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Publication
Journal: Journal of the Royal Society of Medicine
May/5/1983
Abstract
Ninety patients and 30 senior hospital doctors were questioned about indigestion and dyspepsia. There were marked discrepancies between the views of patients and doctors. Most doctors considered indigestion to be synonymous with dyspepsia and associated it with peptic ulcer. Patients, however, were not generally conversant with the term dyspepsia and linked indigestion with psychological factors, feeding patterns and bowel function rather than physical illness. The patients' concept of indigestion corresponded closely with medically-accepted features of irritable bowel syndrome. Uncritical use of these terms may lead to misinterpretation of the patient's complaint and inappropriate management.
Publication
Journal: Current Opinion in Gastroenterology
May/12/2014
Abstract
OBJECTIVE
Dyspepsia affects up to 40% of the general population and significantly reduces quality of life. A small proportion of patients have peptic ulcer disease as cause and this can be treated empirically with Helicobacter pylori eradication therapy in those that are infected. Approximately 20% have gastro-oesophageal reflux disease and this can be effectively treated with proton pump inhibitor therapy. Patients who remain symptomatic may warrant an endoscopy, but most will have functional dyspepsia. Treatment of functional dyspepsia remains a challenge.
RESULTS
Recent large randomized trials suggest tricyclic antidepressant therapy may be effective in functional dyspepsia. A phase III randomized controlled trial reports that a new prokinetic, acotiamide, reduces dyspepsia symptoms in functional dyspepsia patients. There are also preliminary data that suggest buspirone, a drug that promotes gastric accommodation, is also effective in functional dyspepsia. There are also data to suggest that functional dyspepsia is caused by subtle manifestations of inflammation in the upper gastrointestinal tract, possibly caused by food sensitivity or a change in gut flora.
CONCLUSIONS
The initial management of dyspepsia is well established, but managing those with continued symptoms is a challenge. Antidepressants and newer gastric motility agents show promise. Targeting the diet and gut microbiome is another area for future research in functional dyspepsia.
Publication
Journal: Medical Journal of Australia
January/28/1987
Abstract
Dyspepsia or indigestion is one of the most common disorders that is managed by general practitioners and gastroenterologists. Non-ulcer dyspepsia can be defined as upper abdominal pain or nausea in patients in whom endoscopy reveals no evidence of peptic ulceration or gastric cancer. Non-ulcer dyspepsia is a heterogeneous disorder and can be the result of such diverse entities as the irritable bowel syndrome, duodenitis or gastro-oesophageal reflux, or may be idiopathic ("essential" dyspepsia). This review traces the development of modern thought on dyspepsia and non-ulcer dyspepsia, from the 16th century to the present.
Authors
Publication
Journal: Gastroenterology
April/27/1992
Abstract
It has been proposed that patients with dyspepsia can be classified into symptom groupings that may represent different pathophysiological entities; however, it remains to be shown that distinct symptom subgroups exist. To estimate the prevalence of dyspepsia (defined as upper abdominal pain) and dyspepsia subgroups, an age- and sex-stratified random sample of Olmsted County, Minnesota, residents, aged 30-64 years, were mailed a valid self-report questionnaire; 82% responded (n = 835). Subgroups were as follows: those with symptoms suggestive of peptic ulceration (ulcerlike dyspepsia), those with gastric stasis (dysmotilitylike dyspepsia), those with gastroesophageal reflux (refluxlike dyspepsia), and the remainder (unspecified dyspepsia). Ulcerlike dyspepsia was the commonest subgroup (prevalence, 16.0/100; 95% confidence interval, 13.4-18.5), but 43% of subjects with dyspepsia could be classified into more than one subgroup. Nearly one third of dyspeptics also had irritable bowel symptoms, but these were not confined to any particular dyspepsia subgroup. Although dyspepsia is very common in the community and the majority have ulcerlike symptoms, there is such overlap among the dyspepsia subgroups that a classification based on symptoms alone in uninvestigated patients may not be useful.
Publication
Journal: Journal of Neurogastroenterology and Motility
July/22/2013
Abstract
Despite being a large ethnic group within the South-East Asia, there is a paucity of reported literatures on dyspepsia in the Malay population. Recent population-based studies indicate that uninvestigated dyspepsia, based on the Rome II criteria, is reported in 12.8% and 11.6% of Malays in the urban and rural communities respectively. Organic causes of dyspepsia including upper gastrointestinal tract cancers, its precancerous lesions, and erosive diseases are uncommon which is largely due to an exceptionally low prevalence of Helicobacter pylori infection in this population. On the other hand, functional dyspepsia and irritable bowel syndrome are relatively common in the Malays than expected. Within a primary care setting, functional dyspepsia, based on the Rome III criteria, is reported in 11.9% of Malays, of which epigastric pain syndrome is found to be more common. Married Malay females are more likely to have functional dyspepsia and psychosocial alarm symptoms. Also based on the Rome III criteria, irritable bowel syndrome, commonly overlapped with functional dyspepsia, is reported in 10.9% of Malays within a community-based setting. Rather than psychosocial symptoms, red flags are most likely to be reported among the Malays with irritable bowel syndrome despite having a low yield for organic diseases. Based upon the above observations, "proton pump inhibitor test" is probably preferable than the "test and treat H. pylori" strategy in the initial management of dyspepsia among the Malays.
Publication
Journal: Bailliere's clinical gastroenterology
February/2/1999
Abstract
There is international agreement that dyspepsia refers to pain or discomfort centered in the upper abdomen. However, the term 'discomfort' has been variably defined. While other symptoms may often be simultaneously present, gastro-oesophageal reflux disease can usually be clearly distinguished by the presence of predominant heartburn. Dyspepsia is a frequent reason for consultation in primary care and in gastrointestinal practice. With the widespread availability and utilization of endoscopy, it has become evident that a structural (or organic) explanation is found in only a minority of patients presenting with dyspepsia. Operationally, functional dyspepsia is defined as persistent or recurrent dyspepsia for 3 or more months in the absence of a clinically identifiable structural disease causing the symptoms. It has been proposed, based on symptoms, that functional dyspepsia be subdivided into symptom subgroups to promote patient homogeneity. The initially proposed 'clustering' of symptoms into ulcer-like and dysmotility-like functional dyspepsia has proved a dismal failure because of the considerable overlap observed, the lack of stability over time and the failure to identify robust pathophysiological abnormalities or responses to therapy. A subcategorization based upon the most bothersome symptom is theoretically more attractive but needs to be prospectively and rigorously tested.
Publication
Journal: Current Opinion in Gastroenterology
April/9/2013
Abstract
OBJECTIVE
A variety of organic diseases can cause dyspepsia, but most patients with epigastric pain have functional dyspepsia. As dyspepsia is common and usually has a benign cause, it is not possible to fully investigate everyone with epigastric pain. Current recommendations suggest that young patients without alarm symptoms can be treated empirically with Helicobacter pylori test and treat and proton pump inhibitor therapy can be offered to those who are negative or remain symptomatic despite treatment for their H. pylori. Patients who remain symptomatic with this strategy may be investigated with endoscopy, but most will have functional dyspepsia.
RESULTS
There are a large number of trials for prokinetic therapy in functional dyspepsia, but treatment efficacy is uncertain, as there is evidence of publication bias. There are very limited data for the effectiveness of tricyclic antidepressants in functional dyspepsia. There has been recent interest in the observation that patients with functional dyspepsia have increased eosinophils in the duodenum and this may be accompanied by other subtle manifestations of upregulated mucosal immunity. It is possible that this is being driven by a dietary substance or by a change in the upper gut microbiome.
CONCLUSIONS
The initial management of dyspepsia is well established, but how to manage those who do not respond is a challenge. Future studies evaluating diet and altering the gut microbiome may give clinicians more therapeutic options.
Publication
Journal: Schweizer Archiv fur Tierheilkunde
November/16/1999
Abstract
Calves with chronic indigestion have disturbed general attitude and condition, decreased appetite, loss of hair, clay-like faeces and ruminal and metabolic acidosis. Possible causes include dysfunction of the oesophageal-groove reflex, reflux of abomasal contents into the rumen and abnormal ruminal motility. The anion gap may be increased or within normal limits. Metabolic acidosis is significantly more severe in calves that are unable to stand than in calves that can stand. Treatment of chronic indigestion consists primarily of intravenous administration of sodium bicarbonate, transfaunation of the rumen and oral administration of electrolyte solutions.
Publication
Journal: EMBO Reports
April/19/2001
Abstract
All cells are equipped with a proteolytic apparatus that eliminates damaged, misfolded and incorrectly assembled proteins. The principal engine of cytoplasmic proteolysis, the 26S proteasome, requires that substrates be unfolded to gain access to the active site; consequently, it is relatively ineffective at degrading aggregated proteins. Cellular indigestion occurs when the production of aggregation-prone proteins exceeds the cell's (or organelle's) capacity to eliminate them. Cellular pathways that resolve this indigestion exist, but appear to have limited capacities. Russell bodies and aggresomes are manifestations of cellular indigestion in the endoplasmic reticulum and cytoplasmic compartments, respectively, and are often associated with disease.
Publication
Journal: Postgraduate Medical Journal
August/17/1984
Abstract
A high proportion (40%) of patients with definite myocardial ischaemia who were questioned on admission to a Cardiac Monitoring Unit had experienced preceding chest pain which had been misinterpreted by both the patients themselves and doctors as 'indigestion' and which had often been inappropriately treated. 'Indigestion' in the chest in previously non-dyspeptic subjects over 40 years of age should be regarded as myocardial ischaemia until proved otherwise.
Publication
Journal: Scandinavian journal of gastroenterology. Supplement
October/22/1991
Abstract
The definition of the term dyspepsia and of derived terms such as organic dyspepsia, functional dyspepsia, reflux-like dyspepsia, and non-ulcer dyspepsia continues to provoke controversy. In recent literature, however, it is apparent that a measure of agreement is now emerging with regard to 'dyspepsia', which is considered simply to denote episodic or persistent symptoms that include abdominal pain or discomfort and which are referable to the upper gastrointestinal tract. Particular symptom patterns may justify the use of descriptions such as reflux-like dyspepsia, ulcer-like dyspepsia, or dysmotility-like dyspepsia, but these terms should not carry any implication that the symptom patterns can be attributed to particular pathogenetic processes. In many patients with dyspepsia, clinical assessment and investigation fail to identify any abnormality to which the symptoms can reasonably be attributed. The label of 'functional dyspepsia' is well-established medical parlance in these circumstances and is generally accepted as the converse of 'organic dyspepsia', which denotes dyspepsia for which a responsible disease process has been identified.
Publication
Journal: Zhongguo zhen jiu = Chinese acupuncture & moxibustion
July/2/2018
Abstract
OBJECTIVE
To observe the clinical efficacy difference among elongated needle, filiform needle and medication for post-stroke indigestion.
METHODS
Sixty cases of post-stroke indigestion were randomly assigned into an elongated needle group, a filiform needle group and a medication group, 20 cases in each one. Acupuncture of restoring consciousness and inducing resuscitation and conventional medical treatment were applied in the three groups. 125 mm elongated needles were perpendicularly inserted at Zhongwan (CV 12), Liangmen (ST 21) and Tianshu (ST 25) in the elongated needle group; 20 to 30 mm perpendicular filiform at the same points in the filiform needle group. All the treatment was given for 4 weeks, 6 times a week, 1 time a day. Domperidone was prescribed orally in the medication group for 4 weeks, 3 times a day and once 10 mg. The indexes were dyspepsia TCM symptom score, Liz dyspepsia questionnaire (LDQ), Nepean Dyspepsia Index of quality of life (NDLQI), Safety Data Sheet (SDS) self rating scale and side effect scale (TESS). The effects were evaluated.
RESULTS
The scores of TCM symptom, LDQ, SDS scores in the three groups decreased and NDLQI increased after 7-day, 14-day, and 28-day treatment as compared with those before treatment (P<0.05, P<0.01). The TCM symptom score and LDQ score in the elongated needle group after 28-day treatment were lower than those in the filiform needle and medication groups (P<0.05, P<0.01). The SDS score in the medication group was lower than that in the elongated needle and filiform needle group (both P<0.05). There were no significant statistical difference for NDLQI score in the three groups (P>0.05). The total effective rate was 90% (18/20) in the elongated needle group; those in the filiform needle group and medication group were 70% (14/20) and 75% (15/20) respectively, indicating statistical significance (P<0.01).
CONCLUSIONS
Acupuncture with elongated needle can obviously improve symptoms in the patients with post-stroke indigestion, which is better than filiform needle and medication.
Publication
Journal: Current Opinion in Gastroenterology
May/7/2009
Abstract
OBJECTIVE
This review critically evaluates the current status of dyspepsia and, in particular, recent advances in epidemiology, pathophysiology and management. The very definition of dyspepsia and of functional dyspepsia, in particular, continues to generate controversy; the Rome III redefinition of functional dyspepsia remains to be proven to be of clinical value. Overlap with gastroesophageal reflux and irritable bowel syndrome further complicate clinical definitions.
RESULTS
Most studies of pathophysiology continue to focus on gastric sensory and motor functions, though some intriguing early data raise the possibility of an infective or immunological contribution. There have been few, if any, major breakthroughs in treatment; most recent studies address instead the niceties of Helicobacter pylori eradication and acid suppressive strategies.
CONCLUSIONS
This continued lack of progress in the area can only lead one to question some very basic concepts in this disorder, such as does functional dyspepsia, as we have come to know it, really exist as a distinct entity?
Publication
Journal: Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru
January/8/1993
Abstract
On the last years there is a discussion about the dyspepsia for its prevalence and because the symptoms could indicate a serious disease. Now, there are problems with the terminology; functional or organic aspects; it is named non-ulcer dyspepsia or ulcer-dyspepsia; also with the diagnosis and management. This paper is a review about the definition and etiology of dyspepsia.
Publication
Journal: Reviews in gastroenterological disorders
August/2/2002
Abstract
Since the discovery of Helicobacter pylori and its role in peptic ulcer disease, two strategies for low-cost treatment of uninvestigated dyspepsia have emerged: "test and treat" and "test and scope." The efficacy of these strategies is examined, with a review of several recent studies. Controversy exists as to the usefulness of eradication of H. pylori in the treatment of non-ulcer dyspepsia. Results of four large trials are presented as an illustration of this controversy. Guidelines for the management of dyspepsia and non-ulcer dyspepsia are reviewed.
Authors
Publication
Journal: Veterinary Record
July/5/1976
Abstract
The incidence of traumatic indigestion in an industrialised agricultural country, the economic losses due to the disease, and its prevention by use of a permanent reticular magnet are reviewed.
Publication
Journal: Journal of Neurogastroenterology and Motility
October/6/2014
Abstract
Patients with dyspepsia/functional dyspepsia (FD) show frequent overlapping of other gastrointestinal (GI) diseases, such as irri-table bowel syndrome, and non-GI diseases, in addition to internal subgroup overlapping. These overlap patients have more frequent or more severe symptoms, poorer health-related quality of life and higher somatization scores, and they are more like-ly to experience anxiety, depression or insomnia compared to non-overlap patients. The higher prevalence of overlap in patients with dyspepsia/FD is not by chance, indicating common pathogeneses, including visceral hypersensitivity, altered GI motility, in-fection, and stressful early life events. There are few clinical trials targeting overlap in patients with dyspepsia/FD, and no ther-apeutic strategy has been established. Further studies in this research area are needed. In this review, we describe the epidemi-ology, pathogenesis and treatment of overlap in patients with dyspepsia/FD.(J Neurogastroenterol Motil 2014;20:447-457).
Publication
Journal: Postgraduate Medicine
March/18/1976
Abstract
Patients who complain of gaseous indigestion may be more sensitive to an underlying intestinal motor abnormality than are others with similar dysfunction. Modifications in living and eating habits are basic steps that can be taken to relieve the problem; drugs that alter intestinal activity or responses may be effective.
Publication
Journal: Current Opinion in Gastroenterology
July/3/2007
Abstract
New definitions of functional disorders in general and nonulcer dyspepsia in particular were published in the period of review. Although the definition of functional dyspepsia as persistent or recurrent unexplained upper abdominal pain or discomfort stayed essentially the same, new definitions of dyspepsia subgroups were introduced based on the predominant symptom; a reflux-like dyspepsia subgroup was not supported. It is hoped that these criteria, derived by a consensus among international experts in the field, will improve the reliability and the interpretability of future epidemiologic and interventional studies. A wide range of studies dealt with the role of putative etiological factors in functional bowel disorders including Helicobacter pylori, altered visceral sensation, or upper intestinal motility. Although eradication of H. pylori does not seem to relieve dyspepsia over placebo in recent studies of nonulcer dyspepsia, eradication of H. pylori has generally been advised because of suspected beneficial long-term effects (eg, treatment of misdiagnosed ulcer disease) that probably overweigh the potential risks.
Related with
Publication
Journal: Comprehensive Psychiatry
April/27/2018
Abstract
OBJECTIVE
Functional dyspepsia, originates from gastroduodenal region, is described as resistant and recurring dyspeptic symptoms with unknown etiology. Although there is some evidence in support of a relationship between functional dyspepsia and psychopathology, attachment patterns of functional dyspepsia patients have not been studied yet. In our study, we aimed to compare attachment patterns of functional dyspepsia patients with organic dyspepsia patients and healthy volunteers.
METHODS
43 patients diagnosed with functional dyspepsia, 38 patients with organic dyspepsia and 42 healthy volunteers matched in terms of age, sex and education were included in the study. All participants were evaluated using a socio-demographic and clinical data questionnaire, the State and Trait Anxiety Inventory, the Experiences in Close Relationships Questionnaire and the Adult Attachment Scale.
RESULTS
There was no difference in sociodemographic features among the three groups. Functional dyspepsia group exhibited significantly higher Trait Anxiety scores compared to organic dyspepsia and control groups. Control group showed significantly higher secure attachment styles compared to functional dyspepsia and organic dyspepsia groups, there was no difference between groups in non-secure attachment styles according to triple attachment model. Dimensionally, functional dyspepsia group showed more avoidant attachment patterns than organic dyspepsia groups and organic dyspepsia group showed more avoidant attachment patterns than control group.
CONCLUSIONS
According to our findings, Functional dyspepsia patients are more anxious than organic dyspepsia patients and healthy volunteers. Non-secure attachment patterns were seen generally in all dyspeptic patients while avoidant attachment patterns are more prominent in functional dyspepsia patients.
Related with
Publication
Journal: Veterinary Record
January/28/1987
Abstract
In 23 cows suffering from a secondary indigestion, in most cases with septicaemia, the syndrome of functional pyloric stenosis or vagal indigestion developed. The signs were anorexia, ruminal distension with fluid material, abomasal reflux into the ruminoreticulum, dehydration, hypochloraemic, hypokalaemic metabolic alkalosis and uraemia. These signs often disappeared after treatment of both the primary causative disease and the secondary indigestion. The importance of recognising this condition is emphasised, because the serious signs of the secondary indigestion may dominate the causative disease. The prognosis depends upon the causative disease and is not necessarily bad.
Publication
Journal: Scandinavian journal of gastroenterology. Supplement
March/14/1996
Abstract
BACKGROUND
Non-Ulcer Dyspepsia (NUD) is a very common problem which has many causes. Trying to group dyspeptic patients according to symptoms has been proposed in order to improve our understanding of the problem and to aid both clinical trials and indeed practice by studying and treating homogeneous groups.
METHODS
The literature has been reviewed to see if sub-groups of dyspepsia are standing up to scrutiny and clinically relevant.
RESULTS
Reflux-like dyspepsia may now be identified accurately in a high proportion by a combination of careful history and the use of intra-oesophageal 24-h pH monitoring. Acid suppressing therapy is often useful in this group. Dysmotility-like dyspepsia is currently an area of active investigation with growing evidence that there is abnormal gastric emptying. Response to pro-kinetic drugs looks encouraging. Ulcer-like dyspepsia: Appears to be the largest dyspeptic group. Acid secretion is normal. Helicobacter pylori does not correlate with any group of dyspepsia.
CONCLUSIONS
Separating NUD into groups is becoming useful in both investigation and treatment, but more specific simple tests are needed to take this further.
Publication
Journal: Current Opinion in Gastroenterology
July/11/2016
Abstract
OBJECTIVE
Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge holds the prospect that targeted therapy may more optimally manage subsets of these patients with functional dyspepsia.
RESULTS
An understanding of gut-to-brain and brain-to-gut pathways in functional dyspepsia is expanding. Minimal mucosal inflammation with eosinophils (and in some cases mast cells) characterized by ultrastructural changes in the duodenum appears to be present in a substantial subgroup of functional dyspepsia patients as identified now by investigators globally. Although antibiotic therapy targeting Helicobacter pylori appears to be effective in a small proportion of functional dyspepsia patients, eradication therapy may be more effective in functional dyspepsia patients with microscopic duodenal inflammation, a potentially important finding needing to be confirmed. This may suggest that the effects of antibiotics for functional dyspepsia are not simply mediated by the eradication of gastric H. pylori, but have other antibacterial effects (e.g., on the duodenal microbiome). Abnormal visceral sensory function plays a key role not only in the manifestations of functional dyspepsia but also in peptic ulcer disease.
CONCLUSIONS
The pathophysiologic concepts underlying functional dyspepsia and related treatment approaches are shifting from a focus on H. pylori, acid suppression or modulation of motility toward new models. New evidence suggests that minimal duodenal inflammation plays a role in symptom generation in at least a proportion of patients with otherwise unexplained symptoms. This is a paradigm shift and ultimately may change the treatment of many patients with functional gastrointestinal disorders.
Publication
Journal: Netherlands Journal of Medicine
June/29/1995
Abstract
Functional dyspepsia is defined as persistent or recurrent upper abdominal pain or discomfort not explained by structural or biochemical abnormalities. In about half of the patients who present to their practitioner with chronic dyspepsia, no underlying disease is established after clinical investigation. Many clinical trials have been performed to demonstrate a certain relationship between functional dyspepsia and several pathogenic mechanisms like dysmotility, Helicobacter pylori infection, acid output and hypersensitivity to distension. Unfortunately, the conclusions of those studies are conflicting. Short-term follow-up, lack of consensus about diagnostic criteria for functional dyspepsia and unvalidated symptom measures make it difficult to interpret their results.
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