1/12. review article: managing the dyspeptic patient--an interactive discussion.dyspepsia, a common disorder, can present some difficult clinical dilemmas. physicians should explore some of the more challenging cases of dyspepsia in a setting that fosters interactive dialogue among colleagues, as was the case at the interactive discussion reported below. A panel of experts presented and discussed three case histories. The audience was able to choose from among several options for diagnosis or treatment and recorded their votes by means of an electronic handset. The first case concerned the relationship between continued non-steroidal anti-inflammatory drug (NSAID) use and recurrent upper gastrointestinal (GI) symptoms without ulcer or helicobacter pylori infection. The second was a woman with complex upper GI symptoms including heartburn. The last featured a young man with dyspepsia and no alarm symptoms. The first case showed that a standard dose of proton pump inhibitor (PPI) is the best treatment for patients with gastritis who continue to use NSAIDs. The second case revealed that 24-h pH monitoring can be used to establish a relationship between symptoms and reflux episodes. The third case demonstrated that it can be difficult to make a definitive diagnosis based on clinical symptoms, and that patients with endoscopy-negative reflux disease usually respond well to PPI therapy.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/12. headache of gastrointestinal origin: case studies.Three patients with headache of gastrointestinal origin are described. Reflux, dyspepsia, and constipation caused the headaches, which responded promptly to treatment of the respective gastrointestinal disorders.- - - - - - - - - - ranking = 4.4615301285709keywords = headache (Clic here for more details about this article) |
3/12. Primary benign ulcer of the gall bladder.It is sometimes impossible to come to a final diagnosis in patients with dyspepsia and upper abdominal pain in spite of extensive investigation. Such patients are usually given vague diagnoses like "non-ulcer dyspepsia" and they represent an important diagnostic challenge.- - - - - - - - - - ranking = 6.1218451575936keywords = abdominal pain, upper (Clic here for more details about this article) |
4/12. Morgagni's hernia.Congenital diaphragmatic hernias, including Morgagni s hernia, usually present in early childhood and are treated by surgical repair. This case report is about an unusual Morgagni s hernia, presenting with dyspepsia and chest pain, at the age of 45 years. For many years the diagnosis remained a dilemma because patient s chest x-ray was not done and she was treated for "angina " and "dyspepsia". diagnosis was obvious once a chest x-ray was done, however, barium studies were performed for further confirmation.- - - - - - - - - - ranking = 0.38488472033802keywords = chest (Clic here for more details about this article) |
5/12. Unusual manifestations of taenia solium infestation.We present two rare cases of unusual manifestations of taenia solium infestation. Taenia infestation usually causes abdominal pain and diarrhea in humans. But there have been no clinical reports of ascites, chronic diarrhea, and malabsorption due to taenia solium without evidence of the ova or larvae of the parasites in stool examinations. Our first unusual case was in a 30-year-old woman with spontaneous pneumothorax, pleural effusion, and ascites; the second case was in a 67-year-old man with a 3-year history of diarrhea, weight loss, and indigestion. Both patients showed blood eosinophilia and positive serologic tests for taenia solium. After antiparasitic agent administration, their symptoms resolved successfully.- - - - - - - - - - ranking = 5.6218451575936keywords = abdominal pain (Clic here for more details about this article) |
6/12. irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome.Recurrent or chronic abdominal pain is a description and not a diagnosis. The clinician should consider both disease and functional pain. In the absence of obvious disease, adolescents fulfilling symptom-based criteria for functional gastrointestinal disorders can be treated for their problems without initially performing extensive diagnostic studies. Most of these patients will have symptoms resembling IBS, functional dyspepsia, or functional abdominal pain syndrome. It is imperative that the clinician takes a biopsychosocial approach in dealing with these patients. Although the clinician still evaluates for biologic disease, he or she maintains an appreciation that psychosocial events may have a profound impact on physiology and symptom production.- - - - - - - - - - ranking = 33.731070945562keywords = abdominal pain (Clic here for more details about this article) |
7/12. Reversal of gastric electrical dysrhythmias by cisapride in children with functional dyspepsia. Report of three cases.Three children (ages 5, 7.6, and 8 years), with recurrent unexplained upper abdominal symptoms such as vomiting, epigastric pain, anorexia, early satiety and without structural or mucosal abnormalities of gastrointestinal tract, underwent electrogastrography (EGG)--recording of gastric electrical activity using cutaneous electrodes positioned on the epigastric region and connected to a recording polygraph. Frequency of EGG signals was analyzed by fast Fourier transform. Significant changes of fasting and fed gastric myoelectrical activity (tachygastria, bradygastria, flatline pattern) were recorded in the three patients; furthermore, gastric emptying (GE) of a solid-liquid mixed meal, measured by ultrasonography, was significantly prolonged in them. A follow-up study was carried out after an eight-week course with oral cisapride: in all patients symptoms improved, GE time normalized, and EGG analysis showed normal electrical rhythm. It is suggested that gastric dysrhythmias can play a pathogenetic role in patients with functional gastrointestinal symptoms and that symptomatic improvement is accompanied by normalization of gastric electrical rhythm.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
8/12. How to manage the difficult-to-treat dyspeptic patient.The main causes of dyspepsia are unexplained gastroduodenal symptoms (i.e. functional dyspepsia), peptic ulcer disease, reflux disease and, rarely, malignancy. A careful clinical evaluation and upper endoscopy will exclude most of the major causes of dyspepsia. The absence of alarm features is reassuring. The yield of other diagnostic tests in this clinical situation is low, and repeat endoscopy is unlikely to be cost-effective. By definition, the difficult-to-treat patient with functional dyspepsia has already had helicobacter pylori infection excluded or eradicated, has failed to respond to an adequate trial of acid-suppression therapy that used appropriate doses and, therefore, seeks other solutions. It is likely that patients who have failed to respond to previous trials of a PPI will not experience therapeutic gains with high-dose PPI therapy. A major gastroduodenal motor disorder should be suspected if there is severe early satiation (inability to finish a normal-sized meal), postprandial fullness, or persistent nausea and vomiting; here, an assessment of gastric emptying or gastric accommodation can be considered, to tailor therapy. Antidepressants (especially low-dose tricyclic agents) and psychological therapies can be useful. Creation of a logical management plan that includes patient education and support remains key.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
9/12. carcinoma of the colon presenting with dyspepsia.Three patients with upper abdominal symptoms responding to anti-ulcer medication are reported who had negative upper gastrointestinal endoscopies. Subsequent barium enemas showed that each of the patients had either a carcinoma of the transverse colon or caecum. Investigation of the colon should be considered in all such cases.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/12. chest pain--indigestion or impending heart attack?A high proportion (40%) of patients with definite myocardial ischaemia who were questioned on admission to a Cardiac Monitoring Unit had experienced preceding chest pain which had been misinterpreted by both the patients themselves and doctors as 'indigestion' and which had often been inappropriately treated. 'Indigestion' in the chest in previously non-dyspeptic subjects over 40 years of age should be regarded as myocardial ischaemia until proved otherwise.- - - - - - - - - - ranking = 0.25658981355868keywords = chest (Clic here for more details about this article) |
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