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Paul Moayyedi - One of the best experts on this subject based on the ideXlab platform.
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global prevalence of and risk factors for uninvestigated Dyspepsia a meta analysis
Gut, 2015Co-Authors: Avantika Marwaha, Alexander C Ford, Ruchit Sood, Paul MoayyediAbstract:Objectives Many cross-sectional surveys have reported the prevalence of uninvestigated Dyspepsia, but there has been no recent systematic review of data from all studies to determine its global prevalence and risk factors. Design MEDLINE, EMBASE and EMBASE Classic were searched (until January 2014) to identify population-based studies that reported the prevalence of uninvestigated Dyspepsia in adults (≥15 years old); Dyspepsia was defined using symptom-based criteria or questionnaires. The prevalence of Dyspepsia was extracted for all studies and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, ORs and 95% CIs were calculated. Results Of the 306 citations evaluated, 103 reported the prevalence of uninvestigated Dyspepsia in 100 separate study populations, containing 312 415 subjects. Overall pooled prevalence in all studies was 20.8% (95% CI 17.8% to 23.9%). The prevalence varied according to country (from 1.8% to 57.0%) and criteria used to define Dyspepsia. The greatest prevalence values were found when a broad definition of Dyspepsia (29.5%; 95% CI 25.3% to 33.8%) or upper abdominal or epigastric pain or discomfort (20.4%; 95% CI 16.3% to 24.8%) were used. The prevalence was higher in women (OR 1.24; 95% CI 1.13 to 1.36), smokers (OR 1.25; 95% CI 1.12 to 1.40), non-steroidal anti-inflammatory drug (NSAID) users (OR 1.59; 95% CI 1.27 to 1.99) and Helicobacter pylori -positive individuals (OR 1.18; 95% CI 1.04 to 1.33). Conclusions The overall pooled prevalence of uninvestigated Dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori -positive individuals, although these associations were modest.
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the rome iii criteria for the diagnosis of functional Dyspepsia in secondary care are not superior to previous definitions
Gastroenterology, 2014Co-Authors: Alexander C Ford, Premysl Bercik, David Morgan, Carolina Bolino, M I Pintossanchez, Paul MoayyediAbstract:Background & Aims Although the Rome III criteria for functional Dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. Methods We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional Dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. Results Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional Dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional Dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional Dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional Dyspepsia. Conclusions In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional Dyspepsia, and were not significantly superior to previous definitions.
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helicobacter pylori infection in functional Dyspepsia
Nature Reviews Gastroenterology & Hepatology, 2013Co-Authors: Hidekazu Suzuki, Paul MoayyediAbstract:Helicobacter pylori infection is one likely cause of functional Dyspepsia. Here, the authors discuss the clinical evidence in relation to H. pylori eradication in patients with functional Dyspepsia if they test positive for this bacterium.
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pharmacological interventions for non ulcer Dyspepsia
Cochrane Database of Systematic Reviews, 2011Co-Authors: Paul Moayyedi, Soo Shelly, Jonathan J Deeks, Brendan Delaney, Michael Innes, David FormanAbstract:Reason for withdrawal from publication Review withdrawn (December 2010) and being split in to four new reviews: Prokinetics for functional Dyspepsia H2 receptor antagonists for functional Dyspepsia Proton pump inhibitors for functional Dyspepsia Antacids, sucralfate and bismuth salts for functional Dyspepsia
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eradication of helicobacter pylori for non ulcer Dyspepsia
Cochrane Database of Systematic Reviews, 2011Co-Authors: Paul Moayyedi, Jonathan J Deeks, Brendan Delaney, Michael Innes, Adam Harris, R Oakes, Susan R Wilson, A Roalfe, Cathy Bennett, David FormanAbstract:BACKGROUND: Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer Dyspepsia is less clear. OBJECTIVES: To determine the effect of H pylori eradication on Dyspepsia symptoms and quality of life scores in patients with non-ulcer Dyspepsia. SEARCH STRATEGY: Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of Dyspepsia and with pharmaceutical companies. SELECTION CRITERIA: All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer Dyspepsia. DATA COLLECTION AND ANALYSIS: Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms. MAIN RESULTS: Seven randomised controlled trials were included in the systematic review. Five trials compared proton pump inhibitor dual or triple therapy with a proton pump inhibitor + placebo antibiotics, and evaluated Dyspepsia at 6-12 months in 1,385 patients. H pylori eradication was significantly superior to placebo in treating non ulcer Dyspepsia (relative risk reduction = 7%; 95% CI = 1% to 12%; p=0.02) and there was no significant heterogeneity between the studies. The number needed to treat to cure one case of Dyspepsia = 19 (95% CI = 11 to 132). A further two trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer Dyspepsia. REVIEWER'S CONCLUSIONS: H pylori eradication may be an effective therapy for H pylori positive non-ulcer Dyspepsia. This result is not robust and further evidence on the efficacy of H pylori eradication in non ulcer Dyspepsia would be helpful. The effect is modest and economic models would help establish whether this approach is cost-effective. This review will be updated as results from other ongoing trials (Malfertheiner 2000) are made available.
Nicholas J. Talley - One of the best experts on this subject based on the ideXlab platform.
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anxiety is associated with uninvestigated and functional Dyspepsia rome iii criteria in a swedish population based study
Gastroenterology, 2009Co-Authors: Pertti Aro, Nicholas J. Talley, Jukka Ronkainen, Tom Storskrubb, Michael Vieth, Svenerik Johansson, Elisabeth Bolling Sternevald, Lars AgreusAbstract:Background & Aims The Rome III criteria for functional Dyspepsia have been changed to include 2 distinct syndromes: postprandial distress syndrome and epigastric pain syndrome. We investigated risk factors for functional Dyspepsia among the functional Dyspepsia subgroups defined by the Rome III criteria. Methods We performed a cross-sectional population-based study in a primary care setting (the Kalixanda study). A random sample (n = 2860) of the adult population from 2 northern Swedish municipalities (n = 21,610) was surveyed using a validated postal questionnaire to assess gastrointestinal symptoms (response rate, 74.2%; n=2122). A randomly selected subgroup (n = 1001) of responders was invited to undergo an esophagogastroduodenoscopy (participation rate, 73.3%) including biopsy specimen collection, Helicobacter pylori culture and serology, and symptom assessments. Results Of the 1001 subjects examined by endoscopy, 202 (20.2%; 95% confidence interval [CI], 17.7–22.7) were classified as having uninvestigated Dyspepsia and 157 (15.7%; 95% CI, 13.4–18.0) as having functional Dyspepsia. Major anxiety (Hospital Anxiety and Depression Scale score ≥11) was associated with uninvestigated Dyspepsia (odds ratio [OR], 3.01; 95% CI, 1.39–6.54), as was obesity (body mass index ≥30 kg/m2) (OR, 1.86; 95% CI, 1.15–3.01). Major anxiety was associated with functional Dyspepsia and postprandial distress syndrome (OR of 2.56 [95% CI, 1.06–6.19] and 4.35 [95% CI, 1.81–10.46], respectively), as was use of nonsteroidal anti-inflammatory drugs (OR, 2.49 [95% CI, 1.29–4.78] and 2.75 [95% CI, 1.38–5.50], respectively). Depression was not associated with any Dyspepsia group. Conclusions Anxiety but not depression is linked to uninvestigated Dyspepsia, functional Dyspepsia, and postprandial distress syndrome but not to epigastric pain syndrome.
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non ulcer Dyspepsia and duodenal eosinophilia an adult endoscopic population based case control study
Clinical Gastroenterology and Hepatology, 2007Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, Pertti Aro, Jukka Ronkainen, Tom Storskrubb, Marjorie M Walker, Laura Hindley, Scott W Harmsen, Lars AgreusAbstract:Background & Aims: Functional abnormalities of the duodenum have been observed in non-ulcer Dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer Dyspepsia. Methods: A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer Dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. Results: The odds ratio for non-ulcer Dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, ≥22, relative to
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functional Dyspepsia delayed gastric emptying and impaired quality of life
Gut, 2006Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, G R Locke, Brian D Lahr, Gervais Tougas, Gregory Ligozio, Mikhail Rojavin, Jan TackAbstract:Background: It remains controversial as to whether delayed gastric emptying in functional Dyspepsia is associated with a specific symptom pattern, and it is unknown if gastric emptying in functional Dyspepsia is a driver of impaired health related quality of life (HRQOL). We aimed to evaluate the relationship between functional Dyspepsia symptoms, gastric emptying, and HRQOL. Methods: US patients (n = 864; mean age 44 years (range 18–82); 74% female) with functional Dyspepsia, as defined by Rome II criteria, were enrolled into one of four clinical trials. All patients had a baseline scintigraphic assessment of gastric emptying of an egg substitute meal, and the trials were stratified on this assessment. Delayed gastric emptying was defined as having at least 6.3% residual volume at four hours. A total of 290 (34%) patients had delayed gastric emptying. HRQOL was assessed by the SF 36 and Nepean Dyspepsia index (NDI). Results: Postprandial fullness was independently associated with delayed gastric emptying but the association was weak (odds ratio (OR) 1.98 (95% confidence interval (CI) 1.02, 3.86); p = 0.04). No independent association was seen with epigastric pain, early satiety, nausea, or bloating. Mean SF 36 physical composite score (PCS) was 42.3 (95% CI 41.6, 43.0) and the mean SF 36 mental composite score (MCS) was 46.8 (95% CI 46.0, 47.5); both mean scores were significantly lower than age and sex adjusted national norms of 50 (p Conclusions: In patients with functional Dyspepsia selected for a clinical trial programme, gastric emptying did not usefully stratify them symptomatically. Quality of life of patients with functional Dyspepsia enrolled in this clinical trial programme was significantly impaired but this was not explained by delayed gastric emptying.
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systemic review the prevalence and clinical course of functional Dyspepsia
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Hashem B Elserag, Nicholas J. TalleyAbstract:Summary Aim : To examine the prevalence of functional Dyspepsia in the general population, and to evaluate the natural history/clinical course of patients with functional Dyspepsia. Methods : Full-length published manuscripts during 1980–2002 were included if: (i) participants had uninvestigated or functional Dyspepsia; (ii) Dyspepsia was defined; (iii) for prevalence, population-based samples were evaluated; (iv) for prognosis, the total number of the inception cohort and the total number of individuals available at the end of follow-up were reported. Results : Twenty-two studies (1976–2002) that examined the prevalence of Dyspepsia fulfilled the inclusion and exclusion criteria; 17 studies examined more than 1000 participants, but only two studies provided information sufficient to calculate the prevalence of functional Dyspepsia (11.5–14.7%). The prevalence of uninvestigated Dyspepsia was in the range 10–40%. When the definition of Dyspepsia was restricted to participants with upper abdominal pain, irrespective of the presence of heartburn or acid regurgitation, the prevalence rate estimate was 5–12%. Thirteen studies examined the clinical course of functional Dyspepsia (seven retrospective and six prospective). Sample sizes were small (n = 35–209). A follow-up ascertainment of symptoms amongst individuals in the original cohorts was obtained in 92.5–98.2% of prospective studies and in 67.7–82.2% of retrospective studies. The follow-up duration was in the range 1.5–10 years for prospective studies and 5–27 years for retrospective studies; the median follow-up duration for all studies was approximately 5 years. A variable prognosis was reported. An outcome of symptom improvement or becoming asymptomatic was reported in at least one-half of patients in 10 of the 13 studies, and in at least two-thirds of patients in six of the 13 studies. Prognostic factors were inconsistent and, in general, poorly described. Conclusions : Functional Dyspepsia is prevalent world-wide, but the prognosis remains poorly defined. There is a need for population-based studies to examine the prevalence and clinical course of documented functional Dyspepsia.
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abc of the upper gastrointestinal tract indigestion when is it functional
BMJ, 2001Co-Authors: Nicholas J. Talley, Nghi Phung, Jamshid S KalantarAbstract:Patients often complain of indigestion, but what do they mean? Indigestion is an old English word that means lack of adequate digestion, but patients and doctors interpret this in different ways. Many patients mean heartburn or acid regurgitation, the classic symptoms of gastro-oesophageal reflux disease. Some describe belching, abdominal rumblings, or even bad breath as indigestion. Others mean pain localised to the epigastrium or a non-painful discomfort in the upper abdomen which may be described as fullness, bloating, or an inability to finish a normal meal (early satiety). Dyspepsia is best restricted to mean pain or discomfort centred in the upper abdomen. #### Major structural causes of Dyspepsia Overlap of subgroups of Dyspepsia based on symptoms in patients with documented functional Dyspepsia There are many causes of Dyspepsia, but at least two thirds of patients have no structural or biochemical explanation for their symptoms. It has been suggested that Dyspepsia can be subdivided based on groups (or clusters) of symptoms. However, subgroups have not proved to be of value in identifying the underlying cause of Dyspepsia and overlap considerably. Some patients report having troublesome burping associated with abdominal bloating or discomfort that is transiently relieved by bringing up the wind. These patients have aerophagy, and repeated swallowing of air may be obvious during the consultation. History taking is key to identifying the likely cause of Dyspepsia. ### Gastro-oesophageal reflux disease It is important and practical to distinguish gastro-oesophageal reflux disease (GORD) from Dyspepsia. Frequent heartburn is a cardinal symptom of GORD; acid reflux causes a retrosternal or epigastric burning feeling that characteristically radiates up towards the throat, is relieved transiently by antacids, and is precipitated by a meal or by lying down. #### Uncommon causes of upper abdominal pain or discomfort that may be confused with Dyspepsia
Alexander C Ford - One of the best experts on this subject based on the ideXlab platform.
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low dose imipramine for refractory functional Dyspepsia a randomised double blind placebo controlled trial
The Lancet Gastroenterology & Hepatology, 2018Co-Authors: Pui Kuan Cheong, Alexander C Ford, Cynthia K Cheung, Jessica Y L Ching, Y C Chan, Joseph J Y Sung, Francis K L ChanAbstract:Summary Background Guidelines recommend the use of neuromodulators in patients with functional Dyspepsia not responding to proton pump inhibitors (PPIs) and prokinetics; however, there is a lack of data from randomised controlled trials supporting their use. We aimed to assess the safety and efficacy of imipramine, a tricyclic antidepressant (TCA), in treatment-refractory functional Dyspepsia. Methods In this single-centre, double-blind, randomised controlled trial, we enrolled consecutive patients with Rome II functional Dyspepsia aged 18–80 years. Eligible patients were Helicobacter pylori-negative, had a normal upper gastrointestinal endoscopy and abdominal ultrasound, and remained symptomatic after open-label treatment with 8 weeks of esomeprazole and 4 weeks of domperidone. Patients completed questionnaires assessing Dyspepsia symptoms, mood, and insomnia, and were then randomly assigned (1:1) via a computer-generated list of random numbers to receive imipramine (at a dose of 25 mg once nightly for the first 2 weeks, and then 50 mg thereafter) or placebo for 12 weeks. The primary endpoint was overall satisfactory relief of global Dyspepsia symptoms at 12 weeks, via patient-reported assessment in the intention-to-treat population. This trial is registered with ClinicalTrials.gov , number NCT00164775 , and is completed. Findings Between Sept 11, 2005, and Aug 20, 2010, 107 patients with treatment-refractory functional Dyspepsia were randomly assigned to receive imipramine (n=55) or placebo (n=52). Relief of global Dyspepsia symptoms at 12 weeks occurred in 35 (63·6%, 95% CI 50·4–75·1) of 55 patients on imipramine compared with 19 (36·5%, 95% CI 24·8–50·1) of 52 on placebo (p=0·0051). Ten (18%) patients on imipramine discontinued the study due to adverse events (three dry mouth, two constipation, two drowsiness, and one each insomnia, palpitations, and blurred vision), compared with four (8%) on placebo (one dry mouth and constipation, and one each palpitations, worsening of gastro-oesophageal reflux, and limb paraesthesia). There were no serious adverse events. Interpretation Low-dose imipramine should be considered as a possible therapy for patients with functional Dyspepsia refractory to both PPIs and prokinetics, although patients should be cautioned about the adverse event profile. Funding None.
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global prevalence of and risk factors for uninvestigated Dyspepsia a meta analysis
Gut, 2015Co-Authors: Avantika Marwaha, Alexander C Ford, Ruchit Sood, Paul MoayyediAbstract:Objectives Many cross-sectional surveys have reported the prevalence of uninvestigated Dyspepsia, but there has been no recent systematic review of data from all studies to determine its global prevalence and risk factors. Design MEDLINE, EMBASE and EMBASE Classic were searched (until January 2014) to identify population-based studies that reported the prevalence of uninvestigated Dyspepsia in adults (≥15 years old); Dyspepsia was defined using symptom-based criteria or questionnaires. The prevalence of Dyspepsia was extracted for all studies and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, ORs and 95% CIs were calculated. Results Of the 306 citations evaluated, 103 reported the prevalence of uninvestigated Dyspepsia in 100 separate study populations, containing 312 415 subjects. Overall pooled prevalence in all studies was 20.8% (95% CI 17.8% to 23.9%). The prevalence varied according to country (from 1.8% to 57.0%) and criteria used to define Dyspepsia. The greatest prevalence values were found when a broad definition of Dyspepsia (29.5%; 95% CI 25.3% to 33.8%) or upper abdominal or epigastric pain or discomfort (20.4%; 95% CI 16.3% to 24.8%) were used. The prevalence was higher in women (OR 1.24; 95% CI 1.13 to 1.36), smokers (OR 1.25; 95% CI 1.12 to 1.40), non-steroidal anti-inflammatory drug (NSAID) users (OR 1.59; 95% CI 1.27 to 1.99) and Helicobacter pylori -positive individuals (OR 1.18; 95% CI 1.04 to 1.33). Conclusions The overall pooled prevalence of uninvestigated Dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori -positive individuals, although these associations were modest.
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the rome iii criteria for the diagnosis of functional Dyspepsia in secondary care are not superior to previous definitions
Gastroenterology, 2014Co-Authors: Alexander C Ford, Premysl Bercik, David Morgan, Carolina Bolino, M I Pintossanchez, Paul MoayyediAbstract:Background & Aims Although the Rome III criteria for functional Dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. Methods We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional Dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. Results Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional Dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional Dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional Dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional Dyspepsia. Conclusions In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional Dyspepsia, and were not significantly superior to previous definitions.
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what is the prevalence of clinically significant endoscopic findings in subjects with Dyspepsia systematic review and meta analysis
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Alexander C Ford, Avantika Marwaha, Allen Lim, Paul MoayyediAbstract:Background & Aims Evolving definitions of Dyspepsia may lead to differences in the prevalence of clinically significant findings encountered at upper gastrointestinal (GI) endoscopy in sufferers. However, few studies report the prevalence of endoscopic findings in individuals with Dyspepsia. We conducted a systematic review and meta-analysis examining this. Methods MEDLINE and EMBASE were searched through April 2010 to identify relevant articles (23,457 citations). Eligible studies recruited adults from the community, workplace, blood donation or screening clinics, family physician offices, or internal medicine clinics. Studies were required to report prevalence of Dyspepsia and perform upper gastrointestinal endoscopy in a proportion of, or all, participants. Prevalence of clinically significant endoscopic findings in subjects with and without Dyspepsia was pooled for all studies, and compared using odds ratios and 95% confidence intervals. Results Of 240 papers evaluated, 151 reported prevalence of Dyspepsia. Nine reported prevalence of endoscopic findings among 5389 participants. Erosive esophagitis was the most common abnormality encountered (pooled prevalence 13.4%) followed by peptic ulcer (pooled prevalence 8.0%). The only finding encountered more frequently in individuals with Dyspepsia, compared with those without, was peptic ulcer (odds ratio, 2.07; 95% confidence interval, 1.52–2.82). Prevalence of erosive esophagitis was lower when the Rome criteria were used to define Dyspepsia compared with a broad definition (6% vs 20%). Conclusions Erosive esophagitis was the most common finding encountered at endoscopy for Dyspepsia, though prevalence was lower when the Rome criteria were used to define Dyspepsia. Only peptic ulcer was more common in individuals with Dyspepsia.
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systematic review and meta analysis of the prevalence of irritable bowel syndrome in individuals with Dyspepsia
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Alexander C Ford, Avantika Marwaha, Allen Lim, Paul MoayyediAbstract:Background & Aims Dyspepsia and irritable bowel syndrome (IBS) are common conditions that can coexist in patients. We performed a systematic review and meta-analysis to estimate prevalence of IBS in Dyspepsia. Methods Relevant articles published through August 2008 were identified from MEDLINE and EMBASE literature searches (23,457 citations). Eligible studies included adults recruited from the community, the workplace, blood donation or screening clinics, and family physician offices or internal medicine clinics. Selected studies reported prevalence of Dyspepsia and IBS within the same population. The prevalence of IBS in subjects with and without Dyspepsia was pooled for all studies and compared. Odds ratios (OR) and confidence intervals (CI) were calculated. The degree of overlap between Dyspepsia and IBS was determined. Results Of 239 papers evaluated, 150 reported prevalence of Dyspepsia and 19 (involving 18,173 subjects) reported the proportion of subjects with IBS within the same population. The prevalence of Dyspepsia was 27% (95% CI, 23%–31%). The prevalence of IBS in subjects with Dyspepsia was 37% (95% CI, 30%–45%) compared with 7% (95% CI, 5%–10%) in those without. The pooled OR for IBS in subjects with Dyspepsia was 8 (95% CI, 5.74–11.16). The degree of overlap between the 2 conditions varied from 15% to 42%, depending on diagnostic criteria used for each. Conclusions Individuals with Dyspepsia have an 8-fold increase in prevalence of IBS compared with the population. The strength of the association suggests common pathogenic mechanisms. Dyspeptic patients should be assessed routinely for IBS.
Alan R Zinsmeister - One of the best experts on this subject based on the ideXlab platform.
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non ulcer Dyspepsia and duodenal eosinophilia an adult endoscopic population based case control study
Clinical Gastroenterology and Hepatology, 2007Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, Pertti Aro, Jukka Ronkainen, Tom Storskrubb, Marjorie M Walker, Laura Hindley, Scott W Harmsen, Lars AgreusAbstract:Background & Aims: Functional abnormalities of the duodenum have been observed in non-ulcer Dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer Dyspepsia. Methods: A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer Dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. Results: The odds ratio for non-ulcer Dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, ≥22, relative to
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functional Dyspepsia delayed gastric emptying and impaired quality of life
Gut, 2006Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, G R Locke, Brian D Lahr, Gervais Tougas, Gregory Ligozio, Mikhail Rojavin, Jan TackAbstract:Background: It remains controversial as to whether delayed gastric emptying in functional Dyspepsia is associated with a specific symptom pattern, and it is unknown if gastric emptying in functional Dyspepsia is a driver of impaired health related quality of life (HRQOL). We aimed to evaluate the relationship between functional Dyspepsia symptoms, gastric emptying, and HRQOL. Methods: US patients (n = 864; mean age 44 years (range 18–82); 74% female) with functional Dyspepsia, as defined by Rome II criteria, were enrolled into one of four clinical trials. All patients had a baseline scintigraphic assessment of gastric emptying of an egg substitute meal, and the trials were stratified on this assessment. Delayed gastric emptying was defined as having at least 6.3% residual volume at four hours. A total of 290 (34%) patients had delayed gastric emptying. HRQOL was assessed by the SF 36 and Nepean Dyspepsia index (NDI). Results: Postprandial fullness was independently associated with delayed gastric emptying but the association was weak (odds ratio (OR) 1.98 (95% confidence interval (CI) 1.02, 3.86); p = 0.04). No independent association was seen with epigastric pain, early satiety, nausea, or bloating. Mean SF 36 physical composite score (PCS) was 42.3 (95% CI 41.6, 43.0) and the mean SF 36 mental composite score (MCS) was 46.8 (95% CI 46.0, 47.5); both mean scores were significantly lower than age and sex adjusted national norms of 50 (p Conclusions: In patients with functional Dyspepsia selected for a clinical trial programme, gastric emptying did not usefully stratify them symptomatically. Quality of life of patients with functional Dyspepsia enrolled in this clinical trial programme was significantly impaired but this was not explained by delayed gastric emptying.
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helicobacter pylori and Dyspepsia a population based study of the organism and host
The American Journal of Gastroenterology, 2000Co-Authors: Richard G Locke, Nicholas J. Talley, Alan R Zinsmeister, Daniel K Nelson, Ken Haruma, Amy L Weaver, Joseph L MeltonAbstract:OBJECTIVE: The role of Helicobacter pylori (HP) infection in Dyspepsia in the absence of peptic ulcer remains controversial. Specific attributes of the organism or the host response may be important. We aimed to determine whether HP infection overall, CagA status, serum gastrin, or serum pepsinogen levels are associated with Dyspepsia in the community. METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota residents, aged 20–50 yr. All respondents who reported symptoms of Dyspepsia or irritable bowel syndrome (cases) and all respondents without significant GI symptoms (controls) were invited to participate (n = 260). They were each assessed by a physician and their medical records reviewed. Serum was obtained to measure HP and CagA antibodies, pepsinogen I and II levels, and basal serum gastrin using validated assays. RESULTS: Of the 148 (57%) subjects who agreed to participate, 36 had Dyspepsia (17 had ulcer-like Dyspepsia), 35 had irritable bowel syndrome (IBS) without Dyspepsia, and 77 were asymptomatic. The proportion who were seropositive for HP were 17% in Dyspepsia (24% in ulcer-like Dyspepsia), 20% in IBS, and 12% in asymptomatic controls. HP was not associated with Dyspepsia, ulcer-like Dyspepsia, or IBS after adjusting for age. Pepsinogen levels and serum gastrin were not associated with any of the conditions studied. However, CagA antibody positivity was associated with IBS (p < 0.05), and a borderline statistically significant association with Dyspepsia was detected (p = 0.08). CONCLUSIONS: In this community, HP infection overall does not seem to explain Dyspepsia, although the role of CagA-positive HP strains deserve further study.
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lack of discriminant value of Dyspepsia subgroups in patients referred for upper endoscopy
Gastroenterology, 1993Co-Authors: Nicholas J. Talley, Amy L Weaver, Dixie L Tesmer, Alan R ZinsmeisterAbstract:Abstract Background: The subdivision of undiagnosed patients with Dyspepsia into symptomatic subgroups (ulcerlike, dysmotilitylike, refluxlike, and nonspecific) may give a clue to the underlying cause; however, the value of this approach in practice is unclear. This study aimed to determine the discriminant value of dyspeptic symptoms and combinations of these symptoms. Methods: A consecutive sample of 820 outpatients (median age, 62 years; 47% male) completed, before endoscopy, a validated questionnaire that measured 46 gastrointestinal symptoms. Results: Of patients with functional Dyspepsia (n = 162), 17% had ulcerlike, 9% dysmotilitylike, and 16% refluxlike Dyspepsia alone; 31% fell into two or more symptom subgroups; and 27% had nonspecific symptoms. A similar distribution of the Dyspepsia subgroups was observed in patients without functional Dyspepsia. Younger age, female gender, frequent upper abdominal pain, no (or sometimes) pain relief with antacid use, and infrequent vomiting were predictive of functional Dyspepsia vs. all other diagnoses (at a specificity of 80%, the sensitivity was 60%). The Dyspepsia subgroups were poor discriminators in a separate model for functional Dyspepsia vs. all other diagnoses (at a specificity of 80%, the sensitivity was only 43%). Conclusions: The Dyspepsia subgroups, as currently defined, appear to have little clinical utility and may be an inappropriate way of classifying Dyspepsia.
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Dyspepsia and Dyspepsia subgroups a population based study
Gastroenterology, 1992Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, Cathy D Schleck, L J MeltonAbstract:It has been proposed that patients with Dyspepsia can be classified into symptom groupings that may represent different pathophysiological entities; however, it remains to be shown that distinct symptom subgroups exist. To estimate the prevalence of Dyspepsia (defined as upper abdominal pain) and Dyspepsia subgroups, an age- and sex-stratified random sample of Olmsted County, Minnesota, residents, aged 30-64 years, were mailed a valid self-report questionnaire; 82% responded (n = 835). Subgroups were as follows: those with symptoms suggestive of peptic ulceration (ulcerlike Dyspepsia), those with gastric stasis (dysmotilitylike Dyspepsia), those with gastroesophageal reflux (refluxlike Dyspepsia), and the remainder (unspecified Dyspepsia). Ulcerlike Dyspepsia was the commonest subgroup (prevalence, 16.0/100; 95% confidence interval, 13.4-18.5), but 43% of subjects with Dyspepsia could be classified into more than one subgroup. Nearly one third of dyspeptics also had irritable bowel symptoms, but these were not confined to any particular Dyspepsia subgroup. Although Dyspepsia is very common in the community and the majority have ulcerlike symptoms, there is such overlap among the Dyspepsia subgroups that a classification based on symptoms alone in uninvestigated patients may not be useful.
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anxiety is associated with uninvestigated and functional Dyspepsia rome iii criteria in a swedish population based study
Gastroenterology, 2009Co-Authors: Pertti Aro, Nicholas J. Talley, Jukka Ronkainen, Tom Storskrubb, Michael Vieth, Svenerik Johansson, Elisabeth Bolling Sternevald, Lars AgreusAbstract:Background & Aims The Rome III criteria for functional Dyspepsia have been changed to include 2 distinct syndromes: postprandial distress syndrome and epigastric pain syndrome. We investigated risk factors for functional Dyspepsia among the functional Dyspepsia subgroups defined by the Rome III criteria. Methods We performed a cross-sectional population-based study in a primary care setting (the Kalixanda study). A random sample (n = 2860) of the adult population from 2 northern Swedish municipalities (n = 21,610) was surveyed using a validated postal questionnaire to assess gastrointestinal symptoms (response rate, 74.2%; n=2122). A randomly selected subgroup (n = 1001) of responders was invited to undergo an esophagogastroduodenoscopy (participation rate, 73.3%) including biopsy specimen collection, Helicobacter pylori culture and serology, and symptom assessments. Results Of the 1001 subjects examined by endoscopy, 202 (20.2%; 95% confidence interval [CI], 17.7–22.7) were classified as having uninvestigated Dyspepsia and 157 (15.7%; 95% CI, 13.4–18.0) as having functional Dyspepsia. Major anxiety (Hospital Anxiety and Depression Scale score ≥11) was associated with uninvestigated Dyspepsia (odds ratio [OR], 3.01; 95% CI, 1.39–6.54), as was obesity (body mass index ≥30 kg/m2) (OR, 1.86; 95% CI, 1.15–3.01). Major anxiety was associated with functional Dyspepsia and postprandial distress syndrome (OR of 2.56 [95% CI, 1.06–6.19] and 4.35 [95% CI, 1.81–10.46], respectively), as was use of nonsteroidal anti-inflammatory drugs (OR, 2.49 [95% CI, 1.29–4.78] and 2.75 [95% CI, 1.38–5.50], respectively). Depression was not associated with any Dyspepsia group. Conclusions Anxiety but not depression is linked to uninvestigated Dyspepsia, functional Dyspepsia, and postprandial distress syndrome but not to epigastric pain syndrome.
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non ulcer Dyspepsia and duodenal eosinophilia an adult endoscopic population based case control study
Clinical Gastroenterology and Hepatology, 2007Co-Authors: Nicholas J. Talley, Alan R Zinsmeister, Pertti Aro, Jukka Ronkainen, Tom Storskrubb, Marjorie M Walker, Laura Hindley, Scott W Harmsen, Lars AgreusAbstract:Background & Aims: Functional abnormalities of the duodenum have been observed in non-ulcer Dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer Dyspepsia. Methods: A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer Dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. Results: The odds ratio for non-ulcer Dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, ≥22, relative to
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irritable bowel syndrome and Dyspepsia in the general population overlap and lack of stability over time
Gastroenterology, 1995Co-Authors: Lars Agreus, Kurt Svardsudd, Olof Nyren, Gosta TibblinAbstract:Abstract Background & Aims: It has been suggested that irritable bowel syndrome (IBS) and functional Dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. Methods: Sequential postal questionnaires were sent to 1290 representative persons (age range, 20–79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. Results: The prevalence of Dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, Dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the Dyspepsia criteria, and the overlap between Dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. Conclusions: The separation of functional gastrointestinal symptoms into Dyspepsia, its subgroups, and IBS may be inappropriate.
