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

Dietary fat has a less prominent role in realimentation than the alternate source of energy, carbohydrate. Presently available therapeutic diets, in typical feeding routines, provide only 3 to 120 g of fat per day. Three major factors contribute to fat underutilization: long-standing belief that fat is to blame for various vague symptoms of indigestion, misconception that daily fecal fat in excess of 7 g represents bowel dysfunction, and fear of fat-induced atherogenesis. None of these apply to refeeding starved and malnourished patients. The small intestine has a vastly underutilized capacity for fat absorption, and at the habitual fat intake of 100 g per day absorption is complete in the proximal one fifth of the gut. In patients requiring vigorous realimentation, the remaining small intestine should also be utilized. Dietary fat is well tolerated, and daily intakes of 500 g of polyunsaturated fat in a complete diet have not been associated with important side effects, while there was a significant improvement in body stores of fat and protein. Compared to diets high in carbohydrate, adequate intake of fat results in better nutrient utilization, less CO2 production and decreased lipogenesis and insulin requirements. Diets higher in fat are also better tolerated because of their lower volume and osmolality. The result is more effective absorption of calories and a faster nutritional recovery. Increased adipose tissue and protein reserve benefits patients who are in stress, immunocompromised, or debilitated. Adequate dietary fat should be considered for malnourished subjects with intact gastrointestinal function, and when intestinal absorptive capacity is reduced by surgery or disease.
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PMID:How much dietary fat in therapeutic nutrition? 219 11

A patient with a somatostatin (SRIH)-secreting islet cell tumor, whose only symptoms were dyspepsia and anemia, is described. The diagnosis of somatostatinoma was based on high plasma SRIH concentrations and immunocytochemical findings. The pancreatic exocrine response to secretin was decreased, whereas the insulin and/or glucagon responses to glucose and arginine were normal. Although the basal plasma GH concentration was normal, the plasma GH response to GHRH was subnormal. Gel permeation chromatography studies indicated that SRIH-14 was the predominant form of SRIH in plasma as well as in tumor tissue.
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PMID:Somatostatin-secreting islet cell tumor (somatostatinoma): suppression of growth hormone (GH) release induced by GH-releasing hormone. 289 73

Fasting and post-prandial circulating levels of insulin, gastrin, gastric inhibitory polypeptide, pancreatic polypeptide and neurotensin were measured in patients with flatulent dyspepsia, with and without gallbladder disease and post-cholecystectomy. Levels were also measured in non-dyspeptic patients with gallbladder disease and normal controls. There were no consistent significant differences from controls for fasting and post-prandial responses in patients with a history of dyspepsia or those who experienced dyspepsia at the time of the test. In patients with gallbladder disease, with and without dyspepsia, there was a reduced neurotensin response compared to normal controls. It is concluded that circulating levels of these hormones are not related to symptoms of flatulent dyspepsia.
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PMID:Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease. 354 53

Results of insulin and pentagastrin tests 2 months after parietal cell vagotomy were compared with clinical outcome in six patients with subsequent duodenal recurrence of ulcer, ten with pyloric or gastric recurrence, 43 with dyspepsia and 75 persistently symptom-free controls. The insulin-stimulated peak acid output (IPAO) and the pentagastrin-stimulated peak acid output (PAO), but not the basal acid output (BAO), were significantly higher in the duodenal recurrence group than in the controls. In the pyloric/gastric recurrence and dyspepsia groups, BAO, IPAO and PAO were similar to the control values. In the duodenal group the postvagotomy reductions of IPAO and PAO were significantly less than in the controls, indicating incomplete vagotomy. In the pyloric/gastric recurrence and dyspepsia groups, the postvagotomy BAO fall was significantly less than in the controls, but IPAO and PAO fell similarly in all three groups, indicating that pyloric or gastric recurrence was related only to inadequately reduced BAO.
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PMID:Relationship between gastric acid secretion and clinical outcome after parietal cell vagotomy. 355 65

This study was designed to investigate the long-term effects of early pancreatic resection for acute necrotizing pancreatitis. During 1973-1978 40 resections were performed in our clinic. Eleven patients died initially (28 per cent). None of the four further deaths was due to pancreatitis or associated disorders. Twenty-four patients were re-examined 5-11 years after resection--one patient refused to participate. Five had not been able to return to work because of severe polyneuropathy; one more had retired because of chronic pancreatitis in the pancreatic remnant. Polyneuropathy was found in five further patients. The reason for this high incidence of polyneuropathy (42 per cent) remains unknown. Eight patients still drank excessive alcohol; three of them had had recurrent pancreatitis and dyspepsia, and insulin requiring diabetes. All but 2 (92 per cent) had diabetes, 14 needing insulin--half of them at 6 months to 6 years after the resection. Moreover, 11 patients (46 per cent) suffered from dyspeptic symptoms. The results suggest that because of the high frequency of late complications, in addition to the early complications, early resection of pancreas should be critically re-evaluated as the treatment for acute necrotizing pancreatitis. If resection is used in patients with extreme pancreatic necrosis, careful and continuous postoperative follow-up will be needed.
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PMID:Long-term results after pancreas resection for acute necrotizing pancreatitis. 404 24

The value of insulin and augmented histamine tests in predicting recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage was assessed in a series of 500 consecutively and electively operated patients. Criteria of recurrence were established by a discriminative analysis of gastric acid secretion parameters. Recurrence was predicted with a probability of about 75% in patients with dyspepsia, the proportion between recurrences and dyspeptic nonrecurrences being 1:1. The discriminatory ability of the insulin test was no better than that of the postoperative histamine test. Men with a preoperative PAO > 46.1 m-equiv/h had a risk of recurrence of 21%, women with a PAO > 41.5 m-equiv/h, 28%. Below these levels the risk was 5 and 1% respectively, demonstrating that recurrence after vagotomy is related to the number of parietal cells before vagotomy. A rationale is provided for antrectomy and vagotomy in duodenal ulcer patients with a high number of parietal cells.
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PMID:Gastric acid secretion and risk of recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage. 443 86

A questionnaire was used to study the choice and use of gastric function tests by members of the British Society of Gastroenterology.Pentagastrin has largely replaced older drugs as the stimulant of choice for evoking maximal acid secretion. Insulin tests are being used in situations where they are unlikely to provide useful clinical information. Fewer physicians than surgeons measure gastric secretion, and they use tests less often. The reluctance of physicians to test patients with uninvestigated dyspepsia or gastric ulcer seems justified, but in patients having dyspepsia with negative x-ray films, or after gastrectomy or vagotomy, the greater investigative keenness of surgeons seems commendable. Only half the surgeons ever try to assess the completeness of their vagotomies, and in only one-third of this half is it their usual practice. Criticism is made of the practice of routine measurement of acid in patients with duodenal ulcer, and of the use of acid measurements to decide whether a patient should have surgery or which type of operation should be performed.
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PMID:Use of gastric function tests by British gastroenterologists. 554 Dec 30

The gastric secretory response to insulin changes in many patients between ;immediate' tests, within two weeks of vagotomy, and ;delayed' tests, done at least six months later. Patients who develop recurrent duodenal ulceration after vagotomy and pyloroplasty show highly significant increases in peak and rise in concentration and output of acid. Those who do not have recurrent dyspepsia show varied individual changes in the test results, but for the group as a whole there is no increase in the peak response and only a slight increase in the rise in acid concentration and output. These findings are interpreted as evidence for vagal recovery, either from neuropraxia or by collateral nerve sprouting, as a major factor in the production of recurrent ulceration. Indeed, it appears to be as important as the functional state of the vagi at the end of the operation. Consequently, only the delayed insulin tests can be of any value in the prediction or diagnosis of recurrence.
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PMID:Changes in the postoperative insulin test in relation to recurrent duodenal ulceration. 557

Patients with dyspepsia were asked to volunteer for two gastric secretion tests preceded by a single intravenous injection of pirenzepine 10 mg in the one and 0.9% saline in the other (in random order). In each test gastric secretion was aspirated continuously. 0.9% saline was infused intravenously for 30 minutes followed by insulin 0.15 micrograms/kg-h for 90 minutes, saline for 30 minutes and finally pentagastrin for 90 minutes in doses of either 6, 1, 0.5 or 0.25 micrograms/kg-h. Gastric samples were analysed for volume, pH, titratable acidity and pepsin. Basal outputs of acid and pepsin were not altered by pirenzepine. Insulin-stimulated acid output was significantly reduced (p less than 0.05) from a mean of 32.7 to 22.6 mmol/h (-31%). The mean percentage reduction was 16%. Acid and pepsin outputs after pentagastrin 0.25-6 micrograms/kg-h were not significantly altered by this dose of pirenzepine.
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PMID:Influence of intravenous pirenzepine on gastric acid and pepsin in man. 678 94

Somatostatinoma is one of the rarest tumours of the endocrine pancreas. Cardinal manifestations of a somatostatinoma include gallstones, mild diabetes mellitus, steatorrhoea, diarrhoea and dyspepsia. Like any other pancreatic islet cell carcinoma, a somatostatinoma may also produce several different hormones such as adrenocorticotropic hormone, calcitonin, vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin, insulin, and glucagon. In many cases, the clinical picture is dominated by the effect of these other hormones. We present a patient with somatostatinoma in which an immunocytochemical study of the specimens from pancreas and liver showed a weak positive reaction for gastrin besides a strong positive reaction for somatostatin. Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.
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PMID:Carcinoid syndrome due to a malignant somatostatinoma. 749 79


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