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)

Breath tests are a simple and safe alternative to more invasive investigation strategies for many gastroenterological conditions. Both the hydrogen breath tests and the new 13C stable radioisotope breath tests are nonradioactive and safe in children and pregnancy. The range of diseases that can be identified include Helicobacter pylori infection, lactose and fructose intolerance, bacterial overgrowth, bile salt wastage, pancreatic insufficiency, liver dysfunction, and abnormal small bowel transit. In this review, the physiology supporting these tests and the principles of normal gas dynamics in the gut are briefly reviewed and then related to the test preparation and interpretation in two parts: 1) detection of H. pylori and 2) small bowel, pancreatic, and hepatobiliary disorders. A MEDLINE search reviewing all English language abstracts from 1966 to March, 2001 was performed, with an additional review of abstracts from major national meetings from 1997 to 2001. Using the information from this review, the performance characteristics of the various tests were detailed, and an attempt is made to provide some literature-based guidance regarding their indications and limitations. The interpretation of "flat" breath tests and the selective use of methane collection and colonic alkalinization are discussed. Breath tests are valuable tools that are, in general, underutilized in evaluating dyspepsia and functional bloating and diarrhea, as well as suspected malabsorption, including lactose intolerance.
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PMID:Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. 1201 15

The main factors involved in the pathophysiology of fat induced dyspepsia were investigated by reviewing a series of controlled double blind randomised studies which sought to determine the role of nutrient fat and the postprandial release of cholecystokinin (CCK) in the development of dyspeptic symptoms in healthy volunteers and in patients with functional dyspepsia. The studies showed that during distension of the stomach, lipids are a major trigger of dyspeptic symptoms such as nausea, bloating, pain, and fullness, and that they modulate upper gastrointestinal sensations and symptoms in a dose related fashion. CCK is a major mediator of the sensitisation of gastric perception by lipids in patients with functional dyspepsia as the CCK-A receptor antagonist dexloxiglumide markedly diminishes this effect. The studies provide important insights into the mechanisms underlying gastrointestinal perception in response to fat and the role of CCK in patients with functional dyspepsia.
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PMID:The role of fat and cholecystokinin in functional dyspepsia. 1207 66

Patients with cancer frequently report gastrointestinal symptoms such as anorexia, early satiety, nausea, vomiting, and bloating. A reduction of the severity of some of these symptoms would benefit the patient by enhancing quality of life and improving their treatment. Forty-eight patients (25 female and 23 male; mean age 63 +/- 11 years) with a minimum two-week history of cancer-associated gastrointestinal symptoms were assigned to a single, open-label treatment group and received controlled-release metoclopramide 20 mg-80 mg q12h for a maximum period of 12 weeks (mean 46 +/- 35 days). There was a 40%-60% decrease in the severity of nausea over the first two weeks of treatment, and an approximate 50% reduction in severity of vomiting over the first four weeks of treatment. Appetite and bloating also improved, although smaller and less consistent changes were observed. Patient ratings of overall clinical effectiveness with respect to relief from symptoms and tolerability of side effects indicated that controlled-release metoclopramide was highly and moderately effective in 36% and 30% of the patients, respectively. Controlled-release metoclopramide is a useful treatment for the management of gastrointestinal symptoms associated with the cancer-associated dyspepsia syndrome including nausea, vomiting, loss of appetite, and bloating.
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PMID:Long-term safety and clinical effectiveness of controlled-release metoclopramide in cancer-associated dyspepsia syndrome: a multicentre evaluation. 1216 5

Nearly one-half of the most frequently reported and most distressing symptoms in patients with advanced cancer are gastrointestinal in nature. This prospective study was designed to assess the frequency of gastrointestinal symptoms among inpatients admitted to a palliative medicine program with advanced cancer. Twenty-nine men and 2l women, with a median age of 64 years (range, 35-84), were interviewed about 17 gastrointestinal symptoms. Age, gender, diagnosis, and medication use were also recorded The most common diagnoses were cancers of the lung (n = 14), breast (n = 6), and prostate (n = 4). Dry mouth (84 percent), weight loss (76 percent), early satiety (71 percent), taste change (60 percent), constipation (58 percent), anorexia (56 percent), bloating (50 percent), nausea (48 percent), abdominal pain (42 percent), and vomiting (34 percent) were the 10 most common gastrointestinal symptoms. Women had more gastrointestinal symptoms than men (median 8 vs. 6, p = 0.018), although this finding was not statistically significant (p = 0.11) after excluding gender-specific cancers. Women had more taste change and diarrhea than men after excluding gender-specific cancers (p = 0.036 and p = 0.046, respectively). Those with primary gastrointestinal cancers (n = 8) had more indigestion and hiccups than those with nongastrointestinal cancers (n = 39). There was no age difference in symptomatology. The drugs prescribed most commonly were opioids (n = 40), laxatives (n = 38), H2 blockers (n = 29), appetite stimulants (n = 29), and antiemetics (n = 29). Findings support that gastrointestinal symptoms are very common in hospitalized patients with advanced cancer and that the frequency and type of symptoms differ with gender and gastrointestinal vs. nongastrointestinal primary site.
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PMID:Gastrointestinal symptoms among inpatients with advanced cancer. 1226 82

The purpose of this qualitative study was to describe the perspectives of women living with ovarian cancer about their experiences with diagnosis, treatment, and follow-up care. A convenience sample of 18 women was interviewed using an open-ended interview guide. This paper will focus on their perspectives during the peri-diagnostic period. Most of the women in this study experienced changes in their bodies--bloating, weight gain around their middles, indigestion, bowel changes, and abdominal pain. The vagueness of the symptoms and lack of awareness by the women and, in the women's opinion, health care professionals caused delays in diagnosis and initial investigations of other body systems. The symptoms were often dismissed by the women as being related to normal body changes such as childbirth, menopause, or stress responses. It was often not until the women's symptoms became severe or included pain that referrals were made to relevant specialists. At this point, many of the women were physically and emotionally spent, leaving them vulnerable and in a weakened state for confronting the diagnosis and coping with the difficult course of treatment. Clearly, the subtle, nebulous nature of the symptoms confounded the diagnosis of ovarian cancer for these women, resulting in patient delays and physician delays.
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PMID:Women's experiences with ovarian cancer: reflections on being diagnosed. 1227 17

Dyspepsia describes a symptom complex thought to arise in the upper gastrointestinal tract and includes, in addition to epigastric pain or discomfort, symptoms such as heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Based on the evidence that heartburn cannot be reliably distinguished from other dyspeptic symptoms, the Rome definition appears to be too narrow and restrictive. It is particularly ill suited to the management of uninvestigated dyspepsia at the level of primary care. In patients presenting with uninvestigated dyspepsia, a symptom benefit is associated with a 'test and treat' approach for Helicobacter pylori infection. A substantial proportion of those who do not benefit prove to have esophagitis on endoscopy. In those with functional dyspepsia, the benefits of H pylori eradication, if any, appear to be modest. Hence, a 'symptom and treat' acid-suppression trial with proton pump inhibitors, and a 'test and treat' strategy for H pylori are two acceptable empirical therapies for patients with univestigated dyspepsia.
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PMID:Etiology of dyspepsia: implications for empirical therapy. 1236 18

BACKGROUND: The aims of this study were to investigate the frequency of halitosis before and after eradication therapy and to determine whether halitosis is a valid indication for eradication therapy in patients with Helicobacter pylori (H. pylori)-positive non-ulcer dyspepsia. METHODS: Dyspepsia, related symptoms, and halitosis were investigated by way of a questionnaire. Only H. pylori-positive patients who showed no organic lesions on endoscopic examination and no atrophy histopathologically were included. A total of 148 patients fulfilled the above criteria and completed the study. Four weeks after the end of eradication treatment, the symptoms were re-evaluated and repeat endoscopy was done to check for H. pylori in the gastric mucosa. Results: H. pylori eradication was successful in 109 patients (73.6%). Prior to treatment, bloating was the most frequent symptom (74.3%), followed by diurnal pain (62.2%) and halitosis (61.5%). The most successfully resolved symptoms in the group as a whole, regardless of eradication status, were halitosis, diurnal pain, and hunger-like pain, respectively. In the patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain, respectively. CONCLUSION: Halitosis is a frequent, but treatable, symptom of H. pylori-positive non-ulcer dyspepsia and may be a valid indication for eradication therapy.
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PMID:Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy? 1255 10

Gastric neuromuscular disorders encompass a spectrum of dysfunction in nerve and smooth muscle that includes gastric visceral hypersensitivity, gastric dysrhythmias, fundic dysfunction, antral hypomotility, and gastroparesis. Patients with each disorder may present with such vague dyspepsia symptoms as early satiety, upper abdominal discomfort, bloating, or nausea with or without vomiting. A careful history and physical examination may suggest a gastric neuromuscular disorder, but symptoms are nonspecific. Gastroparesis is the most severe form of neuromuscular dysfunction. Such reversible causes of gastroparesis as mechanical obstruction of the stomach and chronic mesenteric ischemia must be excluded. Gastroparesis, gastric dysrhythmias, and hypersensitivity may follow viral infection or be due to degenerative processes that affect the gastric enteric neurons, smooth muscle, or interstitial cells of Cajal. Commonly, the cause of these gastric neuromuscular disorders is unknown. An approach to the diagnosis and treatment of gastric neuromuscular disorders is reviewed, including dietary counseling, drugs, and medical devices.
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PMID:Diagnosis and treatment of neuromuscular disorders of the stomach. 1286 63

Chronic hepatitis has many causes. Symptoms include upper abdominal pain. To allow for a better understanding of this pain we compare HCV patients with other liver diseases and normal controls on their reporting of pain over one month and describe associations. A cross-sectional, case control study was performed. Three groups are studied: (1) normal individuals (NC) (N = 64), (2) patients with chronic liver diseases other than HCV (LD) (N = 53), and (3) HCV infection (N = 64). A dyspepsia questionnaire was utilized, which inquired about a one-month symptom presence of upper abdominal pain and associated symptoms. There was a one-month period prevalence of upper abdominal pain of 45.3% in the HCV group vs 32% in the LD and 20.3% in the NC groups (P = 0.01). The LD (22.6%) and HCV (26.6%) groups had markedly more pain that was worsened by eating compared with NC (1.6%) (P = .003). On univariate analysis, when comparing those with upper abdominal pain to those without, there was a lower age (41.3 vs 44.5), a higher BMI (30.3 vs 26), and more symptoms of fatigue, bloating, and pain worsened by eating and early satiety. On multivariate analysis, age < 50 (OR 5.1; CI 1.5-17), BMI > 30 (OR 4.1; CI 1.5-10.9), nausea (OR 4.1; CI 1.6-10.4), and pain with eating (OR 30: CI 6.7-133) predicted upper abdominal pain. In conclusion, upper abdominal pain is more commonly reported over one month in those with chronic liver diseases. That the abdominal pain worsened after meals in liver patients but not in the normal subjects was a surprise. Possible explanations for this finding are offered.
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PMID:Characteristics of upper abdominal pain in those with chronic liver disease. 1462 32

Epigastric pain may occur as a specific and localized symptom, as part of a group of symptoms that include heartburn, or in association with bloating or early satiety. The current classification (Rome II) characterizes ulcer-like dyspepsia by predominant pain centered in the upper abdomen and characterizes dysmotility-like dyspepsia by discomfort. The large number of patients presenting with epigastric pain has led to the development of empirical strategies.
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PMID:Epigastric pain in dyspepsia and reflux disease. 1467 10


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