Severity Of Dyspeptic Symptoms Research Articles

Somatisation in functional dyspepsia: integrating gastric physiology with psychological state

Functional dyspepsia is considered to be the result of a complex interaction between biological, psychological and social factors. In this issue of the journal, Van Oudenhove and colleagues1 ( see...

Relationship Between Symptoms and Dietary Patterns in Patients With Functional Dyspepsia

Patients with functional dyspepsia (FD) often report that their symptoms are related to food ingestion. However, there is a lack of information about differences in eating patterns and nutrient intake between these patients and healthy individuals or the association with specific symptoms. We performed a prospective trial to evaluate the relationship between FD symptoms and dietary factors. Twenty patients with FD (17 women) and 21 healthy subjects (18 women) completed detailed diet diaries, recording all foods eaten, drinks consumed, and times of consumption, as well as the occurrence, timing, and severity of dyspeptic symptoms (ie, nausea, discomfort, fullness, bloating, upper-abdominal/epigastric pain) for 7 days. Data from the diet diaries were analyzed for the number of meals, light meals, snacks and drinks, energy intake, and macronutrient distribution. Patients with FD ate fewer meals (P < .01) and consumed less total energy (P = .1) and fat (P = .1) than healthy subjects. Their symptoms were modest in severity (score out of 10; 5 [range, 3-8]) and occurred within 31 minutes (range, 8-64 min) of eating. Fullness was related directly to the amount of fat ingested (z, 1.91; P < .05) and overall energy intake (z, 2.12; P < .05) and related inversely to the amount of carbohydrate ingested (z, -1.9; P = .05). Similarly, bloating was related to the amount of fat ingested (z, 1.68; P = .09). There was no significant relationship between symptom severity and any of the dietary variables measured. Management of patients with FD might be improved by instructing them to consume smaller meals with reduced fat content.

Generation of dyspeptic symptoms by direct acid infusion into the stomach of healthy Japanese subjects

The relationship between acid and dyspeptic symptoms has not been fully understood. To investigate the type and severity of dyspeptic symptoms induced by direct acid infusion into the stomach of Japanese healthy subjects. This was a multi-centre, cross-over, randomized, double-blind study in 27 healthy subjects (mean age 27). Each fasted subject received two tests with 150 mL of 0.1 mol/L hydrochloric acid infusion (15 mL/min for 10 min) and the same volume of pure water infusion. The type and severity of symptoms were assessed by a 10 cm visual analogue scale administered every 2 min up to 30 min. Various symptoms were reported after both acid and water infusions. Most of the symptoms were more severe after acid infusion compared with water infusion (acid vs. water: discomfort 1.8 +/- 0.4 vs. 0.5 +/- 0.1, pain 0.6 +/- 0.3 vs. 0.1 +/- 0.1, reflux 1.0 +/- 0.3 vs. 0.3 +/- 0.1 and satiety 1.1 +/- 0.4 vs. 0.2 +/- 0.1). The area under curve for dysmotility like symptoms (heavy feeling in the stomach, bloating, nausea or feeling sick, and belching) was significantly higher in acid infusion, and symptoms continued after infusion of the acid. Acid induced into stomach induced dysmotility-like predominant dyspeptic symptoms in Japanese healthy control subjects, demonstrating the possible importance of acid in symptom generation.

Drinking Capacity and Severity of Dyspeptic Symptoms During a Water Load Test After Nissen Fundoplication

Up to 30% of subjects undergoing Nissen fundoplication develop dyspeptic symptoms. Previous studies using the water load test have shown that functional dyspepsia patients have a diminished drinking capacity due to increased visceral sensitivity. Here we investigate drinking capacity and severity of symptoms in 9 patients with dyspeptic symptoms after fundoplication, 9 patients without symptoms after surgery, 18 functional dyspepsia patients, and 18 controls. The water load test was performed by having subjects drinking room-temperature tap water at a predetermined rate of 15 ml/min. The presence and severity of symptoms during the test were evaluated every 5 min using a Likert scale. We found that patients with dyspeptic symptoms after fundoplication had a significantly lower drinking capacity and higher symptoms scores than controls (P<0.05) but values similar to those of functional dyspepsia patients (P>0.05). In contrast, drinking capacity in patients without symptoms after surgery was similar to that in controls (P>0.05). These findings suggest that, as in functional dyspepsia, severe dyspeptic symptoms after Nissen fundoplication are associated with an impaired drinking capacity, reflecting visceral hypersensitivity or impaired gastric accommodation or both.

Gastroduodenal Lesions and Helicobacter pylori Infection in Dyspeptic Patients With and Without Chronic Renal Failure

Patients with chronic renal failure (CRF) often have dyspeptic symptoms and may develop peptic disease or digestive disorders leading to severe gastrointestinal complications. The primary aim of this study was to evaluate the prevalence of peptic lesions and Helicobacter pylori infection, and the severity of dyspeptic symptoms, in dyspeptic patients with and without CRF. Our secondary aim was to investigate whether uremic status may affect the diagnostic efficiency of the [13]C-urea breath test ([13]C-UBT). We consecutively enrolled in the study 50 dyspeptic patients with chronic kidney failure (mean age 52 +/- 5 years), of whom 11 were on hemodialysis treatment (HD), and 93 subjects (mean age 54 +/- 7 years) with chronic dyspepsia and normal renal function (NRF). All patients completed an oriented and validated questionnaire scoring the severity of nine dyspeptic symptoms (i.e. epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating, belching, nausea and vomiting) and underwent upper endoscopy with multiple bioptic sampling for rapid urease test and histological examination, [13]C-UBT and HpSA test. The prevalences of peptic lesions and H. pylori infection and mean symptom score were 74%, 52% and 3.5 +/- 3, respectively, in dyspeptic patients with CRF and 18%, 36% and 8 +/- 5, respectively, in dyspeptic patients with NRF. The diagnostic accuracy of [13]C-UBT with respect to histological diagnosis was 94% and 97% for dyspeptic patients with and without renal failure, respectively. 1, A high frequency of peptic lesions and low symptom scores were observed in uremic patients in spite of H. pylori infection; 2, uremic status did not affect the diagnostic accuracy of [13]C-UBT.

Helicobacter pylori eradication ameliorates symptoms and improves quality of life in patients on long-term acid suppression. A large prospective study in primary care.

Our objective was to determine prescribing patterns for H2 receptor antagonists (H2RA) in primary care and to establish the prevalence and impact of Helicobacter pylori (Hp) eradication in this population of patients. Patients on long-term (6 months or longer) H2RA were identified through a computerized database at the six primary care practices in North England. Hp status was identified by serology, and those positive received standard proton pump-based triple therapy followed by a urea breath test to confirm Hp eradication. The main outcome measures were the indications for prescribing long-term H2RA in primary care, the prevalence of patients with a positive Hp serology, and the impact of Hp eradication on the subsequent need for acid suppression, severity of dyspepsia, gastrointestinal symptom rating score (GSRS), quality of life (QOL), and overall feeling of well-being. One thousand seven (1.5%) patients were on long-term H2RA. Peptic ulcer disease (PUD) was the most common indication for prescribing (42%), followed by nonulcer dyspepsia (28%) and gastroesophageal reflux disease (23%). In 81% of the patients treatment with H2RA therapy followed a previous endoscopic or radiological investigation. Only 27 (2.5%) patients had had their Hp status checked within the last 6 months. Of the 471 patients who eventually had their Hp serology tested, 297 (63%) were Hp positive. Fifty-eight percent of the Hp-positive patients had PUD. Successful Hp eradication was achieved in 250 (84%) of the patients, of whom 247 (83%) finished the 1-year follow-up. This was associated with a significant reduction in the amount of H2RA being consumed (P < 0.00001). There was also a significant improvement in the symptom scores and the GSRS after successful Hp eradication (P < 0.00001). Overall 67% of the patients reported an improvement in the QOL and 77% noted a feeling of well-being 1 year after Hp eradication. A significant proportion of patients in primary care is still being maintained on long-term H2RA, imposing a considerable financial drain on the NHS resources. Approximately two-thirds of these patients will be Hp positive, and among them the largest group will comprise patients with PUD. Hp eradication in such patients results in a significant reduction in usage of acid suppression and an improvement in overall QOL and severity of dyspeptic symptoms.

Delta13CO2 excretion and expression of dyspeptic symptoms in patients evaluated for Helicobacter pylori infection by [13C] urea breath test.

Previous studies showed that either the urease activity possessed by H. pylori and the bacterial load may influence the results of the [13C] urea breath test. However, the correlation between urease activity and dyspepsia is unclear. The aim of our study was to evaluate whether the urease activity of the gastroduodenal tract may influence the severity of dyspeptic symptoms. In all, 2520 dyspeptic patients (1109 men, 1411 women; mean age 47 +/- 16 years) without gastroesophageal reflux disease, diabetes, vascular disorders, liver and biliary tract diseases, and tumors of the gastrointestinal tract and with a normal appearing abdominal ultrasonography were enrolled. All these patients underwent a [13C] urea breath test and filled out a questionnaire on dyspeptic symptoms. Subjects were divided in five different groups according to delta over baseline (DOB) values (group 1 < 3.5, group 2 = 3.5-6; group 3 = 6.1-11, group 4 = 11.1-23, group 5 > 23.1). The prevalence and intensity of dyspeptic symptoms were compared among groups. In all, 1688 patients (67%, 928 females and 760 males; mean age 48 +/- 15 years) were H. pylori-positive. The chi-squared test and analysis of variance showed increase of frequency and intensity of each dyspeptic symptom according to DOB values. In conclusion, Dyspepsia may parallel gastric urease activity. However, whether higher DOB values are related to higher bacterial load or, alternatively, to the presence of particular H. pylori strains able to produce larger amounts of urease is uncertain.

Helicobacter pylori and NSAIDs--what interaction.

Much controversy surrounds the interaction of Helicobacter pylori infection and the use of Aspirin (ASA) or non-aspirin nonsteroidal anti-inflammatory drugs (NANSAIDs). The issue is comprised of many components, best dealt with singly. In summary, the severity of drug-associated gastritis, but not its incidence or prevalence, is influenced by infection prior to ASA or NANSAID therapy. Furthermore, the severity of dyspeptic symptoms appears worse in infected drug users. Both Chemical and Helicobacter gastritis, by increasing neutrophils in the tissue, lead to ulcers, although the induction of prostaglandin synthesis by inflammation in some circumstances may also be mildly protective. More ulcers are found in Hp+ve than Hp-ve users of NSAIDS, but ulcers in the stomach may heal more easily with acid suppressive therapy in infected patients. Eradication of infection is beneficial in aspirin users and in those beginning NANSAID therapy. Adaptation to aspirin is confined to Hp-ve cases. However, in long-term users of NANSAIDs, H. pylori eradication does not appear to speed ulcer healing, reduce recurrence, or prevent complications. These are best achieved by long-term maintenance therapy with a proton-pump inhibitor drug.

Role of autonomic dysfunction in patients with functional dyspepsia.

The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.

Treatment of uninvestigated dyspepsia with cisapride for patients with negative Helicobacter pylori serologies

OBJECTIVE: The aim of this study was to compare symptoms for patients with uninvestigated dyspepsia and a negative Helicobacter pylori serology who were treated with cisapride or placebo. METHODS: Helicobacter pylori-seronegative patients with chronic dyspepsia were randomized to receive cisapride 10 mg t.i.d. or placebo t.i.d. for 30 days. Symptom scores were performed 1 month and 3 months after randomization. Outcomes measured were dyspepsia symptom scores and a treatment “success” variable defined as absence of symptoms or decrease in the most severe individual symptom by two grades. RESULTS: A total of 60 patients were randomized; 56 completed the 1-month follow-up and 40 completed the 3-month follow-up interview. The mean score for all patients at the time of entry was 11.0 and declined to 8.3 and 8.2 at 1 and 3 months, respectively, after randomization. At 1 month and 3 months after randomization, there was no significant difference in the number of patients meeting the “success” variable for patients receiving cisapride as compared to placebo. The mean decline in symptom severity scores was not significantly different for patients receiving placebo or cisapride at 1 month (mean, −2.8 vs −3.1; difference = 0.3, p = 0.74) or 3 months (−3.1 vs −2.6, difference = −0.5, p = 0.58) after randomization. CONCLUSIONS: No significant difference in the severity of dyspeptic symptoms was found for patients receiving cisapride as compared to placebo in the setting of uninvestigated dyspepsia and a negative Helicobacter pylori serology.

The effect of nissen fundoplication on gastric emptying and dyspeptic symptoms

Dyspeptic symptoms are not uncommon after Nissen fundoplication, but whether delayed gastric emptying is a contraindication for Nissen fundoplication, with the risk of deterioration of these symptoms,is unertain. Aim: To study the effect of Nissen fundoplication on gastric emptying in patients with a normal and delayed gastric emptying. Methods: 36 patients (26m, IOf, mean age: 43.1) were studied before and 4 months after operation. Frequency and severity of dyspeptic symptoms were scored, from O(no symptoms)to 3(daily and severe). Gastric emptying studies were performed using a dual isotope technique. Results: 10 patients had delayed gastric emptying before operation that normalised in all but two after operation (TI/2: 390(440) vs. 82(29) min, p=0.05). Nissen fundoplication also enhanced gastric emptying of solids in patients with normal gastric emptying (TI/2: 115(21) vs. 83(24)min, p<O.OI). Heartbum and regurgitation were significantly reduced after operation for both groups (p<O.OI). Patients with a normal pre-operative gastric emptying showed a significant increase in early postprandial satiety (p<O.OI), flatulence (p=0.03) and a decrease in vomiting (p=O.03), while in patients with delayed gastric emptying these symptoms were not altered by operation. Other dyspeptic symptoms: belching and nausea were not affected by Nissen fundoplication (see table). No correlation was found between the presence of early satiety or nausea and gastric emptying rate. Conclusion: Nissen fundoplication accelerates gastric emptying without an effect on symptoms in patients with preexistent delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying.

Influence of bacterial CagA status on gastritis, gastric function indices, and pattern of symptoms in H. pylori-positive dyspeptic patients.

To date, little is known about a possible relationship between H. pylori-related disturbances of gastric function and the bacterial virulence. The aim of this study was to assess whether certain gastric function indices as well as the pattern of symptoms in nonulcer dyspepsia (NUD) are related to CagA status. A total of 56 consecutive patients with NUD (38 H. pylori-positive and 18 H. pylori-negative) were studied. Dyspeptic symptoms were categorized according to the predominant complaints and scored for severity and frequency. In all subjects, basal and pentagastrin-stimulated acid secretion, fasting and meal-induced gastrin release, fasting serum pepsinogen I (PG I) levels, and gastric emptying of solids were determined. CagA status was determined by assaying serum CagA IgG antibodies by western blotting. Eighteen of 38 (47%) H. pylori-positive dyspeptics were CagA seropositive. Type and severity of dyspeptic symptoms did not significantly differ between CagA-positive and CagA-negative dyspeptics nor between H. pylori-positive and negative patients. Among the gastric function indices studied, only meal-stimulated gastrin was significantly influenced by CagA status (peak gastrin 129.9 [44.1] vs 99.1 [48.6] pg/ml in CagA-positive and negative NUD, respectively), but this was not accompanied by any significant modification of basal or stimulated acid secretion or gastric emptying of solids. The activities of both antral and corpus gastritis in NUD harboring CagA-positive strains were significantly higher than those of CagA-negative NUD. Accordingly, serum PG I levels were significantly higher in CagA-positive than CagA-negative or H. pylori-negative dyspeptics. These findings support a role for CagA status in influencing the activity and perhaps the distribution of gastritis in NUD, as well as the degree of gastrin response to a meal; however, this is not accompanied by disturbances of acid secretion or gastric emptying or by differences in the type and severity of symptoms.

Influence of bacterial CagA status on gastritis, gastric function indices, and pattern of symptoms in H. pylori-positive dyspeptic patients

Objective: To date, little is known about a possible relationship between H. pylori-related disturbances of gastric function and the bacterial virulence. The aim of this study was to assess whether certain gastric function indices as well as the pattern of symptoms in nonulcer dyspepsia (NUD) are related to CagA status. Methods: A total of 56 consecutive patients with NUD (38 H. pylori-positive and 18 H. pylori-negative) were studied. Dyspeptic symptoms were categorized according to the predominant complaints and scored for severity and frequency. In all subjects, basal and pentagastrin-stimulated acid secretion, fasting and meal-induced gastrin release, fasting serum pepsinogen I (PG I) levels, and gastric emptying of solids were determined. CagA status was determined by assaying serum CagA IgG antibodies by western blotting. Results: Eighteen of 38 (47%) H. pylori-positive dyspeptics were CagA seropositive. Type and severity of dyspeptic symptoms did not significantly differ between CagA-positive and CagA-negative dyspeptics nor between H. pylori-positive and negative patients. Among the gastric function indices studied, only meal-stimulated gastrin was significantly influenced by CagA status (peak gastrin 129.9 [44.1] vs 99.1 [48.6] pg/ml in CagA-positive and negative NUD, respectively), but this was not accompanied by any significant modification of basal or stimulated acid secretion or gastric emptying of solids. The activities of both antral and corpus gastritis in NUD harboring CagA-positive strains were significantly higher than those of CagA-negative NUD. Accordingly, serum PG I levels were significantly higher in CagA-positive than CagA-negative or H. pylori-negative dyspeptics. Conclusions: These findings support a role for CagA status in influencing the activity and perhaps the distribution of gastritis in NUD, as well as the degree of gastrin response to a meal; however, this is not accompanied by disturbances of acid secretion or gastric emptying or by differences in the type and severity of symptoms.

Density of gastric Helicobacter pylori colonization is not associated with occurrence of dyspeptic symptoms.

In most studies, the prevalence of Helicobacter pylori infection in patients with dyspeptic symptoms does not clearly differ from the prevalence in asymptomatic controls. However, the degree of H. pylori colonization might play a role for the occurrence and severity of dyspeptic symptoms. Between August 1993 and July 1994, we screened 1500 apparently healthy volunteers (1036 men, 464 women, 42 +/- 12 years) for H. pylori infection using the [13C] urea breath test. The noninvasive urea breath test enables a semiquantitative assessment of the extent of H. pylori colonization in the stomach. Of the 1500 volunteers, 526 (35.1%) complained of occasional or frequent dyspeptic symptoms. No difference was observed in the H. pylori prevalence between asymptomatic subjects (35.5%) and those with dyspeptic symptoms (35.9%; P > 0.95). A high density of H. pylori colonization in the gastric mucosa was not associated with a higher frequency of dyspepsia (P > 0.80). According to these findings, an eradication therapy on the basis of dyspeptic symptoms alone cannot be recommended as H. pylori is not a proven etiology of dyspepsia.

Effect of H pylori eradication on the severity of dyspeptic symptoms in du patients - a one year follow up study

Effect of H pylori eradication on the severity of dyspeptic symptoms in du patients - a one year follow up study

Long-term nonsteroidal anti-inflammatory drug use and gastroduodenal injury: The role of Helicobacter pylori

To evaluate the association of Helicobacter pylori infection with gastroduodenal ulceration and symptoms in rheumatoid arthritis patients chronically ingesting nonsteroidal anti-inflammatory drugs (NSAIDs), a population-based study was performed. Residents of Olmsted County, Minnesota, and surrounding counties, 40 years of age and over with active rheumatoid arthritis taking therapeutic doses of NSAIDs daily for 6 months or more were evaluated (n = 50). An endoscopic score from 0 to 5 was assigned and independently confirmed. Biopsies were obtained from the antrum and gastric body for the presence of H. pylori. A symptom score based on the frequency and severity of dyspeptic symptoms was calculated. Substantial mucosal injury (≥ grade 2) was observed at endoscopy in 33 patients (66%); 14 (28%) had chronic ulcers. Eleven of the community patients with rheumatoid arthritis (22%) were H. pylori positive; adjusting for age, the prevalence of H. pylori was not significantly different to that in 67 healthy controls (25%). One or more upper gastrointestinal symptoms were reported by 19 of the community patients (38%). Adjusting for age, community rheumatoid arthritis patients with H. pylori were not more likely to have visible mucosal damage or dyspepsia, but were significantly more likely to have histological gastritis (P < 0.01). The results suggest that, in primarily asymptomatic persons from the community with rheumatoid arthritis taking daily NSAIDs for 6 months or more, H. pylori infection is not related to the severity of visible mucosal injury.

Comparison of sucralfate and ranitidine in the treatment of chronic nonerosive gastritis: A randomized, multicenter trial

In a randomized trial involving 20 Italian centers, the effectiveness of 1 g sucralfate three times a day and 150 mg ranitidine twice a day in the treatment of chronic gastritis was assessed and compared. Five hundred outpatients with dyspeptic symptoms and endoscopic evidence of chronic nonerosive gastritis were randomly assigned to either treatment for a period of eight weeks. Endoscopic scores were determined at the beginning and at the end of the study. The severity of dyspeptic symptoms was assessed at Weeks 0, 2, 4, 6, and 8. Four hundred seventy-three patients completed the study. In 331 cases, biopsies were taken during endoscopy, and a histologic evaluation was also performed, according to Whitehead's criteria. Sucralfate was significantly more effective than ranitidine in inducing healing or improvement of both endoscopic (p <0.02) and histologic (p <0.001) features. At the end of the study, 77.6 percent of the patients in the sucralfate group and 79.4 percent in the ranitidine group were symptom free. Ranitidine was significantly more efficacious at relieving pain during the first four weeks of therapy. Mild side effects were reported by 4.9 percent of patients treated with sucralfate and by 3.6 percent of patients treated with ranitidine. Treatment was withdrawn in one patient treated with sucralfate because of nausea. In conclusion, sucralfate appears significantly superior to ranitidine in improving endoscopic and histologic aspects of chronic nonerosive gastritis. The symptomatic activity of the two drugs is similar, although more rapid relief is obtained with ranitidine.