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)

Abnormalities in gastrointestinal motility have been reported in a substantial proportion of patients with functional dyspepsia, supporting the use of prokinetic drugs for treatment of dyspeptic symptoms. To evaluate efficacy and safety of levosulpiride in short-term treatment, 1298 patients were enrolled in a double-blind multicentric study carried out in 45 Italian Gastroenterology Departments. Patients were randomly assigned to either levosulpiride (25 mg tid), domperidone (10 mg tid), metoclopramide (10 mg tid) or placebo (1 tablet tid) for 4 weeks. Patients were selected on the basis of: a) occurrence in the last 4 weeks of at least 5/10 selected symptoms (anorexia, nausea, vomiting, upper abdominal pain, postprandial bloating, abdominal fullness, early satiety, belching, heartburn, regurgitation), severity of which should reach/exceed a total score of 8, as assessed by a specific scale ranging from 0 (absent) to 3 (severe); b) normal results of routine biochemical, ultrasound and endoscopic examinations. In addition, each patient subjectively evaluated efficacy of treatment by a visual analogue scale. Significant improvement was recorded for all symptoms at days 10 and 28 in all groups (p < 0.001), but levosulpiride was significantly (p < 0.01) superior to domperidone, metoclopramide and placebo both in the overall clinical improvement scale as well as in a subgroup of symptoms (postprandial bloating, epigastric pain, heartburn). Active treatments and placebo were comparable as far as concerns occurrence of side-effects (12-20%) including galactorrhoea, breast tenderness and menstrual changes.
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PMID:Levosulpiride in functional dyspepsia: a multicentric, double-blind, controlled trial. 889 46

In the present double-blind placebo-controlled study the effect of cisapride on functional dyspepsia was evaluated in patients with and without histological gastritis. Patients with functional dyspepsia and whose symptoms persisted after a 2 week run-in period with antacid treatment were randomized to receive cisapride (10 mg) or matching placebo three times daily for 4 weeks. Symptoms of epigastric pain, bloating, nausea, belching, early satiety and heartburn were graded on a four-point scale based on patients' feedback and diary card recording. A global response was also formulated by the investigators. One hundred and four patients entered the study and 76 completed the trial, comprising 36 patients with histological gastritis and 40 patients without gastritis. Symptom scores in both gastritis and non-gastritis groups were significantly improved by both cisapride and placebo; however, the improvement was not statistically different between the two treatment groups. Cisapride produced a good or better global response in 58% of subjects with histological gastritis and in 53% of subjects without gastritis compared with 47% and 52%, respectively, of patients on placebo; this difference was not statistically significant. Gastric histology did not influence the effect of cisapride on the symptoms of functional dyspepsia.
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PMID:Effect of cisapride on functional dyspepsia in patients with and without histological gastritis: a double-blind placebo-controlled trial. 907 16

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.
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PMID:Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis. 909 97

Cisapride is a substituted benzamide with gastrointestinal prokinetic effects presumed to be due to the enhancement of the physiological release of acetylcholine at the myenteric plexus. In a multicentre study, 189 patients with nonulcer dyspepsia (NUD) received single-blind placebo treatment for two weeks. A total of 123 patients with no or minimal response to placebo and epigastric pain of at least moderate severity and frequency were randomly assigned to one of the three parallel double-blind treatments for six weeks: cisapride 10 mg tid, cisapride 20 mg tid or placebo. The severity and frequency of individual symptoms (epigastric pain, heartburn, nausea, vomiting anorexia, postprandial discomfort, regurgitation, lower abdominal pain, bloating and constipation) were assessed on a four- and five-point categorical scale, respectively, by the investigator at three on treatment visits and by patients in a daily diary. Analysis of investigator and patient assessments for differences in symptom severity x frequency composite scores among the three treatment groups showed no statistically significant differences for individual symptoms or symptom clusters. As assessed by the investigator, and compared with baseline, cisapride 20 mg tid significantly (P < 0.05) improved epigastric pain, bloating and early satiety as well as improved the total symptom cluster. Investigator evaluation of the five most severe and frequent symptoms for each patient showed statistically significant improvement in each treatment group. For patient diary assessments, statistically significant within-treatment improvement of the total symptom cluster, the five most severe symptoms cluster, bloating and early satiety was observed for both cisapride 20 mg and placebo, whereas epigastric pain significantly (P < 0.05) improved in all three treatment groups. Investigator evaluation of global response (good+excellent) rate at the end of the six week treatment period was 38% for cisapride 20 mg, 47% for cisapride 10 mg and 33% for placebo. No statistically significant difference in this parameter among treatments was noted. Cisapride was well tolerated at both doses with a side effect profile comparable with that of placebo. It is concluded that in this double-blind multicentre study with a single-blind two-week placebo run in phase, cisapride 10 mg tid and 20 mg tid were not effective compared with placebo in improving symptoms in NUD patients. This study re-emphasizes the good prognosis of patients with NUD, with 14% of patients improving in the two-week placebo run-in phase and a further 33% improving in the next six weeks while on placebo. Within-treatment analysis of investigator assessments showed improvement for cisapride 20 mg tid suggesting a trend of efficacy at this dose.
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PMID:A double-blind randomized study of cisapride in the treatment of nonulcer dyspepsia. The Canadian Cisapride Nud Study Group. 911 11

The HT4-agonist Cisapride (CIS) and the peripheral D2-antagonist Domperidone (DOMP) have distinct prokinetic actions. We compared their clinical efficacy in 127 dyspeptic patients. Patients with upper abdominal complaints of > 1 month duration, who had a normal UGE were allocated to the REFLUX-group (RG), (predominance of heartburn, acid regurgitation or retrosternal pain) or if devoid of this specific symptomatology to the DYSPEPSIA-group (DG) In a double-blind randomised fashion and allocated to 10 mg CIS or 20 mg DOMP qid (RG) or tid (DG) for 1 month and followed-up for further 2 months. In RG (N = 43, p < 0.05) the response rates were clearly in favour of CIS, but not in DG (N = 84). In RG DOMP was more effective against nausea. The benefit of both therapies was largely maintained in the follow-up period. Cisapride and domperidone were effective in the treatment of dyspepsia. Cisapride was more effective than domperidone in the REFLUX-Group.
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PMID:Study with two prokinetics in functional dyspepsia and GORD: domperidone vs. cisapride. 922 23

Two cases of esophagitis associated with the use of alendronate are described. Both patients were women with no past history of heartburn or dyspepsia, who started alendronate for postmenopausal osteoporosis at least one week before the symptoms onset, by taking the drug with half a glass of tap water at bedtime. The first patient suffered from a severe chest pain; endoscopy showed confluent erosions of the lower third of the esophagus. The second patient had odynophagia and developed exudates and greyish plaques on the mucosa of the upper third of the esophagus. Histological examination of the esophageal specimens of both patients disclosed no Monilia, hyphae, or nuclear viral inclusions. Both patients stopped alendronate with complete recovery at follow-up. A brief review of the etiopathogenesis of pill esophagitis is also presented. Finally, emphasis is placed on the selection of patients for therapy with alendronate with warnings on how to take the drug correctly.
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PMID:[Alendronate-induced esophagitis. A report of 2 cases]. 924 56

Male gender and smoking have an established discriminant value of increased risk for duodenal ulcers. The present analysis is focused on whether this could be generally enhanced by considering Helicobacter pylori status in dyspeptic patients consulting their primary physician. Patients were enrolled into our Dyspepsia Study if they met the following criteria: Symptoms for minimum one month, informed consent for drug trial, including upper gastrointestinal endoscopy (UGE), if required. All were prospectively screened for criteria suggesting an organic origin of the disorder such as nocturnal pain, severe pain, severe regurgitation or heartburn, loss of weight, pain relieved by food, age > 50 years. 16% of patients had one or more relevant lesion: 7.8% oesophagitis, 8.5% duodenal ulcers, and 1.8% gastric ulcers. Of the clinical criteria enumerated only nocturnal pain and/or severe regurgitation or heartburn had a marginal discriminant power (P < 0.1). In contrast smoking and/or positive CLO-urease test had a substantial and significant (P < 0.001), discriminant value both for oesophagitis and duodenal ulcers. Patients with both a positive CLO-urease test and who smoked accounted for only 16% of the population but for 46% of the lesions, but this was only 4% for the 42% subjects who were non-smokers and had a negative CLO-urease test. Positive H. pylori status and smoking appear to have an important and probably additive discriminant value to distinguish between organic and functional dyspepsia.
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PMID:Epidemiology of dyspepsia: discriminant value of smoking and Helicobacter pylori status as predictors of peptic lesions in primary care. 944 58

Fourty adult patients with coxarthrosis were treated for 30 days with oral diclofenac sodium at the daily dose of 150 mg: 20 of these were administered one 150 mg prolonged-release capsule per day, the other 20 received one 50 mg enteric-coated tablet every 8 hours. The presence and severity of several symptoms and signs (various pain types, cramps, morning stiffness, impaired function capacity), the intensity of pain through the Visual Analogical Scale and some laboratory tests (Erythrocyte Sedimentation Rate, C-reactive protein, Rheuma test) were controlled to monitor drug efficacy. The routine laboratory tests of blood, liver and kidney function, the gastrointestinal tolerance of the two administered formulations and the appearance of any adverse event were controlled to monitor drug tolerability. Both administration schemes yielded very positive results as to treatment efficacy, although the prolonged-release capsule often induced a somewhat quicker response. At the end of the one-month treatment more than half of patients in both groups registered disappearance of several symptoms and a noticeable reduction of the remainder ones. Systemic tolerability was also good, with superimposable results in the two groups; gastrointestinal tolerance on the contrary was better in the recipients of the prolonged-release capsules (2 cases of dyspepsia) with respect to those treated with the enteric-coated tablets (2 cases of gastric pyrosis and 2 cases of gastralgia). No adverse events were registered.
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PMID:Open study of a diclofenac sodium prolonged-release in patients suffering from coxarthrosis. 944

The objective of this study was to evaluate the reliability and validity of the gastrointestinal Symptom Rating Scale (GSRS) in US patients with gastroesophageal reflux disease (GERD). Five hundred and sixteen adults with predominant heartburn symptoms of GERD were recruited from gastroenterologist and family physician practices and treated with 6 weeks of 150 mg ranitidine twice daily to identify poorly responsive symptomatic GERD. The GSRS, the Medical Outcomes Study Short Form-36 (SF-36) Health Survey and the Psychological General Well-being (PGWB) scale were administered at baseline and after 6 weeks of treatment. Reported ratings of GERD-related symptoms from physician and patient diaries were measured. The GSRS contains five scales: reflux syndrome, abdominal pain, constipation syndrome, diarrhoea syndrome and indigestion syndrome. The internal consistency reliabilities for the GSRS scales ranged from 0.61 to 0.83 and the intraclass correlation coefficients ranged from 0.42 to 0.60. The GSRS scale scores were correlated with the SF-36 and PGWB scales and with the number and severity of heartburn symptoms. Patients with two or three clinician-rated GERD-related symptoms reported worse GSRS scale scores compared with patients with fewer symptoms (p < 0.0001). Statistically significant differences in the mean GSRS scale scores were observed between treatment responders and non-responders (p < 0.0001) and patients showing a response to treatment had larger mean changes in their GSRS scales than patients not showing a response to treatment (p < 0.0001). The standardized response means ranged from 0.42 to 1.43 for the GSRS scale scores. It was concluded that the GSRS is a brief, fairly comprehensive assessment of common gastrointestinal symptoms. The GSRS has good reliability and construct validity and the GSRS scales discriminate by GERD symptom severity and are responsive to treatment. The GSRS is a useful patient-rated symptom scale for evaluating the outcomes of treatment for GERD.
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PMID:Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. 948 Nov 53

Dyspepsia, defined as "pain or discomfort centered in the upper abdomen" is reported by one in four adults in Western societies. The most important causes are non-ulcer (functional) dyspepsia, peptic ulcer, gastroesophageal reflux, and, rarely, gastric cancer. Persons with heartburn alone are not considered to have dyspepsia. The division of dyspepsia into symptom-based subgroups (ulcer-like, dysmotility-like, reflux-like, and unspecified dyspepsia) has proven to be of doubtful value for the clinician, as it has a low predictive value for identifying the causes of dyspepsia. Upper endoscopy remains the "gold standard" test; ultrasound and blood tests have a low yield. The role of Helicobacter pylori in peptic ulcer disease is well known, but the clinical role of the infection in non-ulcer dyspepsia remains very controversial. In uninvestigated dyspeptic patients who are H. pylori infected based on a non-invasive test, empiric anti-H. pylori therapy is a reasonable and probably cost-effective option. In documented non-ulcer dyspepsia, prokinetics are superior to placebo while antisecretory therapy is of less certain efficacy.
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PMID:Dyspepsia: current understanding and management. 950 76


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