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Query: UMLS:C0027497 (nausea)
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Gastroparesis-or delayed gastric emptying--is associated with upper gastrointestinal symptoms that include early satiety, nausea, vomiting, regurgitation, fullness, and bloating. Gastroparesis should be considered in the diagnosis of a patient with these symptoms after mechanical and structural lesions have been ruled out. This review briefly summarizes gastric motor physiology and discusses the etiology and diagnostic approach to the treatment of a patient with possible gastroparesis. We highlight the methods available to measure gastric motility and describe their relative advantages and disadvantages.
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PMID:The diagnosis and work-up of the patient with gastroparesis. 1073 Sep 17

Symptoms related to fungal esophagitis were studied in patients with alcoholic liver disease who underwent upper gastrointestinal endoscopy. Data of 517 patients were studied retrospectively (group I) and 100 alcoholic liver disease patients, that were successively admitted to hospital, were enrolled in the prospective part (group II). Out of the 41 cases with fungal esophagitis found in group I, data of 38 could be evaluated. In group II 13 of the 93 evaluable patients had fungal esophagitis; according to Kodsi's grading 10 patients had grade 1., one patient grade 2. and two patients grade 2-3. oesophagitis. There was no case with grade 4. esophagitis. The rate of symptoms among the 51 patients with fungal esophagitis was: anorexia 23 (45.0%), abdominal pain 22 (43.1%), vomiting 17 (33.3%), nausea 15 (29.4%), occult gastrointestinal bleeding 12 (23.5%), weight loss 9 (17.6%), melena 7 (13.7%), bloating 6 (11.7%), acidic regurgitation 3 (5.8%), haematemesis 2 (3.9%), thoracic pain 2 (3.9%), singultus 1 (1.9%), odynophagia 0 and dysphagia 0. In 7 patients (13.7%) none of the studied symptoms could be identified. Despite the relatively high frequency of symptom free fungal esophagitis reported in the literature, the total lack of odynophagia and dysphagia in our patient group was remarkable. In the lack of deglutition disorders the other symptoms do not raise the suspicion of esophagitis. The diagnosis in such cases can be established only by endoscopy.
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PMID:[Symptoms of fungal esophagitis in alcoholic liver disease]. 1094 8

A total of 40 patients (28 males, 12 females; mean age, 56.6 years; range, 41-72 years), 1-1.5 years (mean, 1.4 years) after subtotal gastrectomy for early gastric cancer (Billroth I, D2 lymph node dissection, curability A) were divided into 2 groups according to the occurrence of interdigestive migrating motor complex (IMMC), phase III from the duodenum, and their postoperative quality of life was compared. Results were as follows: (i) patients in the IMMC, phase III positive group (28 patients) had evidently more appetite and ate more food, with less decrease in body weight compared with the IMMC, phase III negative group (12 patients); and (ii) patients in the IMMC, phase III positive group had clearly less symptoms, such as early dumping symptoms (systemic symptoms), symptoms of reflux esophagitis (e.g. heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distention, and borborygmus, compared with the negative group. These results showed more satisfactory quality of life in the IMMC, phase III positive group compared with the negative group.
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PMID:Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with distal subtotal gastrectomy for early gastric cancer. 1107 27

A total of 30 patients (18 men, 12 women; 43-79 years, mean 58.9 years) 1.0 to 1.5 years (mean 1.25 years) after distal gastrectomy for early gastric cancer (Billorth I, D2 lymph node dissection, curability A) were divided into two groups based on the occurrence of interdigestive migrating motor complex (IMMC) phase III (pIII) from the duodenum and their postoperative gastrointestinal symptoms. They were compared before and after cisapride therapy (at an oral dose of 7.5 mg/day for 3 months). Results were as follows. Before cisapride therapy: (1) Patients in the IMMC-pIII-positive group (n = 20) had more appetite and ate more food with less decrease in body weight than those in the IMMC-pIII-negative group (n = 10); (2) patients in the IMMC-pIII-positive group clearly had fewer symptoms, such as early dumping (systemic) symptoms, symptoms of reflux esophagitis (e.g., heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distension, and borborygmus, than the IMMC-pIII-negative group. After cisapride therapy: eight patients (80%) in the IMMC-pIII-negative group became IMMC-pIII-positive, and their appetite and food consumption were obviously improved; body weight increased in six patients (60%), with alleviation of other abdominal symptoms and disappearance of the early dumping syndrome. These results showed a more satisfactory condition in regard to gastrointestinal symptoms in the IMMC-pIII-positive group than in the IMMC-pIII-negative group. It is concluded that cisapride therapy results in the occurrence of IMMC-pIII and subsequently alleviates various abdominal symptoms, contributing to the improved postoperative gastrointestinal condition of patients after gastrectomy.
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PMID:Relation between gastroduodenal interdigestive migrating motor complex and postoperative gastrointestinal symptoms before and after cisapride therapy following distal gastrectomy for early gastric cancer. 1107 71

Rumination is an unusual gastrointestinal symptom that is characterized by the repetitive regurgitation of gastric contents into the oropharynx. The regurgitation occurs very soon after a meal and tends to persist for 1 to 2 hours. Rumination is defined by the setting in which it occurs. It is seen in three distinct populations: infants; individuals with psychiatric and neurologic disorders, particularly developmental disabilities; and adults who do not have overt psychiatric or neurologic disorders. The hallmark of rumination, which separates it from other disorders of the upper gastrointestinal tract (such as gastroesophageal reflux disease or cyclic vomiting syndrome), is the fact that in patients with rumination, the gastric contents appear in the oropharynx without retching or nausea. Rather, the patient makes a conscious decision on how to handle the regurgitated material after it presents into the oropharynx. The regurgitated meal usually consists of undigested or partially digested food. The regurgitation is effortless or at most is preceded by a sensation of belching immediately prior to the regurgitation itself. The management of patients with rumination needs to be accomplished in a highly individualized manner. Children with infant rumination syndrome often have symptoms related to significant defects in bonding with their mother. Thus, problems of mother-child bonding in pediatric patients with rumination syndrome should be identified and appropriately addressed. The management of adult patients with developmental disabilities or neurologic impairments who ruminate focuses mainly on behavioral modalities, including adversive conditioning and contingency management. The healthy adult who ruminates and has no evidence of neurologic or developmental disability is best seen as someone with a habit. Management in these patients is directed towards adjunctive therapies (ie, the use of proton pump inhibitors or H(2 )receptor antagonists to decrease acid injury to the esophagus) as well as identifying situations and emotions that trigger the patient's symptoms. Randomized controlled trials of various treatment modalities need to be undertaken; likewise, the evaluation strategy needed to best diagnose rumination is yet to be well defined. At this time, the challenge for gastroenterologists is to understand the nature of rumination, to identify individuals at high risk, and to use the management strategies most associated with good outcomes in patients with rumination in various clinical settings.
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PMID:Rumination. 1146 94

Cholelithiasis and gastroesophageal reflux are both very common diseases that may occur simultaneously. Management of asymptomatic gallstones is still controversial. Because severe complications due to gallstones may occur incidental cholecystectomy during nonrelated abdominal surgery may be offered to patients with coexisting gallbladder disease. The aim of this study was to assess the clinical outcome of patients after laparoscopic fundoplication and incidental cholecystectomy for cholelithiasis compared with the outcome of patients after fundoplication alone. We conducted a retrospective chart review and prospective analysis using a questionnaire of the clinical outcome of patients who underwent laparoscopic fundoplication and incidental cholecystectomy from June 1991 to January 2000 in comparison with sex- and age-matched patients who had antireflux surgery alone. Sixty-seven (6.3%) of 1065 patients had a laparoscopic cholecystectomy at the time of laparoscopic antireflux surgery; 101 (75%) of 134 answered the questionnaire. The mean follow-up time was 4.6 years. Laparoscopic cholecystectomy did not influence surgical morbidity or mortality. Postoperative symptom score (1-10) did not show a statistically significant difference regarding bloating, diarrhea, abdominal pain, nausea, vomiting, biliary problems, jaundice, pancreatitis, dysphagia for liquids and solid, heartburn, regurgitation, and chest pain when the two groups were compared. We conclude that incidental cholecystectomy during laparoscopic antireflux surgery is safe and does not appear to influence the clinical outcome of the antireflux procedure.
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PMID:Incidental cholecystectomy during laparoscopic antireflux surgery. 1213 45

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.
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PMID:A new questionnaire for the diagnosis of dyspepsia. 1213 88

This study reports the reliability and validity of the distress subscale of the GERD Symptom Assessment Scale (GSAS) and the acute SF-36 Health Survey in a clinical trial setting. Patients with moderately severe GERD completed the GSAS and SF-36 at baseline and four weeks following treatment. The age (mean +/- SD) of the 187 patients was 45.5 +/- 11.1 years and most were female (63%) and Caucasian (78%). All scales met the 0.70 reliability criterion except for the SF-36 bodily pain scale. Mean baseline GSAS scores were significantly (P < 0.001) poorer by 10-17% among patients reporting more severe levels of all symptoms. Mean baseline SF-36 physical component summary scores were significantly (P < 0.02) poorer among patients reporting more severe levels of regurgitation, early satiety, bloating, and nausea. Patients reporting complete and satisfactory heartburn relief reported improvements in GSAS scores that were 13% and 10% greater, respectively, than patients who did not experience these levels of relief (P < 0.001). In conclusion, the GSAS and SF-36 scales were reliable and valid measures in this clinical trial. Differences of 10% in GSAS distress scores correspond to differences in symptom severity at a point in time and to changes in symptom severity over time. The SF-36 was not as useful in detecting differences in symptom severity over time.
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PMID:Measuring symptom distress and health-related quality of life in clinical trials of gastroesophageal reflux disease treatment: further validation of the Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS). 1214 13

Laparoscopic antireflux surgery has dramatically changed the way heartburn and regurgitation have been managed over the last 10 years. The possibility of surgical correction with limited morbidity has resulted in a substantial increase in the number of fundoplications performed. Given that the rate of operative failure can be expected to be constant the need for surgical management of recurrent symptoms will become more prevalent. Between August 1996 and December 2001 55 patients presented with recurrent symptoms after a previous antireflux surgery. The presentation, management, and operative outcomes of patients undergoing reoperative fundoplication were studied. The 55 patients (25 male and 30 female) had a mean age of 47.1 years (range 22-69 years). Mean laparoscopic operative time was 234 minutes (range 180-330 minutes), and mean open time was 261 minutes (range 150-390 minutes). A laparoscopic repair was attempted in 45 patients and was completed without conversion in 37 (82.3%); seven of the eight patients requiring conversion had at least one prior open antireflux procedure. Average length of stay was 4.6 days (range one to 46 days); laparoscopic patients were in the hospital an average of 2 days (range one to 6 days). There were eight (12.7%) perioperative complications, no esophageal leaks, and no deaths. Average follow-up was 21.3 months (range 1-65 months). In patients who had a definitive antireflux procedure (53) 49 (92.5%) reported good to excellent outcomes; four had fair outcomes. All stated they were improved. Four patients reported occasional dysphagia, three reported intermittent nausea, five have infrequent to frequent chest pain, and four have diarrhea at least weekly. Despite being technically difficult reoperative fundoplication effectively alleviates dysphagia, regurgitation, and reflux symptoms in the majority of patients with low operative morbidity. The operation can be completed laparoscopically in most of those whose original operation was performed laparoscopically.
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PMID:Surgical experience in fifty-five consecutive reoperative fundoplications. 1245 86

A total of 22 patients (16 men, 6 women; age 33 to 70 years, m mean, 60.2 years) 1.0 to 1.5 years (mean 1 year and 2 months) after total gastrectomy with Roux-en- Y reconstruction for early gastric cancer (D2 lymph node dissection, curability A) were divided into two groups based on the occurrence of interdigestive migrating motor complex, phase III (IMMC-pIII) from the Roux-en- Y loop, and postoperative quality of life (QOL) was compared. Results were as follows: (1) Patients in the IMMC- pIII positive group (n = 12) had more appetite and ate more food with less decrease in body weight than those in the IMMC-pIII negative group (n = 10). (2) Patients in the IMMC-pIII positive group clearly had fewer symptoms, such as early dumping symptoms (systemic symptoms), symptoms of reflux esophagitis (e.g., heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal fullness, and borborygmus, than those in the IMMC-pIII negative group. These results showed a more satisfactory condition in regard to abdominal symptoms in the IMMC-pIII positive group than in the IMMC-pIII negative group.
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PMID:Relationship between jejunal interdigestive migrating motor complex and quality of life after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. 1261 29


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