Treatment Of Non-ulcer Dyspepsia Research Articles

Helicobacter pylori eradication therapy in nonulcer dyspepsia is beneficial

Non-ulcer dyspepsia (NUD) is a common condition, and no therapy is dramatically effective in treating this disorder. It is therefore vital that there should be a reliable evidence for the efficacy of treatments prescribed to NUD patients. This updated systematic review suggests that H. pylori eradication has a small but statistically significant benefit in treating NUD. One-half of the world's population has Helicobacter pylori (H. pylori) infection, with an estimated prevalence of 30% in North America[1–2] compared with a prevalence of 80–90% in the developing world.[3] The annual incidence of new H. pylori infections in industrialized countries is approximately 0.5 per 100 persons of the susceptible population compared with three or more per 100 persons in the developing countries.[4,5] In southern part of Saudi Arabia, H. pylori was present in 81% of nonulcer dyspepsia (NUD) patients (with normal esophago-gastroduodenoscopy [EGD]) reported[6] in 1993, but a recent report[7] after 11 years (2004) from the same area, showed a significant reduction (53%) in the incidence of H. Pylori. This reduction is most likely secondary to improved socioeconomic and hygienic conditions, in addition to widespread treatment of H. Pylori in dyspepsia patients. Risk factors for acquiring H. pylori infection include residence in a developing country, poor socioeconomic conditions, family overcrowding, and possibly an ethnic or genetic predisposition. Dyspeptic symptoms affect 15–40% of the adult population in the western world.[8] Most affected individuals do not have structural or biochemical alterations that could explain these symptoms and, thus, are classified as having nonulcer or functional dyspepsia.[9] The pathophysiology of NUD is poorly understood; it may be associated with changes in motility, secretion, or sensitivity of the digestive tract.[10–12] Data from epidemiological studies are controversial in terms of the association of H. pylori with NUD symptoms.[13–15] Clinical studies focusing on the symptomatic benefits of eradicating H. pylori infections in patients with NUD have yielded conflicting results.[16,17] The majority of these studies were performed in low-prevalence H. pylori infection populations. [18–22] There are few studies reporting the consequences of eradicating these bacteria in infected functional dyspeptic patients in high-prevalence populations. Brazil is a country with a high H. pylori prevalence, with 60–87% of the adult population being infected with the bacteria.[23–25] H. pylori infection is the main cause of peptic ulcer and eradication therapy successfully cures this chronic relapsing and remitting disease.[26] This discovery has made an enormous difference to patients with peptic ulcer disease, but this accounts for only 5–10% of the population that has dyspepsia.[27] The majority of patients with dyspepsia have a normal endoscopy and in the absence of predominant reflux symptoms these patients are defined as having NUD.[28] The pathogenesis of this condition is uncertain and is likely to be multifactorial. H. pylori infection may have a role in this disorder, as the organism causes a chronic inflammatory response and has effects on gastric acid secretion.[29] The effect of H. pylori eradication therapy on NUD symptoms has been evaluated in several large, well designed, randomized controlled trials (RCTs).[30] Systematic reviews of RCTs can be a powerful method of assessing the effectiveness of a therapy. Unfortunately, many high-quality systematic reviews have been published with differing conclusions. This review aims to show that H. pylori eradication is beneficial and cost-effective in the treatment of NUD.

Nonulcer dyspepsia.

Nonulcer dyspepsia is a common condition in clinical practice. It is a heterogeneous disorder, and no single therapeutic agent is effective in all patients. The treatment of nonulcer dyspepsia is still dissatisfactory. Eradication of Helicobacter pylori organisms has a limited role and little effect. Antisecretory therapy has a modest effect in alleviating symptoms. Prokinetic agents may be effective, but selection bias in the trials performed to date may exaggerate their benefit. Partial 5-HT(4) agonists stimulate gastric emptying and may also affect gastric accommodation. They are promising but need further study. Data are limited on 5-HT(3) antagonists and hypnotherapy. New treatment approaches are necessary for this common and often chronic condition.

Treatment of Non-Ulcer Dyspepsia: Are Prokinetics Effective?

TO THE EDITOR: We have read with great interest the article by Allescher et al. (1) about the medical treatment of nonulcer dyspepsia. Based on a review of parts of the available literature, the authors state that gastroprokinetics are superior to H2-blockers and that both treatment modalities are signie cantly better than placebo. We have a number of reservations about the methodology used in this analysis and about the interpretation of the results from the clinical trials that were included in the analysis. 1) Five cross-over trials of gastroprokinetics were included in the meta-analysis and apparently results from both treatment periods added to the overall outcome. We feel this is a potential eaw: Four of the e ve studies did not include a wash-out period and there is a possibility of carry-over effects as well as period effects. All e ve studies tested for period and carry-over effects but the results of these analyses were not presented in the original papers. Two studies found evidence of period effects (2, 3) and only one study claimed that no such bias was found in the trial (4). Thus, only the e rst period in the cross-over trial should have been included in the meta-analysis since the results from the second treatment period may not be valid. 2) Allescher et al. state that they included all randomized controlled clinical trials published in the period 1978 to 1998. However, three large studies (5‐7) comparing cisapride with placebo were not included in the analysis, even though they were published before 1999 and fulelled the inclusion criteria stated in the paper. These studies randomized a total of 456 patients and none of the studies showed a signie cant effect of cisapride compared to placebo. Moreover, these studies focused on patients in primary care and thus a less selected group of patients compared to those recruited from tertiary care centres in the early cisapride studies. Therefore, adding the results from these more recent studies to the meta-analysis may very well have changed the conclusions. 3) Many of the early prokinetic studies included avariety of patients with abdominal complaints apart from epigastric pain or discomfort and some studies even included patients with organic diseases like oesophagitis or previous ulcer. For example, the study by Creytens (8) included patients with a predominant complaint of postprandial nausea, and epigastric pain or discomfort was not the primary outcome.

Treatment of Non-Ulcer Dyspepsia: Prokinetics Are Effective

Treatment of Non-Ulcer Dyspepsia: Prokinetics Are Effective

Psychological interventions for non-ulcer dyspepsia.

Studies have also shown that NUD patients have higher scores of anxiety, depression, neurotism, chronic tension, hostility, hypochondriasis, and tendency to be more pessimistic when compared with the community controls. This review aims to determine the effectiveness of psychological interventions including psychotherapy, psychodrama, cognitive behavioral therapy, relaxation therapy, guided imagery or hypnosis in the improvement of either individual or global dyspepsia symptom scores and also quality of life scores patients with non-ulcer dyspepsia (NUD). Trials were located through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and PsycLIT, using appropriate subject headings and text words and searching bibliographies of retrieved articles. All randomised controlled trials (RCTs) or quasi-randomised studies assessing the effectiveness of psychological interventions (including psychotherapy, psychodrama, cognitive behavioural therapy, relaxation therapy, guided imagery or hypnosis) for non-ulcer dyspepsia (NUD). Data were collected on individual, global dyspepsia symptom scores, as well as measures of quality of life (QoL) scores and adverse effects. The three trials identified showed that there was improvement in the dyspepsia symptom scores at the end of treatment and one trial showed improvement in the psychological parameters. However, meta-analysis was not possible as these trials used different psychological interventions and two of the trials only reported mean change in symptoms and did not give standard deviations of this change. Psychological intervention in the form of psychodynamic psychotherapy and cognitive behavioral therapy may be useful in the treatment of NUD. However, we need more trials to assess dyspepsia symptom scores and also psychological intervention in order to give us a clearer picture of the role of psychological intervention in NUD.

Treatment of Non-Ulcer Dyspepsia: a Meta-Analysis of Placebo-Controlled Prospective Studies

Background: Dyspeptic symptoms are commonly reported complaints in clinical practice and are mostly the result of functional disorders. Empirical treatment with histamine H2-receptor blockers or gastroprokinetics for 2-4 weeks has frequently been proposed as first line management of these patients. The clinical trials which support the use of these agents, show a high variation in clinical success rate and benefit of these treatments. Methods: The available clinical trials were evaluated, pooled where appropriate and subjected to a meta-analysis with the principal goal to provide valid treatment recommendations for patients with non-ulcer dyspepsia. In the present meta-analysis 19 studies on gastroprokinetics (cisapride, domperidone) and 10 studies on histamine H2-receptor antagonists (cimetidine, ranitidine) were included. Results: Based on these studies, a total of 1540 patients were evaluated for histamine H2-receptor antagonists (verum n = 786, placebo n = 754) and 1235 patients for gastroprokinetics (verum n = 616, placebo n = 619). The probability for treatment success compared to placebo was 0.2026 (0.1261; 0.2791) for histamine H2-receptor antagonists and 0.4029 (0.3042; 0.5069) for gastroprokinetics. Conclusions: Based on these data both treatments are significantly more effective than placebo in the symptomatic treatment of non-ulcer dyspepsia, with gastroprokinetics (cisapride, domperidone) being more effective than histamine H2-receptor antagonists (cimetidine, ranitidine).

Stress, coping, and depression in non-ulcer dyspepsia patients

Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non-organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State–Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas, problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed.

H. pylori therapy is not effective for treatment of non-ulcer dyspepsia: Meta-analysis of randomized controlled trials

H. pylori therapy is not effective for treatment of non-ulcer dyspepsia: Meta-analysis of randomized controlled trials

Cisapride for treatment of non-ulcer dyspepsia (NUD): A meta-analysis of randomized controlled trials

Cisapride for treatment of non-ulcer dyspepsia (NUD): A meta-analysis of randomized controlled trials

Nonulcer Dyspepsia: A Look Into the Future

Nonulcer Dyspepsia: A Look Into the Future

心療内科の一般性と専門性に関する考察 : 都心部内科クリニックと大学病院心療内科におけるNon-ulcer dyspepsiaの治療における比較検討(心身医学の一般性と専門性)(第36回日本心身医学会総会)

心療内科の一般性と専門性に関する考察 : 都心部内科クリニックと大学病院心療内科におけるNon-ulcer dyspepsiaの治療における比較検討(心身医学の一般性と専門性)(第36回日本心身医学会総会)

Treatment of Helicobacter pylori infections

The available literature on the relationship between several diseases and Helicobacter pylori (H. pylori) is reviewed. Duodenal ulcer, gastric ulcer, complicated peptic ulcer, abdominal symptoms and gastroduodenal mucosal damage during the use of non-steroid anti-inflammatory drugs (NSAIDs), non-ulcer dyspepsia (NUD) and gastric malignancy are discussed. The case for and against eradication is critically discussed. Eradication of H. pylori should be pursued in all patients with peptic ulcer disease, whether they are using NSAIDs or not. Eradication of H. pylori in the treatment of NUD should be considered experimental. Treatment aimed at the eradication of H. pylori should be considered in all patients with low-grade malignant mucosa-associated lymphoid tissue (MALT) lymphoma and in all patients with Ménétrier's disease. Finally, this treatment should be considered in a subset of H. pylori-infected patients who possibly are at an increased risk of gastric cancer: patients with a strong family history of gastric carcinoma and patients in need of long-term treatment with a proton-pump inhibitor. In view of the importance of patient compliance, the risk of side-effects and the possibility of inducing metronidazole resistance when treatment with a metronidazole-containing regimen is used, treatment aimed at the eradication of H. pylori should be carefully implemented and monitored.

Helicobacter pyloriInfection and Non-Ulcer Dyspepsia: The Effect of Treatment with Colloidal Bismuth Subcitrate

A study was undertaken to determine the role of Helicobacter pylori in non-ulcer dyspepsia (NUD) and to determine the efficacy of colloidal bismuth subcitrate (CBS) in the treatment of NUD. Seventy-one patients were randomly allocated (double blind) to CBS or placebo, two tablets twice daily for 4 weeks. The severity of dyspepsia was scored and endoscopies performed before and after treatment, and antral biopsy specimens were taken for bacteriologic and histologic examination. Forty patients had H. pylori infection, and all had changes of chronic active gastritis. H. pylori was cleared from 17 to 21 patients (81%) treated with CBS, whereas none of the 19 patients treated with placebo cleared the bacteria. Improvement in histology was noted in 15 of 21 patients (71.4%) treated with CBS, whereas no improvement was noted in any of the placebo controls. Thirty-one patients were negative for H. pylori. All had either normal gastric histology or minor degrees of inflammation. Seventeen of these patients received CBS, and 14 received placebo. All groups reported improvement in the symptom score; however, the H. pylori-positive, CBS-treated group recorded a significantly higher improvement than the other groups (p less than 0.001). Relapse of H. pylori infection after initial clearance of the bacteria was high. Twelve of 16 patients evaluated relapsed 1 month after withdrawal of CBS.

Clinical Indications and Efficacy of Colloidal Bismuth Subcitrate

Colloidal bismuth subcitrate (CBS; DeNol) has been studied in clinical trials investigating the treatment of duodenal and gastric ulcer, non-ulcer dyspepsia, duodenitis, non-steroidal anti-inflammatory drug (NSAID)-induced disease, and Helicobacter pylori-induced gastroduodenitis. Healing rates for duodenal ulcer with CBS are significantly better than with placebo and are similar to results obtained with cimetidine or ranitidine. CBS is significantly better in the treatment of duodenal ulcer resistant to standard doses of H2 antagonists than increased doses of H2 antagonists. Duodenal ulcer relapse at 12 months after initial healing with CBS is significantly less than with H2-antagonist therapy. Ulcer healing with CBS is not influenced by smoking. H. pylori eradication with CBS appears to have little effect in ulcer healing but is of major importance in preventing ulcer relapse. CBS is effective in combination with antibiotics in eradicating H. pylori-associated gastritis. In gastric ulcer disease CBS therapy resulted in significant healing advantages over placebo and was comparable to treatment with cimetidine and sucralfate. CBS has been shown to be effective in the treatment of erosive duodenitis. The role of CBS in treatment of non-ulcer dyspepsia and NSAID-induced damage awaits further clinical studies.

▾ Cisapride – more selective than metoclopramide

Metoclopramide (Maxolon; Primperan), has been around for over 20 years and domperidone (Motilium - Sterling Winthrop) for eight years. Both are prokinetic drugs which speed gastric emptying, increase oesophageal sphincter pressure, stimulate gut motility and in addition have a central antiemetic effect. Cisapride (Prepulsid - Janssen; Alimix - Cilag) has a similar chemical structure to metoclopramide and is intended for the reduction of oesophageal reflux and relief of symptoms caused by impaired gastrointestinal motility. The product licence has recently been extended to include treatment of non-ulcer dyspepsia.

Cimetidine in the treatment of non-ulcer dyspepsia: Results of a randomized double-blind, placebo-controlled study

A randomized double-blind, placebo-controlled study was carried out in 56 patients with essential dyspepsia to investigate the therapeutic efficacy of cimetidine in providing symptomatic relief. Patients received either 1 tablet of cimetidine (400 mg) or identical looking placebo twice daily for a period of 4 weeks. A detailed symptomatic assessment was made at weekly intervals. Abdominal pain, the primary symptom, was relieved in a higher proportion of cimetidine-treated patients compared to placebo group (67% versus 40%, p less than 0.05). Most of the secondary gastro-intestinal symptoms also improved in a higher proportion of patients in the cimetidine group although the difference was statistically not significant. The outcome of treatment was not influenced by factors such as duration of disease, initial severity of pain and smoking habits of the patient.

Sucralfate versus placebo in treatment of non-ulcer dyspepsia

One hundred fifty-one patients with non-ulcer dyspepsia, defined as chronic epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of any organic disease other than macroscopic or microscopic gastritis/duodenitis seen at endoscopy on entry into the trial, were randomly assigned to treatment for four weeks with sucralfate or a placebo, 1 g three times a day one-half hour before meals, according to a double-blind model. Seventy-nine patients received sucralfate and 72 patients received a placebo. According to patients' subjective assessment of their symptoms at four weeks, 61 patients (77 percent) in the sucralfate group and 40 patients (56 percent) in the placebo group had become symptom-free or showed improvement, whereas the condition of 18 (23 percent) in the former group compared with 32 (44 percent) in the latter group remained unchanged or deteriorated. The difference between the groups was significant (p <0.01). The best response to sucralfate treatment (84 percent or more symptom-free or improved) was achieved in patients with mild or moderate symptoms and without macroscopic or microscopic inflammation of their gastric mucosa—a typical patient with non-ulcer dyspepsia. Our results indicate that sucralfate is significantly more effective than placebo in the treatment of non-ulcer dyspepsia.