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)

Prevention of gastrointestinal toxicity begins with the selection of an appropriate analgesic or anti-inflammatory agent. For conditions without inflammation, such as some cases of osteoarthritis, an analgesic with no risk for gastrointestinal toxicity is appropriate. Risk factors for nonsteroidal anti-inflammatory drug (NSAID)-related complications include advanced age; history of ulcer disease or gastrointestinal bleeding; concomitant corticosteroid or anticoagulant use; use of high-dose or multiple NSAIDs; and certain chronic diseases, such as cardiovascular disease. If an NSAID must be used in a patient with risk factors, the patient should receive the lowest-risk NSAID and, in most cases, co-therapy to reduce the risk for NSAID-associated ulcers and their complications. The PGE1 prostaglandin analogue misoprostol is highly efficacious for the prevention of both gastric and duodenal ulcers and has also been shown to reduce the incidence of NSAID-induced ulcer complications. Side effects, such as diarrhea, may limit patient acceptance of the drug. Acid suppression with traditional ulcer-healing doses of H2-blockers significantly reduces rates of duodenal ulcer but is ineffective in reducing gastric ulceration. More potent acid inhibition with double-dose H2-blockers reduces rates of both gastric and duodenal ulcers. Proton-pump inhibitors, such as omeprazole, have been shown to prevent gastric and duodenal ulcers with an efficacy equal to that of misoprostol. They also reduce NSAID-related dyspepsia. Specific cyclooxygenase-2 (COX-2) inhibitors are associated with a markedly reduced rate of endoscopic ulcers. Very high-risk patients who receive these agents may still require co-therapy to prevent complications or reduce dyspepsia. This protocol may be changed by the results of long-term gastrointestinal outcome studies now underway.
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PMID:Preventing NSAID Toxicity to the Upper Gastrointestinal Tract. 1109 21

Celastrus paniculatus L. (Celastraceae) (CP), Picrorhiza kurroa L. (Scrophulariaceae) (PK) and Withania somnifera L. (Solanaceae) (WS) are Indian medicinal plants having a remarkable reputation, as a factor of health care, among the indigenous medical practitioners. The plants exhibit varying degrees of therapeutic value some of which useful in the treatment of cognitive dysfunction, epilepsy, insomnia, rheumatism, gout, dyspepsia. In this work, we have investigated the free radical scavenging capacity of methanolic extracts from CP, PK, WS and the effect on DNA cleavage induced by H2O2 UV-photholysis. In addition, we investigated whether these plant extracts are capable of reducing the hydrogen peroxide-induced cytotoxicity and DNA damage in human non-immortalized fibroblasts. These extracts showed a dose-dependent free radical scavenging capacity and a protective effect on DNA cleavage; methanolic extracts from PK was more active than extracts from CP and WS. These results were confirmed by a significant protective effect on H2O2-induced cytoxicity and DNA damage in human non-immortalized fibroblasts. These antioxidant effects of active principle of CP, PK and WS may explain, at least in part, the reported anti-stress, immunomodulatory, cognition-facilitating, anti-inflammatory and antiaging effects produced by them in experimental animal and in clinical situations and may justify the further investigation of their other beneficial biological properties.
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PMID:Indian medicinal plants as antiradicals and DNA cleavage protectors. 1131 55

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 article presents new results of treatment of 69 children with ulcer-like dyspepsia, associated with Helicobacter pylori. Triple therapy included Proton Pomp Inhibitor (PPI-omeprasol) and two antibiotics (amoxicilline and claritromicine). The obtained results have shown good effectiveness of the eradicating triple therapy in children with Helicobacter pylori-associated ulcer-like dyspepsia.
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PMID:[Efficacy of anti-Helicobacter therapy in children with ulcer-like functional dyspepsia]. 1496 5

Ethanolic extracts from nine medicinal plants are combined in Iberogast (IG). This phytomedicine is successfully used in the treatment of gastrointestinal disorders. Functional gastrointestinal diseases such as non-ulcerous dyspepsia (NUD) are in many cases initiated by, or correlated to, inflammatory processes, where reactive oxygen species (ROS) play a crucial role. In this respect one prominent source of ROS are myeloperoxidase (MPO)-driven oxidation and chlorination reactions, assumed to be mainly responsible for tissue damage. In this study the contribution of the nine extracts to the overall performance of IG was compared with emphasis on MPO produced ROS. Concerning the influence on MPO-dependent chlorination reactions, it turned out that of the nine IG-components Iberis amara extract (IAE) exerted the highest activity. Furthermore, this can impressively be reproduced in an ex vivo experiment with whole blood, where neutrophilic leukocytes are activated by zymosan. Moreover, along with the extract of chamomile flowers, IAE counteracts the pro-oxidative properties of caraway, peppermint and celandine. As a consequence. IG was also efficiently inhibiting MPO-catalysed chlorinations. As shown by the addition of catalase, the pro-oxidative effects of caraway, peppermint and celandine are due to their content of hydrogen peroxide. The latter is probably an autoxidation product of certain monoterpenes in the essential oil part of these extracts. If one of the component extracts of IG is omitted, the antioxidant acitivity is reduced. Thus we conclude that all the single extracts combined in IG are of importance for the therapeutical effect, working in concert.
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PMID:Comparison of the inhibition of myeloperoxidase-catalyzed hypochlorite formation in vitro and in whole blood by different plant extracts contained in a phytopharmacon treating functional dyspepsia. 1534 43

The development and introduction into clinical practice of proton pump inhibitors (PPIs) have influenced the management of acid-peptic disorders dramatically. PPIs inhibit the gastric hydrogen/potassium adenosine triphosphatase selectively and irreversibly which is the final step in acid secretion. PPIs are currently the most effective form of therapy in acid-peptic diseases. All PPIs are potent, effective and generally safe, but little different in equivalent doses. PPIs undergo hepatic metabolism by cytochrome P450 (CYP) system. Polymorphism of CYP2C19 influences the pharmacokinetics and pharmacodynamics of PPIs. Doses and dosing schemes of PPIs based on CYP2C19 genotype status is expected to increase the efficacy in clinical outcome. The major indication of PPIs are acid-related diseases such as peptic ulcers and their complications, gastroesophageal reflux diseases, Zollinger-Ellison syndrome and eradication of Helicobacter pylori with antibiotics and dyspepsia. The potency and cost-effectiveness of PPIs have extended their clinical uses. However, their widespread and long-term use may limit the therapeutic benefit between efficacy and clinical problems such as acid rebound hypersecretion, enhanced oxyntic gastritis, problems with carcinoids in rodents and long-term concern for gastric cancer development. Further studies are needed to minimize the side effects and to maximize the therapeutic effects of PPIs.
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PMID:[Clinical use of proton pump inhibitors in gastrointestinal diseases]. 1655 71

Proton-pump inhibitors (PPIs) remain the leading evidence-based therapy for upper gastrointestinal disorders, including gastroesophageal reflux disease, dyspepsia, and peptic ulcer disease. The effectiveness of PPIs has led to overutilization in multiple treatment arenas, exposing patients to an increasing number of potential risks. The overutilization of PPIs in ambulatory care settings is often a result of failure to re-evaluate the need for continuation of therapy, or insufficient use of on-demand and step-down therapy. PPI overutilization in the inpatient setting is often a result of inappropriate stress ulcer prophylaxis (SUP) in nonintensive care unit patients, and failure to discontinue SUP prior to hospital discharge. Potential consequences of prolonged PPI therapy include hypergastrinemia, enterochromaffin-like cell hyperplasia, and parietal cell hypertrophy, leading to rebound acid hypersecretion. PPIs have been linked via retrospective studies to increased risk of enteric infections including Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fracture, nutritional deficiencies, and interference with metabolism of antiplatelet agents. Reducing inappropriate prescribing of PPIs in the inpatient and outpatient settings can minimize potential for adverse events, and foster controllable cost expenditure.
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PMID:Overutilization of proton-pump inhibitors: what the clinician needs to know. 2277 88

Dyspepsia is a common symptom frequently encountered in general practice. Functional dyspepsia is an exclusion diagnosis after an organic cause has been ruled out, and is a defined entity which can be subdivised in two different subtypes based on the cluster of symptoms, namely epigastric pain and postprandial distress syndromes. The term gastroparesis is used when persistently and severly delayed gastric emptying is found in the absence of mechanical obstruction. Helicobacter pylori infection should be treated, although symptomatic benefice is small. Proton pumps inhibitors offer a clinical benefit in epigastric pain syndrome, whereas prokinetics are probably useful in postprandial distress syndrome. Cisapride has been withdrawn last year due to the risk of potential severe cardiac arrythmies. Domperidone is safer, although caution has to be paid in long-term use because of potential ventricular arrythmies. Dietary advice and psychological therapies might be a useful adjunct. There are difficulties with new treatment development for functional dyspepsia, due to pathophysiological heterogeneity, lack of well-accepted endpoints, a huge placebo effect, and unconfirmed results in large clinical studies after early positive results for promising drugs. Acotiamide, a new cholinesterase inhibitor improving dyspeptic symptoms is not yet available in Europe.
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PMID:[Management of gastroparesis and functional dyspepsia after cisapride withdrawal]. 2309 51

Single nucleotide polymorphism (SNP) arrays possess clinical potential due to their high throughput capacity, sensitivity and versatility. We used such an array to perform a genome-wide SNP analysis of a patient with a multi-system undiagnosed disease involving peripheral neuropathies and food intolerances. The patient had a homozygous deletion within the gene encoding maltase-glucoamylase (MGAM), an intestinal starch digestion enzyme, predicting absence of enzyme activity and potential starch indigestion. We then performed validation testing using a functional MGAM analysis that involved starch ingestion followed by measuring blood glucose and insulin levels as well as hydrogen breath levels. Gastrointestinal tissue was also obtained via endoscopy and immunohistochemical staining for intestinal MGAM was performed. Our results strongly suggest the presence and functioning of MGAM which disproved deficiency predictions based on SNP array analysis findings, classifying the deletion as a functional polymorphism. This study highlights a current clinical limitation of SNP arrays, i.e., distinguishing deleterious genomic alterations from misleading functional polymorphisms. We conclude that novel findings from SNP arrays should be clinically validated and published.
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PMID:An apparent homozygous deletion in maltase-glucoamylase, a lesson in the evolution of SNP arrays. 2313 69

This study assessed the gastric acid antisecretory effect of DLBS2411 fractionated from Cinnamomum burmannii. Hydrogen potassium adenosine triphosphatase (H(+)/K(+) ATPase) activity and its gene expression were observed, and the antioxidant activity of DLBS2411 was also investigated. Treatment of DLBS2411 decreased the level of H(+)/K(+) ATPase messenger RNA expression on human embryonic kidney 293 cells and rat gastric parietal cells in a dose-dependent manner, in vitro and ex vivo. DLBS2411 also acted as a competitive inhibitor by showing inhibition in gastric H(+)/K(+) ATPase activity at various pHs. In gastric ulcer animal models induced with indomethacin and ethanol, DLBS2411showed a reduction in the number of petechiae, suggesting that the fraction also confers gastroprotective activity. Moreover, DLBS2411 was also found to have potent antioxidant activity. Taken together, DLBS2411 is a promising novel agent for the management of dyspepsia, a condition of hyperacidity and diseases in the stomach requiring gastroprotection.
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PMID:Hydrogen potassium adenosine triphosphatase activity inhibition and downregulation of its expression by bioactive fraction DLBS2411 from Cinnamomum burmannii in gastric parietal cells. 2410 79


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