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

To identify factors associated with the decision to consult with dyspepsia, patients with dyspepsia were identified from a postal survey in the community. A random sample of 69 patients who had consulted their general practitioner and 66 patients with dyspepsia who had not consulted were interviewed in their homes. Differences in consultation behaviour were not explained by differences in self-reported severity or frequency of symptoms or by the presence of associated symptoms. The most striking difference between the two groups was concern among the consulters about the possible seriousness of symptoms. Consulters were also more likely to be worried about cancer and heart disease and to have experienced more disruptive or threatening life events than the non-consulters. These results emphasize the importance of looking beyond the presentation of common symptoms in general practice to patients' fears about the significance of the symptoms and to non-physical determinants of consultation behaviour.
J R Coll Gen Pract 1989 Dec
PMID:Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. 255 4

This paper reports the incidence of dyspepsia in general practice, the characteristics of patients, the types of complaints presented and the management of the dyspeptic patient by general practitioners. Fourteen general practitioners in the Maastricht region of the Netherlands studied 318 consecutive patients presenting with dyspepsia. Two questionnaires were used: one filled in by the patient (82% response), the other by the physician (100% response). The diagnostic conclusions which were established after three months of follow-up were compared with the diagnostic hypotheses at the initial consultation. The annual consultation rate for dyspepsia was calculated as 27 per 1000 registered subjects. One third of the patients had an earlier history of dyspepsia. Almost all patients (95%) complained of pain, and 37% had been suffering from pain for more than three months before consulting the general practitioner. The general practitioner prescribed medication in 70% of cases; less commonly the patient was referred for x-ray (14%), endoscopy (13%) or to a specialist (11%). A higher age was associated with a higher probability of referral, and with the finding of organic disease. A history of ulcer disease was strongly correlated with the diagnosis of an ulcer during the current episode. The overall concordance between the general practitioner's diagnostic hypothesis at the initial consultation and the diagnostic conclusion after three months of follow-up was 78%; it was highest when minor pathology was suspected. We conclude that dyspepsia is managed well in general practice and is only rarely associated with major lesions. Dyspeptic patients referred to a specialist therefore constitute a highly selected population.
J R Coll Gen Pract 1989 Dec
PMID:How well do general practitioners manage dyspepsia? 255 5

Gastric motor dysfunction and concomitant gastric stasis have been implicated in the pathogenesis of nonulcer dyspepsia, but a cause-and-effect relationship is not established. Essential dyspepsia refers to a subgroup of nonulcer dyspepsia patients who have no evidence of irritable bowel syndrome, gastroesophageal reflux, or pancreaticobiliary disease. In 32 patients with essential dyspepsia, and 32 randomly selected dyspepsia-free community controls of similar age and sex, we measured gastric emptying of solids using Tc99m-Sulphur Colloid in a fried egg sandwich. Subjects with neuromuscular or other diseases that may alter gastric emptying were excluded. Symptoms were assessed by a standard questionnaire. Data processing was carried out "blinded" to the subjects' clinical status. Female patients took significantly longer to empty half the initial stomach activity (mean 90 min) than female controls (mean, 73 min; p = 0.02). The rate of emptying at 25 min was also significantly less in female patients than in controls. Female and male controls, and male patients, had similar emptying times. Delayed emptying was not associated with the occurrence of postprandial pain, belching, or nausea; there was a trend for the half-time rate of emptying to be greater in patients with abdominal distention. While gastric emptying of solids is slightly delayed in females with essential dyspepsia as a group, this may not explain their symptoms.
J Clin Gastroenterol 1989 Dec
PMID:Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. 258 62

The effect of treatment of Campylobacter pylori-associated gastritis on acid secretion was studied to examine further the strong association between C. pylori and peptic diseases. Twelve symptomatic patients with non-ulcer dyspepsia and C. pylori-associated histologic gastritis had basal and pentagastrin-stimulated gastric acid analysis before and after a 14-day course of amoxicillin 250 mg qid and bismuth subsalicylate 524 mg qid. Endoscopy, antral biopsies, and symptom questionnaires were obtained at entry and at the conclusion of the study. C. pylori was identified by Warthin-Starry stain. Biopsy specimens were also graded for the severity of chronic inflammation and the presence of neutrophils in the epithelium. The treatment regimen cleared C. pylori in 10 of 12 patients. Dyspeptic symptoms improved in 10 of 12 patients, two of whom did not clear the organism, and were unchanged in the remaining two patients, both of whom cleared the bacteria. Neutrophil infiltration in the antral biopsies resolved in 10 patients, including nine with C. pylori clearance and one with persistence of the organism. The severity of the underlying chronic inflammation improved in only one of the 10 organism-free patients and one of the two persistently infected individuals. Pretreatment gastric acid analysis demonstrated hypochlorhydria in three of 12 patients, mild hyperchlorhydria in three of 12 patients, mild hyperchlorhydria in two of 12, and normal acid secretion in the remaining seven patients. Posttreatment acid studies revealed that four of 12 patients were hypochlorhydric, one of 12 had hyperchlorhydria, and seven of 12 were normochlorhydric. After treatment, there was no significant change in basal or maximal acid secretion in the 10 patients who cleared the organism. The two patients who failed to clear C. pylori had insignificant increases in acid secretion after treatment. Our data show no consistent pretreatment pattern of acid secretion in patients with C. pylori-associated gastritis. In addition, gastric acid output did not show a consistent change after treatment for C. pylori. This suggests that the association between C. pylori infection and peptic diseases does not occur via altered acid secretion.
Am J Gastroenterol 1989 Dec
PMID:Treatment of Campylobacter pylori does not alter gastric acid secretion. 259 52

Abdominal discomfort after eating cowpeas is known to be a major constraint on their greater consumption. Problems associated with cowpea consumption were identified by questionnaire in 448 randomly selected families. Some (28%) of the respondents had never experienced flatulence. Those who did said it occurred when cowpeas were eaten at all (16.7%), as dinner (42%) or without other foods (15%). A subsample of 40 people who complained of serious abdominal discomfort were fed cowpeas cooked by eight different methods at three consecutive dinners for each method. The problems reported were indigestion, vomiting, diarrhoea, increased belching, bad breath, offensive stool, flatulence, constipation, mild abdominal discomfort and sleepiness. Many respondents complained of mild abdominal discomfort with undehulled cowpeas (72.5%) and dehulled cowpeas (42.5%) that had been cooked at atmospheric pressure. Only 12.5% of the respondents complained of discomfort with dehulled cowpeas cooked under extra pressure. Thus, dehulling resulted in substantial reduction in the frequency and incidence of reported discomforts but pressure cooking also had beneficial effects, probably because of the higher cooking temperature attained.
Appetite 1989 Dec
PMID:Flatulence and other discomforts associated with consumption of cowpea (Vigna unguiculata). 259 40

Gastric antral endoscopic pinch biopsies from a group of dyspeptic patients were analysed for acute and chronic inflammatory cell numbers in the lamina propria and surface epithelial layer using computer-linked graphic tablet planimetry, and independently graded for Campylobacter pylori (CP) infection using a visual scoring system with grade 1 assessed as patchy epithelial infection and grade 2 as a continuous layer of organisms on the mucosal surface extending into gastric pits. The study group consisted of 36 patients (18 duodenitis; 18 non-ulcer dyspepsia). Within the 140 biopsies analysed, grade 1 and 2 biopsies had significantly higher acute and chronic inflammatory cell counts than CP-negative biopsies (grade 0) in lamina and surface epithelium (P less than 0.001). Acute inflammatory cell counts were significantly higher in the surface epithelium in grade 1 (P less than 0.05) and grade 2 biopsies (P less than 0.001) but chronic inflammatory cells were only higher in grade 1 (P less than 0.01). No significant differences were present between grade 1 and grade 2 biopsies for any parameter. This study confirms that highly significant quantitative differences in the inflammatory status are related to the presence of CP.
J Pathol 1989 Dec
PMID:Investigation of the relationship between gastric antral inflammation and Campylobacter pylori using graphic tablet planimetry. 261 72

Recently, a close relation has been found between infection of the gastric mucosa by Campylobacter pylori and chronic gastritis. To establish the possible existence of characteristic morphologic changes in this disease, which can be differentiated from other unrelated forms of gastritis, we analyzed the antral biopsies obtained from 75 patients, 35 with duodenal peptic ulcer and 40 with nonulcerous dyspepsia. The diagnosis of C. pylori infection is based on positive biopsy culture or, if not, when following three requirements are met: positive urease test before 24 hours, identification of the germ by Gram stain and visualization in the tissue of microorganisms with morphology similar to that of C. pylori. We found that 85.5% of the 55 patients with C. pylori infection present active chronic gastritis with lymphoid nodes (GCA + NL), while this morphology is only found in 5 of the 20 uninfected patients. The association of GCA + NL with C. pylori infection is highly significant (p less than 0.0001). We think that it could be a local immunologic response to the stimulus of the bacterial antigen, and that it has sufficient morphologic entity to differentiate it from other inflammatory processes of the gastric mucosa of still unknown etiology.
Rev Esp Enferm Apar Dig 1989 Dec
PMID:[Morphology of chronic gastritis associated with Campylobacter pylori infection]. 262 10

Some forms of arthritis cause few symptoms and little or no disability, while others cause severe pain, deformity and loss of function, and may even be fatal. Management must vary accordingly between the simple and the complex, the latter necessitating the use of potentially toxic agents. This article highlights some therapeutic approaches and emphasises the factors that influence the decision making process. Some areas of difficulty are discussed, particularly the treatment of dyspepsia in chronic arthritis.
Aust Fam Physician 1989 Dec
PMID:Current treatment concepts in arthritis. 269 59

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.
Lancet 1988 Dec 10
PMID:Do young patients with dyspepsia need investigation? 290 61

During a 4-year longitudinal nutritional survey at the age of retirement from work, 94 subjects participated, both before and after retirement. Investigations included 7-day weighed dietary records, questionnaire interviews and health screening. A further 89 subjects added to the data by questionnaire interviews. Dietary fibre intakes calculated from the 7-day weighed dietary records were: pre-retirement 17.6 +/- 6.5 g/day, range 7-35 g; post-retirement 18.4 +/- 6.1 g/day, range 7-34 g. Before their retirement 88 per cent of the sample were not reaching the NACNE short-term recommendation of 25 g/day and 95 per cent had not reached the long-term recommendation of 30 g/day. There was little change in these percentages after retirement from work. Those individuals whose intakes were greater than 30 g/day had sometimes adopted a somewhat unusual style of eating. The percentage contributions to dietary fibre intake from the main food groups remained consistent, with vegetables and breads as the major sources, followed in importance by breakfast cereals and fruits. In spite of the ready availability of higher fibre foods, and publicity from the mass media and nutritional counselling, the increased awareness of the role of dietary fibre in the prevention of constipation had not, for the majority, altered food choice. There was a significantly higher intake of dietary fibre when breakfast was eaten daily but no significant effect on intake with alterations in food choice caused by dentures, chewing difficulties, indigestion or weight control.(ABSTRACT TRUNCATED AT 250 WORDS)
Hum Nutr Appl Nutr 1986 Dec
PMID:Dietary fibre intakes in the United Kingdom before and after retirement from work. 302 6


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