop in these patients. Therefore, in patients with GORD and functional dyspepsia, treatment of GORD should have the highest priority. Pharmacologic treatment of GORD comprises H2 receptor antagonists, proton-pump inhibitors and cisapride. The pharmacologic treatment of functional dyspepsia is less documented and in most studies the symptomatic pattern could not predict the pharmacologic principle of clinical benefit. This may be because a separation between presence of symptoms and presence of symptoms as a major problem has not been taken into account. Cisapride is the drug that has been proven clinically useful in most randomized studies. This does not, however, rule out that other drugs are better in subgroups of patients with functional dyspepsia.
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PMID:Is this a reflux patient or is it a patient with functional dyspepsia with additional reflux symptoms? 854 27

Tagamet and Pepcid PM-two potent H2 antagonists for dyspepsia, heartburn and other conditions produced by excess acid in the stomach-are now available from pharmacies without prescription. Making these effective medicines more widely available should help many indigestion sufferers. (NB: these medicines are not recommended during pregnancy or for the under-16s). Indigestion can sometimes be prevented by avoiding spicy foods, alcohol and stress. Enquire about other symptoms and if necessary refer the patient to a doctor. A pharmacist should be consulted if the patient is already taking other medication. Other medicines recently available from pharmacies without prescription are the antacid Mucaine, and Adcortyl in Orabase and Corlan pellets for gum and mouth lesions. Eczema patients can now obtain Hydrocortisone Topical direct from the pharmacy. It was previously not allowed to be sold to treat eczema Haemorrhoid sufferers can now obtain Anusol Plus (containing hydrocortisone) direct from the pharmacy. Hay fever patients can now get Syntaris Nasal Spray without prescription.
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PMID:Remedies for common family ailments: 7. What's new in POMs to Ps? 868 Feb 22

With the aim to assess the clustering of abdominal symptoms in a random population, data from a cohort study of a 70 year old Danish population were analysed. The cohort comprised 1,119 subjects of which 72% participated in a primary study and 91% of the survivors in a similar study five years later. The following clusters of symptoms were constantly associated. One group constituted abdominal distension, borborygmi, altering stool consistency and number of bowel movements. Pain relieved by bowel movement was associated with this cluster. Nausea and vomiting comprised another cluster. Heartburn/acid regurgitation did not show a consistent association to any other symptoms and may be considered as a cluster of it own. Pain characteristics traditionally related to upper dyspepsia did not specifically relate to any cluster. It is concluded that, in this 70-year-old population abdominal symptoms occur in clusters comparable to clusters in younger populations. The clusters, however, does not totally confirm the traditional concept of Upper Dyspepsia and Irritable Bowel Syndrome.
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PMID:Irritable bowel syndrome and upper dyspepsia among the elderly: a study of symptom clusters in a random 70 year old population. 881

Dyspepsia and heartburn are common symptoms in primary care practice. This article outlines the diagnosis and management of these problems with an emphasis on cost-effectiveness as well as the prevention of complications. It reviews what evaluations and treatments have been shown in the literature to be helpful and which have been found to be ineffective or much more expensive without clear benefit. It also clarifies the various diseases that can present as dyspepsia and refers readers to the appropriate articles included in this book.
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PMID:Cost-effective management of dyspepsia and gastroesophageal reflux disease. 888 45


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