Dyspepsia in healthy blood donors

WhetherHelicobacter pylori is causally linked to dyspepsia remains controversial. The aims of this study were to assess in healthy blood donors the prevalence of dyspepsia and dyspepsia subgroups, determine ifH. pylori is associated with different categories of dyspeptic symptoms, and evaluate the association between dyspepsia and nicotine, alcohol, and analgesic use. Consecutive blood donors (N=180) who had no clinical evidence of organic disease were included. Abdominal symptoms were measured by means of a standardized questionnaire that has been previously validated. Subjects with dyspepsia (defined as pain localized to the upper abdomen) were further subdivided into those with ulcer-like, dysmotility-like, reflux-like, or nonspecific dyspepsia. A total of 65 subjects reported abdominal pain or discomfort during the prior 12 months [36.1%, 95% confidence interval (CI) 29.1–43.1]; 44 subjects (24.4%, 95% CI 18.2–30.7) had dyspepsia. Dysmotility-like, reflux-like, and ulcer-like symptoms were reported by 19.4% (95% CI 13.7–25.2), 17.2% (95% CI 11.7–22.7), and 16.7% (95% CI 11.2–22.1) of subjects with dyspepsia, respectively. Fifty-seven subjects (31.7%, 95% CI 24.9–38.5) wereH. pylori positive; 26% of subjects withH. pylori and 24% withoutH. pylori had dyspepsia (P>0.50). The seroprevalence ofH. pylori was also similar among the different categories of dyspepsia. We conclude that infection withH. pylori is not associated with abdominal complaints in otherwise healthy subjects.     

Dyspepsie

Functional dyspepsia is a chronic and polymorphic disorder with a prevalence of approximately 10% in the adult population. Management of this disease represents a considerable economic burden worldwide. Functional dyspepsia is defined as a pain or a sensation of discomfort located in the upper abdomen, according to the Rome II criteria. A dyspepsia subgroup classification based on the predominant symptom has been proposed: dysmotility-like dyspepsia, ulcer-like dyspepsia and non-specific dyspepsia. In patients with alarm symptoms, upper endoscopy has to be performed. In the absence of alarm features, the patient needs to be reassured and psychotherapy must be discussed. Then, empirical therapy with proton pump inhibitors (ulcer-like dyspepsia) or domperidone (dysmotility-like dyspepsia) may improve symptoms in some cases. Efficacy of Helicobacter pylori eradication in dyspepsia is probably poor; on the other hand, treatment of Helicobacter pylori infection could reduce the prevalence of gastric cancer but further investigations are needed to clarify this point. Pathophysiology of dyspepsia remains unclear. The psychological factors are not the only involved in this functional disorder. The identification of the mechanisms that lead to symptom generation should facilitate the development of newer and more effective therapeutic strategies in functional dyspepsia.     

Predominant symptom behavior in patients with persistent dyspepsia during treatment

BACKGROUND: Grouping of patients based on a predominant dyspeptic symptom is frequently employed in management strategies for dyspepsia. Such subdivision, however, suggests that dyspeptic symptom patterns are constant over time. OBJECTIVE: To investigate the behavior of symptoms over time and to study the effects of diagnostic procedures and treatment on the pattern and severity of dyspeptic symptoms. METHODS: Patients with persistent dyspeptic symptoms completed a validated questionnaire at regular time intervals as part of a clinical trial in primary care. Based on predominant symptoms, patients were classified into ulcer-like dyspepsia, reflux-like dyspepsia, dysmotility-like dyspepsia, and unspecific dyspepsia according to the Rome II criteria. RESULTS: Questionnaires were returned at baseline, 1, 3, and 6 months by 185, 172, 169, and 170 patients, respectively. At baseline, 35% of patients reported predominantly reflux-like dyspepsia, 34% had ulcer-like dyspepsia, 16% had dysmotility-like dyspepsia, and in 15% symptoms were not specific. During the 6-month follow-up period, only 35% of patients kept the same predominant symptom. Symptom (in)stability was not dependent on diagnostic procedures or on therapy with proton pump inhibitors, H2-receptor antagonists, prokinetics, or antacids. CONCLUSION: In the majority of dyspeptic patients, symptoms change continuously as time goes on. Symptom instability is not influenced by diagnostic procedures or therapy. Thus, there is little sense in symptom-based management of dyspepsia in primary care.     

功能性消化不良及其分型组的胃窦十二指肠运动

本研究对功能性消化不症状分型的常规标准做了一些调整，并观测了３９例ＦＤ患者空腹及餐后胃窦十二指肠运动，以探讨ＦＤ患乾胃窦十二指肠运动状况及其与分型组之间的关系。结果显示〈ＦＤ患者空腹及餐后胃窦十二指肠动力减弱，在胃窦表现为运动指数、平均振幅和频率均显著低于正常组，在十二指肠表现为平均振     

Fluctuation in dyspepsia subgroups over time. A three-year follow-up of patients consulting general practice for dyspepsia

BACKGROUND: General practitioners base their treatment and investigation on the symptoms presented by the patients. Subgroups of dyspepsia have been defined in order to guide management. AIM: To study prospectively changes over time in the presentation of dyspepsia according to different subtypes in a general practitioner population. SUBJECTS: Patients consulting the general practitioner because of dyspeptic complaints. METHODS: A random sample of general practitioner patients consulting with different dyspepsia subtypes (ulcer-like, reflux-like, dysmotility-like, uncharacteristic and relapsing dyspepsia) were studied three years after the initial consultation by postal questionnaires to the general practitioners (obtaining information from the patient records) and to the patients (obtaining self-reported symptoms during twelve months). The subtype of dyspepsia at baseline was compared to the subtype in the patient questionnaire. RESULTS: Between 20 and 34% of the patients reported no dyspepsia after three years, with so significant difference between the subtypes. Changes from one subtype to another were common, ulcer-like and reflux-like often changed into dysmotility-like dyspepsia. Dysmotility-like dyspepsia was significantly more stable over time. Patients with more than one episode of dyspepsia changed subtype significantly less. CONCLUSIONS: Most patients who presented with dyspepsia to the general practitioner still reported symptoms three years later. Few patients with dysmotility-like dyspepsia changed subtype over time, whereas changes from one subtype to another were common in other subtypes. This implies that dyspeptic patients could end up having dysmotility-like complaints possibly due to the lack of effective treatment for this condition, compared to the other dyspepsia subtypes.     

Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia

The relative contributions of altered gastric motor function andHelicobacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated scintigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; patients were subdivided on the basis of both specific symptom clusters and the presence or absence ofH. pylori gastritis. Twenty-one (28%) patients displayed abnormal solid and/or liquid gastric emptying, with prolonged solid lag time the most prominent alteration detected. The number of patients with abnormal scintigraphic patterns increased to 36 (48%) when intragastric distribution parameters (fundal half-emptying time and antral maximal fraction) were examined. Although patients with reflux-like dyspepsia (N=36) demonstrated significantly slower rates of liquid emptying at 45 and 70 min and a higher prevalence of abnormal liquid intragastric distribution when compared to patients with motility-like dyspepsia (N=39) or to controls (N-34), the absolute differences were small and unlikely to be of clinical significance. Patients withoutH. pylori gastritis (N=50) demonstrated a significantly more prolonged solid lag time when compared to those withH. pylori gastritis (N=25), but the difference was small and there were no other differences between these two subgroups. We conclude that in patients with functional dyspepsia: (1) abnormal solid gastric emptying is present in less than one third; (2) assessment of parameters of intragastric distribution enables more subtle gastric motor dysfunction to be identified; and (3) neither dividing patients into symptom subgroups nor accounting for the presence or absence ofH. pylori gastritis has a major influence on the prevalence or type of gastric motor dysfunction.     

Double blind,randomised, placebo controlled study of four weeks of lansoprazole for the treatment of functional dyspepsia in Chinese patients

BACKGROUND: The use of proton pump inhibitors for the treatment of functional dyspepsia is controversial and the role of Helicobacter pylori infection in functional dyspepsia is uncertain. AIM: To evaluate the efficacy of different doses of lansoprazole for the treatment of functional dyspepsia in Chinese patients. METHOD: Patients with a clinical diagnosis of functional dyspepsia according to the Rome II criteria and normal upper gastrointestinal endoscopy were recruited and randomised to receive: (1) lansoprazole 30 mg, (2) lansoprazole 15 mg, or (3) placebo, all given daily for four weeks. Dyspepsia symptom scores and quality of life (SF-36 score) were evaluated before and four weeks after treatment. RESULTS: A total of 453 patients were randomised. There was no difference in the proportion of patients with complete symptom relief in the lansoprazole 30 mg (23%) and lansoprazole 15 mg (23%) groups compared with the placebo group (30%). The proportion of H pylori positive patients with a complete response was similar with lansoprazole 30 mg (34%) and lansoprazole 15 mg (20%) versus placebo (22%). All symptom subgroups (ulcer-like, dysmotility-like, reflux-like, and unspecified dyspepsia) had similar proportions of patients with complete symptom relief after treatment. CONCLUSION: Proton pump inhibitor treatment is not superior to placebo for the management of functional dyspepsia in Chinese patients.     

Empiric clustering of dyspepsia into symptom subgroups: a population-based study

BACKGROUND: Different definitions of dyspepsia are applied by researchers yet measurement of the influence of these on prevalence estimates is uncertain. Despite continued debate regarding dyspepsia subgroups, few studies have used a data-drive approach to assess the existence and relevance of symptom clusters. We aimed to address both these issues. METHODS: A random population sample (n = 2300) identified in New South Wales. Prevalence estimates of dyspepsia were calculated by applying four standardized dyspepsia definitions. Principal components analyses, using firstly the presence/absence of symptoms and then secondly severity of symptoms, were undertaken to determine if symptom factors existed. RESULTS: Prevalence estimates ranged from 11% to 36%. Similar prevalence rates for men and women were observed for all definitions except Rome II. Over one-third of respondents nominated heartburn or epigastric pain as their most bothersome symptom. However, 22% of respondents were unable to answer this question. The principal components analysis produced four symptom factors: a nausea factor, dysmotility-like dyspepsia (early satiety and fullness), ulcer-like (epigastric pain and bloating) and reflux-like (heartburn and acid regurgitation). However, the factors accounted for less than 50% of the variance. Similar factors were identified in men and women for dysmotility-like and reflux-like dyspepsia. Use of presence/absence or severity of symptoms made little difference to the symptom factors produced or the amount of variance explained. CONCLUSIONS: The prevalence of dyspepsia depends on the definition applied. While there is some empirical evidence of symptom subgroups, they appear to be of little clinical utility.     

Empiric Clustering of Dyspepsia into Symptom Subgroups: a Population-based Study

Background: Different definitions of dyspepsia are applied by researchers yet measurement of the influence of these on prevalence estimates is uncertain. Despite continued debate regarding dyspepsia subgroups, few studies have used a data-drive approach to assess the existence and relevance of symptom clusters. We aimed to address both these issues. Methods: A random population sample ( n = 2300) identified in New South Wales. Prevalence estimates of dyspepsia were calculated by applying four standardized dyspepsia definitions. Principal components analyses, using firstly the presence/absence of symptoms and then secondly severity of symptoms, were undertaken to determine if symptom factors existed. Results: Prevalence estimates ranged from 11% to 36%. Similar prevalence rates for men and women were observed for all definitions except Rome II. Over one-third of respondents nominated heartburn or epigastric pain as their most bothersome symptom. However, 22% of respondents were unable to answer this question. The principal components analysis produced four symptom factors: a nausea factor, dysmotility-like dyspepsia (early satiety and fullness), ulcer-like (epigastric pain and bloating) and reflux-like (heartburn and acid regurgitation). However, the factors accounted for less than 50% of the variance. Similar factors were identified in men and women for dysmotility-like and reflux-like dyspepsia. Use of presence/absence or severity of symptoms made little difference to the symptom factors produced or the amount of variance explained. Conclusions: The prevalence of dyspepsia depends on the definition applied. While there is some empirical evidence of symptom subgroups, they appear to be of little clinical utility.     

Role of eradication of Cag A Helicobacter pylori in non ulcer dyspepsia.

The role of Helicobacter pylori (H.pylori) in patients with non ulcer dyspepsia (NUD), the relationship of the virulence of the organism to the occurrence and severity of NUD and the need for eradication of H. pylori in alleviating symptoms of NUD remain controversial. This study was carried out for the purpose of determining the interaction between virulent H.pylori and symptoms of NUD and to clarify whether H. pylori eradication is beneficial in-patients with NUD. Sixty consecutive patients who fulfilled standard criteria for the diagnosis of NUD and who were positive H. pylori status by the urease test were studied. NUD was classified into ulcer-like and dysmotility-like as per standard criteria. All patients were treated with a triple drug regimen for H. pylori for 10 days, which consisted of Clarithromycin, Amoxicillin and Omeprazole. Blood was drawn for IgG antibodies against Cag A strains and H. pylori by ELISA. All patients were evaluated at 6 months for symptomatic improvement, which was, correlated with Cag A H. pylori positive status. No significant difference was seen in the H. pylori Cag A prevalence between ulcer-like and dysmotility-like dyspepsia. While there was a trend towards a better symptomatic improvement with H.pylori eradication in patients with ulcer-like NUD as opposed to dysmotility-like NUD, this did not reach significance (73% vs. 57%, p= 0.18). However "there was a statistically significant benefit of eradication of H. pylori in-patients with ulcer-like NUD who were positive for Cag A H.pylori status (p=0.02). No such benefit was seen in-patients with dysmotility-like NUD. H. pylori eradication seems to confer significant benefit as regards symptomatic relief inpatients with ulcer like NUD who are positive for Cag A strain for H. pylori.     

Comparison of PPIs and H2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia

AIM: To compare efficacy of proton pump inhibitors (PPIs) with H₂-receptor antagonists (H₂RAs) plus prokinetics (Proks) for dysmotility-like symptoms in functional dyspepsia (FD).METHODS: Subjects were randomized to receive open-label treatment with either rabeprazole 10 mg od (n = 57) or famotidine 10 mg bid plus mosapride 5 mg tid (n = 57) for 4 wk. The primary efficacy endpoint was change (%) from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment.RESULTS: The improvement in dysmotility-like dyspepsia symptom score on day 28 was significantly greater in the rabeprazole group (22.5% ± 29.2% of baseline) than the famotidine + mosapride group (53.2% ± 58.6% of baseline, P < 0.0001). The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine + mosapride group (87.7% vs 59.6%, P = 0.0012). Rabeprazole therapy was the only significant predictor of treatment response (P < 0.0001), defined as a total symptom score improvement ≥ 50%.CONCLUSION: PPI monotherapy improves dysmotility-like symptoms significantly better than H₂RAs plus Proks, and should be the treatment of first choice for Japanese FD.     

Use of the upper gastrointestinal endoscopy in dyspeptic patients

BACKGROUND AND AIMS: Dyspepsia is a common complaint that may signal the presence of diseases like cancer or peptic ulcer. The aim of our study was to assess if the clinical patterns of dyspepsia can be considered a valid guideline for the appropriate use of endoscopy. METHODS: According to the symptomatological patterns, our 243 patients were defined as sufferers from: ulcer-like (93 patients), reflux-like (25) and dismotility-like dyspepsia (125). Erosive gastritis and erosive duodenitis were regarded as minor inflammatory lesions. RESULTS: A negative endoscopy (normal or presenting minor inflammatory lesions) was found in 36.6% of ulcer-like dyspepsia patients: this rate was 52% in the reflux-like group, and 49.6% in the dismotility-like one. Duodenal ulcer was the most frequent abnormal lesion in the three groups. The frequency of negative endoscopies was significantly higher in dismotility-like than in ulcer-like (49.6% vs. 36.6%--P < 0.05) dyspepsia. In those patients with dismotility-like dyspepsia under 41 years, the rate of negative endoscopies was 72.7%, and neoplasms were not observed. CONCLUSION: Our data indicate that endoscopy could be considered inappropriate for patients under 41 years old with dismotility-like dyspepsia. These subjects account for 18.1% of the patients studied, what could lead to a good percentage of reduction in endoscopic service load.     

Evaluation of Helicobacter pylori status and endoscopic findings among new outpatients with dyspepsia in Japan

Purpose

The 2005 ACG guidelines for the management of dyspepsia recommend eradication and proton pump inhibitors for patients who are H. pylori-positive and-negative, respectively. To establish Japanese guidelines for dyspepsia, we evaluated H. pylori status and endoscopic findings among outpatients with dyspepsia.

Methods

The status of H. pylori in dyspeptic patients was determined by measuring urinary levels of anti-H. pylori antibody (RAPIRAN^®). We then compared the endoscopic findings between H. pylori-positive and -negative patients.

Results

The prevalence of H. pylori among 258 dyspeptic patients was 47.8%, and increased with age (11.1% at age 10–19 years; >50% at age >50 years). The prevalence of H. pylori in each age-group tended to be lower among male than female dyspeptic patients. Endoscopy (n = 138) showed that H. pylori-negative patients rarely had peptic ulcers or gastric cancer, and 84.7% had no endoscopic findings, which was significantly higher when compared to H. pylori-positive patients (67.3%) (p = 0.029).

Conclusions

Over half of the dyspeptic Japanese patients examined were negative for H. pylori. Patients who are H. pylori-positive should undergo endoscopy to rule out gastric malignancy, peptic ulcers and other diseases.     

Helicobacter pylori Protection Against Reflux Esophagitis

Background and Aim

Negative association has been reported between presence of Helicobacter pylori and developing gastroesophageal reflux disease (GERD) and its complications. The aim of this study was to determine whether H. pylori (HP) can be protective against GERD in an African American (AA) population.

Methods

From 2004 to 2007, we studied 2,020 cases; esophagitis (58), gastritis (1,558), both esophagitis and gastritis (363) and a normal control group (41). We collected their pathology and endoscopy unit reports. HP status was determined based on staining of gastric biopsy.

Results

HP data was available for 79 % (1,611) of the cases. The frequency of HP positivity in gastritis patients was 40 % (506), in esophagitis patients 4 % and in normal controls 34 % (11), while HP was positive in 34 % of the patients with both esophagitis and gastritis. After adjusting for effects of age and sex, odds ratio of HP was 0.06 (95 % CI 0.01–0.59; P value = 0.01) for the esophagitis group versus the normal group.

Conclusions

Our results show H. pylori has a significant negative association with esophagitis in AAs which may point to a protective role of H. pylori in the pathogenesis of esophagitis. In addition, H. pylori may be the reason for the low GERD complications in AAs.     

Functional dyspepsia: definition, classification, clinical and therapeutic management

Dyspepsia is a very common syndrome characterized by pain and/or discomfort of the upper abdomen. Sometimes, an organic disease causes this syndrome (organic dyspepsia); more frequently, there are no known diseases (functional dyspepsia). These latter conditions are identified by exclusion. The pathogenesis of this syndrome is yet to be clarified. Currently, functional dyspepsia is classified in ulcer-like dyspepsia, dysmotility-like dyspepsia and nonspecific dyspepsia, in which symptoms do not clearly fit into any of the above categories. The current guidelines for the management of "uninvestigated dyspepsia" suggest testing for Helicobacter pylori infection and relative treatment if positive. A gastroscopy should be performed in case of persistence of symptoms to discriminate between the organic and functional forms. In the latter, to optimize patient management, it is necessary to find the exact subgroup. Antacids, H2-receptor antagonists and proton pump inhibitors have been demonstrated to be useful in ulcer-like dyspepsia. Prokinetic agents are more effective in the dysmotility-like dyspepsia. Further studies will be necessary to confirm the efficacy of emerging therapeutic strategies.     

The effect of Helicobacter pylori eradication on dyspeptic symptoms,acid reflux and quality of life in patients with functional dyspepsia

BackgroundThe aims of this study were to investigate the effect of Helicobacter pylori eradication on gastroesophageal reflux, gastrointestinal symptoms and quality of life in patients with functional dyspepsia.Methods20 H. pylori positive patients diagnosed as having functional dyspepsia according to Roma-II criteria completed the study period. Esophageal motility testing and pH recordings were obtained from each patient before and at the end of the study period. Each patient's gastrointestinal symptoms were evaluated according to Glasgow dyspepsia score. 36-Item short-form health survey (SF-36) and EDQ5 health survey were obtained form each patient.ResultsH. pylori eradication was accomplished in 13 patients (65%). Glasgow dyspepsia symptom score improved in H. pylori eradicated patients (10.3 vs 7.5, p < 0.05) compared to baseline. Fasting lower esophageal sphincter pressures increased (21.6 vs 25.4 mmHg, p < 0.05) after H. pylori eradication Neither the amplitude of peristaltic contractions in the esophageal body (59.4 vs 57.7 mmHg, p = ns) nor the velocity of peristaltic contractions changed before and after eradication. The percent time of esophageal pH < 4 (0.7 vs 2.6, p < 0.001), reflux events longer than 5 min (0 vs 0.7, p < 0.005) and total reflux number (10.3 vs 19.3, p < 0.005) significantly increased after eradication therapy. In the SF-36 health-related quality of life survey, general health score was 3.5 vs. 3.4, physical activity 25.2 vs. 26.4, physical role 5.9 vs. 6.3, emotional pain 4.6 vs. 4.5, social activity 2.0 vs. 1.9, physical pain 3.4 vs. 3.0, vitality 32.3 vs. 34.6, and mental health 11.9 vs. 11.5, before and at the end of treatment (p = ns), respectively.ConclusionsH. pylori eradication did not influence quality of life in patients with functional dyspepsia. Majority of the patients experienced a significant change in esophageal acid exposure after H. pylori eradication. H. pylori eradication significantly decreases gastrointestinal symptoms, however has no effect on quality of life in patients with functional dyspepsia.     

The Impact of Dyspepsia Definition on Prevalence Estimates: Considerations for Future Researchers

Background: The role of Helicobacter pylori infection in functional dyspepsia is still controversial, and subgroups of patients with functional dyspepsia who may benefit from H. pylori eradication should be identified. Patients with functional dyspepsia and antrum‐predominant H. pylori‐positive chronic gastritis, it has been argued, have fewer symptoms after eradication therapy. In the present study, we analysed the clinical significance of antrum‐predominant gastritis on the long‐term prognosis of functional dyspepsia. Methods: Consecutive unselected dyspeptic patients were investigated in primary care and the patients with functional dyspepsia were enrolled in this long‐term follow‐up study. Altogether 182 patients were recruited: 65 with normal histology of the stomach, 36 with antrum‐predominant gastritis, 21 with corpus‐predominant gastritis and 60 with pangastritis. Patients' medical histories were reviewed after 6 to 7 years, with total number and outcome of repeated investigations analysed. At the end of follow‐up, all patients were invited for voluntary gastroscopy. Results: At the end of follow‐up, the proportion of asymptomatic patients ranged from 21% (normal histology) to 26% (antrum‐predominant gastritis). No statistically significant differences between groups appeared in regard to re‐visits or to proportion of patients examined by sigmoideo‐ or colonoscopy during follow‐up. Patients with antrum‐predominant gastritis less often underwent upper endoscopy. Peptic ulcer was more frequent (P?=?0.05) in patients with antrum gastritis than in other groups, but no other differences existed among any organic gastrointestinal findings. No significant differences between subgroups appeared among the 30% of patients using drugs for upper abdominal complaints during the previous year. Conclusions: Functional dyspepsia has an excellent long‐term prognosis. Antrum‐predominant gastritis in functional dyspepsia seems to carry an increased risk for peptic ulcer, and for this group in particular, H. pylori eradication should be considered. This finding requires confirmation in future studies performed in primary care.     

Placebo-Controlled Trial of Cisapride and Nizatidine in Unselected Patients With Functional Dyspepsia

Objective : Patients in most trials of pharmacotherapy for nonorganic dyspepsia have been groups referred selectively for endoscopy, which could have led to a selection bias of nonresponders, explaining the negative outcome of most controlled treatment trials in nonorganic dyspepsia. The aim of this study was to evaluate the effects of cisapride and nizatidine in patients with nonorganic dyspepsia who were recruited directly from primary care settings, and to evaluate the therapeutic implications of dyspepsia subgrouping. Methods : A consecutive series of patients who consulted their general practitioner with dyspepsia were invited to an interview and endoscopy. Before endoscopy, symptoms were classified as reflux-like, dysmotility-like, ulcer-like, or unclassifiable. A total of 330 patients with either minor or no abnormalities at endoscopy were randomized to double blind treatment with cisapride 10 mg t.i.d. , nizatidine 300 mg at night, or placebo for 2 wk. Results : A symptomatic response was found in 62% of patients on cisapride (therapeutic gain cisapride vs placebo: 0.1% [95% confidence interval –14% to 14%]) and in 54% of patients on nizatidine (therapeutic gain nizatidine vs placebo: –8% [95% confidence interval –22% to 7%]). Response to treatment was independent of symptom classification. Conclusions : The effects of a 2-wk course of cisapride or nizatidine in unselected patients with dyspepsia recruited from primary care were not superior to those of placebo. Symptom subgrouping was not predictive of response to therapy.