New-onset Dyspepsia Research Articles

Development of functional gastrointestinal disorder symptoms following laparoscopic cholecystectomy: a prospective cohort study.

The casual relationship between the role of cholecystectomy and functional gastrointestinal disorders (FGIDs) are a controversial clinical challenge. This study aimed to investigate: (1) the overlap of FGIDs before cholecystectomy and its long-term outcome after surgery in patients with symptomatic cholelithiasis, and (2) the incidence of new-onset FGIDs after cholecystectomy. Patients with symptomatic gallstone disease who underwent elective, laparoscopic cholecystectomy were prospectively enrolled. Healthy populations who underwent medical check-ups were selected as age- and sex-matched controls. Questionnaires regarding sociodemographic characteristics, gastrointestinal symptoms and a somatization symptom checklist (SSC) were completed at baseline and 12 months thereafter. The prevalence of all FGID symptoms before cholecystectomy were significantly higher in the group of patients with symptomatic cholecystolithiasis compared to the control group. In cholecystectomy group, the preoperative FGID symptoms improved after surgery, except for chronic diarrhea. Compared to the controls, the new-onset FGIDs, including functional dyspepsia (14.8% vs. 6.9%; p = 0.040), functional diarrhea (6.6% vs. 0.2%; p < 0.001), and chronic abdominal pain (11.9% vs. 4.4%; p = 0.024), were more common at 1 year after cholecystectomy. Somatization was independent predictors of new-onset dyspepsia and abdominal pain, while newly occurring diarrhea was not realted to somatization. Overlap of FGIDs was common in patients with symptomatic cholelithiasis before surgery and at follow-up 1 year after cholecystectomy. Furthermore, new-onset FGIDs could be occurred after cholecystectomy. Therefore, a delicate diagnostic approaches and appropriate treatments about co-existent FGIDs should be given in patients with cholelithiasis before and after cholecystectomy.

Dyspepsia: a more complex approach

Dyspepsia is defined as epigastric pain that lasts at least one month and may be associated with a range of other upper gastrointestinal symptoms. Approximately 2/3 of outpatients with dyspepsia have a functional dyspepsia. The clinical assessment of dyspepsia is based on age of patients as well and the search for severity criteria. The endoscopy in cases of new-onset dyspepsia is recommended from an age of 55-60 and the presence of at least 1 severity criteria. A non-invasive test for Helicobacter pylori (HP) should be performed in all patients and followed by HP eradication when HP test is positive. The first-choice treatment of functional dyspepsia is a proton pump inhibitor (PPI) at maximal dose for 8 weeks. A therapeutic trial with a prokinetic or a central neuromodulator are alternatives to consider in case of failure of PPI treatment.

Is there an alternative to diclofenac i/m injections for rapid relief of severe pain? Results of randomized controlled and partially blind forsage study

Diclofenac Potassium sachets (DPS) is a new faster-absorption and rapid onset of pain relief drug dosage form of Diclofenac with high analgesic potential.Objective. To assess efficacy and safety of Diclofenac sachets and intramuscular injections in relieving acute pain in patients with rheumatic diseases (RDs).Materials and methods: The study group included 30 RD patients, 53.3% females and 46.7% males, mean age 41.8 ± 10.7 years, with severe acute pain (≥7 cm VAS pain rating, VAS 0-10 cm). After signing informed consent patients were randomized into DPS 50 mg t.i.d. and Diclofenac 75 mg i/m b.i.d. The first administration of Diclofenac was blind, i.e., patients from both groups were also administered placebo – either placebo injection in Group 1 randomized to sachet or placebo sachet in Group 2. The study lasted for 3 days. Level of analgesia was assessed in 15, 30, 60, 120, 180 minutes after the first administration, then three times a day during two following days and in the morning on day 4. Serum levels of CRP, IL-6 and P substance biomarkers were also monitored.Results. Pain relief in Group 1 was documented already in 15 min after administration – from 8.1±0.8 to 5.7±1.7 cm VAS (р=0.012), with continuing increase of analgesic effect thereafter. Group 2 demonstrated significant pain relief in 1 hour after Diclofenac administration – from 7.6±0.7 to 4.5±1.9 cm VAS (р=0.04). Based on obtained data analgesic effect was more powerful in Group 1 vs Group 2 in 15 and 30 minutes after drug administration (р=0.019; р=0.037). Starting from the 3rd hour post-administration there was no statistically significant difference in pain intensity between the two groups. Final assessment in the morning on day 4 showed significant pain reduction by 4.5±2.6 cm VAS in Group 1 vs baseline, and by 3.6±1.4 cm VAS in Group 2 (p=0.545). Functional improvement in both groups reached 3.7±1.9 and 3.3±1.3 cm VAS, respectively (p=0.837). The results were rated as “good” and “excellent” by 77.0% in Group 1, and 61.5% – in Group 2 (р=0.302). No correlation between decreasing pain intensity and fluctuating CRP, IL-6, and substance P concentrations was established. Three patients from Group 1 reported new-onset dyspepsia, resulting in discontinuation of treatment in 2 of them. Similarly, 2 discontinuations occurred in 2 patients with new-onset dyspepsia in Group 2, plus one additional withdrawal due to gastric ulcer and elevated blood pressure.Conclusion. DPS is not inferior to i/m Diclofenac injections in terms of analgesic potential and rapid onset of pain relief. Oral intake is associated with fewer adverse reactions compared to i/m injections.

2738 A Rare Cause of Dyspepsia: Gastric Sarcoidosis

INTRODUCTION: Dyspepsia is one of the most commonly addressed gastrointestinal problems in the outpatient settings, globally thought to affect 7-45% of the population. The majority of cases with dyspepsia are functional, as defined by the Rome Criteria, and have no organic cause. A rare cause of organic dyspepsia is gastric sarcoidosis, with only 40-60 cases described in literature so far. We present a case of new onset dyspepsia secondary to sarcoidosis. CASE DESCRIPTION/METHODS: Our patient was a 48 year-old African American female with a history of pulmonary sarcoidosis, which had been treated with systemic steroids and methotrexate and had been stable off medications. During a routine healthcare visit, she reported new onset of nausea and heartburn for one month, failed trial of PPI and then was referred for an EGD. Endoscopy showed grade A gastro-esophageal junction esophagitis and erosive gastritis. Biopsies of gastric antrum and body showed severe active chronic gastritis with non-necrotizing granulomatous inflammation, with negative staining for fungi, mycobacteria and H pylori, diagnosed as gastric sarcoidosis. DISCUSSION: Dyspepsia is a constellation of upper GI symptoms, including the presence of upper abdominal pain or discomfort with or without other symptoms such as nausea, belching and vomiting. Less than 30% of cases of dyspepsia are found to have an organic cause, the most common of which are chronic peptic ulcer disease, gastroesophageal reflux (with or without esophagitis) and malignancy. Among the rarer causes is sarcoidosis. Sarcoidosis is a multi-systemic disease characterized by the histological presence of non-caseating granulomas, which commonly has pulmonary manifestations. Gastrointestinal involvement is extremely uncommon in sarcoidosis and usually asymptomatic, with only 0.1-0.9% of all cases of GI sarcoidosis displaying symptoms. The mainstay of diagnosis is endoscopy with biopsy showing the characteristic non-caseating lesions, after ruling out infections and other etiology. Management consists of immunosuppressive therapy, including corticosteroids. Although rare, it remains the second most common cause of granulomatous gastritis in developed countries and should be kept in mind investigating GI symptoms especially in patients with preexisting disease. Our case also highlights the importance of appropriate upper endoscopy evaluation in cases of new-onset dyspepsia.

Primary Gastric Lymphoma: Clinicopathological Profile.

IntroductionGastrointestinal tract (GIT) is the most common site of involvement of extranodal non-Hodgkin’s lymphoma (NHL). There is regional variation in anatomical distribution of extranodal NHL, stomach being the most common site followed by small intestine. Primary gastric lymphoma (PGL) predominantly involves the antrum and corpus of the stomach. It arises from mucosa-associated lymphoid tissue (MALT) and is of B-cell lineage and often associated with Helicobacter pylori infection. Primary gastric lymphoma often presents with nonspecific symptoms. The present study was undertaken to ascertain the clinicopathological characteristics of PGL at a tertiary care center in South India.Materials and methodsIt is a retrospective study from 2006 to 2016. Patient’s data were obtained from institutional medical records. The histopathology slides were reviewed. The relevant immunohistochemistry (IHC) markers done were leukocyte common antigen (LCA), CD3, CD20, CD79a, CD10, Bcl-2, Bcl-6, CD5, Cyclin D1, CD138, and Ki-67. Correlating with the immunoprofile, further subtyping was done.ResultsA total of 405 patients of NHL were seen during the study period, out of which 43 patients were PGL. There were 32 males and 11 females, with M:F of 2.9:1. The mean age at diagnosis was 58 years. Abdominal pain and new-onset dyspepsia were the commonly observed presenting symptoms. The common site of involvement was antrum (20). Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype. Helicobacter pylori infection was seen in 18 (41%) patients. Majority of the patients were in stages II and III.ConclusionIn our study, the initial presentation of PGL was with nonspecific symptoms like abdominal pain and new-onset dyspepsia. High degree of suspicion of such symptoms and biopsy of all suspicious lesions is essential for early detection. Diffuse large B-cell lymphoma was the most common histological subtype seen in our study.How to cite this article: Malipatel R, Patil M, Rout P, Correa M, Devarbhavi H. Primary Gastric Lymphoma: Clinicopathological Profile. Euroasian J Hepato-Gastroenterol 2018;8(1):6-10.

Functional Dyspepsia

Functional dyspepsia (FD), formerly “nonulcer dyspepsia,” makes up approximately 50 to 75% of dyspepsia presentations. These presentations are defined by having no identifiable structural disease that would explain the symptoms. Recognizing the heterogeneity within the diagnosis of FD, the Rome III criteria further classify FD based on primary symptoms: postprandial distress syndrome and epigastric pain syndrome. The former term refers to bothersome fullness or early satiety with regular meals, whereas the latter is characterized by intermittent epigastric pain or burning that is not predictably meal associated. This review addresses FD, detailing the epidemiology, pathophysiology and pathogenesis, differential diagnosis, diagnosis, treatment, and prognosis. A figure shows the diagnostic algorithm for new-onset dyspepsia. Tables list the Rome III criteria for functional dyspepsia, alarm features in dyspepsia, and medications commonly associated with dyspepsia. This review contains 1 highly rendered figure, 3 tables, and 27 references.

Anxiety Is Linked to New-Onset Dyspepsia in the Swedish Population: A 10-Year Follow-up Study

Functional dyspepsia (FD) is associated with anxiety but it is not clear if one causes the other. We investigated whether anxiety and depression precede the onset of FD (based on the modified Rome III criteria) and gastroesophageal reflux symptoms (GERS) in a population-based follow-up study. Participants from the Kalixanda study (n= 3000), randomly selected from the national population register of Sweden, were given the validated Abdominal Symptom Questionnaire 1998-2001; 1000 of these participants then were selected randomly to undergo esophagogastroduodenoscopy and were given the Abdominal Symptom Questionnaire along with the Hospital Anxiety and Depression Scale questionnaire. All eligible subjects who underwent endoscopy (n= 887) were invited to participate in a follow-up study in June-August 2010 and were given the same questionnaires. Data were analyzed by logistic regression. Of the 703 subjects who completed the follow-up questionnaires (79.3%); 110 were found to have FD at baseline (15.6%) and 93 at the follow-up examination (13.3%); 48 of these were new cases of FD. GERS without organic disease was reported by 273 individuals (38.8%) at baseline and by 280 at follow-up examination (39.8%); 93 cases were new. Major anxiety was associated with FD at the follow-up evaluation (odds ratio [OR], 6.30; 99% confidence interval [CI], 1.64-24.16). Anxiety was associated with postprandial distress syndrome at baseline (OR, 4.83; 99% CI, 1.24-18.76) and at the follow-up examination (OR, 8.12; 99% CI, 2.13-30.85), but not with epigastric pain syndrome. Anxiety at baseline was associated with new-onset FD at the follow-up examination (OR, 7.61; 99% CI, 1.21-47.73), but not with GERS. In a study of the Swedish population, anxiety at baseline, but not depression, increased the risk for development of FD by 7.6-fold in the next 10 years. Anxiety did not affect risk for GERS.

Should we step‑up or step‑down in the treatment of new‑onset dyspepsia in primary care?

Dyspepsia is common in the community, and the condition represents a considerable burden to the health service. Individuals over the age of 50 to 55 years consulting with new-onset dyspepsia and those with alarming features, such as dysphagia and weight loss, require urgent endoscopy to exclude gastro-esophageal malignancy. For younger individuals without alarm features prompt endoscopy and "test and scope" are not cost-effective initial management strategies. "Test and treat" or empirical acid suppression therapy should be preferred, depending on patient and physician choice, as well as local prevalence of Helicobacter pylori. If empirical acid suppression therapy is favored, a recent primary care-based trial from the Netherlands suggests the choice of initial acid suppressant (antacid or proton pump inhibitor [PPI]) has little effect on the likelihood of remaining symptomatic, and that stepping-up from antacid to PPI is more cost-effective than stepping-down from PPI, when current prices of branded drugs were considered.

Band ligation resection of duodenal carcinoid (with video)

A 51-year-old woman with a 10-year history of irritable bowel syndrome manifested by intermittent abdominal cramps, bloating, and watery diarrhea developed worsening symptoms and new-onset dyspepsia. EGD revealed a small nodule in the duodenal bulb, biopsy specimens of which revealed a carcinoid tumor. She was subsequently referred for endoscopic resection of the lesion (A). There were no clinical features to suggest carcinoid syndrome. Laboratory values were as follows: urinary 5-hydroxyindoleacetic acid screen was negative; serum calcium, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase levels were normal; gamma-glutamyl transferase was 46 U/L (range, 13-40 U/L).

American Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia

American Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia

Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool

The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

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12 How should new-onset dyspepsia be managed in general and specialist practice?

Managing patients with new-onset dyspeptic symptoms represents a real challenge in clinical decision-making. The major controversy has been over the optimal management strategy of patients with new-onset dyspeptic symptoms who do not present with alarm symptoms. Since unaided clinical diagnosis is unreliable, proposed management strategies have included empirical treatment algorithms, computer-assisted predictive score models and Helicobacter pylori-based strategies such as test-and-scope or test-and-treat algorithms. Endoscopy remains the diagnostic ‘gold standard’, and the management should ideally be based on endoscopic diagnosis. Because of economic constraints and increasing waiting lists, this is not possible. When precise and comprehensive guidelines have been formulated, future patients will probably be managed in primary care by a Helicobacter test-and-treat policy, leaving only empirical treatment failures for specialist evaluation.