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

Fifty-three patients with previously uninvestigated chronic dyspepsia symptoms in the absence of gastrointestinal or extra-gastrointestinal disease (functional dyspepsia) underwent antral and duodenal mucosal biopsies to detect the role of such samplings in the presence of normal endoscopic findings. Patients were enrolled in a randomized, placebo-controlled, double-blind trial, receiving either eradicating treatment (colloidal bismuth subcitrate plus metronidazole) or placebo if they had Helicobacter pylori-associated gastritis (20 patients), or cisapride or placebo if they had normal antral mucosa (28 cases). Unsuspected celiac sprue was found in one patient. Eradicating treatment ameliorated histological gastritis (p = 0.01). However, owing to great placebo efficacy, symptom remission rates following a 1-month wash-out period in both treatment groups were no higher than that in controls. Independent of the initial randomization, an extremely low symptom recurrence rate was observed during a drug-free follow-up study equivalent to the mean duration of symptoms before enrollment. We conclude that in functional dyspepsia, bulbar and antral biopsies are not useful in clinical management, equivalent symptom relief can be achieved in patients randomly assigned to both drugs and placebos, and such improvement can be long lasting in the absence of any maintenance treatment. We believe the prevalence of unsuspected villous atrophy and the therapeutic role of investigation-based reassurance deserve further assessment.
J Clin Gastroenterol 1993 Sep
PMID:Are routine duodenal and antral biopsies useful in the management of "functional" dyspepsia? A diagnostic and therapeutic study. 840 29

Nonulcer dyspepsia (NUD) is an enigmatic disorder which likely has heterogeneous etiologies. Helicobacter pylori-associated gastritis has been identified in a large number of patients with NUD, raising speculation that chronic infection with this organism may cause dyspepsia in some patients. Prospective case-control and cohort studies however do not suggest that H. pylori prevalence is greater in NUD than in asymptomatic controls. Limited therapeutic trials of H. pylori-eradication therapy have not shown a convincing symptomatic improvement compared with placebo treatment. Definition of the role of H. pylori in NUD awaits further well-designed, well-controlled epidemiologic and therapeutic studies. Until such information is available, routine endoscopic gastric biopsies looking for H. pylori in patients with NUD should be abandoned.
J Clin Gastroenterol 1993 Sep
PMID:Endoscopy-negative dyspepsia. Hold those forceps! 840 11

Adverse GI effects of NSAIDs include dyspepsia, occult bleeding, overt bleeding and ulcer disease. Consequences of NSAID-induced GI toxicity include anemia, hospitalization, and death. External factors, such as drugs and alcohol, can disrupt the gastric barrier that protects the GI tract from erosive substances. Pharmacists should counsel patients who frequently use non-prescription analgesics and determine whether further medical evaluation is needed. In contrast to NSAIDs, acetaminophen has not been associated with GI toxicity of increased risk of GI tract bleeding.
J Am Pharm Assoc (Wash) 1996 Sep
PMID:GI effects of OTC analgesics: implications for product selection. 882 76

In patients with progressive systemic sclerosis (PSS) suffering from chronic dyspepsia the stomach may be affected by this disease. The objective of this study was to investigate both antral myoelectrical activity and gastric emptying in PSS patients. Electrogastrography (EGG) was performed in 17 PSS patients (16 female, one male, median age 58 years, range 32-74 years) with chronic dyspepsia. After an overnight fast during one hour in the fasting and one hour in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electrical activity was measured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG parameters including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute [cpm]), bradygastria (< 2 cpm) and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects. In addition, the data were compared to gastric retention of the radionuclide at 60 min measured by simultaneous scintigraphy. The PSS patients did not reveal electrical disturbances. They even exhibited a significant postprandial decrease in DFIC, bradygastria, and tachygastria (ns) compared to healthy subjects. Over 50% of the PSS patients showed a delayed gastric emptying. However, EGG did not correlate to radioscintigraphy significantly. Our results reflect an absent relationship between antral myoelectrical activity in EGG and gastric emptying. Therefore, electrogastrography is unsuitable to assess gastric involvement in PSS.
Z Gastroenterol 1996 Sep
PMID:Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying. 887 54

Dyspepsia and heartburn are common symptoms in primary care practice. This article outlines the diagnosis and management of these problems with an emphasis on cost-effectiveness as well as the prevention of complications. It reviews what evaluations and treatments have been shown in the literature to be helpful and which have been found to be ineffective or much more expensive without clear benefit. It also clarifies the various diseases that can present as dyspepsia and refers readers to the appropriate articles included in this book.
Prim Care 1996 Sep
PMID:Cost-effective management of dyspepsia and gastroesophageal reflux disease. 888 45

In the present study we assessed the diagnostic accuracy of four commercial IgG enzyme-linked immunosorbent assay (ELISA) kits (Autoplate, H.pylori-EIA-Well, Enzygnost, Helori-test) and evaluated the performance of these tests in patients with fundic atrophic gastritis. Serum antibodies to Helicobacter pylori were measured in 70 out-patients attending endoscopy for dyspepsia and 43 patients with non-autoimmune fundic atrophic gastritis. Using the cut-off values recommended by the manufacturers, and comparing serological findings with gastric biopsy results of dyspeptic out-patients attending endoscopy, the four kits showed a sensitivity and specificity, respectively, of 91% and 96%, for Autoplate, 67% and 100% for H.pylori-EIA-Well, 79% and 100% for Enzygnost, and 81% and 96% for Helori-test. Evaluation in patients with atrophic gastritis revealed a high prevalence of antibodies to Helicobacter pylori (84%) and it demonstrated that patients with and those without gastric colonization by this microorganism had a similar rate of seropositivity (76-84% vs 50-78%). In conclusion, our data demonstrate that: a) this assay is a reliable and valid method to detect gastric colonization by Helicobacter pylori; b) positive serum antibody associated with a negative detection of Helicobacter pylori in the gastric mucosa suggests mucosal atrophy; c) patients with fundic atrophic gastritis should be excluded from studies investigating the value of serology in diagnosing Helicobacter pylori infection.
Ital J Gastroenterol 1996 Sep
PMID:Value of serology (ELISA) for the diagnosis of Helicobacter pylori infection: evaluation in patients attending endoscopy and in those with fundic atrophic gastritis. 893 37

The aim of our study is to evaluate the efficacy and tolerability of four different therapeutic regimens for Helicobacter pylori eradication. One-hundred and thirty-two consecutive patients suffering from either peptic ulcer or non-ulcer dyspepsia, with Helicobacter pylori infection, were allocated to one of the following 4 groups with different therapeutic regimens: A) omeprazole 20 mg bid for 14 days/amoxycillin 1000 mg bid for 14 days/tinidazole 500 mg bid for 14 days (30 patients, 13 with peptic ulcer); B) omeprazole 20 mg bid for 14 days/amoxycillin 1000 mg bid for 14 days (41 patients, 23 with peptic ulcer); C) omeprazole 20 mg bid for 14 days/azithromycin 500 mg/day for 3 days for 2 consecutive weeks (25 patients, 12 with peptic ulcer); D) omeprazole 20 mg/day for 7 days/clarithromycin 250 mg bid for 7 days/tinidazole 500 mg bid for 7 days/ (36 patients, 14 with peptic ulcer). The Helicobacter pylori status was evaluated by means of histology, culture and urease test, at entry and 8 weeks after treatment. 2 group A, B and D patients, 1 D patient didn't complete the treatment. In evaluable patients, the Helicobacter pylori eradication was obtained in 24 patients of group A (85.71%), in 24 of group B (58.98%), in 11 of group C (45.83%) and in 24 of group D (70.58%). On intention-to-treat analysis, Helicobacter pylori eradication was 80% in group A, 56.09% in group B, 44% in group D and 66.67% in group D. Sideeffects occurred in 6 patients of group A (20.68%), in 5 of group B (12.5%), in 3 group D (8.82%) and none of group C. In conclusion, triple therapy with omeprazole/clarithro-mycin/tinidazole is better for cost/benefit ratio; omeprazole/amoxycillin/tinidazole is more effective than others regimens in the Helicobacter pylori eradication, but causes more side effects; double therapy with omeprazole/azithromycin is the most tolerable and the least efficacy for Helicobacter pylori eradication.
Panminerva Med 1996 Sep
PMID:Evaluation of the efficacy and tolerability of four different therapeutic regimens for the Helicobacter pylori eradication. 900 77

RAP is a broad descriptive term commonly used in pediatrics to define a heterogeneous group of patients who experience episodic attacks of abdominal pain over a period of at least 3 months. The majority of patients who seek medical attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of the GI tract provoked by a variety of physical and psychological stimuli. There are three distinct clinical presentations of functional abdominal pain in children and adolescents: periumbilical paroxysmal abdominal pain, dyspepsia, and irritable bowel. The medical history, physical examination, and selected laboratory, radiologic, and endoscopic evaluations allow a positive diagnosis of a functional disorder in each type of clinical presentation.
Pediatr Rev 1997 Sep
PMID:Recurrent abdominal pain: an update. 928 50

Because of their high prevalence in clinical practice, the field of gastrointestinal motility has tended to focus its clinical and research efforts on such functional disorders as nonulcer dyspepsia, the irritable bowel syndrome, and functional constipation. Because these disorders are difficult to define and their diagnosis remains exclusively symptomatic, progress has been difficult in these areas, and advances in clinical gastrointestinal motility generally have been hampered. This review attempts to emphasize the prevalence and importance of "organic" motility disorders, ie, those disorders of gastrointestinal motor dysfunction that are to a greater or lesser extent based on defined pathology and pathophysiology. Although some of these disorders are rare, recent dramatic progress has important lessons for motility in general and should point the way toward a greater understanding of the more common motor disorders.
Gastroenterologist 1997 Sep
PMID:Enteric neuropathology: recent advances and implications for clinical practice. 929 77

The IARC convened a Working Group of experts in Lyon, France, on April 2-8, 1997 to evaluate the cancer-preventive activity of four nonsteroidal anti-inflammatory drugs (aspirin, sulindac, piroxicam, and indomethacin). Epidemiological observational studies of aspirin that differed in design, location, population, and motivating hypothesis have consistently shown that regular use lowers the risk for colorectal cancer by up to 50%; however, the one randomized trial did not show protection by aspirin. Definite evidence of chemopreventive activity normally requires data from appropriately designed randomized trials. The strength of the scientific evidence that aspirin prevents colorectal cancer in humans was thus considered to be limited. In animal models, there was sufficient evidence that aspirin prevented against cancer. Aspirin and aspirin-like drugs may have an important adverse side effects, the most frequent of which are gastrointestinal disturbances ranging in severity from dyspepsia to peptic ulcer. Given the remaining uncertainties in the preventive effect and the risk of adverse side effects, detailed consideration of the total benefits and of toxicity will be required before widespread use of aspirin for the prevention of colorectal cancer can be recommended. Sulindac shows promise in reducing the number and size of adenomatous polyps in patients with familial adenomatous polyposis. Further research is required, however, to determine whether and to what extent the risk for colorectal cancer in such patients is reduced. In people without familial adenomatous polyposis, there is inadequate evidence that sulindac has cancer-preventive activity. Fewer data were available on piroxicam and indomethacin than on aspirin and sulindac. Although these drugs consistently prevent colorectal cancers in experimental animal models, the evidence that they prevent colorectal cancer in humans was considered to be inadequate. The results of the meeting, including recommendations for future research, will be published as Volume 1 of the IARC Handbooks of Cancer Prevention.
Cancer Epidemiol Biomarkers Prev 1997 Sep
PMID:An international evaluation of the cancer-preventive potential of nonsteroidal anti-inflammatory drugs. 929 84


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