Eradication of Helicobacter pylori may improve dyspepsia in the elderly for the long term

Background Therapy for eradication of Helicobacter pylori (H. pylori) improves symptoms of H. pylori-associated dyspepsia (HPD), but the effects of eradication in elderly patients are unclear. The aim of our study was to investigate dyspepsia symptoms and long-term effects of eradication in elderly patients. Methods This retrospective study included 496 patients who received H. pylori eradication therapy. The patients were divided into a group of elderly patients (group E: ≧ 65 years old) and a group of non-elderly patients (group N: < 65 years old). Abdominal symptoms were evaluated using a questionnaire about abdominal symptoms before eradication and after eradication (1–2 months and more than one year). Dyspepsia was defined as a score of 4 points or more for at least one of 4 items (postprandial fullness, early satiety, epigastric pain, and hunger pain). Improvement of symptoms was defined on the basis of changes in Global Overall Systems scores. Results There were no differences in abdominal symptoms before eradication between the two groups. Successful eradication improved symptoms in patients with dyspepsia within 2 months (in 75.6% (56/74) of the patients in group N and in 64.5% (20/31) of the patients in group E). The questionnaire showed that 80% (32/40) of the patients in group N and 60% (12/20) of the patients in group E had long-term relief of dyspepsia. The scores for abdominal symptoms in group E continued to improve for a mean period of 54.8 months after eradication. Conclusions Eradication of H. pylori age-independently improved dyspepsia symptoms for the long term.

Diffi culties of diff erential diagnosis in functional dyspepsia

Dyspepsia syndrome is understood as a complex of symptoms, including epigastric pain and epigastric burning, postprandial fullness and early satiation. In cases when organic diseases cannot be detected in patients as the cause of these symptoms, the term functional dyspepsia (FD) should be used. Rome IV criteria of FD in the absence of “alarm symptoms” consider it possible to make a diagnosis of FD without instrumental examination (fi rst of all, without esophagogastroduodenoscopy). The recommendations of the Russian Gastroenterological Association emphasize that this approach leads to serious diagnostic errors, and therefore the diagnosis of PD should be considered as a diagnosis of exclusion, which can be made only after a comprehensive examination of patients.

Efficacy of trimebutine in the treatment of functional gastrointestinal disorders: an observational multicenter study

Aim. Evaluation of the practice of using trimebutine (tablets, 300 mg, extended release), for the treatment of patients with functional gastrointestinal disorders (FGID) in primary health care. Materials and methods. A prospective observational multicenter non-interventional study was carried out, which included patients of both sexes aged 18 to 60 years with a verified diagnosis of functional gastrointestinal disorders (functional dyspepsia, irritable bowel syndrome, biliary tract dysfunction, sphincter of Oddi dysfunction, postcholecystectomy syndrome). Trimebutine was prescribed in accordance with the instructions for medical use: orally, 300 mg twice per day for 28 days. The severity of simptoms was evaluated by five-point rating scale. Results. The study included 4433 patients, the per protocol sample consisted of 3831 people. The proportion of patients with a significant decrease in the severity of abdominal pain after treatment was 74.73% (95% confidence interval CI 73.3276.11). At the and of the study a statistically significant decrease in the severity of FGID` simptoms was observed: epigastric pain/burning (mean score at the 1st visit was 1.21 [95% CI 1.181.25], at the 2nd visit 0.22 [95% CI 0.20.23]; p0.001), abdominal pain (1st visit 2.01 [95% CI 1.982.04), 2nd visit 0.33 [95% CI 0.310.35]; p0.001), biliary pain (1st visit 1.22 [95% CI 1.181.26], 2nd visit 0.2 [95% CI 0.190.22]; p0.001), postprandial fullness and early satiation (1st visit 1.29 [95% CI 1.251.32], 2nd visit 0.21 [95% CI 0.190.22]; p0.001), severity of heartburn (1st visit 0.92 [95% CI 0.880.95], 2nd visit 0.18 [95% CI 0.170.20]; p0.001), belching (1st visit 1.13 [95% CI 1.091.16], 2nd visit 0.22 [95% CI 0.210.24]; p0.001), as well as abdominal distention (1st visit 1.99 (95% CI 1, 96, 2.03), 2nd visit 0.43 [95% CI 0.410.45]; p0.001). Conclusion. The present prospective observational multicenter non-interventional study has demonstrated that trimebutine is an effective approach to treating FGID.

Dysphagia, dyspepsia, and hiccups

Dysphagia, or difficulty swallowing, is a complex problem. Although patients may present with dysphagia as an issue that requires palliation, other patients may develop dysphagia as a complication of progressive disease and increasing debilitation. The diagnosis of dyspepsia requires patients to be experiencing one or more of the following four problems: epigastric pain, epigastric burning, postprandial fullness, or early satiety. Dyspepsia may occur either as a functional disorder where the cause is not clear or as a secondary disorder. Hiccup, or more correctly, singultus, is a problem where patients experience a sharp and involuntary contraction of the muscles of inspiration which cause a sudden sharp inspiration and closure of the glottis. For most, this is a short-lived experience. This chapter discusses the definition, prevalence, pathophysiology, causes, presenting problems, investigations, and management of dysphagia, dyspepsia, and hiccups.

Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management

Patients with Parkinson disease (PD) experience a range of non-motor symptoms, including gastrointestinal symptoms. These symptoms can be present in the prodromal phase of the disease. Recent advances in pathophysiology reveal that α-synuclein aggregates that form Lewy bodies and neurites, the hallmark of PD, are present in the enteric nervous system and may precede motor symptoms. Gastroparesis is one of the gastrointestinal involvements of PD and is characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction. Gastroparesis has been reported in nearly 45% of PD. The cardinal symptoms include early satiety, postprandial fullness, nausea, and vomiting. The diagnosis requires an appropriate test to confirm delayed gastric emptying, such as gastric scintigraphy, or breath test. Gastroparesis can lead to malnutrition and impairment of quality of life. Moreover, it might interfere with the absorption of antiparkinsonian drugs. The treatment includes dietary modifications, and pharmacologic agents both to accelerate gastric emptying and relieve symptoms. Alternative treatments have been recently developed in the management of gastroparesis, and their use in patients with PD will be reported in this review.

Dispepsia funcional y gastroparesia: ¿dos entidades superpuestas? De la fisiopatología a la terapéutica

Functional dyspepsia and gastroparesis represent the most common sensory-motor disorders of the upper gastrointestinal tract. Scientific advances in the last decade have shown that there is significant overlap between them. This review aims to address current knowledge about their pathophysiology, diagnosis and treatment. Functional dyspepsia is a medical condition that is characterized by one or more of the following symptoms: early satiety, postprandial fullness, and epigastric pain or burning. The pathophysiological mechanisms involved are: the gastroduodenal motility and sensory abnormalities, the immune dysfunction, the duodenal inflammation, the gastrointestinal infections, the alterations in the gastrointestinal microbiota and the dysfunction of the gut-brain axis. The Rome IV criteria make possible to establish a presumptive diagnosis of functional dyspepsia in most patients, although it continues to be a diagnosis of exclusion that requires the performance of an upper digestive video endoscopy to confirm it. The recommended therapeutic options are: the eradication of Helicobacter pylori, the proton pump inhibitors, the tricyclic antidepressants and prokinetics. Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of a mechanical obstruction. The pathophysiology is caused by neuromuscular abnormalities of gastric motor function. Gastric emptying scan is the current gold standard for diagnosis. The mainstays of treatment are restoration of hydration and nutrition, and pharmacological treatment with prokinetics and antiemetics.

The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

Background: Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p<0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p <0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p <0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p <0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.

An Unexpected Gastric Subepithelial Mass

A63-year-old man came to our observation complaining of symptoms referable to gastroesophageal reflux disease. No epigastric pain, postprandial fullness, or vomiting were present during clinical examination. His history did not show noteworthy pathologies. The patient did not follow any pharmacological therapy, and there was no family history for neoplasia of the digestive system.

A148 DESMOID FIBROMATOSIS DIAGNOSED IN A 27-YEAR-OLD MALE AFTER BEING MISTAKEN FOR A GASTRIC GIST

Background The gastrointestinal tract can be affected by both epithelial and non-epithelial tumors. When considering non-epithelial tumors, gastrointestinal stromal tumors (GISTs) are the most common with an incidence of 7–15 cases per million per year. Fibroblastic desmoid tumors, originating from mesenchymal cells, are rarer with an incidence of 2–4 cases per million per year. Despite being distinct lesions, these tumors may appear similar on imaging when they involve the stomach wall or bowel. As a result, they may be confused with one another when initially diagnosed. Aims This report aims to present a case where a desmoid tumor was mistaken for a gastric GIST despite extensive investigation prior to laparotomy. Methods Retrospective review of one patient. Results A 27-year-old gentleman presented with acute left-sided abdominal pain and postprandial fullness that began 2 days prior. A CT-abdomen/pelvis demonstrated a large exophytic mass arising from the lesser sac of the stomach, in keeping with an aggressive gastrointestinal stromal tumor (GIST). He was admitted and was further investigated with an endoscopic ultrasound, which demonstrated an exophytic hemorrhagic mass arising from the muscularis propria of the gastric wall. Again, this was most consistent with a GIST and urgent surgical resection was recommended. An exploratory laparotomy was organized the following day. There were no signs of a GIST intraoperatively, but rather a soft tissue tumor of the left mesentery of the transverse colon. This mass was resected, and a biopsy of the peritoneum was collected. Pathology identified a low-grade spindle cell tumor, CD117/CD34 negative with patchy cytoplasmic and nuclear β-catenin staining, in keeping with desmoid fibromatosis. Conclusions This case illustrates how GISTs and desmoid tumors are often mistaken for one another when associated with the stomach wall or bowel. Despite morphologic features of both tumors outlined in the literature, pathology, with focus on specific staining patterns, is necessary in many cases to distinguish the two. This distinction is paramount for appropriate prognostication and management, including timely investigation for associated diseases such as Familial Adenomatous Polyposis in patients with desmoid tumors. Funding Agencies None

Topical Mastic Oil for Treatment of Functional Dyspepsia: A Randomized Triple-Blind Controlled Trial

Background: The main goal of the present study was to evaluate the effect of topical mastic oil, compared to placebo on treatment of functional dyspepsia (FD). Materials and Methods: Sixty-three patients with FD were included. Thirty-two subjects received the topical mastic oil (10 drops/TDS after meal) with massage and 31 patients received topical sesame oil with massage. Both groups received pantoprazole (40 mg daily) along with oil and massage. The severity of early satiation, postprandial fullness, epigastric pain and epigastric burning was assessed after 4 weeks using the Visual Analogue Scale (VAS) as well as frequency of symptoms. Satisfaction with the treatment was also assessed using a researcher-made questionnaire. Changes in the severity of symptoms were evaluated by Friedman’s test. Results: Mean and standard deviation of age of the subjects were equal to 36.95±13.64 and 50 (79.4%) patients were female. Both groups experienced a significant decrease in the severity of all the four symptoms (P<0.001). The percentage of decrease in the severity of early satiation was significantly higher in the mastic group than the control group (76.03±34.91% vs. 37.24±38.86%, P=0.003). No significant differences were found in the percentage of decrease in the severity of postprandial fullness, epigastric pain and burning between the study groups (P=0.05, 0.06, and 0.13, respectively). The frequency of symptoms was decreased similarly in both groups. Satisfaction with the treatment was reported to be significantly higher in the mastic group than the sesame group (P=0.01). There were no intolerable side effects in both groups. Conclusion: Mastic oil reduced early satiation better than the placebo. In addition, satisfaction with the treatment was higher in the mastic group than the sesame group. [GMJ.2021;10:e1965]