1
|
Chung SH, Lee KJ, Kim JY, Im SG, Kim E, Yang MJ, Ryu SH. Association of the Extent of Atrophic Gastritis With Specific Dyspeptic Symptoms. J Neurogastroenterol Motil 2015; 21:528-36. [PMID: 26424039 PMCID: PMC4622135 DOI: 10.5056/jnm15074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/18/2015] [Accepted: 07/15/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIMS It remains unclear whether atrophic gastritis can affect dyspeptic symptoms. We aimed to investigate whether the extent of atrophic gastritis is associated with specific dyspeptic symptoms. METHODS Consecutive adults in a routine health-checkup program were enrolled in the study. The extent of atrophic gastritis was classified into 3 groups based on the Kimura-Takemoto criteria; the gastritis with no or little atrophy (group A: C0), the gastritis with atrophy mainly in the antrum (group B: C1 and C2), and the gastritis with atrophy in the large area of the corpus (group C: C3 and O). Upper gastrointestinal symptoms were categorized into "typical reflux symptoms," "epigastric pain syndrome (EPS)-related symptoms," and "postprandial distress syndrome (PDS)-related symptoms." RESULTS A total of 1827 patients (1009 males, mean age 45.1 years) were included in the analysis. The subgroups of atrophic gastritis were as follows: group A (n = 1218, 66.7%), group B (n = 392, 21.4%), and group C (n = 217, 11.9%). Typical reflux, EPS-related, and PDS-related symptoms were present in 10.5%, 19.8%, and 16.2% of the subjects, respectively. PDS-related and EPS-related symptoms were significantly more prevalent in the group C of male patients and the group B of female patients, respectively, compared with other groups. PDS-related and EPS-related symptoms were independently associated with the group C in males (OR, 2.123; 95% CI, 1.090-4.136) and the group B in females (OR, 2.571; 95% CI, 1.319-5.025), respectively. CONCLUSIONS The extent of atrophic gastritis appears to affect the generation of specific dyspeptic symptoms in a gender-dependent manner.
Collapse
Affiliation(s)
- Sook Hee Chung
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Ja Yeon Kim
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Seon Gyo Im
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Eunkyung Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| | - Seo Hee Ryu
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggido, Korea
| |
Collapse
|
2
|
Gastric hypochlorhydria is associated with an exacerbation of dyspeptic symptoms in female patients. J Gastroenterol 2013; 48:214-21. [PMID: 22829345 DOI: 10.1007/s00535-012-0634-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 06/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gender and gastric acid have been suggested to be independently involved in the pathophysiology of functional dyspepsia, but the interrelationship among gender, dyspeptic symptoms, and gastric acid secretion remains to be evaluated. We sought to explore this issue in dyspeptic patients. METHODS A total of 89 outpatients (male, 36; mean age, 55.6 years) with dyspeptic symptoms were analyzed. The degree of dyspeptic symptoms was evaluated and scored using a symptom questionnaire consisting of 3 subcategories: dysmotility-related symptoms, reflux-related symptoms, and epigastric pain-related symptoms. Stimulated gastric acid secretion was directly measured using an endoscopic gastrin test. RESULTS The total symptom scores and the epigastric pain-related symptom scores were significantly higher in female patients than in male patients. The dysmotility-related and reflux-related symptom scores were also higher, but not significantly, in the female patients. Multiple regression analysis of age, gender, habitual drinking, smoking, Helicobacter pylori infection, and gastric acid secretion revealed that gender and gastric hypochlorhydria, defined as less than 2.1 mEq/10 min in the endoscopic gastrin test, were significantly associated with higher dyspeptic symptom scores. The total scores and the dysmotility-related scores were significantly higher in the patients with gastric hypochlorhydria than in those with gastric non-hypochlorhydria, and this difference was found to be present only in females. CONCLUSIONS Gastric hypochlorhydria in female dyspeptic patients may be involved in the exacerbation of dyspeptic symptoms. Differences in the responsiveness to gastric hypochlorhydria between males and females may be partly responsible for the gender differences in the prevalence and severity of dyspeptic symptoms.
Collapse
|
3
|
Waldum HL, Martinsen TC, Hauso O, Qvigstad G. Oral proton-pump inhibitors and step-down therapy for nonulcer dyspepsia: is this the right approach? Therap Adv Gastroenterol 2010; 3:73-6. [PMID: 21180591 PMCID: PMC3002572 DOI: 10.1177/1756283x09357220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
4
|
Moayyedi P, Soo S, Deeks J, Forman D, Harris A, Innes M, Delaney B. Systematic review: Antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia. Aliment Pharmacol Ther 2003; 17:1215-27. [PMID: 12755835 DOI: 10.1046/j.1365-2036.2003.01575.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence for the effectiveness of antacids, histamine-2 receptor antagonists, bismuth salts, sucralfate and prokinetic therapy in non-ulcer dyspepsia is conflicting. AIM To conduct a systematic review evaluating these therapies in non-ulcer dyspepsia. METHODS Electronic searches were performed using the Cochrane Controlled Trials Register, Medline, EMBASE, Cinahl and SIGLE until September 2002. Dyspepsia outcomes were dichotomized into cured/improved vs. same/worse. RESULTS Prokinetics [14 trials, 1053 patients; relative risk reduction (RRR), 48%; 95% confidence interval (95% CI), 27-63%] and histamine-2 receptor antagonists (11 trials, 2164 patients; RRR, 22%; 95% CI, 7-35%) were significantly more effective than placebo. Bismuth salts (RRR, 40%; 95% CI, - 3% to 65%) were superior to placebo, but this was of marginal statistical significance. Antacids and sucralfate were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic and histamine-2 receptor antagonist results could be due to publication bias. CONCLUSIONS The meta-analyses suggest that histamine-2 receptor antagonists and prokinetics are superior to placebo. These data are difficult to interpret, however, as funnel plot asymmetry suggests that the magnitude of the effect could be due to publication bias or other heterogeneity-related issues.
Collapse
Affiliation(s)
- P Moayyedi
- Gastroenterology Unit, City Hospital NHS Trust, Birmingham, UK.
| | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
During recent years, a greater understanding of the pathophysiology of functional bowel disease, and a surge of interest in this challenge among pharmacologists, basic scientists, and clinical investigators, have led to novel insights and promising therapies. The evidence to support current therapies in nonculcer dyspepsia and irritable bowel syndrome (IBS) is reviewed, and some of the novel therapeutic approaches on the threshold of clinical application are described.
Collapse
Affiliation(s)
- B Coulie
- GI Unit, Mayo Clinic, Alfred 2-435, 200 First Street SW, Rochester, MN 55905, USA
| | | |
Collapse
|
6
|
Miwa H, Sato N. A long way toward understanding the pathogenesis of functional dyspepsia, but we should go forward with the accumulation of clinical evidence. J Gastroenterol Hepatol 2000; 15:967-8. [PMID: 11059924 DOI: 10.1046/j.1440-1746.2000.02318.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
7
|
Abstract
With accumulated evidence for a close relationship between Helicobacter pylori infection and many gastric disorders, the idea that this infection may invoke dyspeptic symptoms appears realistic. If curative therapy for H. pylori can bring about relief of symptoms in these patients, we would possess a new therapeutic tool for functional dyspepsia. Although there have been many clinical trials on this issue, the benefits of H. pylori treatment have been controversial. However, several large-scale clinical studies have been very recently published, and suggest a specific direction on this clinical question. From these results, the current consensus is that H. pylori infection does not directly affect symptoms in patients with functional dyspepsia. However, most clinical trials have been performed on Western populations, and there are few reports from Asian countries. Our recent study on the Japanese population also supported the consensus, that is, a negative relationship between H. pylori infection and symptoms in functional dyspepsia patients.
Collapse
Affiliation(s)
- H Miwa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
| | | |
Collapse
|
8
|
Talley NJ, Lam SK, Goh KL, Fock KM. Management guidelines for uninvestigated and functional dyspepsia in the Asia-Pacific region: First Asian Pacific Working Party on Functional Dyspepsia. J Gastroenterol Hepatol 1998; 13:335-53. [PMID: 9641295 DOI: 10.1111/j.1440-1746.1998.tb00644.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Dyspepsia is most optimally defined as pain or discomfort centred in the upper abdomen. The symptom complex may be caused by peptic ulcer disease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is the method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia Pacific region where health services are limited. A detailed treatment algorithm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm features. In patients without alarm features, treatment for 2-4 weeks with an empirical anti-secretory or prokinetic agent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establish the efficacy and cost-effectiveness of the approaches recommended.
Collapse
Affiliation(s)
- N J Talley
- Department of Medicine, University of Sydney, Nepean Hospital, New South Wales, Australia.
| | | | | | | |
Collapse
|
9
|
Affiliation(s)
- M Camilleri
- Gasteroenterology Research Unit, Mayo Clinic Rochester, Minnesota 55905, USA
| |
Collapse
|
10
|
Troncon LE, Thompson DG, Ahluwalia NK, Barlow J, Heggie L. Relations between upper abdominal symptoms and gastric distension abnormalities in dysmotility like functional dyspepsia and after vagotomy. Gut 1995; 37:17-22. [PMID: 7672673 PMCID: PMC1382761 DOI: 10.1136/gut.37.1.17] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postprandial bloating and fullness are commonly found both in dysmotility like functional dyspepsia, and after vagotomy but the relation between gastric accommodation and symptom production has not been investigated. Intragastric pressure levels and symptoms developed during controlled distension of the gastric fundus were recorded in nine patients with functional dyspepsia, in seven patients after truncal vagotomy, and in 11 healthy volunteers. The procedure was repeated after ingestion of a liquid nutrient meal (250 ml; 250 kcal). Gastric tone, expressed as the average value of pressure over the distension period was lower in controls (median: 11.3 mm Hg) than in either the dyspeptic patients (median: 16.48 mm Hg) or postvagotomy patients (median: 19.12 mm Hg) (p < 0.05). Meal ingestion reduced gastric tone in controls, but no significant change occurred in either the dyspepsia or the postvagotomy patients. Volumes at which discomfort was elicited by distension during fasting were lower both in dyspeptic patients (median: 210 ml) and in postvagotomy patients (median: 180 ml) than in healthy volunteers (median: 660 ml) (p < 0.05). Discomfort thresholds were unaffected by meal ingestion. These results suggest that a disturbance of gastric relaxation may be related to symptom development in dysmotility like functional dyspepsia, while similarities between dyspeptic patients and postvagotomy patients suggest that the impaired gastric accommodation in functional dyspepsia may be due to an underlying vagal defect.
Collapse
Affiliation(s)
- L E Troncon
- Department of Medicine, University of Manchester Medical School, Hope Hospital, Salford
| | | | | | | | | |
Collapse
|
11
|
Di Lorenzo C, Hyman PE, Flores AF, Kashyap P, Tomomasa T, Lo S, Snape WJ. Antroduodenal manometry in children and adults with severe non-ulcer dyspepsia. Scand J Gastroenterol 1994; 29:799-806. [PMID: 7824859 DOI: 10.3109/00365529409092514] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonulcer dyspepsia is common in adults but has been recognized only recently in children. METHODS We compared signs, symptoms, and antroduodenal motility findings in 34 children and 35 adults with severe nonulcer dyspepsia. RESULTS Symptoms and signs were similar in the two groups. Ten children (29%) and one adult (3%) required tube feedings (p = 0.01). Abdominal surgery had been performed on 6 of 34 (18%) children and 18 of 35 adults (51%) (p < 0.01), without relief of symptoms. Esophageal manometry was abnormal in 5 of 23 (22%) children and 6 of 31 (19%) adults. Antroduodenal manometry was suggestive of neuropathy in 25 children and 26 adults and of myopathy in 3 children and 2 adults. Absence of phase 3 of the migrating motor complex was found in 4 children and 17 adults (p = 0.01). Antroduodenal manometry was normal in six children and seven adults. CONCLUSION Signs, symptoms, and discrete manometric abnormalities of childhood nonulcer dyspepsia resembled those of adult nonulcer dyspepsia. Manometric findings in nonulcer dyspepsia resembled those reported in chronic intestinal pseudo-obstruction, suggesting that these conditions are on a continuum of enteric neuromuscular diseases.
Collapse
|
12
|
Fumagalli I, Hammer B. Cisapride versus metoclopramide in the treatment of functional dyspepsia. A double-blind comparative trial. Scand J Gastroenterol 1994; 29:33-7. [PMID: 8128175 DOI: 10.3109/00365529409090434] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The efficacy and tolerability of cisapride (5 mg three times daily) and metoclopramide (10 mg three times daily) were evaluated in a randomized double-blind trial in patients with functional dyspepsia. Sixty patients, equally distributed in the two groups, entered the trial. After 4 weeks of treatment there was a significant improvement of symptom severity versus base line (p < 0.001) in both groups. The percentage of responders (with no or only mild symptoms) was 87% in the cisapride group and 77% in the metoclopramide group (no statistically significant intergroup difference). At the follow-up visit 2 weeks after completion of the trial this response rate was significantly higher in the cisapride group (73%) than in the metoclopramide group (47%) (p < 0.05). Four of the patients receiving cisapride and 2 of the patients receiving metoclopramide reported adverse events. On assessment of extrapyrimidal symptoms, relevant clinical values were found in one patient receiving metoclopramide. Increased prolactin concentrations were observed in seven patients of the metoclopramide group versus only 1 of the cisapride group (p < 0.05). The present data indicate that during the 2 weeks after completion of treatment in patients with functional dyspepsia, cisapride may result in a better, more sustained overall response when compared with metoclopramide.
Collapse
|
13
|
Verhaeghe J, Jaecques N, Rombouts J, Spaepen W, Cardon E, Lebrun F, Meurant JP. Functional dyspepsia versus other functional gastrointestinal disorders: a practical approach in Belgian general practices. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1993; 195:25-34; discussion 34-5. [PMID: 8516655 DOI: 10.3109/00365529309098325] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This paper identifies the symptom profile associated with the four main diagnoses of functional digestive disorders (dyspepsia, gastro-oesophageal reflux disease (GORD), gastritis, and constipation) made by general practitioners in Belgium. Results are also presented from a multicentre study in which the effects of cisapride, administered as an oral tablet or suspension, were evaluated in patients with these functional digestive disorders. Analysis of symptom patterns revealed that early satiety and postprandial abdominal bloating were the most prominent symptoms, followed by eructation (belching), heartburn, regurgitation, postprandial epigastric burning or discomfort, and nausea. These symptoms occurred in all diagnostic groups. However, different symptom patterns were associated with each of the disorders; for example, heartburn and regurgitation were the core symptoms in patients diagnosed as having GORD, early satiety and abdominal bloating were characteristic of patients diagnosed with dyspepsia, and fasting or postprandial pain were characteristic of patients given the diagnosis of gastritis. Therefore, it appears that these diagnoses used by general practitioners in Belgium closely correspond to reflux-like, dysmotility-like and ulcer-like dyspepsia, as defined by an international working party. Cisapride improved the core symptoms in about 80% of patients with GORD or dyspepsia, relieved all epigastric symptoms in about 80% of patients with gastritis, and significantly decreased the use of laxatives and increased stool frequency in constipated patients. Cisapride was well tolerated and thus appears to be a useful option in the treatment of functional digestive disorders in a general practice setting.
Collapse
|
14
|
Fehr HF. Risk factors, co-medication, and concomitant diseases: their influence on the outcome of therapy with cisapride. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1993; 195:40-5; discussion 45-6. [PMID: 8516657 DOI: 10.3109/00365529309098327] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a 28-day non-blinded study of 1071 patients with functional dyspeptic symptoms in a general practice setting, 666 presented with mainly typical symptoms of functional dyspepsia and received 5 mg cisapride three times daily, while 405 with predominating symptoms indicative of gastroesophageal reflux received 10 mg cisapride three times daily. On the basis of an anamnestic risk factor analysis for organic lesions, 'low-risk' patients were to be treated directly with cisapride, while for 'high-risk' patients a more thorough gastrointestinal examination was recommended before starting cisapride. Of patients in the dyspepsia group 75% reported a good or excellent response; the corresponding rate was 80% in the reflux group. Low-risk patients in both groups tended to respond better than high-risk patients (mean difference, 11%). Patients and investigators reached identical assessments of response. Concomitant antacids, calcium antagonists, beta-blockers and sedatives did not affect the results, but concomitant NSAIDs reduced the mean improvement rate by 14% (p < 0.01). Adverse effects such as abdominal cramps and loose stools were uncommon (< or = 3.4%).
Collapse
Affiliation(s)
- H F Fehr
- Dept. of Gastroenterology, Kantonsspital, Aarau, Switzerland
| |
Collapse
|
15
|
Nyrén O. Therapeutic trial in dyspepsia: its role in the primary care setting. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1991; 182:61-9. [PMID: 1896831 DOI: 10.3109/00365529109109538] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Owing to the vast proportions of the dyspeptic patient population, it is not practicable to initiate diagnostic investigations immediately in every single patient who presents with dyspepsia. The risks associated with postponing definite diagnosis 4-8 weeks in dyspeptic patients aged less than 45 years are exceedingly small. Therefore, empiric therapeutic trial without a firm diagnosis is an acceptable alternative in those age groups. Those who recover during the course of the trial are spared the costs and inconvenience of invasive tests. Possible adverse consequences for the patients are minimized if the therapy covers those organic diseases that may cause complications (such as peptic ulcer and esophagitis). The concept of diagnosis-free therapeutic trials presupposes, however, that a sufficiently large number of patients are cured and that their need of investigation is permanently eliminated. If not, inevitable investigations are only postponed. In those patients the costs will thereby not only be the same as if early investigation had been carried out, but the total costs may in fact increase in a longer perspective owing to suboptimal management in the period before a firm diagnosis has been established. Thus, the ideal strategy would be to treat those who have a high probability of recovering during the ensuing 6-8 weeks and to investigate those in whom a prolonged course is anticipated. An empiric therapeutic trial must be followed by a thorough evaluation within 8 weeks.
Collapse
Affiliation(s)
- O Nyrén
- Dept. of Surgery, University Hospital, Uppsala, Sweden
| |
Collapse
|