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)

It has been suggested that functional dyspepsia might arise from the effect of stress on upper gut motility in susceptible individuals. The aim of this study was to evaluate posticibal antral motility in the presence and absence of sustained experimental stress by means of a transcutaneous electrical nerve stimulator. Two groups of patients could be recognized from these studies: first, those with postcibal antral hypomotility that was not changed during stress; and second, patients with normal postcibal motility which was normally suppressed by stress. Experimental stress significantly increased skin conductance and plasma beta-endorphin levels. However, in these two groups, there were no differences in clinical presentation and personality traits or in autonomic and humoral variables either before or during stress. Stepwise discriminant analysis of the autonomic or humoral responses to stress was unable to predict the different postcibal antral motor responses among the subsets of patients with functional dyspepsia. These data suggest that there are two subtypes of antral motility in functional dyspepsia: disordered gastric function under basal conditions resulting in antral hypomotility, and normal basal antral motility and autonomic and gastric motor responses to stress. In the latter subgroup, the cause of symptoms is unclear, but it appears not to be a motility disorder.
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PMID:Gastric and autonomic responses to stress in functional dyspepsia. 294 8

Cisapride, a substituted piperidinyl benzamide chemically related to metoclopramide, is an orally administered prokinetic agent which facilitates or restores motility throughout the length of the gastrointestinal tract. Its novel mechanism of action is thought to involve enhancement of acetylcholine release in the myenteric plexus of the gut. Because of its specificity cisapride is devoid of central depressant or antidopaminergic effects; side effects such as diarrhoea or loose stools, which occur infrequently, are related to its primary pharmacological action. Evidence exists from comparisons with placebo in initial trials to establish the efficacy of cisapride in improving healing rates and symptoms in patients with reflux oesophagitis, in alleviating symptoms in patients with non-ulcer dyspepsia, and in accelerating gastric emptying in gastroparesis. There are less conclusive data regarding the efficacy of cisapride in relieving symptoms in patients with gastroparesis, although preliminary results support a role for cisapride in certain groups such as diabetics. Limited data suggest that patients with chronic constipation due to underlying motility disorders may benefit from cisapride. Unfortunately, there is a paucity of trials comparing the efficacy of cisapride with other therapeutic agents. Thus, the relative position of cisapride in therapy cannot be defined at present. Should future results support preliminary evidence of comparable efficacy to metoclopramide, domperidone and ranitidine (in oesophagitis), cisapride with its favourable tolerability profile should claim a prominent position in the therapy of patients with a variety of gastrointestinal motility disorders.
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PMID:Cisapride. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use as a prokinetic agent in gastrointestinal motility disorders. 306 57

The results of cholecystectomy in terms of symptomatic improvement were prospectively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery. Indications for cholecystectomy were biliary pain (n = 65), previous complications of gall stone disease (n = 52), and flatulent dyspepsia (n = 7). At two years 93 patients could be re-evaluated, of whom only 49 (53%) were completely symptom free. Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia (which had relapsed in 22 of 46 patients who suffered it preoperatively), dull abdominal pain or diarrhoea. Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones. Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history. The results reconfirm that cholecystectomy eradicates specific symptoms and complications of gall stone disease, but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing 'postcholecystectomy' symptoms. These are probably caused by previously undiagnosed functional gut disease associated with, but unrelated to, gall stones. A systemic approach to multisymptomatic patients with gall stones is recommended.
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PMID:Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. 342 78

We define the concept of functional dyspepsia and analyze the putative mechanisms involved in its pathogenesis. We consider the evidence for gastroduodenitis, including the relationship of spiral organisms and viruses in this entity, and for functional dyspepsia as a manifestation of gastric secretory dysfunction and upper gut dysmotility. Functional dyspepsia is probably a heterogeneous condition in which multiple etiopathogenetic mechanisms are involved. Nevertheless, patients with functional dyspepsia constitute a sizable fraction of gastroenterological practice and therefore this disorder deserves intense research.
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PMID:Functional dyspepsia. Symptoms and underlying mechanism. 353 16

Seventy-four patients with rheumatoid arthritis were treated with sulphasalazine. There was a significant improvement in clinical score, with substantial falls in serum C-reactive protein concentrations and erythrocyte sedimentation rate four weeks after starting the drug. Improvement was maintained in the 38 patients who remained on the drug for one year. The mean Rose-Waaler titre did not change. There was little difference between the results in seropositive and seronegative patients. The commonest adverse effect was dyspepsia, but five patients developed a megaloblastic anaemia and one patient neutropenia; all made a complete recovery. The results suggest that the drug has a disease-modifying action not attributable to its "salicylate" content. The mode of action might be by an antibacterial effect on gut flora.
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PMID:Sulphasalazine in rheumatoid arthritis. 610 77

New techniques in the study of gut motility must aim to improve our understanding of the flow of luminal contents, since this is the ultimate function of such motility. This paper reviews some areas of gastroduodenal motility relevant to our understanding of duodenogastric reflux. Antroduodenal motility has been studied in the past both manometrically and radiologically, but the function of the pylorus remains in doubt. Observations made using a new impedance technique at endoscopy on the timing of pyloric closure during antroduodenal motor activity suggest that the pylorus, in addition to being a functional appendage of the terminal antrum, can contract independently and in association with isolated duodenal contractions to prevent reflux. Retroperistaltic duodenal contractions, however, may not close the pylorus in time to prevent reflux, and duodenal activity rather than the pylorus may be the key to duodenogastric reflux. Studies using invasive techniques have implicated reflux in the aetiology of some gastric ulcers and gallstone dyspepsia. Non-invasive studies on reflux with the HIDA radionuclide scan have confirmed that reflux is minimal in normal subjects, more common in gallstone dyspepsia, and related to gallbladder function.
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PMID:New developments in the evaluation of gastroduodenal motility with special reference to duodenogastric reflux and its clinical significance. 638 78

Early work using the monkey as subject in behavioral experiments found that chronic, perforating duodenal ulcers could develop. In our own experiments, we were unable to reproduce this finding but did observe the regular occurrence of self-limited lesions in areas of the gut susceptible to chronic ulcer formation in man. Of the three lesions we examined histologically, we found that two of them consisted of foci of gastric metaplasia, lesions found in man in association with dyspepsia and ulcer disease. We also noted that these subjects were delivering normal amounts of hydrogen ion to their duodenums, while subjects with gastric lesions had suppressed entry rates into the duodenum. We thus hypothesized that the combination of stress plus normal rate of entry of hydrogen ion into the duodenum had produced the gastric metaplastic changes.
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PMID:Effect of multiple stress procedures on monkey gastroduodenal mucosa. 677 Sep 67

It is hypothesized that chronic gastritis and ulcerative colitis both are induced by viral infection, and that such chronic infection of the mucosa may lead to ulceration and occasionally cancer. Duodenal ulcer disease and Crohn's disease may on the other hand, be due to activation of latent viral infection of the corresponding neural ganglions, with subsequent migration of virus along the nerves to the gut wall. The gastric acid hypersecretion often occurring in patients with duodenal ulcer disease might be a consequence of viral interference with the efferent nerve function of vagal ganglions. Correspondingly, non-ulcer dyspepsia as well as irritable colon may reflect viral infection of afferent nerve function leading to pain and discomfort.
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PMID:Gastritis, peptic ulcer disease, inflammatory bowel disease, and stomach and colon cancers- are they all caused by viral infections? 732 19

Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (P < 0.0001), but in addition had significantly lower sensory thresholds for both perception and discomfort evoked by balloon distension of the esophagus (mean +/- SEM: 8.8 +/- 1.3 ml vs 12.1 +/- 1.5 ml (P < 0.05) and 12.2 +/- 1.4 ml vs 16.4 +/- 1.4 ml (P < 0.02) respectively. Patients with FD showed similarly enhanced esophageal sensitivity, with thresholds for perception and discomfort of 8.1 +/- 0.9 ml (P < 0.02), and 10.1 +/- 1.0 ml (p < 0.001), respectively, but were also found to have sensory thresholds for rectal distension similar to those observed in the IBS group, significantly lower than in controls: IP 45.0 +/- 17.6 vs 59.3 +/- 1.5 ml (P < 0.001), DD 98.0 +/- 17.9 vs 298.7 +/- 9.0 ml (P < 0.0001), U 177.2 +/- 25.4 vs 415.1 +/- 12.6 ml (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity. 764 57

GI motility changes little--if at all--with age in healthy patients. However, a variety of diseases, including diabetes and Parkinson's disease, may cause autonomic neuropathy that is manifest as a motility disorder in the GI tract. Autonomic neuropathy can cause dysmotility in the esophagus, stomach, and gut. Symptoms are often nonspecific, including difficulty in swallowing, nausea, vomiting, heartburn, indigestion, diarrhea, and constipation. Nonpharmacologic treatment includes management of underlying diseases, avoidance of anticholinergic medications, and dietary changes. Agents with prokinetic action are the therapy of choice when drug treatment is indicated.
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PMID:GI motility disorders: diagnostic workup and use of prokinetic therapy. 790 Nov 29


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