Clinical presentation of patients with "dyspepsia". Detailed symptomatic study of 360 patients.

Horrocks, Jane C.; Dombal, F. T. de

doi:10.1136/gut.19.1.19

Cited by 121 publications

(18 citation statements)

References 19 publications

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“…The most salient is the heterogeneity of NUD in terms of both its pathophysiology and clinical presentation (1)(2)(3)(4)(5). NUD is, by definition, a diagnosis of exclusion and has been and continues to be the subject of considerable controversy.…”

Section: Discussionmentioning

confidence: 99%

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A Double‐Blind Randomized Study of Cisapride in the Treatment of Nonulcer Dyspepsia

MacCANNELL

Thomson

et al. 1997

Canadian Journal of Gastroenterology and Hepatology

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MC CHAMPION, KL MACCANNELL, ABR THOMSON, ET AL, FOR THE CANADIAN CISAPRIDE NUD STUDY GROUP.A double-blind randomized study of cisapride in the treatment of nonulcer dyspepsia. Can J Gastroenterol 1997;11(2):127-134. Cisapride is a substituted benzamide with gastrointestinal prokinetic effects presumed to be due to the enhancement of the physiological release of acetylcholine at the myenteric plexus. In a multicentre study, 189 patients with nonulcer dyspepsia (NUD) received single-blind placebo treatment for two weeks. A total of 123 patients with no or minimal response to placebo and epigastric pain of at least moderate severity and frequency were randomly assigned to one of three parallel double-blind treatments for six weeks: cisapride 10 mg tid, cisapride 20 mg tid or placebo. The severity and frequency of individual symptoms (epigastric pain, heartburn, nausea, vomiting, anorexia, postprandial discomfort, regurgitation, lower abdominal pain, bloating and constipation) were assessed on a four-and five-point categorical scale, respectively, by the investigator at three on-treatment visits and by patients in a daily diary. Analysis of investigator and patient assessments for differences in symptom severity x frequency composite scores among the three treatment groups showed no statistically significant differences for individual symptoms or symptom clusters. As assessed by the investigator, and compared with baseline, cisapride 20 mg tid significantly (P<0.05) improved epigastric pain, bloating and early satiety as well as improved the total symptom cluster. Investigator evaluation of the five most severe and frequent symptoms for each patient showed statistically significant improvement in each treatment group. For patient diary assessments, statistically significant within-treatment improvement of the total symptom cluster, the five most severe symptoms cluster, bloating and early satiety was observed for both cisapride 20 mg and placebo, whereas epigastric pain significantly (P<0.05) improved in all three treatment groups. Investigator evaluation of global response (good + excellent) rate at the end of the six-week treatment period was 38% for cisapride 20 mg, 47% for cisapride 10 mg and 33% for placebo. No statistically significant difference in this parameter among treatments was noted. Cisapride was well tolerated at both doses with a side effect profile comparable with that of placebo. It is concluded that, in this double-blind multicentre study with a single-blind two-week placebo run-in phase, cisapride 10 mg tid and 20 mg tid were not effective compared with placebo in improving symptoms in NUD patients. This study re-emphasizes the good prognosis of patients with NUD, with 14% of patients improving in the two-week placebo run-in phase and a further 33% improving in the next six weeks while on placebo. Within-treatment analysis of investigator assessments showed improvement for cisapride 20 mg tid suggesting a trend for efficacy at this dose. (Pour le résumé, voir page 128) Key Words: Cisapride, N...

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Section: Discussionmentioning

confidence: 99%

“…T he term dyspepsia has been used to describe the symptom-complex epigastric pain that is often associated with other dysmotility symptoms such as nausea, vomiting, regurgitation, heartburn, early satiety and anorexia referable to the upper abdomen (1). Pain, the primary symptom, is usually located in the epigastrium and is often related to eating.…”

mentioning

confidence: 99%

A Double‐Blind Randomized Study of Cisapride in the Treatment of Nonulcer Dyspepsia

MacCANNELL

Thomson

et al. 1997

Canadian Journal of Gastroenterology and Hepatology

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“…1 GERD = Gastroesophageal reflux disease. 2 One patient had giardiasis and GERD, one had GERD and PUD. 3 Two patients had PUD and GERD.…”

Section: Resultsmentioning

confidence: 99%

“…Moynihan claims that most patients who present with dyspepsia could be correctly diagnosed solely on the basis of their symptoms (1). On the other hand, Horrocks and de Dombal conclude in their prospective study that a ''classical'' picture of ulcer pain and the symptoms of patients with peptic ulcer do not have a close association (2). In primary care, most patients with upper abdominal complaints are managed without referrals or further investigations (3 -5).…”

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confidence: 99%

GPs' ability to diagnose dyspepsia based only on physical examination and patient history

Heikkinen

Pikkarainen²,

Eskelinen³

et al. 2000

Scandinavian Journal of Primary Health Care

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“…Although upper abdominal complaints are very common in primary care, it is difficult to make an accurate aetiological diagnosis of dyspepsia. The diagnosis of dyspepsia cannot reliably be based on the history (1,2), and the question of which patients warrant further investigation is often discussed with enthusiasm (3.4). Increased health costs also bring pressure on general practitioners (GPs) to consider more carefully how to investigate their patients.…”

mentioning

confidence: 99%

Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy

Heikkinen

Pikkarainen

Takala

et al. 1997

Scandinavian Journal of Primary Health Care

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Clinical presentation of patients with "dyspepsia". Detailed symptomatic study of 360 patients.

Cited by 121 publications

References 19 publications

A Double‐Blind Randomized Study of Cisapride in the Treatment of Nonulcer Dyspepsia

A Double‐Blind Randomized Study of Cisapride in the Treatment of Nonulcer Dyspepsia

GPs' ability to diagnose dyspepsia based only on physical examination and patient history

Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy

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