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Biomedical subjects

N J Talley

Publications and source records attributed to N J Talley.

At least 109 records · Page 6Linked to original sources
PubMed2001

Impact of chronic gastrointestinal symptoms in diabetes mellitus on health-related quality of life.

OBJECTIVES: Morbidity from GI symptoms in diabetes is considered to be high, but no studies have quantified the impact of GI symptoms in diabetes on health-related quality of life. We hypothesized that diabetics reporting increased GI symptoms would experience more impaired quality of life. METHODS: Subjects from the community with diabetes (n = 892) and outpatients with diabetes (n = 209) were recruited for this study. Subjects were divided into type 1 (diabetes diagnosed at age <30 yr and requiring insulin) and type 2. A validated questionnaire measuring GI symptoms and diabetes status and the Short Form-36 were completed. The results were compared with Australian normal data. GI symptom groups measured were frequent abdominal pain, bowel-related abdominal pain, reflux, dyspepsia, constipation, diarrhea, and fecal incontinence. RESULTS: There was a clinically significant decrease in quality-of-life scores in diabetics compared with population norms across all subscales. The impact on quality of life in diabetes was predominantly observed in type 2 diabetics. The quality-of-life scores in all subscales decreased markedly with increasing numbers of distinct GI symptom groups, and this was similar in community and outpatient diabetics. For all the Short Form-36 subscales, GI symptom groups were significantly (all p < 0.0001) associated with poorer quality of life in diabetes, independent of age, gender, smoking, alcohol use, and type of diabetes. CONCLUSIONS: GI symptoms impact negatively on health-related quality of life in diabetes mellitus.

Adult↗
PubMed2001

Apoptosis in gastric epithelium induced by Helicobacter pylori infection: implications in gastric carcinogenesis.

OBJECTIVES: Helicobacter pylori is an identified carcinogen for gastric cancer, however, the underlying mechanisms remain to be defined. In this review, we sought to elucidate the role of apoptosis in gastric carcinogenesis, to determine the influence of H. pylori infection on apoptosis, and finally to provide insights into the mechanisms by which H. pylori may lead to gastric carcinogenesis. METHODS: A broad-based MEDLINE and Current Contents literature search was performed to identify relevant publications between 1966 and March 2000 addressing H. pylori infection, apoptosis, cell proliferation, gastric carcinoma, oncogenes, and tumor suppressor genes, as well as the products of these genes. Abstracts from recent major conferences that provided adequate additional data were also included. RESULTS: Apoptotic cells are rare in the glandular neck region (the generative cell zone) of normal gastric mucosa. With progression of atrophic gastritis, the generative cell zone shifts downward and a relatively large number of apoptotic cells occur. In intestinalized glands, both apoptotic cells and proliferative cells are present in deeper portions of the glands, corresponding to the generative zone. A higher frequency of apoptosis has been observed in gastric dysplasia than in coexisting gastric carcinomas, whereas the number of proliferative cells is significantly higher in gastric carcinoma than in dysplasia. Upregulation of oncogene bcl-2 in premalignant lesions and "downregulation" of the gene after malignant change is probably a common event. Accumulation of p53 protein is first detected in dysplasia, although mutation of the pS3 gene may occur in intestinal metaplasia. H. pylori infection induces apoptosis in gastric epithelial cells, which returns to normal after eradication of the infection. Numerous molecules produced by H. pylori including cytotoxin (VacA), lipopolysaccharide, monochloramine, and nitric oxide may directly induce apoptosis. Moreover, H. pylori-stimulated host inflammatory/immune responses lead to release of a large amount of cytokines. Cytokines produced by type 1 T helper cells, such as TNF-alpha and IFN-gamma, markedly potentiate apoptosis. Gastric cell proliferation is significantly higher in patients with H. pylori infection than in normal controls, and eradication of the infection leads to a reduction in cell proliferation. Apoptosis and cell proliferation are also increased in precancerous lesions such as gastric atrophy, intestinal metaplasia, and dysplasia in the presence of H. pylori infection. However, H. pylori-induced apoptosis may no longer be cell cycle-dependent in these lesions because of the occurrence of alterations and mutations of apoptosis-regulating genes, resulting in a loss of balance between apoptosis and cell proliferation. CONCLUSIONS: It is hypothesized that H. pylori-induced apoptosis may play a key role in gastric carcinogenesis by increasing cell proliferation and/or resulting in gastric atrophy.

Apoptosis↗
PubMed2001

Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.

OBJECTIVES: Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument. METHODS: Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey. For psychometric analyses, primary care patients completed the new questionnaire at enrollment and at intervals ranging from 3 days to 3 wk. Multitrait scaling, test-retest reliability, and responsiveness were assessed. Predictive validity analyses of all scales and items used specialty physician diagnosis as the "gold standard." RESULTS: Iterative factor analyses yielded three scales of four items each including heartburn, acid regurgitation, and dyspepsia. Multitrait scaling criteria including internal consistency, item interval consistency, and item discrimination were 100% satisfied. Test-retest reliability was high in those reporting stable symptoms. Scale scores significantly changed in those reporting a global change. Regressing specialty physician diagnosis on the three scales revealed significant effects for two scales (heartburn and regurgitation). Combining the two significant scales enhanced the strength of the model. Symptom response to self-directed treatment with nonprescription antisecretory medications was highly predictive of the diagnosis also, although the item demonstrated poor validity and reliability. CONCLUSIONS: A brief, simple 12-item questionnaire demonstrated validity and reliability and seemed to be responsive to change for reflux and dyspeptic symptoms.

Adult↗
PubMed2001

Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis.

BACKGROUND: The efficacy of prokinetic agents in functional (nonulcer) dyspepsia has been questioned based on recent trial results. We performed a meta-analysis to determine the efficacy of cisapride and domperidone in functional dyspepsia. METHODS: Computer and manual searching was used to identify placebo-controlled studies that included >20 patients. The statistical analysis focused on: global assessment by the investigator, epigastric pain, early satiety, abdominal distension and nausea (all rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis was performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated. RESULTS: For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For all outcome measures, there was a statiscally significant benefit in favor of cisapride: global assessment of improvement by the investigator or patient (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), early satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% CI 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of publication, and country where study was performed had only small modifying effects. There were insufficient data to determine whether there is a relationship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of global assessment of improvement by the investigator. This showed an OR of 7.0 (95% CI 3.6-16) in favor of domperidone. CONCLUSIONS: Both cisapride and domperidone seem to be efficacious in functional dyspepsia, although this conclusion is largely based on global assessment by the investigator, which may not be an optimal outcome measure.

Cisapride↗
PubMed2001

Self-reported effectiveness and physician consultation rate in users of over-the-counter histamine-2 receptor antagonists.

OBJECTIVE: Decreased physician visits for dyspepsia were predicted with the histamine-2 receptor antagonists (H2RA) release to over-the-counter (OTC) status. The aim of this study was to examine the presentation frequency for dyspeptic complaints before and after the OTC release of the H2RA and the self-reported effectiveness of OTC H2RA. METHODS: Two cross-sectional surveys were used in a community sample. The patients comprised a random age- and sex-stratified sample of 1600 ambulatory adults in 1993 and 1800 in 1997. Self-report, valid mail surveys gathered information on healthcare seeking and gastrointestinal symptoms in 1993 and 1997 and antisecretory use in 1997. RESULTS: Presentation frequency for dyspepsia was 22% in 1993 versus 23.5% in 1997. Only 16% of chronic users of the OTC H2RA obtained complete relief of symptomatic episodes. Use of an OTC H2RA was highly associated with presentation to a physician in the past year. CONCLUSIONS: OTC H2RA infrequently provided the complete relief desired by patients. Presentation frequency to physicians for dyspeptic complaints did not change with availability of H2RA OTC.

Adult↗
PubMed2001

Helicobacter pylori infection is not associated with diabetes mellitus, nor with upper gastrointestinal symptoms in diabetes mellitus.

OBJECTIVE: The association between Helicobacter pylori (H. pylori) infection and diabetes mellitus is controversial. We aimed to determine the prevalence of H. pylori infection in patients with diabetes and nondiabetic controls, and assess whether H. pylori infection was associated with upper gastrointestinal (GI) symptoms in diabetes mellitus. METHODS: A total of 429 patients with type 1 (n = 49) or type 2 (n = 380) diabetes mellitus (48.6% women, mean age 60.7 yr) and 170 nondiabetic controls (34.7% women, mean age 60.4 yr) were evaluated. All subjects completed a validated questionnaire (the Diabetes Bowel Symptom Questionnaire) to determine upper GI symptoms, and a blood sample was tested for H. pylori infection using a validated ELISA kit (sensitivity 96%, specificity 94%). RESULTS: Seroprevalence of H. pylori was 33% and 32%, respectively, in patients with diabetes and controls (NS). In both groups, the seroprevalence was significantly higher in men than in women; 39% vs 25% (p = 0.002) in diabetic patients, and 40% vs 20% (p = 0.01) in controls. Patients with diabetes had a significantly higher prevalence of early satiety (OR = 2.30), fullness (OR = 3.15), and bloating (OR = 1.50) compared with controls. Upper GI symptoms were present in 49% of H. pylori-positive and 53% of H. pylori-negative patients with diabetes (OR = 0.87, 95% CI 0.58-1.31, p = 0.56). H. pylori infection was also not associated with any of the individual upper GI symptoms before or after adjustment for potential confounding factors. However, patient age and female gender were identified as independent risk factors for upper GI symptoms. Smoking was a risk factor for bloating and early satiety. CONCLUSIONS: H. pylori infection appears not to be associated with diabetes mellitus or upper GI symptoms in diabetes mellitus.

Diabetes Complications↗
PubMed2001

Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?

OBJECTIVE: Different subgroups can be identified in functional dyspepsia based on symptom type or severity, and may correlate with pathophysiological disturbances. In particular, female sex and severe fullness and vomiting have been reported to be strong independent predictors of slow solid gastric emptying. We aimed to determine if symptom patterns or severity could identify those with abnormal gastric emptying among patients with dysmotility-like functional dyspepsia and, for comparison, type I diabetes mellitus. METHODS: Patients with postprandial symptoms and documented functional dyspepsia by endoscopy (n = 551) and patients with type I diabetes who had postprandial dyspepsia (n = 247) enrolling in two separate randomized controlled trials were evaluated at baseline. Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated C13 octanoic acid breath test with sampling over 4 h. A self-report questionnaire measured the presence and severity of eight symptoms on visual analog scales. The validated Nepean Dyspepsia Index measured the frequency, severity, and bothersomeness of 15 upper GI symptoms on Likert scales. RESULTS: Gastric emptying was definitely delayed (t1/2 > 192 min) in 24% of patients with functional dyspepsia and 28% with diabetes. Delayed gastric emptying was associated with female gender but not age or Helicobacter pylori status. The age- and sex-adjusted risk (odds ratio) of delayed gastric emptying for the upper GI symptoms ranged from 0.99 to 1.0 (all p values > or =0.2). The results were very similar in functional dyspepsia and diabetes. There was also no correlation between t1/2 and number of symptoms or symptom severity scores. CONCLUSIONS: Symptom prevalence and severity were similar in dyspeptic patients with and without delayed gastric emptying. Specific symptoms do not seem to be of predictive value in dysmotility-like dyspepsia for identifying alterations of gastric emptying.

Adult↗
PubMed2001

The irritable bowel syndrome and psychiatric disorders in the community: is there a link?

OBJECTIVE: Psychiatric morbidity is high among patients who present to referral centers with irritable bowel syndrome (IBS). However, few studies have investigated the relationship between psychiatric disturbance and IBS in community samples. We hypothesized that psychiatric disorders are linked to IBS in the general community, but this is influenced by the criteria used to establish a diagnosis of IBS. METHODS: The data were collected from a birth cohort born in Dunedin (New Zealand) between April 1972 and March 1973. This cohort consisted of 1037 members (52% male), who were assessed at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, and 26 yr. GI symptoms were recorded at age 26 yr, using an abbreviated version of the Bowel Symptom Questionnaire; psychiatric history was obtained at ages 18 and 21 yr, using a modified version of the Diagnostic Interview Schedule. RESULTS: The prevalence of IBS was 12.7% according to the Manning criteria and 4.3% according to the Rome II criteria. The IBS was not significantly related to a diagnostic history for psychiatric illness overall, nor to a history of anxiety disorders, depressive disorders, and substance dependence. These results were independent of the IBS criteria used; there was no association between psychiatric history and IBS when IBS was defined according to the Manning criteria (p = 0.11 to 0.98) or the Rome criteria (p = 0.18 to 0.92): Rome and Manning criteria subjects did not significantly differ from each other in terms of psychiatric history (p = 0.16 to 0.89). CONCLUSION: In a cohort of young adults with IBS from New Zealand, IBS appears to not be related to psychiatric disorders.

Adolescent↗
PubMed2001

Abdominal wall muscle activity in irritable bowel syndrome with bloating.

OBJECTIVE: Recurrent episodes of bloating and visible abdominal distension are common and distressing in irritable bowel syndrome, but the mechanisms are unknown. Patients often note that the distension is most pronounced in the upright posture, suggesting that the bloating may be the result of a decrease or absence of the normal rise in electromyograph activity in the abdominal wall muscles when standing. There are no reports of noninvasive electromyograph recordings of abdominal wall muscles in irritable bowel syndrome. We examined the hypothesis that abdominal distension is the result of relaxation of anterior abdominal wall musculature. METHODS: Studies were performed on patients with irritable bowel syndrome and a history of visible distension (n = 11, mean age 48.6 yr, body mass index 24.8) and normal volunteers (n = 13, mean age 39.9 yr, body mass index 24.6). Surface recordings of muscle activity were made while subjects were lying, performing voluntary contraction of the abdominal wall, and standing. The examiners were blind as to the clinical status of the subjects. RESULTS: There were no differences in abdominal wall muscle activity (by electromyograph voltage) when comparing patients with irritable bowel syndrome to normal volunteers (e.g., relaxed lower abdomen supine mean electromyograph voltage in irritable bowel syndrome was 14.0 vs 14.6 in controls, p = 0.7, and relaxed lower abdomen standing in irritable bowel syndrome was 29.6 vs 25.2 in controls, p = 0.4). There was increased activity in both groups when contracting the muscles and when standing. CONCLUSIONS: Patterns of abdominal wall muscle activity do not differ between normal subjects and patients with irritable bowel syndrome. However, there is a clear increase in muscle activity in the standing position. Episodic distension is unlikely to be due to permanent anterior abdominal muscle weakness or a persistent inability of the muscles to activate with standing in irritable bowel syndrome.

Abdominal Muscles↗
PubMed2001

Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors.

OBJECTIVES: Health care use is a costly outcome of the irritable bowel syndrome (IBS) and nonulcer dyspepsia (NUD), but the predictors of this behavior remain poorly defined. We aimed to systematically review the literature to determine which symptoms and psychosocial factors drive health care seeking in these disorders. METHODS: A broad based MEDLINE and Current Contents search between 1966 and 2000 identified 44 relevant publications. References from these articles were also reviewed. RESULTS: The literature suggests that symptom severity is an important factor, but only explains a small proportion of the health care seeking behavior associated with these disorders in population-based studies. Psychosocial factors including life event stress, psychological morbidity, personality, abuse and abnormal illness attitudes and beliefs have been found to characterize those that seek help versus those that do not. The role of other psychosocial factors such as social support, coping style and knowledge about illness are as yet undetermined. CONCLUSIONS: A model for health care seeking for IBS and NUD, with an emphasis on psychosocial factors is presented, but remains to be tested.

Colonic Diseases, Functional↗
PubMed2001

Quality of life in patients with endoscopy-negative heartburn: reliability and sensitivity of disease-specific instruments.

OBJECTIVES: Endoscopy-negative gastroesophageal reflux disease (GERD) lacks objective markers of disease severity. Evaluation of therapies for GERD must therefore rely on subjective measures, including patient self-report questionnaires, to measure the clinical effectiveness of therapeutic interventions. We aimed to evaluate the previously validated Gastrointestinal Symptoms Rating Scale (GSRS) and the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires for reliability and responsiveness to change over time. METHODS: Patients (n = 1143) with heartburn, but no esophagitis included in a randomized clinical trial assessing the effectiveness of active treatment with proton pump inhibitors over 4 wk were evaluated. RESULTS: The test-retest reliability of both questionnaires over time was good to excellent (GSRS 0.53-0.69; QOLRAD 0.65-0.76), as was the responsiveness estimated by standardized response means (GSRS reflux dimension, -1.43; QOLRAD 0.81-1.43) and effect sizes (GRSR reflux dimension, -1.74; QOLRAD 0.82-1.56). The relationship between improvement in the GSRS reflux dimension score and the amount of clinical benefit as estimated by the patients themselves (based on the Overall Treatment Evaluation) suggested a minimally clinical relevant change is 0.5 on the seven graded scales applied. The importance rating indicated that an important change in the GSRS reflux dimension and the QOLRAD dimensions is equivalent to 1.0, and a very important change to 1.5. CONCLUSIONS: The GSRS and QOLRAD are valid questionnaires that are reliable and sensitive to change. Both questionnaires should be suitable for use in clinical trials of therapeutic interventions for patients with heartburn.

Adolescent↗
PubMed2001

Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study.

OBJECTIVE: Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community-based studies are sparse, and long-term natural history data are unavailable. We aimed to determine the natural history of these conditions. METHODS: A representative Swedish sample (20-79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively; 79% responded to all three mailings). RESULTS: The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (<10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in > or = 90% of cases. CONCLUSION: There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD.

Adult↗
PubMed2001

Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15 000 Australian adults.

BACKGROUND: The association of social class with health has been extensively studied, yet relationships between social class and gastrointestinal symptoms remain almost unexplored. AIMS: To examine relationships between social class and gastrointestinal symptoms in a population sample. METHODS: The prevalence of 16 troublesome gastrointestinal symptoms was determined by a postal questionnaire sent to 15 000 subjects (response rate 60%) and compared with a validated composite measure of socioeconomic status (index of relative socioeconomic disadvantage). Comparisons across social class were explored for five symptom categories (oesophageal symptoms; upper dysmotility symptoms; bowel symptoms; diarrhoea; and constipation). Results are reported as age standardised rate ratios with the most advantaged social class as the reference category. RESULTS: There were clear trends for the prevalence rates of all gastrointestinal symptoms to increase with decreasing social class. These trends were particularly strong for the five symptom categories. Lower social class was associated with a significantly (p<0.0001) higher number of symptoms reported overall and with a higher proportion of individuals reporting 1-2 symptoms and more than five symptoms. In both sexes, the most pronounced effects for subjects in the lowest social class were found for constipation (males: rate ratio 1.83 (95% confidence intervals (CI) 1.16-2.51); females: rate ratio 1.68 (95% CI 1.31-2.04)) and upper dysmotility symptoms (males: rate ratio 1.45 (95% CI 1.02-1.88); females: rate ratio 1.35 (95% CI 1.07-1.63)). Oesophageal symptoms and diarrhoea were not associated with social class. CONCLUSIONS: Troublesome gastrointestinal symptoms are linked to socioeconomic status with more symptoms reported by subjects in low socioeconomic classes. Low socioeconomic class should be considered a risk factor for both upper and lower gastrointestinal symptoms.

Adult↗
PubMed2001

Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial.

INTRODUCTION: Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying. METHODS: Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit. RESULTS: The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms. CONCLUSIONS: The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.

Adolescent↗
PubMed2001

Helicobacter pylori infection--current treatment practice.

Helicobacter pylori infection, which is present in 30 - 60% of the population in developed countries and in more than 60% in developing countries, is established to be a major cause of gastritis, peptic ulcer disease and gastric cancer. Eradication therapy has been incorporated into clinical practice over the past 15 years. Treatment regimens include a 2 week bismuth-based triple therapy (a bismuth compound plus metronidazole, tetracycline or amoxycillin), a 1 week proton-pump inhibitor (PPI)-based triple therapy and a 1 week ranitidine bismuth citrate (RBC)-based triple therapy (a PPI or RBC plus any two of the three antibiotics, metronidazole, amoxycillin and clarithromycin). These regimens achieve eradication rates of >> 80%. H. pylori resistance to metronidazole and clarithromycin decreases the clinical efficacy of most regimens, despite the high eradication rates for resistant strains achieved by the RBC-triple therapy in some recent trials. The dose of antibiotics (especially clarithromycin) and the duration of treatment may also influence the eradication rate. Doctors' beliefs impact on clinical practice and, thus, influence the clinical application of eradication therapy. Whereas peptic ulcer disease and primary gastric low-grade B-cell mucosa-associated lymphoid tissue lymphoma (MALToma) have become established as definite indications for eradication therapy, there remain controversies surrounding non-ulcer dyspepsia, gastro-oesophageal reflux disease, atrophic gastritis, intestinal metaplasia, use of non-steroidal anti-inflammatory drugs (NSAIDs) and H. pylori-related extradigestive diseases.

Aged↗
PubMed2001

Drug therapy options for patients with irritable bowel syndrome.

Existing pharmacotherapeutic options for the treatment of patients with irritable bowel syndrome (IBS) are limited in treating the multiple symptoms associated with the disorder. There is much interest in the use of serotonin agents as new therapeutics. Acting primarily through 5-HT3 and 5-HT4 receptors, serotonin elicits changes in motor function and possibly visceral sensation. Two serotonin agents were developed specifically for IBS: tegaserod, a 5-HT4 receptor partial agonist, and alosetron, a 5-HT3 receptor antagonist (which is no longer available). Phase III clinical trial data show that during a 12-week treatment period with tegaserod, IBS patients with abdominal pain and discomfort, bloating, and constipation experienced significant global relief (i.e., improvement in overall well-being, abdominal pain, and bowel habit) compared with placebo. Improvement in bowel movement frequency and consistency was achieved and pain was relieved by 1 week. During 12 weeks of treatment, alosetron was shown to elicit significant relief of abdominal pain and discomfort compared with placebo or mebeverine in female IBS patients with diarrhea. Alosetron slowed colonic transit and treatment efficacy was apparent after a week of treatment. Another 5-HT4 receptor agonist, prucalopride, which is being developed for chronic constipation, accelerates colonic transit and increases stool frequency. Therefore, this agent may be of benefit in IBS patients with constipation.

Abdominal Pain↗
PubMed2000

Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease.

OBJECTIVE: To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease. DESIGN: Cross-sectional study of peptic ulcer disease in prospectively recruited PATIENTS undergoing gastroscopy. PATIENTS: 277 consecutive patients referred for gastroscopy in 1996-1998. MAIN OUTCOME MEASURES: Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers. RESULTS: 54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups. CONCLUSIONS: Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.

Adolescent↗