Glasgow Dyspepsia Severity Score Research Articles

The relationship between peritoneal membrane permeability and dyspepsia in peritoneal dialysis patients.

The aim of this study is to determine whether there is a relationship between peritoneal membrane permeability and dyspepsia in peritoneal dialysis patients. This study included 95 peritoneal dialysis patients aged 18 and older. The presence of dyspepsia in patients was recorded according to the 2016 ROME-IV Functional Dyspepsia Diagnostic Criteria. Subsequently, the Glasgow Dyspepsia Severity Score questionnaire was administered to assess the severity of dyspepsia. Endoscopy was performed for those who agreed to exclude organic pathology, or the results of endoscopy conducted within the last 2years were recorded. Furthermore, stool samples were examined for H. pylori to exclude organic causes of dyspepsia. PET (peritoneal equilibration test) and Kt/V values of patients were calculated using the "PD Adequest" computer software. PET values were categorized as low and low-normal for low permeability and high and high-normal for high permeability. Dyspepsia was detected in 51.6% of all peritoneal dialysis patients. H. pylori was found positive in 11.6% of all patients and 12.2% of those with dyspeptic symptoms. There was no significant difference in the rate of H. pylori occurrence between low and high permeability groups. The Glasgow Dyspepsia Severity Score did not differ significantly between H. pylori-positive and -negative patients. Dyspepsia was more frequent and severe in the low permeability group. Dyspepsia in the low permeability group was mostly considered as functional dyspepsia due to the predominance of normal endoscopic findings. Dyspepsia is a common health problem in approximately half of peritoneal dialysis patients. Dyspepsia observed in those with low peritoneal membrane permeability is generally of functional origin. Furthermore, the frequency and severity of dyspepsia are higher in individuals with low permeability. When planning peritoneal dialysis for these patients, the current status should be taken into consideration, and patients should be informed about necessary precautions and recommendations.

Seronegative Celiac Disease in Patients with Isolated Refractory Dyspepsia and Gastroesophageal Reflux Disease.

Background/AimsTo investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints.MethodsThis was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up.ResultsThe median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the HLA-DQ2 and DQ8 haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487).ConclusionsSeronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.

AsdamarinTM relieves functional dyspepsia in healthy adults in only 7 days: A randomized, double-blind, placebo-controlled pilot study

Functional dyspepsia (FD) is a prevalent global health concern increasing with years. Inspired by the Traditional Chinese Medicine (TCM) liver-stomach disharmony syndrome in order to find a quick natural alternative treatment, a Ferula asafoetida-Silybum marianum (Asdamarin™) combined extract has been developed and proved its rapid efficiency and its safety with a 7-day randomized, double-blind, placebo-controlled pilot study (CTRI/2018/05/013993 dated 21/05/2018) conducted on 70 healthy human volunteers (aged 18–60 years) supplemented with 250 mg / twice a day of either a placebo or Asdamarin™. Subjects were evaluated from baseline to the end of the study (EOS) through changes in Gastrointestinal Symptom Rating Scale (GSRS), changes in Glasgow Dyspepsia Severity Score (GDSS) and changes in the short form of Nepean Dyspepsia Index (NDI-SF) for Quality of Life. Compared to the baseline a significant reduction (p &lt; 0.001) of GDSS questionnaire score was noted in the Asdamarin™ group (from 5.66 ± 3.1 at baseline to 5.09 ± 2.8 at the End Of Study (EOS)) compared to placebo group (from 2.77 ± 1.3 baseline to 2.69 ± 1.3 EOS), a significant decrease (p &lt; 0.001) of GSRS score noted in the Asdamarin™ group (from 32.11 ± 8.6 baseline to 19.11 ± 5.4 EOS) compared to the placebo group (from 25.23 ± 3.6 baseline to 23.2 ± 4.9 EOS), and a significant reduction (p &lt; 0.001) of NDI-SF scoring was noted in the Asdamarin™ group (from 15.74 ± 4.1 baseline to 11.54 ± 2.1 EOS) compared to placebo group (from 12.54 ± 3.2 baseline to 11.63 ± 2.6 EOS). Asdamarin™ has been found safe and very well tolerated during the study.

Effect of moderate aerobic exercises on symptoms of functional dyspepsia.

Functional dyspepsia (FD) is a commonly encountered entity worldwide and is difficult to treat. Most of the treatment modalities have low-quality evidence for use, except for proton pump inhibitors. Aerobic exercise has been shown to improve the symptoms, but its direct effect on symptoms has never been studied. The objective was to study the effects of moderate aerobic exercise on symptoms of FD and to compare the effect of conventional treatment alone vs. exercise plus conventional treatment. Out of 112 patients, 72 were randomly divided into controls (conventional treatment;n=36) and experimental (aerobic exercise for 30 min per session, 5 times a week for 6 weeks with conventional treatment; n=36) groups. Both thegroups were assessed on day 1 and at the end of 6 weeks, using Glasgow Dyspepsia Severity Score (GDSS), Depression Anxiety Stress Scales-42 (DASS-42), and visual analogue scale (VAS). Pre-treatment GDSS, DASS-42, and VAS in the experimental group were significantly different as compared to the post-treatment scores (p=0.00019, p=0.0002, p=0.00019, respectively). Even in the control group, pre- and post-treatment GDSS, DASS-42, and VAS scores were significantly different (p=0.00019, p=0.0002, p=0.00019, respectively). However, on the head-to-head comparison of the 2 groups, scores at the end of 6 weeks were significantly different (p< 0.05), in favor of the experimental group. Aerobic exercise as an auxiliary therapy to conventional treatment has better outcomes in the functional well-being of dyspepsia.

Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology

Background: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p = 0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.

Trimebutine Maleate Monotherapy for Functional Dyspepsia: A Multicenter, Randomized, Double-Blind Placebo Controlled Prospective Trial.

Background and Objectives: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD. Materials and Methods: A multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. The Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test. Results: Of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. The groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). The 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group, p = 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM. Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation.

Effect of Laparoscopic Cholecystectomy in Alleviating Dyspeptic Symptoms in Patients with Cholelithiasis

Objective: To compare the change in preoperative and postoperative dyspeptic symptoms. Introduction: In the era of increasing prevalence of gall stones due to more frequent incidental detection radiologically, it is the need of the hour that we assess the benefit of these increasing cholecystectomies with regard to dyspeptic symptoms. Till now there is not enough evidence on the basis of which we can determine whether laparoscopic cholecystectomy can resolve the dyspeptic symptoms in patients of gall stones. There is a need to establish a guideline to operate in view of alleviating dyspeptic symptoms. Methodology: A total of 308 (M:F=2:3) patients were evaluated for dyspeptic symptoms using the Glasgow dyspepsia severity score (GDSS). They were followed up after 1 month, 6 months. Disease distribution and change in GDSS scores were analysed. Results: The mean age was 47.2 ± 15.42 years. Preoperatively mean GDSS was 11.49 ± 2.11. One month post surgery 82% had a GDSS around 2.95. 12% had a significant drop in GDSS at the end of 6 months (p<0.001). 3.89% had a GDSS of more than 10 which indicated persistentdyspepsia. 3 patients 0.97% had subsequent worsening of GDSS. Conclusion: Most symptomatic patients undergoing laparoscopic cholecystectomy are objectively relieved of dyspeptic symptoms. Very few patients have persistent symptoms even after 6 months. Patients tend to associate relief of dyspepsia with successful outcome of surgery. It is extremely essential that patients be counselled in detail about the possibility of persistence of dyspeptic symptoms which may in-fact be functional/inorganic.

A prospective, randomized, open-label, placebo-controlled comparative study of Bacillus coagulans GBI-30,6086 with digestive enzymes in improving indigestion in geriatric population.

Introduction:Digestive symptoms are common affecting more than 60% of the elderly people. Digestive enzyme deficiency and dysbiosis in the gastric fluid microbiota are the major contributors in the pathophysiology of indigestion. Therefore, therapeutic strategy targeting the gastric microbiota and digestive enzymes has the potential to treat indigestion. This study was conducted to evaluate the efficacy and tolerability of probiotic Bacillus coagulans GBI30,6086 along with digestive enzymes in improving indigestion in geriatric population.Methods:An open-labelled, randomized, prospective study was conducted in geriatric patients with complaints of indigestion. The study group (n = 25) received 5 ml of reconstituted probiotic syrup containing Bacillus coagulans GBI-30, 6086, and digestive enzymes daily and the control group (n = 25) received 5 ml of placebo syrup twice daily for 5 days and followed-up after 7 days.Results:Reduction in Modified Glasgow dyspepsia severity score from baseline to follow up was statistically significant in the study group when compared to the control group (P < 0.0001). Improvement in indigestion, abdominal pain, and flatulence was also greater in the study group compared to the control group.Conclusion:Bacillus coagulans along with digestive enzymes are effective in treating indigestion in geriatric patients. It is well tolerated and safe to be used in geriatric patients without any major adverse effects.

A Study of the Role of Nigella Sativa Oil in the Eradication of H.Pylori Infection in Symptomatic Children

AbstractBackground: Helicobacter pylori (H.pylori) is a gram-negative flagellated spiral bacterium which is usually acquired during childhood, and the infection persists throughout life unless specifically treated. Resistance against H.pylori is increasing, and it is necessary to find new effective agents. Nigella sativa has possible role of N. sativa oil in eradication of H.pylori infection in symptomatic children.Aim of Study: The aim as present work was to study the possible role of N.sativa oil in eradication of H.pylori infection in symptomatic children.Subjects and Methods: This randomized clinical trial was carried out on 60 symptomatic children with being proven positive for H.pylori stool antigen test from those attending the Diarrheal Diseases and Nutrition Unit of Pediatric Depart-ment at Tanta University. The patients were randomly assigned to one of the following three groups: Group 1: Included 20 patients who received triple therapy for two weeks including clarithromycin 15mg/kg/day divided into two doses + metri-nodazole 15-20mg/kg/day divided into two doses + omeprazole 1mg/kg/day, for two weeks. Group 2: Included 20 patients who received 2g Nigella sativa oil two capsules (each of 450mg) twice daily after meals and omeprazole 1mg/kg/day for two weeks. Group 3: Included 20 patients who received triple therapy combined with Nigella sativa oil for two weeks. All patients had a full sheet, complete clinical examination and routine laboratory investigations (CBC, ALT, AST, BUN, S.creatinine, ESR), occult blood in stool, H.pylori antigen in stool before and after treatment and assessment of severity of dyspepsia using Modified Glasgow Dyspepsia Severity Score before and after treatment.Results: There was statistically significant differences between the three studied groups as regard H.pylori antigen in stool after treatment. The difference was evident on com-paring either Group I or Group III versus Group II. Signifi-cantly more cases in Group I (65%) and in Group III (75%) became negative to H.pylori antigen in stool in comparison to only (30%) of the patients in Group II.Conclusion: Addition of N.sativa to the traditional triple therapy increased the probability of H.pylori eradication more than that achieved through triple therapy alone.

Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study.

Functional dyspepsia (FD) is a highly prevalent disorder having nonspecific symptoms and varied pathophysiology. Its treatment remains a challenge as therapeutic options are limited, unsatisfactory, and elusive. Thus, safety and efficacy of DigeZyme®, a proprietary multienzyme complex (MEC), was evaluated as a dietary supplement in FD patients. In this randomized, double-blind, placebo-controlled, parallel-group study, 40 patients were randomly assigned (1:1 ratio) to receive either MEC (50 mg, TID; n = 20) or placebo (n = 20) for 60 days. Reports of adverse or serious adverse events (AEs), abnormal results of vital signs, abnormal findings during physical examination, and abnormal laboratory investigations were monitored closely. Efficacy measures were change in Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Nepean Dyspepsia Index-Short Form (NDI-SF), Visual Analog Scale (VAS), Clinical Global Impression Severity Rating Scale (CGI-S), and Glasgow Dyspepsia Severity Score (GDSS) at baseline and follow-up visits on day 15, 30, and 60. Supplementation with MEC was associated with statistically significant differences (P value ranging from .0401 to .0033) in all efficacy parameters compared with placebo. The between-group comparison also revealed that MEC supplement had a significantly greater effect (P < .001) versus placebo. No investigation product-related AEs were reported. There were no clinically significant abnormalities in physical findings and no statistically significant changes in biochemical and hematological parameters, vital signs, body weight, and body mass index observed between the two groups at baseline and follow-up visits. MEC supplementation represents an effective and safe alternative to manage dyspepsia symptoms in FD patients.

Author's reply: "A question on dyspeptic patients analyzed by psychometric scores".

First of all, we want to thank Pellicano et al. for their comments on our article "New psychometric data from the Spanish versions of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health scale measures". The aim is always the scientific improvement of the manuscript.

New psychometric data from the Spanish versions of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale measures.

There are no structural abnormalities in functional dyspepsia, therefore it is essential to have a viable questionnaire to measure treatment outcome according to patient perception. The aim of the study was to extensively document psychometric characteristics of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale that are currently available in Spanish. Patients with functional dyspepsia (n = 158) were recruited from a randomized trial that assessed standard vs. standard and psychological treatment. Participants had completed the validation questionnaires and the Medical Outcome Study Short-form 36. Reliability (Cronbach's alpha), validity (Confirmatory Factor Analysis, convergent and known group validity) and responsiveness (minimal clinically important difference) were analyzed. A Confirmatory Factor Analysis of the Glasgow Dyspepsia Severity Score showed a one-factor solution model, but a low Cronbach's alpha (0.61). With regard to the Dyspepsia-Related Health Scale, the Cronbach's alpha (0.80-0.97) and Confirmatory Factor Analysis supported a model with four inter-correlated dimensions and suggested a need to improve the "Satisfaction with dyspepsia-related health" dimension (Cronbach's alpha < 20). Finally, the global scores for both the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale were responsive at six months post-treatment, with a minimal clinically important difference of 4 and 6, respectively. Our findings support the continued application of the Dyspepsia-Related Health Scale and the need to improve the "Satisfaction with dyspepsia-related health" dimension. Although the Glasgow Dyspepsia Severity Score is a promising questionnaire, further review of the content is required to eliminate and add items in order to provide greater consistency to the evaluated construct.

Effect of Helicobacter pylori eradication in Iranian patients with functional dyspepsia: a prospective, randomized, placebo-controlled trial.

IntroductionWhether patients with functional dyspepsia (FD) should receive Helicobacter pylori (H. pylori) eradication therapy remains controversial. The objective of this trial was to evaluate the effect of H. pylori eradication therapy on dyspeptic symptoms of patients with FD.Material and methodsA prospective, randomized, placebo-controlled trial of H. pylori eradication for FD was conducted. A total of 720 FD patients diagnosed by Rome III criteria were consecutively enrolled. We randomly assigned 186 H. pylori infected patients with FD to receive quadruple therapy for 14 days and 173 such patients to receive identical-appearing placebos. Severity of abdominal symptoms was assessed with the Glasgow Dyspepsia Severity Score (GDSS), and eradication of H. pylori by 13C-urea breath test was evaluated during one year.ResultsThe rate of eradication of H. pylori infection was 87.1% in the treatment group and 2.9% in the placebo group at 6 weeks (p = 0.001). The mean GDSS at 12 months was 4.9 ±2.8 in the treatment group, as compared to 5.2 ±3.4 in the placebo group (p = 0.064). The scores in both groups were lower than those at baseline. According to the intention-to-treat analysis, at 12 months, there was no significant difference between groups in the rate of successful treatment (48.6% in the treatment group and 51.2% in the placebo group; p = 0.84). There was no significant difference in mean symptom scores between the two treatment groups at any point during follow-up.ConclusionsThe results of our study provide no evidence that H. pylori eradication leads to relief of symptoms 12 months after treatment, and there is a need for further studies.

Rome III Criteria Cannot Distinguish Patients with Chronic Gastritis from Those Functional Dyspepsia Patients

Functional dyspepsia is thought to be a diagnosis made after excluding endoscopically detectable lesions by the current Rome III criteria. However, whether these "functional dyspepsia" patients were diagnosed appropriately is still controversial. A total of 223 patients diagnosed with functional dyspepsia by Rome III criteria were enrolled. All patients were submitted to endoscopic examination, rapid urease test, and histologic evaluation. We also appraised the effect of a 7-day treatment based on the Glasgow Dyspepsia Severity Score. Helicobacter pylori infection and neutrophil infiltration were found in 37.7% and 36.3% cases, respectively, and were both more frequent in the subgroup with epigastric pain symptom (EPS) than in the other two subgroups. In addition, neutrophil infiltration was more common and severe in the H. pylori-positive individuals than in the patients without infection (Mann-Whitney U-test = 431.500, p < .001). The treatment was useful in symptom improvement of all three subgroups, and the EPS subgroup had the greatest change of symptom scores before and after treatment as compared with the subgroup with postprandial distress symptom (PDS) and PDS/EPS subgroup (χ(2) = 42.745, p < .001), and the eradication of H. pylori revealed a statistical significant difference in different subgroups (χ(2) = 11.300, p = .001). Our findings showed that many H. pylori-positive subjects diagnosed as "functional dyspepsia" were actually chronic gastritis patients, especially the EPS cases who are more likely to be patients with "active gastritis under microscope," and also benefit most from the treatment of proton-pump inhibitors or eradication of H. pylori.

Are There Any Differences in Sleep Disorder, Quality of Life and Gastric Motility Among Subtypes of Functional Dyspepsia?

The pathophysiology of functional dyspepsia (FD) is related to symptoms characterized by multifunctional disorders of the upper gastrointestinal (GI) tract, such as disorders of GI motility, abnormal acid secretion, visceral hypersensitivity, Helicobacter pylori infection and potent psychological factors. FD has been subclassifed into 2 disease categories under the Rome III classification criteria: epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS).1 We read with interest the original article by Yamawaki et al2 regarding the prevalence and relationship for sleep disorders and quality of life in patients with subtypes of FD (EPS, PDS and EPS-PDS overlap). Sleep disorder is a common medical problem, and has been associated with functional GI disorders including gastroesophageal reflux disease and irritable bowel syndrome.3,4 The higher prevalence of sleep disorder in FD patients has been reported by previous other studies. In this study, the authors reported that sleep disorders distribution in 3 FD subtypes was significantly higher compared to that in healthy volunteers. However, the study did not suggest whether treatment for FD improved the quality of sleep. Actually, it is possible that both sleep disorders and functional GI disturbances may be the result of some underlying problem, such as depression, anxiety or other psychological conditions. Geeraerts et al5 have reported that experimentally induced anxiety was associated with decreased gastric compliance and accommodation to a meal and with increased epigastric symptoms score during a standard nutrient challenge in health volunteers. Some studies have suggested that the presence of anxiety could modulate the gut function and produce GI disorders.6 So, previous study showed a positive correlation with state anxiety.7 However, this study did not suggest that correlation between the gastric emptying (Tmax) and State-Trait Anxiety Inventory score (STAI-trait/-state score). Instead, this study showed that there was a significant relationship between total Glasgow dyspepsia severity score (GDSS) and global Pittsburgh Sleep Quality Index (PSQI) score in PDS and EPS. And also, the study showed that health-related quality of life by measuring 8-item short form health survey (SF-8) was significantly associated with sleep disorder (global PSQI) in FD subtypes patients. In a previous study, they reported that Tmax value as a marker of gastric emptying in PDS patients was significantly greater compared with healthy volunteers.8,9 The study showed that there were significant differences between 3 subtypes of FD patients and health volunteers. However, the study did not suggest a difference among 3 subtypes of FD patients. Despite several limitations such as small number of patients and lack of data about the FD treatment on quality of sleep, it provides us about prevalence for sleep disorders, gastric motility and quality of life in each subtype of FD patients. Further studies are needed to evaluate the physiologic factors and psychological factors in each FD subtype. And, it is necessary to clarify that treatment for each subtype of FD patients for alleviating the dyspeptic symptoms may improve the quality of life or quality of sleep.

Giardia intestinalis in patients with nonulcer dyspepsia

Background and study aimsGiardiasis may present with dyspeptic symptoms that may mimic other gastrointestinal and/or biliary disorders. The objective of this study was to determine the prevalence of giardiasis in stool and duodenal aspirate of patients with NUD, assess symptomatic benefit of therapy, and compare the diagnostic tools for giardiasis utilizing stool and duodenal aspirates microscopic evaluation versus ELISA testing. Patients and methods109 Patients with endoscopic diagnosis of NUD out of 278 consecutive patients with dyspepsia were included. The severity of dyspepsia and the quality of life were assessed utilizing Rome II criteria and SF-36 for Quality of Life and concomitant stool and/or duodenal aspirate samples were submitted for ELISA antigen test for Giardia intestinalis. Those who tested positive for giardiasis (Group 1) were assigned to receive Tinidazole 2.0g. single dose plus omeprazole for 4weeks and the remaining patients (Group 2) omeprazole alone for 4weeks. One month after therapy, both groups were reassessed and Stool ELISA antigen test for G. intestinalis for Group 1, was performed. ResultsELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%). The two groups were well matched with respect to age, sex, initial results on the Glasgow Dyspepsia Severity Score, prevalence of previously prescribed antisecretory-drug therapy, prevalence of smoking, predominant symptom at presentation, and quality of life. The outcome of patients at 1month, on an intention-to-treat basis, showed that the symptoms were resolved (defined as a score of 0 or 1) in 17 of 21 patients (81%) in Group 1 as compared with 31 of 88 patients (35%) in Group 2 P<0.001. The scores in both groups were lower than those at base line and there was a highly statistically significant difference between both groups. ConclusionG. intestinalis as a cause of dyspepsia should be considered in patients with negative endoscopy and in those who remain symptomatic in spite of adequate treatment for known upper G.I. disorders. NUD associated with the presence of Giardia, had better symptomatic benefit (81%) with specific treatment than controls (35%). ELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%).

BMI is superior to symptoms in predicting response to proton pump inhibitor: randomised trial in patients with upper gastrointestinal symptoms and normal endoscopy

ObjectivesIn most patients undergoing endoscopy for upper gastrointestinal (GI) symptoms in the Western world, no macroscopic abnormality or evidence of Helicobacter pylori infection is identified. Following this negative investigation, proton...

A randomised controlled trial of structured nurse-led outpatient clinic follow-up for dyspeptic patients after direct access gastroscopy

BackgroundDyspepsia is a common disorder in the community, with many patients referred for diagnostic gastroscopy by their General Practitioner (GP). The National Institute of Clinical Excellence (NICE) recommends follow-up after investigation for cost effective management, including lifestyle advice and drug use. An alternative strategy may be the use of a gastro-intestinal nurse practitioner (GNP) instead of the GP. The objective of this study is to compare the effectiveness and costs of systematic GNP led follow-up to usual care by GPs in dyspeptic patients following gastroscopy.ResultsDirect access adult dyspeptic patients referred for gastroscopy; without serious pathology, were followed-up in a structured nurse-led outpatient clinic. Outcome measurement used to compare the two study cohorts (GNP versus GP) included Glasgow dyspepsia severity (Gladys) score, Health Status Short Form 12 (SF12), ulcer healing drug (UHD) use and costs. One hundred and seventy five patients were eligible after gastroscopy, 89 were randomised to GNP follow-up and 86 to GP follow-up. Follow-up at 6 months was 81/89 (91%) in the GNP arm and 79/86 (92%) in the GP arm. On an intention to treat analysis, adjusted mean differences (95%CI) at follow-up between Nurse and GP follow-up were: Gladys score 2.30 (1.4–3.2) p < 0.001, SF12 140.6 (96.5–184.8) p =< 0.001 and UHD costs £39.60 (£24.20–£55.10) p =< 0.001, all in favour of nurse follow-up.ConclusionA standardised and structured follow-up by one gastrointestinal nurse practitioner was effective and may save drug costs in patients after gastroscopy. These findings need replication in other centres.

Does Helicobacter pylori-induced inflammation of gastric mucosa determine the severity of symptoms in functional dyspepsia?

Inflammation induces some structural and biochemical alterations and oxidative damage in gastric tissue. In this study, we aimed to investigate the relationship among the severity of symptoms, oxidative stress, and grading scales of Helicobacter pylori-induced gastric inflammation in functional dyspepsia. Thirty-five patients with functional dyspepsia were enrolled in the study. The severity of dyspepsia within the last 6 months was evaluated by Glasgow Dyspepsia Severity Score. In biopsy specimens of gastric mucosa, severity of gastritis was estimated by the revised Sydney Classification System, and oxidative stress parameters were studied. Although there was no statistically significant relationship between symptom scores and degree of chronic inflammation, a tendency for symptoms to be more severe has been observed in low levels of gastritis. Levels of sulfhydryl groups were lower in subjects with high levels of chronic inflammation, and Helicobacter pylori intensity (P < 0.001 and P = 0.02, respectively). Levels of malondialdehyde were higher in subjects with high levels of chronic inflammation (P = 0.04). There was a statistically significant but a weak positive correlation between symptom scores and sulfhydryl levels (P < 0.001, r = 0.323). In conclusion, there may be an inverse relation between severity of symptoms and level of Helicobacter pylori induced gastric inflammation or oxidative stress in patients with functional dyspepsia.

Helicobacter pylori related dyspepsia: prevalence and treatment outcomes at University Kebangsaan Malaysia-Primary Care Centre

BackgroundOptimum management of dyspepsia in primary care is a debatable subject. Testing for Helicobacter pylori (HP) has been recommended in primary care as this strategy will cure most underlying peptic ulcer disease and prevent future gastro duodenal disease.MethodsA total of 98 patients completed Modified Glasgow Dyspepsia Severity Score Questionnaire (MGDSSQ) at initial presentation before undergoing the 13Carbon Urea Breath Test (UBT) for HP. Those with positive UBT received Eradication Therapy with oral Omeprazole 20 mg twice daily, Clarithromycin 500 mg daily and Amoxycillin 500 mg twice daily for one week followed by Omeprazole to be completed for another 4 to 6 weeks. Those with negative UBT received empirical treatment with oral Omeprazole 20 mg twice daily for 4 to 6 weeks. Patients were assessed again using the MGDSSQ at the completion of treatment and one month after stopping treatment.ResultsThe prevalence of dyspepsia at Universiti Kebangsaan Malaysia-Primary Care Centre was 1.12% (124/11037), out of which 23.5% (23/98) was due to HP. Post treatment assessment in both HP (95.7%, 22/23) and non HP-related dyspepsia (86.7%, 65/75) groups showed complete or almost complete resolution of dyspepsia. Only about 4.3% (1/23) in the HP related dyspepsia and 13.3% (10/75) in the non HP group required endoscopy.ConclusionThe prevalence of dyspepsia due to HP in this primary care centre was 23.5%. Detection of HP related dyspepsia yielded good treatment outcomes (95.7%).