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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Motility-like dyspepsia, a clinical subgroup of functional dyspepsia, refers to the cluster of symptoms which suggests an underlying motility disturbance of the upper gut. Characteristic symptoms, in addition to upper abdominal pain or discomfort, are nausea, vomiting, early satiety, anorexia, postprandial abdominal bloating and excessive repetitive postprandial belching. Patients with concomitant symptoms of irritable bowel syndrome are currently excluded from this clinical entity. Delayed gastric emptying of solids and/or liquids, postprandial antral hypomotility and antroduodenal incoordination, gastric myoelectrical arrhythmias and dysfunction of visceral afferents are the major alterations in upper gut sensorimotor activity which have been described. An empirical trial of medical therapy is warranted if there are no "alarm" symptoms at presentation. If symptoms are not relieved after 2-4 weeks, then investigations of the upper gastrointestinal tract, preferably by endoscopy, to exclude the presence of organic disease, is advisable. Management approaches are then reassurance, dietary manipulations and attention to psychosocial aspects. Prokinetic agents appear to be useful as short-term medical therapy in some patients, but optimum long-term treatment strategies, including the use of medications which may improve a diminished tolerance to gut distension, are not established.
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PMID:Motility-like dyspepsia. Current concepts in pathogenesis, investigation and management. 144 83

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

Fasting antral area was examined by ultrasonography in 40 healthy subjects and in 106 patients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) before and after treatment with cisapride or placebo. The patients were examined twice, first after a run-in period of 14 days of placebo and then after 14 days of cisapride, 10 mg three times daily, or placebo. The relaxed width of the antral area was measured in two sections: a vertical section in which the antrum, the superior mesenteric vein, and the aorta were visualized simultaneously, and a horizontal section that included the pylorus and the middle of the antrum up to 5 cm proximal to the pylorus. The mean antral area was wider (p less than 0.001), both in vertical and horizontal sections, in patients with NUD and EPC than in controls. The antral area in NUD patients was wider (p less than 0.05) in smokers than in non-smokers. The area tended to decrease during treatment with cisapride (p = 0.08). Bloating was the only symptom significantly associated with a wide antral area (p = 0.01). The results suggest a relationship between a wide fasting antral area and NUD with EPC.
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PMID:Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. 152 80

Acute Helicobacter pylori infection is associated with dyspeptic symptoms but chronic infection has not clearly been shown to cause symptoms. To define further the role of H. pylori infection and gastritis in dyspepsia, we interviewed all patients about to undergo upper endoscopy, recorded the primary indication for endoscopy, noted the endoscopic findings, and obtained antral biopsies. Among non-ulcer patients there was a strong correlation of acute gastritis with H. pylori. Gastritis and H. pylori increased with age, and non-steroidal anti-inflammatory drug use correlated with normal histology. Neither H. pylori concentration nor gastritis grade correlated with gender, use of alcohol and tobacco, indication for endoscopy, or symptoms (epigastric pain, nausea, vomiting, bloating, belching, heartburn, halitosis, and flatulence).
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PMID:Symptoms, gastritis, and Helicobacter pylori in patients referred for endoscopy. 851 92

Dyspepsia is one of the most common ailment that is managed by general practitioners and gastroenterologists worldwide and particularly so in Tropical Africa. Non-ulcer dyspepsia can be defined as the presence of classic ulcer symptoms or any combination of burning, bloating, indigestion or other abdominal symptoms which only sometimes have a relation to food intake with out any radiological or endoscopic evidence of peptic ulceration. Compared to peptic ulcer disease, the literature on Non-ulcer dyspepsia is relatively scanty and studies have been done mostly in populations non-negroid origin. The present study has reviewed Non-ulcer dyspepsia with particular reference to the Africans and has highlighted the intriguing areas of the disorder with the consequent dilemma posed to its management. Further research on this topic is indicated and would be fascinating but a challenging task.
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PMID:Non-ulcer dyspepsia and the dilemma posed to its management. 184 50

Dyspepsia can be defined as the presence of upper abdominal pain or discomfort; other symptoms referable to the proximal gastrointestinal tract, such as nausea, early satiety, and bloating, may also be present. Symptoms may or may not be meal related. To be termed chronic, dyspepsia should have been present for three months or longer. Over half the patients who present with chronic dyspepsia have no evidence of peptic ulceration, other focal lesions, or systemic disease and are diagnosed as having non-ulcer (or functional) dyspepsia. Non-ulcer dyspepsia is a heterogeneous syndrome. It has been proposed that this entity can be subdivided into a number of symptomatic clusters or groupings that suggest possible underlying pathogenetic mechanisms. These groupings include ulcer-like dyspepsia (typical symptoms of peptic ulcer are present), dysmotility (stasis)-like dyspepsia (symptoms include nausea, early satiety, bloating, and belching that suggest gastric stasis or small intestinal dysmotility), and reflux-like dyspepsia (heartburn or acid regurgitation accompanies upper abdominal pain or discomfort). The aetiology of non-ulcer dyspepsia is not established, although it is likely a multifactorial disorder. Motility abnormalities may be important in a subset of dyspepsia patients but probably do not explain the symptoms in the majority. Epidemiological studies have not convincingly demonstrated an association between Helicobacter pylori and non-ulcer dyspepsia. Other potential aetiological mechanisms, such as increased gastric acid secretion, psychological factors, life-event stress, and dietary factors, have not been established as causes of non-ulcer dyspepsia. Management of non-ulcer dyspepsia is difficult because its pathogenesis is poorly understood and is confounded because of a high placebo response rate. Until more data are available, it seems reasonable that treatment regimens target the clinical groupings described above. Antacids are no more effective than placebo in non-ulcer dyspepsia, although a subgroup of non-ulcer dyspepsia patients with reflux-like or ulcer-like symptoms may respond to H2-receptor antagonists. However, there is no significant benefit of these agents over placebo in many cases. Bismuth has been shown to be superior to placebo in patients with H. pylori in a number of studies, but these trials had several shortcomings and others have reported conflicting findings. Sucralfate was demonstrated in one study to be superior to placebo, but this finding was not confirmed by another group of investigators. Prokinetic drugs appear to be efficacious, and may be most useful in patients with dysmotility-like and reflux-like dyspepsia.
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PMID:Non-ulcer dyspepsia: myths and realities. 188 33

Gastrointestinal bloating is a common complaint met within the general practitioner's office. The most important cause of this symptom is an increase in the volume of gas in the gastrointestinal tract. Differential diagnoses include aerophagia, ingestion of gas-producing foods, gastric hypersecretion, bacterial overgrowth in the small intestine, disordered gastrointestinal transit, malabsorption or maldigestion of carbohydrates. In addition, nonulcer dyspepsia and the irritable bowel syndrome must be excluded. The diagnosis is based on a history of eructation, heart burn, flatulence and diarrhea, dietary habits, physical examination, laboratory analysis and apparative diagnostic measures. Therapy depends on the underlying cause of the disease.
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PMID:[Meteorism]. 191 70

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

One hundred and eighty-five patients were perforated duodenal ulcer were treated at one hospital over the 21-year period which straddled the introduction of H2-receptor antagonists. Of these 107 had simple closure, 58 simple closure with immediate H2-receptor antagonists and 20 immediate definitive surgery. The overall operative mortality rate was 5.4%. The rate of subsequent definitive surgery declined significantly in the years after the introduction of H2-receptor antagonists. Only a minority of those who came to subsequent definitive surgery had done so within the first year, the percentage rising from 16% at 1 year to 43.7% at 10 years. Of the patients treated by simple closure alone, 44.3% had subsequent definitive surgery compared with 24.1% having H2-receptor antagonists in addition, but this difference was not statistically significant using life table analysis. Review of the 104 patients available in 1989 showed no significant differences in symptoms between the treatment groups. The only preoperative predictor of subsequent definitive operation was non-steroidal anti-inflammatory drug consumption which showed a negative correlation. A 3-month history of dyspepsia before perforation did not predict the need for subsequent surgery. The symptomatic results in a different group of patients who had undergone highly selective vagotomy subsequent to a previous perforation were no different from patients treated by simple closure alone or with immediate prescription of H2-receptor antagonists. Bloating, however, was significantly more common after highly selective vagotomy. We believe that perforated duodenal ulcer should be treated by simple closure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Impact of H2-receptor antagonists on the outcome of treatment of perforated duodenal ulcer. 198 17

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


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