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)

One-hundred and one patients admitted to hospital with acute upper gastrointestinal haemorrhage whose initial barium-meal X-ray examination revealed no abnormality have been followed up 5 to 14 years later. Forty-five were symptom-free, and 8 had dyspepsia, but the barium-meal X-ray findings were still normal. Disease of the lower oesophagus, the stomach or the duodenum was found in 20, 16 of whom had a chronic peptic ulcer and two had gastric carcinoma. There was a poor prognosis for those gastric-ulcer patients whose diagnosis had been missed initially.
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PMID:Acute upper gastrointestinal haemorrhage with negative barium-meal x-ray findings: follow-up investigation. 108 53

Villous tumors of the duodenum are rare, but treatment may be problematic because of their association with invasive adenocarcinoma. Two cases of villous tumor of the duodenum are described and 39 other reported cases are reviewed. Presenting symptoms were bleeding 27%; obstruction 24%; jaundice 22% and vague dyspepsia 20%. Diagnosis may be made by radiographic barium contrast evaluation of the duodenum, especially with the addition of air contrast hypotonic studies and by fibro-optic endoscopy. Twenty-seven per cent of villous tumors of the duodenum are associated with adenocarcinoma. Invasive tumor is more common in patients over 50 years old (35%), in tumors of the third and fourth portions of the duodenum (44%) and in tumors over 4 cm in diameter (30%). Local excision is the treatment of choice for benign lesions. Pancreatico-duodenectomy is recommended for tumors which include invasive carcinoma in patients without distal metastases.
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PMID:Villous tumors of the duodenum. 111 48

Duodenal ulcer is a common cause of dyspepsia. The clinical features are non-specific, and suspicion of this lesion requires confirmation with a barium meal, perferably using a double-contrast technique. Duodenoscopy and gastric-acid-secretion studies are helpful in selected cases. Medical treatment is essentially symptomatic but nevertheless remains perfectly acceptable to many ulcer suffers. Surgical intervention is usually necessary in the presence of ulcer complications, but careful assessment is required before recommending operation for a patient with an uncomplicated duodenal ulcer. This decision should be based predominantly on the severity and duration of symptoms.
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PMID:Common gastroenterological problems. IV.--Duodenal ulcer. 114 69

A randomized clinical trial assessed the medical costs during 6 months after the evaluation of dyspepsia by gastroenterology consultation with esophagogastroduodenoscopy versus barium radiography. Primary care physicians entered patients whose dyspepsia responded incompletely to empiric therapy or recurred. The consultation/endoscopy group (N = 32) was similar (p greater than 0.23) to the radiography group (N = 34) regarding age, gender, physician visits, and costs of all dyspepsia drugs and H2 blockers during 6 months before evaluation. Most patients had non-ulcer dyspepsia. Costs during the succeeding 6 months (consultation/endoscopy versus radiography groups) were physician visits ($33.1 +/- 14.5 vs. $114.2 +/- 23.3, p less than 0.005); radiologic procedures ($70.5 +/- 37.3 vs. $67.6 +/- 22.5, p greater than 0.30); all dyspepsia drugs ($30.4 +/- 10.0 vs. $100.1 +/- 36.8, p = 0.08); H2 blockers ($25.4 +/- 9.5 vs. $96.0 +/- 34.7, p = 0.06); and total cost ($134.0 +/- 43.8 vs. $435.3 +/- 93.9, p = 0.006). The higher total cost in the radiography group was partly due to the referral of 7 patients (21%) for gastroenterology consultation due to persistent dyspepsia, 6 of whom had endoscopy versus the performance of radiography in 0 of the 32 consultation/endoscopy patients (p less than 0.025). Dyspepsia self-ratings were similar.
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PMID:Long-term costs after gastroenterology consultation with endoscopy versus radiography in dyspepsia. 139 33

This study examines the preference of 64 out-patients for either a barium meal or an upper gastrointestinal endoscopy. The sequence of the examinations was randomized to avoid order bias. An initial preference for a barium meal of almost two-to-one, with 53% having no preference, was changed after the investigations to a preference for endoscopy of two-to-one with 5% having no preference. The use of mild sedation and the skill of the endoscopist had a major impact on the patients' opinion of the endoscopic procedure, and on their choice of examination for any repeat study. There was little agreement between clinical diagnosis and the result of investigation, but clinicians tended to accept the reported result of the investigation, especially if the result was abnormal. Despite a change in diagnosis in 34 of 49 patients there was little change in management as a result of the investigations, supporting the view that young patients with dyspepsia may be managed with symptomatic treatment initially, and without investigation. This study lends further support to the view that endoscopy should be the investigation of choice in patients with persistent dyspepsia, especially those whose age or infirmity may make barium examination suboptimal.
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PMID:Barium meal or endoscopy? A prospective randomized study of patient preference and physician decision making. 176 Sep 7

A validated postal questionnaire has been used to establish the prevalence of dyspeptic symptoms in five geographical locations from the south coast of England to the north of Scotland. The six month period prevalence of dyspepsia in the 7428 respondents to the questionnaire is 41% and equal between the sexes, with similar prevalence rates in the centres studied. There is considerable overlap between upper abdominal symptoms and symptoms of heartburn; 56% of patients with dyspepsia experience both groups of symptoms. Symptom frequency falls progressively with age in men and women, but the proportion of people seeking medical advice for dyspepsia rises with age. One quarter of the dyspeptic patients studied have consulted a general practitioner about their symptoms. This study suggests that the prevalence of dyspepsia in the community has changed little over the last 30 years, despite evidence that the frequency of peptic ulcer disease is falling. Symptom prevalence is unrelated to social class, but this factor is associated with consultation behaviour, the consultation rate rising from 17% in social class 1 to 29% in social class 4. The use of investigations--barium meal and endoscopy--is similarly related to social class; the lowest rate for ulcer diagnosis (4.7%) is found in social class 1 and the highest (17.1%) in social class 5.
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PMID:Dyspepsia in England and Scotland. 233 64

In a 20-year follow-up of 40 patients with coarse duodenal folds, details were obtained about 34 patients of whom 11 had died. Clinical details were reviewed from the remaining 23 patients, and recent barium meal examinations were reviewed from eight patients. Ten of the 23 surviving patients continued to have recurrent dyspepsia, and the radiological appearance in three of the eight recent barium meals showed that coarse mucosal folds persisted. The clinical course of those with coarse duodenal folds is similar to that of peptic ulcer, with recurrent symptoms in some patients continuing for many years, and in others complicated by development of peptic ulcer. Coarse mucosal folds in the duodenum are usually associated with a high acid secretion and treatment to reduce acid secretion is appropriate in view of the severity of symptoms and risk of ulceration.
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PMID:Coarse mucosal folds in the duodenum: a twenty-year follow-up. 238 59

There is much controversy regarding the chronic nonspecific duodenitis as autonomous clinical entity. We have studied 36 patients (16 women, 20 men), aged 24-59 years (mean age 37.8 years), with biliary dyspepsia and endoscopic changes suggesting "duodenitis"; in all patients the following investigations were carried out: gastric secretion, barium X-ray and histological examination of the duodenal mucosa specimens obtained by endoscopic biopsy. There was no significant difference between the patients with duodenitis and normal subjects regarding the maximal acid output. Unspecific radiological changes were noticed in 55.5% of patients with chronic duodenitis. Endoscopy showed varied changes of duodenal mucosa including edema, erythema, erosions and hypertrophic folds. Histology confirmed the presence of inflammation. The patients have been followed-up for three years and none of them developed duodenal ulcer. We conclude that chronic nonspecific duodenitis is an autonomous clinical entity.
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PMID:[Chronic nonspecific duodenitis: myth or reality?]. 263 65

During 1986, 1386 patients with simple dyspepsia were referred by general practitioners for endoscopy (686) or double-contrast barium meal examination (700) at Leicester General Hospital. 618 (45%) were under the age of 45 years. Abnormal findings were more common in older than younger dyspeptic patients (58% vs 40% at endoscopy, 69% vs 25% by barium meal). Malignant disorders were diagnosed in 5% at endoscopy and 3% at barium meal, but in no patient under 45 years old. The incidence of malignant disorders at endoscopy was analysed for the 6 years 1980-86. Of 707 cases identified, only 13 (1.8%) occurred in patients under 45 years old; all 13 had symptoms suggesting pathology more serious than simple dyspepsia. It can be concluded that young patients with simple dyspepsia are overinvestigated. A majority can be treated safely with antacids and/or histamine receptor type 2 antagonists.
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PMID:Do young patients with dyspepsia need investigation? 290 61

It is now possible readily to investigate dyspeptic symptoms using either a double-contrast barium meal or upper gastrointestinal endoscopy. The accuracy of endoscopy makes it preferable for routine use. As oesophagogastro-duodenoscopy (OGD) is invasive, some risks (albeit very small) are involved. Moreover, this technique has some weaknesses. For these reasons, selection of patients is important. Organic disease is most likely to occur in older patients: anyone presenting with dyspepsia for the first time over the age of 40 years should be investigated automatically. In individuals under 40 years of age, organic disease is less common and some selection criteria should be applied to reduce the number of negative investigations. After age, smoking is probably the single most important adverse factor. For gastric ulcer, endoscopy with biopsy, repeated after a course of therapy, is routine, but for duodenal ulcer repeat examination need not normally be undertaken owing to the effectiveness of modern healing drugs. Methods for improving the diagnostic accuracy of patient histories and clinical examinations need to be developed in order to utilize diagnostic investigations more efficiently for the patients' benefit.
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PMID:When should endoscopy (or radiology) be used in dyspepsia and peptic ulcer disease? 297 3


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