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Non-Ulcer Dyspepsia

  • Nicholas J. Talley
Chapter
Part of the Topics in Gastroenterology book series (TGEN)

Abstract

Dyspepsia is one of the most common gastrointestinal complaints. In a population study in Göteburg, Sweden, Tibblin found that it was by far the most common gastrointestinal symptom in 50-year-old men and was exceeded in frequency only by backache, tiredness, and irritability.1 In the United Kingdom, the prevalence of indigestion and abdominal pain was reported to be 38%.2 In the United States, the overall age- and sex-adjusted prevalence of rate of frequent upper abdominal pain in a random population sample of persons aged 30-64 years was 16 per 100.3 In Sweden, non-ulcer dyspepsia ranks fourth amongst all diagnoses in general practice, and 98% of consultations result in drug prescriptions, mostly for antacids.4 Despite its striking prevalence in the community, there is a surprising diversity of fact and opinion in relation to this disorder, which confounds attempts at efficient management. Not the least of these is its nomenclature.

Keywords

Gastric Emptying Food Allergy Functional Dyspepsia Lower Esophageal Sphincter Pressure Dyspeptic Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Tibblin G. Introduction to the epidemiology of dyspepsia. Scand J Gastroenterol 1985;20(Suppl 109 ):29–33.CrossRefGoogle Scholar
  2. 2.
    Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. Br Med J 1989;298:30–32.CrossRefGoogle Scholar
  3. 3.
    Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ. Dyspepsia and dyspepsia subgroups: A population-based study. Gastroenterology (in press).Google Scholar
  4. 4.
    Tyllstrom J, Adami H-O, Agnäs I, et al. The clinical diagnosis of gastritis. II. Aspects of current therapy and drug consumption. Scand J Gastroenterol 1984;19:755–760.PubMedGoogle Scholar
  5. 5.
    Talley NJ, Phillips SF. Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med 1988;108:865–879.PubMedGoogle Scholar
  6. 6.
    Report of a working party. Management of dyspepsia. Lancet 1988;1:576–579.Google Scholar
  7. 7.
    Talley NJ, Piper DW. The association between non-ulcer dyspepsia and other gastrointestinal disorders. Scand J Gastroenterol 1985;20:896–900.PubMedCrossRefGoogle Scholar
  8. 8.
    Talley NJ, McNeil D, Piper DW. The discriminant value of dyspeptic symptoms. A study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration and cholelithiasis. Gut 1987;28:40–46.PubMedCrossRefGoogle Scholar
  9. 9.
    Greenlaw R, Sheahan DG, DeLuca V, et al. Gastroduodenitis. A broader concept of peptic ulcer disease. Dig Dis Sci 1980;25:660–672.PubMedCrossRefGoogle Scholar
  10. 10.
    Cotton PB, Shorvon PJ. Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease. Clin Gastroenterol 1984;13:383–403.PubMedGoogle Scholar
  11. 11.
    Earlam RJ. Production of epigastric pain in duodenal ulcer by lower oesophageal acid perfusion. Br Med J 1970;4:714–716.PubMedCrossRefGoogle Scholar
  12. 12.
    Graham DY, Smith JL, Patterson DJ. Why do apparently healthy people use antacid tablets? Am J Gastroenterol 1983;78:257–260.PubMedGoogle Scholar
  13. 13.
    Machella TE, Dworken HJ, Biel FJ. Observations on the splenic flexure syndrome. Ann Intern Med 1952;37:543–552.PubMedGoogle Scholar
  14. 14.
    Kellow JE, Phillips SF, Miller LJ, Zinmeister AR. Dysmotility of the small intestine in irritable bowel syndrome. Gut 1988;29:1236–1243.PubMedCrossRefGoogle Scholar
  15. 15.
    Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978;2:653–654.PubMedCrossRefGoogle Scholar
  16. 16.
    Lasser RB, Bond JH, Levitt MD. The role of intestinal gas in functional abdominal pain. N Engl J Med 1975;293:524–526.PubMedCrossRefGoogle Scholar
  17. 17.
    Geenen JE, Hogan WJ, Dodds WJ, et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989;320:82–87.PubMedCrossRefGoogle Scholar
  18. 18.
    Price WH. Gall-bladder dyspepsia. Br Med J 1963;2:138–141.PubMedCrossRefGoogle Scholar
  19. 19.
    Bainton D, Davies GT, Evans KT, Gravellel H. Gallbladder disease: Prevalence in a South Wales industrial town. N Engl J Med 1976;294:1147–1149.PubMedCrossRefGoogle Scholar
  20. 20.
    Smith RC, Talley NJ, Dent OF, et al. Exocrine pancreatic function and chronic unexplained dyspepsia. A case-control study. Int J Pancreatol 1991;8:253–262.PubMedGoogle Scholar
  21. 21.
    Wegener M, Börsch G, Schaffstein J, et al. Are dyspeptic symptoms in patients with Campylobacter pylori-a.ssocia. ted type B gastritis linked to delayed gastric emptying? Am J Gastroenterol 1988;83:737–740.PubMedGoogle Scholar
  22. 22.
    Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311–1314.PubMedCrossRefGoogle Scholar
  23. 23.
    Marshall BJ, McGechie DB, Rogers PA, Clancy RJ. Pyloric Campylobacter infection and gastroduodenal disease. Med J Aust 1985;142:439–444.PubMedGoogle Scholar
  24. 24.
    Ormand JE, Talley NJ. Helicobacter pylori: controversies and an approach to management. Mayo Clin Proc 1990;65:414–426.PubMedGoogle Scholar
  25. 25.
    Talley NJ. Campylobacter pylori-associated gastritis. Is antibiotic therapy now justified? J Clin Gastroenterol 1988;10:10–12.PubMedCrossRefGoogle Scholar
  26. 26.
    Sobala GM, Dixon MF, Axon ATR. Symptomatology of Helicobacter pylori-associated dyspepsia. Eur J Gastroenterol Hepatol 1990;2:445–449.Google Scholar
  27. 27.
    Sircus W. Duodenitis: a clinical, endoscopic and histopathologic study. Q J Med 1985;56:593–600.PubMedGoogle Scholar
  28. 28.
    Thomson WO, Joffe SN, Robertson AG, et al. Is duodenitis a dyspeptic myth? Lancet 1977;1:1197–1198.PubMedCrossRefGoogle Scholar
  29. 29.
    MacKinnon M, Willing RL, Whitehead R. Cimetidine in the management of symptomatic patients with duodenitis: A double-blind controlled trial. Dig Dis Sci 1982; 27:217–219.PubMedCrossRefGoogle Scholar
  30. 30.
    Collen MJ, Loebenberg MJ. Basal gastric acid secretion in nonulcer dyspepsia with or without duodenitis. Dig Dis Sci 1989;34:246–250.PubMedCrossRefGoogle Scholar
  31. 31.
    Camilleri M, Malagelada J-R, Kao PC, Zinmeister AR. Gastric and autonomic responses to stress in functional dyspepsia. Dig Dis Sci 1986;31:1169–1177.PubMedCrossRefGoogle Scholar
  32. 32.
    Malagelada J-R, Stanghellini V. Manometric evaluation of functional upper gut symptoms. Gastroenterology 1985;88:1223–1231.PubMedGoogle Scholar
  33. 33.
    Geldof H, van der Schee EJ, van Blankenstein M, Grashuis JL. Electrogastrophic study of gastric myoelectrical activity in patients with unexplained nausea and vomiting. Gut 1986;27:799–808.PubMedCrossRefGoogle Scholar
  34. 34.
    You CH, Lee KY, Chen Y, Menguy R. Electrogastrographic study of patients with unexplained nausea, bloating and vomiting. Gastroenterology 1980;79:311–314.PubMedGoogle Scholar
  35. 35.
    Corinaldesi R, Stanghellini V, Raiti C, et al. Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gas-troparesis. Gut 1987;28:300–305.PubMedCrossRefGoogle Scholar
  36. 36.
    Talley NJ, Shuter B, McCrudden G, et al. Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. J Clin Gastroenterol 1989;11:625–630.PubMedCrossRefGoogle Scholar
  37. 37.
    Camilleri M, Malagelada J-R, Abell TL, et al. Effect of six weeks of treatment with cisapride in gastroparesis and intestinal pseudoobstruction. Gastroenterology 1989;96:704–712.PubMedGoogle Scholar
  38. 38.
    Davis RH, Clench MH, Mathias JR. Effects of domperidone in patients with chronic unexplained upper gastrointestinal symptoms: a double-blind, placebo-controlled study. Dig Dis Sci 1988;33:1505–1511.PubMedCrossRefGoogle Scholar
  39. 39.
    Jørgensen LS, Bønløkke L, Wamberg P. Non-ulcer upper dyspepsia. Aspects of pain. Scand J. Gastroenterol 1985;20:46–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Lémann M, Dederding JP, Flourie B, et al. Abnormal perception to visceral pain in response to gastric distention in chronic idiopathic dyspepsia: The irritable stomach syndrome. Dig Dis Sci 1991;36:1249–1254.PubMedCrossRefGoogle Scholar
  41. 41.
    Mearin F, Cucala M, Azpiroz F, Malagelada J-R. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 1991;101:999–1006.PubMedGoogle Scholar
  42. 42.
    Pearson DJ. Food allergy, hypersensitivity and intolerance. J R Coll Physicians Lond 1985;19:154–162.PubMedGoogle Scholar
  43. 43.
    Farah DA, Calder I, Benson L, MacKenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985;26:164–168.PubMedCrossRefGoogle Scholar
  44. 44.
    Canonica GW, Ciprandi G. Food allergy and dyspepsia (letter to the editor). Lancet 1988; 1:1233.Google Scholar
  45. 45.
    Larkai EN, Smith JL, Lidsky MD, et al. Dyspepsia in NSAID users: the size of the problem. J Clin Gastroenterol 1989;11:158–162.PubMedCrossRefGoogle Scholar
  46. 46.
    Talley NJ, McNeil D, Piper DW. Environmental factors and chronic unexplained dyspepsia: association with acetaminophen but not other analgesics, alcohol, coffee, tea, or smoking. Dig Dis Sci 1988;33:641–648.PubMedCrossRefGoogle Scholar
  47. 47.
    Nyrén O, Adami HO, Gustavsson S, et al. The “epigastric distress syndrome.“ A possible disease entity identified by history and endoscopy in patients with non-ulcer dyspepsia. J Clin Gastroenterol 1987;9:303–309.PubMedCrossRefGoogle Scholar
  48. 48.
    Nyré;n O, Adami H-O, Gustavsson S, et al. Social and economic effects of non-ulcer dyspepsia. Scand J Gastroenterol 1985;20(Suppl 109):41–47.Google Scholar
  49. 49.
    Talley NJ, Fung LH, Gilligan IJ, et al. Association of anxiety, neuroticism and depression with dyspepsia of unknown cause: A case-control study. Gastroenterology 1986;90:886–892.PubMedGoogle Scholar
  50. 50.
    Talley NJ, Piper DW. Major life event stress and dyspepsia of unknown cause. A case-control study. Gut 1986;27:127–134.PubMedCrossRefGoogle Scholar
  51. 51.
    Carr MF Jr., Ma J, Green PHR. Giardia lamblia in patients undergoing endoscopy: lack of evidence for a role in non-ulcer dyspepsia. Gastroenterology 1988;95:972–974.PubMedGoogle Scholar
  52. 52.
    Allison MC, Green EL, Bhattacharya DN, et al. A microscopic and immunodiagnostic search for giardiasis in patients with gastrointestinal disorders. Scand J Gastroenterol 1988;23:209–212.PubMedCrossRefGoogle Scholar
  53. 53.
    Brody H. The lie that heals: the ethics of giving placebos. Ann Intern Med 1982;97:112–118.PubMedGoogle Scholar
  54. 54.
    Dal Monte PR. Treatment of non-ulcerative dyspepsia. Hepatogastroenterology 1983;30:1–2.Google Scholar
  55. 55.
    Gotthard R, Bodemar G, Brodin U, Jönsson K-Å Treatment with cimetidine, antacid or placebo in patients with dyspepsia of unknown origin. Scand J Gastroenterol 1988;23:7–18.PubMedCrossRefGoogle Scholar
  56. 56.
    Nørrelund N, Helles A, Schmiegelow M. Uncharacteristic dyspepsia in general practice: A controlled trial with aluminum aminoacetate and magnesium hydroxide. Ugesk Laeg 1980;142:1750–1753.Google Scholar
  57. 57.
    Nyrén O, Adami H-O, Bates S, et al. Absence of therapeutic benefit from antacids or cimetidine in non-ulcer dyspepsia. N Engl J Med 1986;314:339–343.PubMedCrossRefGoogle Scholar
  58. 58.
    Bendtsen F, Danø P, Guldhammer B, et al. Cimetidine therapy in radio-negative dyspepsia. Ugesk Laeg 1983;145:3090–3093.Google Scholar
  59. 59.
    Kelbaek H, Linde J, Eriksen J, et al. Controlled clinical trial of treatment with cimetidine for non-ulcer dyspepsia. Acta Med Scand 1985;217:281–287.PubMedCrossRefGoogle Scholar
  60. 60.
    Lance P, Wastell C, Schiller KFR. A controlled trial of cimetidine for the treatment of non-ulcer dyspepsia. J Clin Gastroenterol 1986;8:414–418.PubMedCrossRefGoogle Scholar
  61. 61.
    Talley NJ, McNeil D, Hayden A, Piper DW. Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia. Gastroenterology 1986;91:149–156.PubMedGoogle Scholar
  62. 62.
    Delattre M, Malesky M, Prinzie A. Symptomatic treatment of non-ulcer dyspepsia with cimetidine. Curr Ther Res 1985;37:980–991.Google Scholar
  63. 63.
    Saunders JHB, Oliver RJ, Higson DL. Dyspepsia: incidence of non-ulcer disease in a controlled trial of ranitidine in general practice. Br Med J 1986;292:665–668.CrossRefGoogle Scholar
  64. 64.
    Casiraghi A, Ferrara A, Lesinigo E, et al. Cimetidine vs. antacids in non-ulcer dyspepsia. Curr Ther Res 1986;39:388–397.Google Scholar
  65. 65.
    Veldhuyzen SJO, Tytgat KMAJ, Jalali S, et al. Can gastritis symptoms be evaluated in clinical trials? An overview of treatment of gastritis, nonulcer dyspepsia and Campy lobacter-associated gastritis. J Clin G?stroenterol 1989;11:496–501.CrossRefGoogle Scholar
  66. 66.
    Johannessen T, Fjøsne U, Kleveland PM, et al. Cimetidine responders in non-ulcer dyspepsia. Sc?nd J G?stroenterol 1988;23:327–336.CrossRefGoogle Scholar
  67. 67.
    Dal Monte PR, D’Imperio N, Accardo P, Daniotti S. Pirenzepine in non-ulcer dyspepsia. A double-blind, placebo-controlled trial. Scand J G?stroenterol 1982;17(Suppl 72):247–250.Google Scholar
  68. 68.
    Hradsky M, Wikander M. Effect of pirenzepine in the treatment of non-ulcer dyspepsia. A double-blind study. Scand J G?stroenterol 1982;17(Suppl 72):251–252.Google Scholar
  69. 69.
    Stephens CJM, Lever L, Hoare AM. Dicyclomine for idiopathic dyspepsia (letter to the editor). Lancet 1988; 1:1004.PubMedCrossRefGoogle Scholar
  70. 70.
    Rokkas T, Pursey C, Uzoechina E, et al. Non-ulcer dyspepsia and short-term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori. Gut 1988;29:1386–1391.PubMedCrossRefGoogle Scholar
  71. 71.
    Lambert JR, Borromeo M, Korman MG, Hansky J. Campy lobacter pylori and non-ulcer dyspepsia—randomized controlled trial (abstract). Gastroenterology 1989;96:A284.Google Scholar
  72. 72.
    Kang JY, Tay HH, Wee A, et al. Effect of colloidal bismuth subcitrate on symptoms and gastric histology in non-ulcer dyspepsia. A double blind placebo controlled study. Gut 1990;31:476–480.PubMedCrossRefGoogle Scholar
  73. 73.
    McNulty CAM, Gearty JC, Crump B, et al. Campylobacter pyloridis and associated gastritis: investigator blind, placebo controlled trial of bismuth salicylate and erythromycin ethyl-succi-nate. Br Med J 1986;293:645–649.CrossRefGoogle Scholar
  74. 74.
    Loffeld RJLF, Potters HVPJ, Stobberingh E, et al. Campylobacter associated gastritis in patients with non-ulcer dyspepsia: a double blind placebo controlled trial with colloidal bismuth subcitrate. Gut 1989;30:1206–1212.PubMedCrossRefGoogle Scholar
  75. 75.
    Kairaluoma MI, Hentilae R, ALavaikko M, et al. Sucralfate versus placebo in treatment of non-ulcer dyspepsia. Am J Med 1987;83(Suppl 3B):51–55.Google Scholar
  76. 76.
    Skoubo-Kristensen E, Funch-Jensen P, Kruse A, et al. Controlled clinical trial with sucralfate in the treatment of macroscopic gastritis. Scand J Gastroenterol 1989;24:716–720.PubMedCrossRefGoogle Scholar
  77. 77.
    Johnson AG. Controlled trial of metoclopramide in the treatment of flatulent dyspepsia. Br Med J 1971;2:25–26.PubMedCrossRefGoogle Scholar
  78. 78.
    Orme MLE, Tallis RC. Metoclopramide and tardive dyskinesia in the elderly. Br Med J 1984;289:397–398.CrossRefGoogle Scholar
  79. 79.
    Nagler J, Miskovitz P. Clinical evaluation of domperidone in the treatment of chronic postprandial idiopathic upper gastrointestinal distress. Am J Gastroenterol 1981;76:495–499.PubMedGoogle Scholar
  80. 80.
    Agorastos I, Zissis NP, Kaprinis I, Goulis G. Double-blind evaluation of domperidone in acute vomiting and dyspeptic disorders. J Int Med Res 1981;9:143–147.PubMedGoogle Scholar
  81. 81.
    Arts E, Anthoni H, de Roy G, D’Hollander J. Domperidone in the treatment of dyspepsia: a double-blind placebo-controlled study. J Int Med Res 1979; 7: 158–161.PubMedGoogle Scholar
  82. 82.
    Bekhti A, Rutgeerts L. Domperidone in the treatment of functional dyspepsia in patients with delayed gastric emptying. Postgrad Med J 1979; 55(Suppl 1):30–32.Google Scholar
  83. 83.
    De Loose F. Domperidone in chronic dyspepsia: a pilot open study and a multicentre general practice crossover comparison with metoclopramide and placebo. Pharmatherapeutica 1979; 2: 140–146.Google Scholar
  84. 84.
    Englert W, Schlich D. A double-blind crossover trial of domperidone in chronic postprandial dyspepsia. Postgrad Med J 1979; 55(Suppl l):28–29.Google Scholar
  85. 85.
    Haarmann K, Lebkuchner F, Widmann A, et al. A double-blind study of domperidone in the symptomatic treatment of chronic postprandial upper gastrointestinal distress. Postgrad Med J 1979; 55(Suppl l):24–27.Google Scholar
  86. 86.
    Sarin SK, Sharma P, Chawla YK, et al. Clinical trial on the effect of domperidone on non-ulcer dyspepsia. Indian J Med Res 1986; 83: 623–628.PubMedGoogle Scholar
  87. 87.
    Van de Mierop L, Rutgeerts L, Van den Langenbergh B, Staessen A. Oral domperidone in chronic postprandial dyspepsia: A double-blind placebo-controlled evaluation. Digestion 1979; 19: 244–250.PubMedCrossRefGoogle Scholar
  88. 88.
    Van Ganse W, Van Damme L, Van de Mierop L, et al. Chronic dyspepsia: double-blind treatment with domperidone (R 33 812) or a placebo. A multicentre therapeutic evaluation. Curr TherRes 1978; 23: 695–701.Google Scholar
  89. 89.
    O’Shea M. A double-blind comparison of domperidone and metoclopramide in the treatment of postprandial dyspeptic symptoms. Curr Ther Res 1980; 28: 367–370.Google Scholar
  90. 90.
    Creytens G. Effect of the non-antidopaminergic drug cisapride on postprandial nausea. Curr TherRes 1984; 36: 1063–1070.Google Scholar
  91. 91.
    Milo R. Non-cholinergic, non-antidopaminergic treatment of chronic digestive symptoms suggestive of a motility disorder: a two-step pilot evaluation of cisapride. Curr Ther Res 1984; 36: 1053–1062.Google Scholar
  92. 92.
    Jian R, Ducrot F, Ruskone A, et al. Symptomatic radionuclide and therapeutic assessment of chronic idiopathic dyspepsia: A double-blind placebo-controlled evaluation of cisapride. Dig Dis Sci 1989; 34: 657–664.PubMedCrossRefGoogle Scholar
  93. 93.
    Rösch W. Cisapride in non-ulcer dyspepsia: Results of a placebo-controlled trial. Scand J Gastroenterol 1987; 22: 161–164.PubMedCrossRefGoogle Scholar
  94. 94.
    DeNutte N, Van Ganse W, Witterhulghe M, Defrance P. Relief of epigastric pain in nonulcer dyspepsia: controlled trial of the promotility drug cisapride. Clin Ther 1989; 11: 62–68.Google Scholar
  95. 95.
    Myren J, Løvland B, Larssen S-E, Larsen S. A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome. Scand J Gastroenterol 1984; 19: 835–843.PubMedGoogle Scholar
  96. 96.
    Christiansen J, Aagaard P, Koudahl G. Truncal vagotomy and drainage in the treatment of ulcerlike dyspepsia without ulcer. Acta Chirug Scand 1973; 139: 173–175.Google Scholar
  97. 97.
    Aase ST, Liavåg I, Roland M. Proximal gastric vagotomy in dyspeptic patients without an ulcer. World J Surg 1984; 8: 303–307.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Nicholas J. Talley
    • 1
  1. 1.Gastroenterology Unit, Mayo ClinicRochesterUSA

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