Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to identify those patients who would benefit from eradication therapy for Helicobacter pylori and to understand the scale of service changes needed to implement eradication therapy. All general practices in Bradford Health Authority were invited to take part in the study. Patients who had received more than one repeat prescription for proton pump inhibitors or H(2) receptor antagonists in the previous twelve months were identified using the repeat prescription systems in the participating practices. Their case notes were examined and the relevant data items extracted by a trained project worker. Forty-four out of 100 practices agreed to take part and they accounted for a population of 262 647 people. Of that population, 2.3% (6037) of patients were on long-term acid suppressing treatment. Seventy-nine percent (n=4784) of patients on long-term acid suppression had a diagnosis recorded in the records; 17% (n=1028) had duodenal ulcer; 5% (n=278) gastric ulcer and the rest, 58% (n=3478), consisted of patients labelled as dyspepsia, heartburn, gastritis, and non-ulcer dyspepsia. Only 131 (10%) of those patients with peptic ulcer had been prescribed eradication therapy. Endoscopy and barium meal examinations had been used to confirm the diagnosis in 2715 patients. In the remaining patients there was no information in the case notes to suggest whether the diagnosis had been confirmed by investigations.A substantial proportion of patients previously diagnosed as having peptic ulcer have not been offered eradication therapy demonstrating a delay in getting research evidence into practice. To ensure all patients within a health district who may benefit from eradication therapy, do benefit, a systematic approach including access to additional investigative facilities is required.
 ...
PMID:Do all patients in primary care who may benefit from eradication of Helicobacter pylori have access to effective care? 1146 1

Patients with peptic ulcer, radiologically negative dyspepsia, and gastric carcinoma have been studied with the modified augmented histamine test described in the previous paper. For each disease a range of values is presented and compared with the normal range, taking account of age and sex. The test may be of diagnostic value because comparison of an observed result with the ranges presented may show that a disorder, for example duodenal ulcer, is almost certainly present or almost certainly not present. Thus, in duodenal ulcer about half the values of peak acid output were above the normal range, and there was a threshold figure for peak acid output below which patients with duodenal ulcer were not found. There was a gradient for peak acid output in patients with ulcers at different sites so that ulcers in the body of the stomach < near the angulus < prepyloric < duodenal ulcers. Normal acid output did not exclude carcinoma of the stomach. Abnormally high basal or peak acid output in patients with dyspepsia but negative barium meals may suggest the presence of peptic ulceration.
 ...
PMID:AN ASSESSMENT OF THE AUGMENTED HISTAMINE TEST IN THE DIAGNOSIS OF PEPTIC ULCER. CORRELATIONS BETWEEN GASTRIC SECRETION, AGE AND SEX OF PATIENTS, AND SITE AND NATURE OF THE ULCER. 1405 66

Congenital diaphragmatic hernias, including Morgagni s hernia, usually present in early childhood and are treated by surgical repair. This case report is about an unusual Morgagni s hernia, presenting with dyspepsia and chest pain, at the age of 45 years. For many years the diagnosis remained a dilemma because patient s chest x-ray was not done and she was treated for "angina " and "dyspepsia". Diagnosis was obvious once a chest x-ray was done, however, barium studies were performed for further confirmation.
 ...
PMID:Morgagni's hernia. 1476 62

Dyspepsia is a common disorder with a prevalence of up to 40% in the general population. The presence of alarm features (age >50 years, loss of appetite, early satiety, loss of weight, dysphagia, abdominal mass, gastrointestinal bleeding, and/or anemia) increase the likelihood of an organic etiology. Despite a plethora of information written on this subject, the literature is sparse in minority populations. We studied the etiology of dyspepsia in relation to age and the presence or absence of alarm features in 678 African-American and Hispanic patients. Five-hundred-thirty patients were investigated by upper gastrointestinal (UGI) endoscopy, 88 by barium radiographs of the UGI tract, and 60 patients had both endoscopy and barium studies. The most common alarm feature in our study was age >50 years, followed by anemia, weight loss, gastrointestinal bleeding, loss of appetite, early satiety, abdominal mass, and dysphagia. The presence of alarm features and older age increased the likelihood of finding an organic lesion. It is concluded, therefore, that endoscopy in our dyspeptic patients who had alarm features appears to increase the diagnostic yield and may consequently result in a more favorable therapeutic outcome.
 ...
PMID:Dyspepsia in African-American and Hispanic patients. 1516 Sep 78

Disorders of the upper digestive tract have a high impact on modern society, in terms of both direct and indirect health care costs and of social burden. The most common presenting symptom is either dysphagia or dyspepsia. Discriminating specific diagnoses within this wide group of diseases requires sound clinical judgment and application of procedures to distinguish organic from nonorganic disease and to further characterize the functional or motility disturbance of nonorganic diseases. Non-radionuclide-based diagnostic techniques include both noninvasive tests (upper gastrointestinal barium series, ultrasonography, and breath test for gastric emptying) and invasive procedures (fiberoptic endoscopy, esophagogastroduodenoscopy, pharyngeal manometry, stationary esophageal manometry, 24-h pH monitoring, esophageal biliary reflux monitoring, multichannel intraluminal impedance, and electrogastrography). Some of these techniques are not well tolerated by patients or not widely available. Radionuclide transit/emptying scintigraphy provides a means of characterizing exquisite functional abnormalities with a set of low-cost procedures that are easy to perform and widely available, entail a low radiation burden, closely reflect the physiology of the tract under evaluation, are well tolerated and require minimum cooperation by patients, and provide quantitative data for better intersubject comparison and for monitoring response to therapy. Despite the relatively low degree of standardization both in the scintigraphic technique per se and in image processing, these methods have shown excellent diagnostic performance in several function or motility disorders of the upper digestive tract. Dynamic scintigraphy with a radioactive liquid or semisolid bolus provides important information on both the oropharyngeal and the esophageal phases of swallowing, thus representing a useful complement or even a valid alternative to conventional invasive tests (such as stationary esophageal manometry) for evaluating abnormalities of oropharyngoesophageal transit. Clinical applications of esophageal transit scintigraphy include disorders such as nutcracker esophagus, esophageal spasm, noncardiac chest pain of presumed esophageal origin, achalasia, esophageal involvement of scleroderma, and gastroesophageal reflux and monitoring of response to therapy (either medical or surgical treatment of disease-for example, organic disease such as esophageal cancer). Scintigraphy with a radiolabeled test meal represents the gold standard for evaluating gastric emptying, whereas more recent radionuclide methods include dynamic antral scintigraphy and gastric SPECT for assessing gastric accommodation. Clinical applications of gastric-emptying scintigraphy include, among others, evaluation of patients with dyspepsia and evaluation of gastric function in various systemic diseases affecting gastric emptying. The present review includes the proposal of clinical algorithms for evaluating patients with the main disorders of the upper digestive tract. These algorithms, originally derived from available literature, have been developed on the basis of a vast clinical experience in conjunction with the specialists more deeply involved in the care of patients with such disorders (medical and surgical gastroenterologists and nuclear medicine physicians). The role of radionuclide gastroesophageal motor studies is clearly identified in the various steps of patients' management, from the initial diagnostic approach to functional characterization to postoperative follow-up or monitoring of medical therapy.
 ...
PMID:Radionuclide gastroesophageal motor studies. 1518 Nov 37

Tuberculosis can involve any part of the gastrointestinal tract and is the sixth most frequent site of extrapulmonary involvement. Both the incidence and severity of abdominal tuberculosis are expected to increase with increasing incidence of HIV infection. Tuberculosis bacteria reach the gastrointestinal tract via haematogenous spread, ingestion of infected sputum, or direct spread from infected contiguous lymph nodes and fallopian tubes. The gross pathology is characterized by transverse ulcers, fibrosis, thickening and stricturing of the bowel wall, enlarged and matted mesenteric lymph nodes, omental thickening, and peritoneal tubercles. Peritoneal tuberculosis occurs in three forms : wet type with ascitis, dry type with adhesions, and fibrotic type with omental thickening and loculated ascites. The most common site of involvement of the gastrointestinal tuberculosis is the ileocaecal region. Ileocaecal and small bowel tuberculosis presents with a palpable mass in the right lower quadrant and/or complications of obstruction, perforation or malabsorption especially in the presence of stricture. Rare clinical presentations include dysphagia, odynophagia and a mid oesophageal ulcer due to oesophageal tuberculosis, dyspepsia and gastric outlet obstruction due to gastroduodenal tuberculosis, lower abdominal pain and haematochezia due to colonic tuberculosis, and annular rectal stricture and multiple perianal fistulae due to rectal and anal involvement. Chest X-rays show evidence of concomitant pulmonary lesions in less than 25 per cent of cases. Useful modalities for investigating a suspected case include small bowel barium meal, barium enema, ultrasonography, computed tomographic scan and colonoscopy. Ascitic fluid examination reveals straw coloured fluid with high protein, serum ascitis albumin gradient less than 1.1 g/dl, predominantly lymphocytic cells, and adenosine deaminase levels above 36 U/l. Laparoscopy is a very useful investigation in doubtful cases. Management is with conventional antitubercular therapy for at least 6 months. The recommended surgical procedures today are conservative and a period of preoperative drug therapy is controversial.
 ...
PMID:Abdominal tuberculosis. 1552 Apr 84

A large proportion of the American population avails itself of a variety of complementary and alternative medicine (CAM) interventions. Allopathic practitioners often dismiss CAM because of distrust or a belief that there is no sound scientific evidence that has established its utility. However, although not widely appreciated, there are thousands of randomized controlled trials (RCTs) that have addressed the efficacy of CAM. We reviewed the RCTs of herbal and other natural products, acupuncture, and homeopathy as examples of typical CAM modalities, focusing on conditions of interest to gastroenterologists. Peppermint (alone or in combination) has supportive evidence for use in patients with dyspepsia, irritable bowel syndrome, and as an intraluminal spasmolytic agent during barium enemas or endoscopy. Ginger appeared to be effective in relieving nausea and vomiting due to motion sickness or pregnancy. Probiotics were useful in childhood diarrhea or in diarrhea due to antibiotics; one particular formulation (VSL#3) prevented pouchitis. Acupuncture appeared to ameliorate postoperative nausea and vomiting and might be useful elsewhere. There is even a suggestion that homeopathy has efficacy in treatment of gastrointestinal problems or symptoms. The major problem in interpreting these CAM data is the generally low quality of the RCTs, although that quality might not be different compared to RCTs in the general medical literature. Gastroenterologists should become familiar with these techniques; it is likely that their patients already are.
 ...
PMID:Complementary and alternative medicine in gastroenterology: the good, the bad, and the ugly. 1555 Dec 47

Peppermint leaf and peppermint oil have a long history of use for digestive disorders. Recent evidence suggests that enteric-coated peppermint oil may be effective in relieving some of the symptoms of irritable bowel syndrome. A combination product including peppermint oil and caraway oil seems to be moderately effective in the treatment of non-ulcer dyspepsia. Topical application of peppermint oil may be effective in the treatment of tension headache. Because of its relaxing effects on smooth muscle, peppermint oil given via enema has been modestly effective for relief of colonic spasm in patients undergoing barium enemas. Peppermint oil is well tolerated at the commonly recommended dosage, but it may cause significant adverse effects at higher dosages.
 ...
PMID:Peppermint oil. 1742 17

"Nutcracker esophagus" (NE) is a primary esophageal motor disorder, first described in patients with noncardiac chest pain. In recent years NE has been associated with gastroesophageal reflux disease (GERD). In this study we compare patients with NE with and without GERD, as defined by pHmetry or endoscopy, with respect to clinical, endoscopic, radiologic, and manometric findings. Fifty-two patients with NE were studied. They were divided in two groups: GERD (17-32.6%) and non-GERD (35-67.4%) patients. Females predominated in both groups, with no significant difference in age (p>0.05). Chest pain was the chief complaint in both groups (p>0.05). Clinical findings in patients with and without reflux included chest pain (52.9% and 51.4%), dysphagia (58.8% and 42.8%), and heartburn (64.7% and 42.8%), followed by regurgitation, dyspepsia, ear, nose, and throat (ENT) complaints, respiratory symptoms, and odynophagia (p>0.05). Erosive esophagitis was found in three patients (5.7%). There were no differences between groups in the findings of barium swallow studies and all manometric findings were similar for both groups (p>0.05). We conclude that there were no differences in patients with NE with or without associated reflux disease. It is important to diagnose reflux properly so patients can be treated adequately.
 ...
PMID:Are there any differences between nutcracker esophagus with and without reflux? 1745 46

A 34-year-old woman presented with epigastric pain, nausea, and dyspepsia. Contrast-enhanced computerized tomography revealed a small mass in the duodenal wall mimicking a periampullary neoplasm and, at endoscopic examination, a periampullary submucosal tumor was suspected. The diagnosis of intramural duodenal diverticulum (IDD) was made by an x-ray barium meal that showed a finger-like sac filled with barium, the so-called "windsock sign." IDD is a rare congenital abnormality caused by an anomalous process of recanalization of the primitive foregut. The intermittent filling and emptying of the IDD is responsible for epigastric pain, nausea, and vomiting. When IDD is symptomatic, surgical or endoscopic treatment is recommended.
 ...
PMID:Intramural duodenal diverticulum mimicking a periampullary neoplasm. 1861 38


<< Previous 1 2 3 4 5 6 7 8 Next >>