Leeds Dyspepsia Questionnaire Research Articles

Helicobacter pylori infection is associated with worse severity of Parkinson's disease.

Some studies have suggested that chronic Helicobacter pylori (HP) infection can aggravate the neurodegenerative process in Parkinson's disease (PD), and targeted intervention could potentially modify the course of this disabling disease. We aimed to study the impact of HP infection on motor function, gastrointestinal symptoms, and quality of life in a large cohort of PD patients. 102 consecutive PD patients underwent (13)C urea breath testing and blinded evaluations consisting of the Unified Parkinson's Disease Rating Scale (UPDRS) including "On"-medication motor examination (Part III), objective and quantitative measures of bradykinesia (Purdue Pegboard and timed gait), Leeds Dyspepsia Questionnaire, and PDQ-39 (a health-related quality of life questionnaire). 32.4% of PD patients were HP-positive. HP-positive patients were older (68.4 ± 7.3 vs. 63.8 ± 8.6 years, P = 0.009) and had worse motor function (UPDRS Part III 34.0 ± 13.0 vs. 27.3 ± 10.0, P = 0.04; Pegboard 6.4 ± 3.3 vs. 8.0 ± 2.7 pins, P = 0.04; and timed gait 25.1 ± 25.4 vs. 15.5 ± 7.6 s, P = 0.08). In the multivariate analysis, HP status demonstrated significant main effects on UPDRS Part III and timed gait. The association between HP status and these motor outcomes varied according to age. Gastrointestinal symptoms and PDQ-39 Summary Index scores did not differ between the two groups. This is the largest cross-sectional study to demonstrate an association between HP positivity and worse PD motor severity.

Mandarin version of the Leeds Dyspepsia Questionnaire: A valid instrument for assessing symptoms in Asians.

To develop and validate a Mandarin version of the Leeds Dyspepsia Questionnaire (M-LDQ) in Asian patients with dyspepsia. The M-LDQ was developed according to standardized methods. The validity, internal consistency, test-retest reliability and responsiveness of the instrument were evaluated in both primary and secondary care patients. A total of 184 patients (mean age 54.0 ± 15.8 years, of whom 59% were women and 72.3% of whom had at least secondary level education) were recruited between August 2012 and March 2013, from both primary (n = 100) and secondary care clinics (n = 84). Both the internal consistency of all components of the M-LDQ (Cronbach's α 0.79) and test-retest reliability (Spearman's correlation coefficient 0.78) were good. The M-LDQ was valid in diagnosing dyspepsia in primary care (area under the receiver operating characteristics curve 0.84) and was able to discriminate between secondary and primary care patients (median cumulative LDQ score 13.0 vs 3.0, P < 0.0001). Among eight patients with organic dyspepsia, the median M-LDQ score reduced significantly from 21.0 (pretreatment) to 9.5 (4 weeks post-treatment) (P < 0.0001). The M-LDQ is a valid and responsive instrument for assessing ethnic Chinese adults with dyspepsia.

Impact of microscopic duodenitis on symptomatic response to Helicobacter pylori eradication in functional dyspepsia.

There is no consensus regarding the benefit of eradicating Helicobacter pylori (H. pylori) infection in patients with functional dyspepsia (FD). We intended to compare the symptom response to H. pylori eradication in FD patients in presence or absence of microscopic duodenitis (MD). Patients with dyspepsia, normal upper gastrointestinal endoscopy and no psychological comorbidity according to the 12-item General Health Questionnaire underwent duodenal biopsy sampling. Of those, subjects with positive rapid urease test and H. pylori colonization in Wright-Giemsa staining were included in the study and evaluated histologically for presence of MD. All patients received sequential H. pylori eradication therapy and underwent urea breath test 4 weeks after the completion of the treatment to confirm the H. pylori eradication. The severity of dyspepsia was assessed using the Leeds Dyspepsia Questionnaire (LDQ) at baseline, 3rd and 6th months after the H. pylori infection was eradicated. Thirty seven patients were included in the study [mean age: 34.9 (8.1), 54.05 % female]. MD was observed in 16 (43.2 %) of the subjects. The mean LDQ score in patients with MD decreased from 12.5 (4.1) at baseline to 4.3 (2.1) at 3rd month and 2.6 (1.9) at 6th month. In patients without microscopic duodenitis, the mean LDQ score decreased from 10.6 (5.2) at baseline to 6.8 (4.1) and 6.2 (3.8) at 3rd and 6th months, respectively. The improvement in severity of symptoms in presence of MD was significantly greater than when it was absent (P < 0.001). FD patients with MD achieved greater symptomatic response with H. pylori eradication than those without microscopic duodenitis.

Acupuncture for patients with functional dyspepsia: study protocol of a randomised controlled trial

IntroductionWhether acupuncture is efficacious for patients with functional dyspepsia is still controversial. So we designed a randomised controlled trial to settle the problem.Methods and analysisWe designed a multicentre, two-arm, sham-controlled...

Meta-analysis of itopride therapy in functional dyspepsia

Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected. Key words: Dyspepsia; Itopride; Meta-analysis

Sa1432 Localizing of the Contractile Deceleration Point (CDP) in High Resolution Manometry (HRM) Studies of Patients With Esophageal Motor Disorders

Background: Patients with anorexia nervosa (AN) often complain about similar symptoms as patients with functional dyspepsia (FD), such as fullness, early satiety and postprandial discomfort. As a consequence of chronic underweight, AN exhibits besides drug abuse, the highest mortality of psychiatric diseases. In these patients dyspeptic symptoms may, additionally to psychiatric co-morbidities, hamper changes in eating behavior (J Gastro Hepatol.24(2009)537) and re-feeding therapy. We therefore aimed to assess dyspeptic and gastroparesis symptoms as well as gastric function in AN and compare them to healthy controls (HC). Methods: 33 individuals participated in this study [17 HC (BMI 21.8±1.8 kg*m-2; age 24.5±6.2 y) and 16 patients with AN (BMI 14.3±1.2 kg*m-2; age 21.6±3.8 y)]. Symptoms were assessed using the Leeds Dyspepsia Questionnaire (LDQ), the Nepean Dyspepsia Index (NDI), Stanghellini's Dyspepsia Score (SDS) and the Gastroparesis Cardinal Symptom Index (GCSI). After ingestion of a 400 kcal muffin, gastric function was noninvasively assessed by MRI (1.5T Achieva, Philips Healthcare, The Netherlands) over a period of 120 min. Every 10 min, 30 axial abdominal MR images were performed during breath hold (volume scan) for the detection of Gastric Content Volume (GCV). In addition MR image series of oblique coronal image planes visualizing the stomach were performed in free breathing (70 images at 102 sec) for the assessment of gastric contraction frequencies. Symptoms data were compared by Mann Whitney test and are presented as median (interquartile range). Gastric emptying and motility data were compared by linear mixed effect modelling and are presented as estimate±SE. Results: Dyspepsia and gastroparesis symptom scores were higher in AN patients compared to HC: LDQ 5(1-11.5) vs 1(0-2); NDI 17(1225) vs 10(0); SDS 2(0-4) vs 0(0); GCSI 1.7(1.3-2.4) vs 0.3(0-0.7) (all p<0.01). Gastric emptying rates were higher for HC than AN (1.47±0.05 ml*min-1 vs 1.35±0.03 ml*min-1, p=0.02). For HC, gastric contraction frequency started at 3.0±0.1 min-1 and showed a decrease of 0.3 min-1 over 120 min (p<0.01). In comparison, AN contraction frequency was lower with 2.7 min-1 (p<0.01) and showed no adaptation over the emptying period. Summary&Conclusion: Patients with AN exhibit more dyspepsia and gastroparesis symptoms than healthy controls. These symptoms are accompanied by delayed gastric content emptying as well as altered gastric contractile activity compared to age matched healthy controls. In addition, AN show no adaptation in gastric contractile activity over the emptying period. Our study supports the use of prokinetic drugs in the treatment of anorexia nervosa in order to support re-feeding therapy in this group of patients.

Su1633 Placebo Effects in Functional Dyspepsia: A Preliminary Analysis on Symptoms in an Ongoing Randomized Placebo Controlled Trial

Background: Functional dyspepsia (FD) is a common disorder; however no currently available therapy is highly effective and most treatments provide only minimal gain over placebo. Due to the spontaneous fluctuation of disease activity, a considerable proportion of patients experience sufficient relief of symptoms even if treated with medications that are effective in a small subgroup of patients. We examined the efficacy of the herbal preparation STW5 (Iberogast®), esomeprazole and placebo in patients with FD. Methods: In a double-blind, double dummy, randomized study, FD patients (Rome III criteria) received either; esomeprazole (Nexium® 20mg/daily) + placebo; STW5 (20 drops/TID) + placebo; dual therapy or double placebo (“active treatment”) for 4 weeks. Thereafter, clinical responders all received placebo (“placebo treatment”) for 2 weeks. Ongoing responders were reassessed after 2 weeks of “no treatment”. Symptoms and severity (Nepean Dyspepsia Index [NDI-S], Gastrointestinal Symptom Score [GIS] and Leeds Dyspepsia Questionnaire [LDQ]), quality of life (Nepean Dyspepsia Index [NDI-QoL]) and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed. Visceral hypersensitivity was assessed with a nutrient challenge test before and after the 4 weeks of “active treatment”. Blinded data was divided into “nonresponder” and “responder” groups. Results: 70 FD patients (44 females; 48±2 years) have completed the study. 51 (73%) were responders to “active treatment”. Of 51 responders, 18 relapsed during “placebo treatment” (35% treatment withdrawal relapsers) and 20 relapsed on visible treatment cessation (39% placebo withdrawal relapsers); 13 continued with sufficient control of symptoms (26% sustained responders) after 2 weeks of “no treatment”. There were no baseline differences between non-responders and responders in regards to their initial symptom occurrence and severity, quality of life or anxiety or depression. In addition, there were no baseline differences between those that responded or relapsed after “treatment withdrawal” and/or “placebo-withdrawal”. After “active treatment” symptoms and severity decreased in responders, when compared with non-responders and this was matched by an improved quality of life (see table). Anxiety, depression and volume consumed during the nutrient challenge test were not different after “active treatment” between the nonresponders and responders. Conclusions: Thus far, 73% of FD patients respond symptomatically to “active treatment” and report an improved quality of life. However, the treatment(35%) and placebo-withdrawal relapse (39%) rates are also high. Baseline patient characteristics thus far have not been shown to predict response.

Itopride therapy for functional dyspepsia: A meta-analysis

To evaluate the therapeutic effects of itopride vs other drugs (placebo, domperidone, mosapride) for functional dyspepsia (FD). Randomized controlled trials (RCTs) of itopride for FD were retrieved from databases. Relevant information was extracted and analyzed, using the relative risk (RR) and weighted mean deviation, as appropriate. A random or fixed effect model was used, based on the heterogeneity of the included articles, and visual inspection of funnel plots was used to evaluate publication bias. Nine RCTs enrolling 2620 FD cases were included; 1372 cases received itopride treatment and 1248 cases received placebo or other drugs (control groups). Compared with control groups, itopride had superior RR values of 1.11 [95%CI: (1.03, 1.19), P = 0.006], 1.21 [95%CI: (1.03, 1.44), P = 0.02], and 1.24 [95%CI: (1.01, 1.53), P = 0.04] for global patient assessment, postprandial fullness, and early satiety, respectively. For the Leeds Dyspepsia Questionnaire score, the weighted mean deviation was -1.38 [95%CI: (-1.75, -1.01), P < 0.01]. The incidence of adverse effects was similar in the itopride and control groups. The funnel plots for all indicators showed no evidence of publication bias. Itopride has good efficacy in terms of global patients assessment, postprandial fullness, and early satiety in the treatment of patients with FD and shows a low rate of adverse reactions. Itopride can greatly improve FD syndromes-score.

Impact of Helicobacter pylori Infection and Microscopic Duodenal Histopathological Changes on Clinical Symptoms of Patients with Functional Dyspepsia

To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while taking the effect of Helicobacter pylori (H. pylori) infection into account. Several gastric and duodenal biopsy specimens were obtained in 217 patients with functional dyspepsia and were evaluated for H. pylori infection and histopathological changes. Severity of symptoms was assessed by Leeds Dyspepsia Questionnaire (LDQ) and its relationship to histopathological changes and H. pylori infection status was assessed. Helicobacter pylori infection was associated with presence and severity of microscopic duodenitis (p < 0.001). In H. pylori-infected patients, the presence of microscopic duodenitis was independent of microscopic gastritis (p = 0.74). Severity of dyspepsia symptoms was not higher in H. pylori-infected patients than non-infected patients (p = 0.15), but in the presence of H. pylori infection and microscopic gastritis, microscopic duodenitis significantly worsened the LDQ symptom severity score (p < 0.001). In multivariate analysis, the odds of experiencing severe symptoms in patients with severe microscopic duodenitis was 2.22 times greater than in individuals with very mild, mild, or moderate duodenitis. Microscopic duodenitis in H. pylori-infected patients may play a major role in producing and aggravating symptoms in FD patients and may be a determinant factor to consider in whether to treat H. pylori infection in functional dyspepsia.

No evidence of impaired gastric emptying in early Huntington‘s Disease

Background: Several factors, such as dysphagia, an increased motor activity, increased metabolic rate and a hypermetabolic state have been discussed as contributing to weight loss even at the early stages of Huntington’s Disease (HD). Aim of this pilot study was to investigate gastric emptying as a possible reason for weight loss in HD. Methods: 11 HD participants at early stages of the disease and matched controls were investigated by using the well-established and non-invasive 13C-octanoate breath test. The “Gastroparesis Cardinal Symptom Index” and the “Short-Form Leeds Dyspepsia Questionnaire” were used for clinical evaluation of gastroparesis or dyspepsia. Results: When compared to standard values ​​given in literature and controls all HD patients had normal breath test results. There was no evidence of gastroparesis or dyspepsia. There was a correlation of breath test results with the cognitive and functional performance of HD participants. Conclusion: According to our data, there is no evidence of impaired gastric emptying in early HD. We can not exclude that gastric emptying contributes to weight loss at more advanced stages of the disease.

Validation study of the Leeds Dyspepsia Questionnaire in a multi‐ethnic Asian population

Outcome measures for clinical trials in dyspepsia require an assessment of symptom response. There is a lack of validated instruments assessing dyspepsia symptoms in the Asian region. We aimed to translate and validate the Leeds Dyspepsia Questionnaire (LDQ) in a multi-ethnic Asian population. A Malay and culturally adapted English version of the LDQ were developed according to established protocols. Psychometric evaluation was performed by assessing the validity, internal consistency, test-retest reliability and responsiveness of the instruments in both primary and secondary care patients. Between April and September 2010, both Malay (n=166) and Malaysian English (n=154) versions were assessed in primary and secondary care patients. Both language versions were found to be reliable (internal consistency was 0.80 and 0.74 (Cronbach's α) for Malay and English, respectively; spearman's correlation coefficient for test-retest reliability was 0.98 for both versions), valid (area under receiver operating curve for accuracy of diagnosing dyspepsia was 0.71 and 0.77 for Malay and English versions, respectively), discriminative (median LDQ score discriminated between primary and secondary care patients in Malay (11.0 vs 20.0, P<0.0001) and English (10.0 vs 14.0, P=0.001), and responsive (median LDQ score reduced after treatment in Malay (17.0 to 14.0, P=0.08) and English (18.0 to 11.0, P=0.008) to dyspepsia. The Malaysian versions of the LDQ are valid, reliable and responsive instruments for assessing symptoms in a multi-ethnic Asian population with dyspepsia.

Anxiety, depression and quality of life differences between functional and organic dyspepsia

The role of psychological disturbance in the pathogenesis of functional dyspepsia is uncertain. We aimed to examine for differences in anxiety, depression and health-related quality of life (HRQOL) between adults with organic (OD) and functional dyspepsia (FD). A prospective, cross-sectional study of Malaysian adults undergoing oesophago-gastro-duodenoscopy (OGDS) for the primary indication of dyspepsia was conducted. Prior to OGDS, locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS), Nepean Dyspepsia Index (NDI) and Leeds Dyspepsia Questionnaire (LDQ) were administered. 839 patients (mean age 49.6 ± 15.8 years, 55.7% female, ethnic division: Malays 30.5% , Chinese 38.4%, Indians 29.4%) were studied between June 2008 and March 2009. 472 (56.3%) and 367 (43.7%) patients had FD and OD respectively. There was no difference in the mean LDQ score between FD and OD patients (18.6 vs 18.1, P = 0.4). Moderate/severe anxiety was more prevalent in FD compared to OD patients (28.5% vs 23.1%, P = 0.05) but there was no significant difference in depression. Summary scores for the NDI revealed a lower mean value in FD patients compared to OD patients (68.6 ± 19.5 vs 71.4 ± 19.6, P = 0.04). Patients with FD have a lower HRQOL compared to those with OD, but this could not be attributed to differences in anxiety nor depression between both groups.

A validation study of the Italian Short-Form Leeds Dyspepsia Questionnaire

Assessment of symptoms should be one of the main outcome measures in dyspepsia clinical trials. This requires a reliable, valid and responsive questionnaire that measures the frequency and severity of dyspeptic symptoms. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) has been proven to fulfil these criteria in its original version in the English language. The aim of the study was to assess the internal consistency, reliability, validity and responsiveness of the Italian version of the SF-LDQ in primary and secondary care. Unselected primary and secondary care patients completed the Italian version of the SF-LDQ. Test-retest reliability was assessed after 2days. Validity was measured by comparison with diagnosis made by physicians. Responsiveness was determined before and after treatment for endoscopically proven disease. The SF-LDQ was administered to 311 patients in primary care and 179 in secondary care patients. Internal consistency, as judged by the Cronbach's α, was 0.90. Pearson's correlation coefficient for test-retest reliability was 0.92. The SF-LDQ had a sensitivity of 80% and a specificity of 82%. A highly significant response to change was also observed (p=0.001). The Italian SF-LDQ is a reliable, valid and responsive self-completed outcome measure for quantifying the frequency and severity of dyspeptic symptoms.

Bismuth-Based First-Line Therapy for Helicobacter pylori Eradication in Type 2 Diabetes Mellitus Patients

Background/Aim: The primary aim of this study was to assess the efficacy of a bismuth-based quadruple regimen as first-line therapy for Helicobacter pylori (HP) eradication in diabetes mellitus (DM) patients. The secondary aim was to study the effect of HP eradication on dyspeptic symptoms in DM patients. Method: Eighty-nine consecutive type 2 DM and 48 non-diabetic age- and sex-matched patients were enrolled in this study. Diabetic patients were randomized to receive either pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1 g b.i.d., PCA-DM group) for 14 days, or pantoprazole (40 mg b.i.d.), bismuth citrate (400 mg b.i.d.), tetracycline (500 mg q.i.d.), and metronidazole (500 mg b.i.d., PBTM-DM group) for 14 days as the eradication regimen. All non-diabetic patients were treated by quadruple therapy (PBTM-non-DM group) for 14 days. We used the validated Leeds Dyspepsia Questionnaire (LDQ) to assess dyspeptic symptoms at baseline and 6 weeks after the end of treatment. Results: The HP eradication rates with intention-to-treat (ITT) and per-protocol (PP) analyses were 51% (for both) in the PCA-DM group; 81 and 85% in the PBTM-DM group, and 85 and 87% in the PBTM-non-DM group. The eradication rates are not different between the PBTM-DM and PBTM-non-DM groups (p > 0.05). The eradication rate was significantly lower in the PCA-DM group with both ITT and PP analysis than in the PBTM-DM and PBTM-non-DM groups (p < 0.05). LDQ score was 4.53 ± 7.7 in DM patients with successful eradication and 14.68 ± 5.9 in DM patients without successful eradication (p < 0.05). Conclusion: The bismuth-based quadruple eradication regimen as first-line therapy is safe, tolerable and achieves a high cure rate in patients with DM, and successful eradication may be beneficial on dyspeptic symptoms.

Quality of life in South East Asian patients who consult for dyspepsia: Validation of the short form Nepean Dyspepsia Index

BackgroundTreatment objectives for dyspepsia include improvements in both symptoms and health-related quality of life (HRQoL). There is a lack of disease-specific instruments measuring HRQoL in South East Asian dyspeptics.ObjectivesTo validate English and locally translated version of the Short-Form Nepean Dyspepsia Index (SF-NDI) in Malaysian patients who consult for dyspepsia.MethodsThe English version of the SF-NDI was culturally adapted locally and a Malay translation was developed using standard procedures. English and Malay versions of the SF-NDI were assessed against the SF-36 and the Leeds Dyspepsia Questionnaire (LDQ), examining internal consistency, test-retest reliability and construct validity.ResultsPilot testing of the translated Malay and original English versions of the SF-NDI in twenty subjects did not identify any cross-cultural adaptation problems. 143 patients (86 English-speaking and 57 Malay speaking) with dyspepsia were interviewed and the overall response rate was 100% with nil missing data. The median total SF-NDI score for both languages were 72.5 and 60.0 respectively. Test-retest reliability was good with intraclass correlation coefficients of 0.90 (English) and 0.83 (Malay), while internal consistency of SF-NDI subscales revealed α values ranging from 0.83 – 0.88 (English) and 0.83 – 0.90 (Malay). In both languages, SF-NDI sub-scales and total score demonstrated lower values in patients with more severe symptoms and in patients with functional vs organic dyspepsia (known groups validity), although these were less marked in the Malay language version. There was moderate to good correlation (r = 0.3 – 0.6) between all SF-NDI sub-scales and various domains of the SF-36 (convergent validity).ConclusionThis study demonstrates that both English and Malay versions of the SF-NDI are reliable and probably valid instruments for measuring HRQoL in Malaysian patients with dyspepsia.

The EQ-5D (Euroqol) is a valid generic instrument for measuring quality of life in patients with dyspepsia

BackgroundThere is little information of the validity of generic instruments in measuring health-related quality of life (HRQOL) in patients with dyspepsia. We aimed to assess the reliability and validity of the EQ-5D, a brief and simple instrument, in measuring HRQOL in adult patients with dyspepsia.MethodsConsecutive adults with dyspepsia attending the Gastroenterology clinic in a tertiary referral center were interviewed with the EQ-5D (both English and Malay versions), the short-form Nepean Dyspepsia Index (SF-NDI), the SF-36 and Leeds Dyspepsia Questionnaire (LDQ). Known-groups and convergent construct validity were investigated by testing hypotheses at attribute and overall levels. A repeat telephone interview was conducted 2 weeks later to assess test-retest reliability.ResultsA total of 113 patients (mean (SD) age: 53.7 (14) years; 49.5% male; 24.8% Malays, 37.2% Chinese; 70.8% functional dyspepsia) were recruited. Response rate was 100% with nil missing data. Known-groups validation revealed 20/26 hypotheses fulfillment. Patients with more severe dyspepsia reported more problems with their usual activity (p = 0.07) and pain (p = 0.06) and demonstrated lower median VAS scores (60 vs 70, p = 0.002) and EQ-5D utility scores (0.72 vs 0.78, p = 0.002). Those reporting problems in various EQ-5D dimensions had significantly lower scores in relevant SF-36 and SF-NDI dimensions. The overall EQ-5D utility score also demonstrated good correlation with the SF-36 summary physical and mental scores and the SF-NDI total score. Intraclass correlation coefficient for test-retest reliability was 0.66 (95% CI = 0.55 – 0.76).ConclusionThe EQ-5D is an acceptable, valid and reliable generic instrument for measuring HRQOL in adult patients with dyspepsia.

Symptoms in patients on long‐term proton pump inhibitors: prevalence and predictors

Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients.

Helicobacter pylori eradication in long‐term proton pump inhibitor users is highly cost‐effective: economic analysis of the HELPUP trial

Proton pump inhibitor (PPI) use is costly and about two-thirds of prescribing is long-term. Although 20-50% of patients may be infected with Helicobacter pylori, eradication is not normal clinical practice. To establish if H. pylori eradication in long-term PPI users is cost-effective. Long-term PPI-using patients (n = 183) testing positive for H. pylori were randomly assigned to true or placebo eradication therapy. Patients provided 2-year resource data, and 1-year symptom severity scores. A within-trial cost effectiveness analysis was conducted from a British health service perspective. Significant reductions in resource use occurred comparing eradication with placebo. After 2 years, PPI prescriptions (full-dose equivalents) fell by 3.9 (P < 0.0001); clinician (GP) consultations by 2.4 (P = 0.0001); upper gastrointestinal (GI) endoscopies by 14.8% (P = 0.008); clinician GI-related home visits by 19.9% (P = 0.005) and abdominal ultrasound scans fell by 20.3% (P = 0.005). Average net savings/patient were pound93 (95% CI: 33-153) after costs of detection and eradication had been deducted. At 1 year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (P = 0.005) and quality-of-life measures improved (EuroQol-5D: 0.089, P = 0.08; visual analogue scale: 5.6, P = 0.002) favouring eradication. Helicobacter pylori eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and symptom severity.

Cost-effectiveness of and satisfaction with a Helicobacter pylori “test and treat” strategy compared with prompt endoscopy in young Asians with dyspepsia

Objective:To compare a Helicobacter pylori “test and treat” strategy with prompt endoscopy in young Asians with dyspepsia.Methods:A randomised, prospective study was carried out on uninvestigated dyspeptics aged <45 years in...

Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials

Background: Functional dyspepsia (FD) is a common disorder but there is currently little efficacious drug therapy. Itopride, a prokinetic approved in several countries, showed promising efficacy in FD in a...