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)

Etodolac is a nonsteroidal anti-inflammatory drug (NSAID) effective in the treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, and in the alleviation of postoperative pain. Etodolac also provides relief of other types of pain, including that arising from gouty conditions and traumatic injury. In all indications, etodolac appears to be at least as effective as other NSAIDs. The incidence of clinical adverse effects other than abdominal pain and dyspepsia is similar to that observed with placebo, and etodolac has been associated with a low rate of gastrointestinal ulceration and other serious events. Data from preliminary animal studies have suggested that etodolac may provide more selective inhibition of prostaglandin synthesis at sites of inflammation than some other currently available NSAIDs. Thus, available evidence indicates that etodolac, with its low incidence of gastrointestinal events, is an effective and well tolerated alternative to other NSAIDs in the treatment of arthritic diseases and pain of various aetiologies and should be considered a first-line therapy.
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PMID:Etodolac. A reappraisal of its pharmacology and therapeutic use in rheumatic diseases and pain states. 171 25

The aim of this clinical, endoscopical study was to evaluate the therapeutic efficacy and the gastric tolerability of etodolac, a new anti-inflammatory, non-steroidal drug, compared with naproxen. The study was conducted on 48 patients suffering from rheumatoid arthritis. 44 of whom completed the trial. After an initial oesophagogastroduodenoscopy to exclude the presence of gastric mucosal lesions, patients were randomly allocated to double-blind treatment with either etodolac 200 mg b.i.d. or naproxen 500 mg b.i.d. for a period of 4 weeks. Endoscopic control followed this treatment period. Both drugs proved effective in relieving clinical symptoms, without a statistically significant difference. Gastric mucosal lesions were observed in 15% of etodolac-treated patients and in 46% of patients treated with naproxen (P less than 0.05) (95% CI 0.01-0.60). Painful dyspepsia was observed in 15% of patients treated with etodolac vs. 38% of patients on naproxen therapy. This study demonstrates that etodolac is at least as active as naproxen in relieving rheumatic symptoms, and its administration results in a significantly lower degree of gastric damage.
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PMID:A double-blind gastroscopic evaluation of the effects of etodolac and naproxen on the gastrointestinal mucosa of rheumatic patients. 182 23

The term "postcholecystectomy syndrome" indicates etiologically and pathogenetically various lesions of the organism related to variably expressed symptoms of pain and dyspepsia. The author has performed endoscopic retrograde cholangiopancreatography (ERCP) to 60 patients with "postcholecystectomy syndrome" to find out what underlies this syndrome. In 34 (56%) of the patients the biliary ducts were dilated. The most frequent cause of this was Vater's papilla stenosis, which was found in 26 patients (43%). The author is of the opinion that this stenosis preceded the cholecystectomy and was the result of inflammatory processes related to cholelithiasis. In 20 patients stones were found in the biliary ducts, single or multiple. In most cases the stones in the biliary duct had been missed during the cholecystectomy. In some patients the stones in the biliary duct were formed after the operation. In 26.6% of the patients ERCP helped in discovering other diseases such as chronic pancreatitis, duodenal ulcer and peripapillary diverticulum which are in the basis of the "postcholecystectomy syndrome". The author recommends to every patients with persistent complaints after cholecystectomy ERCP to be performed in order to find out the cause of the complaints and determine the correct treatment--medicamentous or surgical.
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PMID:[The so-called postcholecystectomy syndrome in light of the results of endoscopic retrograde cholangiopancreatography]. 189 12

Sensory and pressure responses to gastric distension were evaluated in 24 consecutive patients suffering from chronic idiopathic dyspepsia and 20 healthy subjects. A latex balloon was placed in the proximal stomach and inflated by increments of 100 ml of air up to a maximal volume of 800 ml. Symptom response and intragastric pressure-volume curve were recorded during the gradual balloon distension. Thirteen of the 24 patients experienced pain at a distension volume less than or equal to 400 ml of air, but only one of the 20 controls (P less than 0.001). Intragastric pressure-volume curves were similar in patients and controls, and in patients with and without abnormal pain threshold, suggesting that a compliance defect was not the cause of the sensory anomaly. Gastric emptying of solids and liquids was measured in 20 of the 24 patients using a dual isotopic technique; psychological status was also evaluated in 18 patients using the Mini-Mult test. The frequency of the sensory anomaly was not different in patients with (7/14) or without (4/6) gastric stasis, but was lower in patients with (5/13) than in those without psychological disturbances (5/5, P less than 0.01). Thus, a primary visceral sensory anomaly, either alone or in conjunction with motility disturbances, can play an important role in chronic idiopathic dyspepsia and must be taken in account for further therapeutic research.
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PMID:Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. 189 8

Patients with functional dyspepsia are a heterogeneous group in whom psychologic and environmental factors and stress may contribute to their reports of symptoms. There is no unique personality profile in patients with functional dyspepsia. Although they have more anxiety, neuroticism, and depression than healthy subjects, their personality scores are no different than other patients with chronic abdominal pain syndromes, be they organic or functional in nature. Social factors including older age, male gender, unmarried status, and social incongruity are associated with increased frequency and severity of symptoms but not health-care-seeking behavior. Childhood role models with abdominal pain and the tendency to perceive negative life events as having great impact on their lives may affect the coping skills of these patients. Although patients with functional dyspepsia react to acute experimental stress with gastric physiologic changes similar to healthy subjects, their visceral pain thresholds are lower, which may contribute to their reports of symptoms. Despite common beliefs, most environmental factors such as smoking, alcohol, coffee, or use of nonsteroidal anti-inflammatory drugs are not important contributors to these patients' symptoms.
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PMID:Stress and psychologic and environmental factors in functional dyspepsia. 189 29

A group of 292 consecutive patients underwent cholecystectomy for gallstones with presumed biliary pain over a 4-year period and all completed a self-assessment questionnaire before operation. Over the following 2 years 18 patients died but no others were lost to follow-up. The remaining 274 patients completed a further questionnaire 1 and 2 years after operation. Demographic characteristics and abdominal symptoms have been compared with an age- and sex-matched control group using the same questionnaire. Before operation symptoms of flatulent dyspepsia were far more frequent in patients with gallstones but operation markedly reduced these symptoms to an incidence which almost matched that of the control group. However, 1 year after cholecystectomy 34 per cent of patients still suffered some abdominal pain and of 35 patients referred back to hospital for investigation none has been shown to have a retained bile duct stone at a minimum follow-up of 5 years. A multivariate analysis indicated that preoperative flatulence together with long duration of attacks of pain are risk factors for postoperative dissatisfaction as judged by a linear analogue scale. However, both these factors are common and neither is a good discriminator of a poor outcome. The prediction of a poor symptomatic outcome after cholecystectomy from preoperative symptoms or patient characteristics had only limited success and all patients should be warned of this risk.
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PMID:Influence of cholecystectomy on symptoms. 191 18

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 symptoms of functional dyspepsia are still unexplained. To evaluate the possible role of abnormal visceral perception, we studied the symptomatic responses and the pressure variations during progressive gastric distension in 10 female healthy control subjects (mean age 33.6 years) and in 10 female patients with functional dyspepsia (mean age 35.2 years). A rubber balloon was positioned 4 cm below the lower esophageal sphincter (LES) and inflated with progressively larger volumes of air by steps of 50 ml; pressures at the gastric fundus and at the LES were continuously recorded by perfused manometric catheters. Each subject was studied on two separate occasions after randomized double-blind administration of either placebo or 20 mg of domperidone. Symptomatic responses and the manometric data were analyzed at the time of the initial recognition of distension (bloating step) and at the time of reporting pain or up to a maximum of 700 ml of balloon inflation (pain or 700-ml step). On placebo, the volumes of gastric distension were more than two times lower in patients than in control subjects at the bloating step (185 +/- 32 ml vs 470 +/- 40 ml, P = 0.001) and at the pain or 700-ml step (265 +/- 54 ml vs 600 +/- 34 ml, P less than 0.005), while the pressure gradients (pressure at inflation steps minus baseline pressure before beginning inflation) were not statistically different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. 198 6

During a 10-year period 2610 patients were operated on for biliary lithiasis; in 225 (8.6 per cent) cases the operation concluded with a choledochoduodenostomy. The commonest preoperative diagnosis (62.2 per cent) in these 225 patients was choledocholithiasis; 30 patients had previously had a cholecystectomy. After choledochoduodenostomy, 4.0 per cent of patients had an intra-abdominal complication; six patients developed an intra-abdominal abscess and three developed an external biliary fistula. Four patients (1.8 per cent) died, three from pulmonary complications and one from a biliary fistula. After a mean follow-up period of 4.6 years, 71.5 per cent of patients were asymptomatic. The remainder suffered from dyspepsia (15.1 per cent), colicky pain (8.7 per cent) or episodes of cholangitis (4.7 per cent). Endoscopy in the symptomatic patients allowed the following conclusions: (a) no patient with dyspepsia had a problem at the anastomosis; (b) 27 per cent of those with colic had anastomotic stenosis or the sump syndrome; and (c) all patients with cholangitis had anastomotic stenosis and residual calculi.
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PMID:Long-term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases. 203 8

The aim of this study was to determine the prevalence of diminished mean tryptic activity (MTA) in duodenal juice of patients with nonulcer dyspepsia following injection of a Lundh test meal. Two separate studies were undertaken. The first examined a consecutive group of 100 patients with suspected pancreatic disease referred over a period of 2 yr. In these patients, receiver-operating-characteristic analysis was used to determine the point of best discrimination, which occurred at 7 microEq/mL/min when non-pancreatic disease patients were compared with those with chronic pancreatitis or pancreatic cancer. The second study involved 22 patients with endoscopically confirmed nonulcer dyspepsia. The MTA for the patients with unexplained dyspepsia did not differ from 17 healthy controls, but a further 16 pancreatic disease control patients had significantly decreased values (p less than 0.01). Six patients with unexplained dyspepsia (27%) had an MTA of 7 microEq/min/mL or less, indicating impaired pancreatic function, which was more frequent than in healthy controls (p = 0.02). These six patients had significantly different symptoms, being more likely to have pain radiating through to the back (p = 0.017) and pain waking them from sleep (p = 0.002), and less likely to have postprandial pain (p = 0.045). It was of interest that the alcohol intake was not greater in these six patients. It is concluded that pancreatic disease may explain the symptoms of some patients with nonulcer dyspepsia.
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PMID:Exocrine pancreatic function and chronic unexplained dyspepsia. A case-control study. 205 Oct 63


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