非溃疡性消化不良与幽门弯曲菌感染

本文旨在通过对100例非溃疡性消化不良(NUD)患者胃窦粘膜固有膜炎性细胞计数以及幽门弯曲菌(CP)检测,以揭示NUD与CP感染的关系.结果表明:NUD患者CP检出率为64％,其胃窦粘膜固有膜炎性细胞总数较CP阴性者为高,且随CP数目增加而增加,说明伴有胃窦胃炎的NUD患者与CP感染有显著的相关性.另外还表明;各类炎性细胞浸润程度与NUD患者各种症状无特异相关性,而CP感染与NUD患者的腹胀、嗳气有高度相关性.     

Gastric Hypersensitivity in Nonulcer Dyspepsia An Inconsistent Finding

Visceral hypersensitivity is claimed to beinvolved in the pathogenesis of nonulcer dyspepsia(NUD). We evaluated whether gastric hypersensitivity isa consistent finding in an unselected group of NUDpatients. In 11 patients and 20 healthy controls, astandardized gastric distension was performed using agastric barostat. Perception was scored by aquestionnaire and compared between the two groups. Therewas a linear pressure/volume relationship duringgastric distension in both groups. The pain threshold inNUD patients was significantly lower compared tocontrols [5.5 ± 4.0 mm Hg above minimaldistending pressure (mdp) and 10.2 ± 2.2 mm Hg above mdp,respectively, P < 0.004], irrespective of the H.pylori status. However, more than 50% of the NUDperception scores were in the control range at mostdistension levels. Gastric hypersensitivity could be confirmed inNUD patients as a group. However, there is aconsiderable overlap concerning perception in responseto distension between unselected NUD patients andcontrols.     

Gastric Emptying Rate of Solids in Patients with Nonulcer Dyspepsia

The underlying role of motility disorders anddelayed gastric emptying in nonulcer dyspepsia is stillquestioned. This study aimed to determine the role ofthe gastric emptying rate of solids in patients with nonulcer dyspepsia. By means of breathtest technology, gastric emptying results of 344consecutive patients with nonulcer dyspepsia werecompared with those of 70 normal healthy volunteers.Although gastric emptying was significantly delayed inpatients with nonulcer dyspepsia compared with normalvolunteers, there was a great overlap between the twogroups. Using 5-95% confidence intervals of the control group in about 30% of the patients withnonulcer dyspepsia gastric emptying was delayed. Nocorrelation was found between gastric emptying rate andage, weight, height, or sex of the subjects in both groups. These findings suggest that, apartfrom gastric emptying, other mechanisms are veryimportant in the etiology of nonulcerdyspepsia.     

Alterations in Upper Gastrointestinal Motility in Helicobacter pylori-positive Nonulcer Dyspepsia

Objective: To study the association between gastrointestinal motility and Helicobacter pylori (HP) among patients with nonulcer dyspepsia (NUD). Methods: We examined the gastric emptying and orocecal transit times (OCTT) in patients with NUD who were colonized with Helicobacter pytori (n = 27). NUD was defined as dyspeptic symptoms for at least 3 months in the absence of gastrointestinal pathology as seen on endoscopy and ultrasound. Subjects with diabetes mellitus, thyroid disorder, or abdominal surgery except appendectomy were excluded. The HP-negative patients with NUD (n = 38) served as controls. Solid phase gastric emptying was assessed by radionuclide scintigraphy. OCTT was determined by measuring exhaled breath hydrogen upon administration of lactulose. Results: The two groups were similar with respect to age, sex, race, and history of smoking. Gastric emptying (t_1/2) was 64.96 ± 3.61 min in the HP-negative and 61.0 ± 6.59 in the HP-positive group ( p =NS). The OCTT was 130.9 ± 17.26 minutes in the HP-negative and 84.28 ± 11.07 in the HP-positive group ( p = 0.03). There was no difference in the prevalence of nonhydrogen producers between the two groups. There was no correlation between gastric emptying and OCTT ( p > 0.05). Conclusions: OCTT is faster among HP-positive patients with NUD than among HP-negative patients. However, gastric emptying is similar in the two groups.     

The Perception of Life Events and Daily Stress in Nonulcer Dyspepsia

Previous studies on the association of nonulcer dyspepsia with major life events were performed without emphasis on the perception of these events, and have yielded conflicting results. The present study examined the perception of life events and, in addition, the role of daily "hassles" (stressful events) in patients with nonulcer dyspepsia. Thirty-three dyspeptic patients as defined by normal endoscopy and ultrasonogram and 33 controls of comparable sex, age, and social class were recruited for study. Both groups were asked to select from 56 major life events those they had experienced and to give a rating on how they perceived them. They were further asked to select similarly from 117 items of daily stress and to rate the severity of each item. The results demonstrated that the number of positive and negative events and the positive score were similar in both dyspeptic patients and controls, but dyspeptic patients had a higher perceived magnitude of negative events and a higher score of total life change as given by the summation of magnitude of positive and negative events (both p less than 0.05). The "hassles" scores were not significantly different between dyspeptic patients and controls. Analysis of individual life events revealed that dyspeptic patients had significantly (p less than 0.05) higher scores than controls in items of minor law violations, major change in closeness of family members, and major personal illness or injury. We conclude that patients with nonulcer dyspepsia have higher negative perception of major life events, which indicates that psychological factors may play a role in the pathogenesis of nonulcer dyspepsia.     

Impaired Postprandial Gastric Myoelectrical Activity in Chinese Patients with Nonulcer Dyspepsia

Using a homemade electrogastrography (EGG) system, we studied the characteristics of the myoelectrical rhythm in Chinese patients with nonulcer dyspepsia (NUD). Based on short-term Fourier transformation, recorded slow waves could be automatically analyzed to obtain the following parameters: dominant frequency/power, percent of normal frequency (2–4 cpm), power ratio, etc. EGG parameters, Helicobacter pylori status, histological examination of gastric mucosa, and dyspeptic symptoms were recorded in 27 NUD patients. Compared to 32 healthy controls, the Chinese NUD patients had abnormal postprandial EGG parameters including a lower percentage of regular 2–4 cpm slow waves (70.10 ± 2.97% vs 79.08 ± 2.95%, P < 0.05), a lower level of increment of dominant power (0.62, ± 0.91 vs 3.76 ± 0.58 dB, P < 0.05), lower power ratio (1.42 ± 0.28 vs 2.79 ± 0.39, P < 0.05) and a higher instability coefficient (0.36 ± 0.03 vs 0.26 ± 0.03, P < 0.05). However, Helicobacter pylori infection and its associated gastritis did not influence any EGG parameters in NUD patients. Six main dyspeptic symptoms and total symptom score had no correlation with any EGG parameters. In conclusion, Chinese NUD patients may have abnormal postprandial stomach myoelectrical activity, but these EGG abnormalities are not a direct result of Helicobacter pylori infection and its related gastritis and do not contribution to the dyspeptic symptoms.     

Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions

Nonulcer dyspepsia (NUD) is a common syndrome,but the optimal treatments have yet to be established.This study was performed to determine the most effectivetreatment for NUD. Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms. When no organic lesions werefound, the patients were directed to consult ourdepartment (Psychosomatic Medicine); 194 consecutive NUDpatients were studied. All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID). Patients with serious NUD were hospitalized, and randomly divided into control(N = 42) and experimental groups (N = 86). The controlswere treated with physical treatment alone. Theexperimental group received psychiatric treatment inaddition, based on the results of SCID. The experimentalgroup showed a significant improvement compared with thecontrols (P < 0.0001). The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective.     

Nonulcer dyspepsia

Opinion Statement Dyspepsia is a heterogeneous symptom complex with differing symptom presentations, underlying pathophysiology and available treatments. Patients older than 50 years and those who have “alarm” symptoms or signs (eg, weight loss, dysphagia, vomiting, anemia, or heme-positive stool) should undergo an initial endoscopic evaluation. Empiric treatment without diagnostic testing may be used in the initial approach to young patients without alarm symptoms. For patients presenting with uncomplicated dyspepsia, initial testing for H. pylori is appropriate. If present, H. pylori infection is generally treated and symptoms are followed. In patients who do not have H. pylori infection or do not respond to H. pylori treatment, initial treatment with an H2 blocker or promotility agent is appropriate empiric therapy. In some patients, gastroesophageal reflux disease (GERD) presents atypically with primarily dyspeptic symptoms. In these patients, a trial of gastric acid suppressant may help implicate GERD. For patients with nonulcer dyspepsia (ie, dyspeptic symptoms with negative endoscopy), prokinetic therapy may be the most effective empiric treatment.     

Prevalence of Gastric Myoelectrical Abnormalities in Patients with Nonulcer Dyspepsia and H. pylori Infection

The aims of this study were to investigate the effects of H. pylori eradication on gastric myoelectrical activity and dyspeptic symptoms. Sixty-two subjects with H. pylori infection and no active peptic ulcer participated in this study, which involved three sessions. Anti-H. pylori therapy consisting of clarithromycin and omeprazole was given for two weeks. Gastric myoelectrical activity was measured using surface electrogastrography and dyspeptic symptoms were scored at each session. A [¹⁴C] urea breath test was performed at baseline and one month after treatment. In comparison with baseline, the percentage of normal slow waves was significantly increased and the mean total symptom score was significantly reduced one and three months after therapy (P < 0.05). Approximately 40% of patients with nonulcer dyspepsia symptoms and H. pylori infection have abnormal gastric myoelectrical activity, which may be normalized following the eradication of H. pylori infection. The normalization of gastric myoelectrical activity may be one explanation for the significant symptom improvement in this subset of the dyspepsia population after H. pylori eradication.     

Predictive Factors and Prevalence of Follicular Gastritis in Adults with Peptic Ulcer and Nonulcer Dyspepsia

Follicular gastritis is an importanthistological entity, because it may progress to overtgastric MALT lymphoma. However, there is no universalagreement on whether there is any correlation offollicular gastritis with histological features of theantral mucosa or on the prevalence of folliculargastritis. To shed further light on these issues, westudied antral biopsies obtained from 735 adultpatients, who had participated in six consecutiveclinical trials. They included 348 patients withduodenal ulcer, 82 with gastric ulcer, and 305 withnonulcer dyspepsia. The Sydney classification system ofgastritis was used, using a score of 0-3 to grade degreeand activity of inflammation, gland atrophy, intestinalmetaplasia, and H. pylori colonization density.Follicular gastritis was defined as prominent lymphoid follicles with no lymphoepithelial lesion. Noneof the H. pylori-negative patients (N = 159) hadfollicular gastritis. Among H. pylori-positive patients,80/340 (23.5%) with duodenal ulcer, 5/77 (6.5%) withgastric ulcer, and 20/159 (12.6% ) with nonulcerdyspepsia had follicular gastritis (P < 0.001).Multivariate discriminant analysis selected thefollowing four significant predictor variables for follicular gastritis (Wilks =0.91, x² = 70.6, df = 4, P < 0.001):gastritis sum score, atrophic gastritis, age of thepatient, and disease. The prevalence of folliculargastritis was linearly correlated (y = 24.55 – 0.98x, r =–0.62, F_1,11 = 6.12, P = 0.03) with theage groups of the 576 H. pylori-positive patientsstudied. In conclusion, follicular gastritis is highlycorrelated with H. pylori-caused severe, activegastritis. It is mostly prevalent in the young H.pylori-infected patients with duodenal ulcer.     

Edrophonium Provocative Testing for the Evaluation of Upper Gastrointestinal Hypersensitivity in Patients with Nonulcer Dyspepsia

The aim of this study was to examine if edrophonium provocative testing is useful for evaluating upper gastrointestinal hypersensitivity in patients with nonulcer dyspepsia (NUD). A questionnaire rating dyspeptic symptoms was done for 58 patients with NUD. The patients were then given an intravenous infusion of saline followed by 5 mg of edrophonium. Baseline esophageal manometry was also done. Patients whose usual symptoms were reproduced (48.3%) had significantly higher symptom scores (13.0 [8.5, 17.0] vs. 8.5 [6.0, 11.0]; P = 0.015) and a significantly higher number of symptoms (4.0 [2.5, 6.0] vs. 3.0 [1.0, 4.0]; P = 0.010) than patients whose usual symptoms were not reproduced. The presence of an esophageal motility disorder was not significantly different between the two groups. These findings suggest upper gastrointestinal hypersensitivity in the patients whose symptoms were reproduced. Edrophonium provocative testing might be useful for evaluating upper gastrointestinal hypersensitivity in patients with NUD.     

非溃疡性消化不良患者胃液体排空功能与肥大细胞超微结构的关系

为了探讨非溃疡性消化不良（NUD）患者胃液体排空功能与肥大细胞超微结构之间的关系,本文对胃液体排空正常组和排空延迟组各4例NUD患者进行了研究。每例活检胃窦部粘膜1块,行电镜检查,观察肥大细胞形态,计数细胞内颗粒数和已释放介质颗粒数,计算细胞内颗粒面积与细胞总面积之比。结果示NUD患者中排空延迟者肥大细胞脱颗粒增多,提示肥大细胞与NUD患者胃液体排空功能关系密切。     

Nonulcer dyspepsia

Nonulcer dyspepsia is a common condition in clinical practice. It is a heterogeneous disorder, and no single therapeutic agent is effective in all patients. The treatment of nonulcer dyspepsia is still dissatisfactory. Eradication of Helicobacter pylori organisms has a limited role and little effect. Antisecretory therapy has a modest effect in alleviating symptoms. Prokinetic agents may be effective, but selection bias in the trials performed to date may exaggerate their benefit. Partial 5-HT₄ agonists stimulate gastric emptying and may also affect gastric accommodation. They are promising but need further study. Data are limited on 5-HT₃ antagonists and hypnotherapy. New treatment approaches are necessary for this common and often chronic condition.     

Specific Helicobacter pylori Antigens Unable to Distinguish Nonulcer Dyspepsia or Peptic Ulcer Cases from Asymptomatic Seropositive Controls:

We investigated in a large industrial population the antibody response to specific H. pylori antigens (CagA and seven others) in relation to peptic ulcer and nonulcer dyspepsia (NUD). The two groups consisted of 37 and 39 employees, respectively, with endoscopically proven peptic ulcer and NUD. Age- and gender-matched controls were H. pylori seropositive employees without abdominal complaints or history of ulcer disease. IgG antibodies against CagA and other antigens were analyzed by western immunoblot. Relative percentages of CagA-positive individuals were 89 and 76% for ulcer cases and their controls (P = 0.22) and 77% and 74% for NUD cases and their controls. The corresponding percentages of VacA-positive individuals were 87 and 76% for ulcer cases and controls and 64% and 77% for NUD cases and controls, respectively. Analysis of other H. pylori-specific antigens was not particularly helpful in discriminating between symptomatic and asymptomatic seropositive individuals for either disease group. In conclusion, assessment of IgG response against specific H. pylori antigens was not predictive of peptic ulcer or NUD case status in this active employee population and would not appear to be useful in routine clinical practice.     

Sucralfate: Nonulcer Uses

Recent studies have shown sucralfate to have cytoprotective features in addition to its known antipepsin and antacid effects. This drug has been shown in limited studies to prevent gastric salicylate injury with pretreatment. A role for sucralfate in the nonulcer population, patients with gastritis, esophagitis, stomatitis, while promising, has not been clearly established and needs to be defined with further studies.     

Expression of Progastrin-Derived Peptides and Somatostatin in Fundus and Antrum of Nonulcer Dyspepsia Subjects With and Without Helicobacter pylori Infection

The hypergastrinemia and hyperacidity associated with Helicobacter pylori infection has been explained by either a primary excess of gastrin or a lack of inhibitory influence by somatostatin (SOM). The objective of the present study was to compare the concentrations of fundic and antral SOM- and antral progastrin-derived peptides in nonulcer dyspepsia (NUD) subjects with and without H. pylori infection. Antral and fundic mucosal biopsies were extracted and assayed for SOM and gastrin amide, glycine–extended gastrin (gastrin gly), progastrin, and total gastrin. There was a significant sixfold reduction in antral SOM but no change in fundic SOM content in H. pylori-infected subjects compared to uninfected subjects. Antral gastrin amide concentrations were significantly higher in infected subjects. However, the concentrations of the nonamidated gastrin forms (progastrin and glycine-extended gastrin) were significantly lower in the infected subjects, indicating an increased conversion of the precursor forms of gastrin to amidated gastrin, the type known to stimulate gastric acidity. The present study demonstrates that the elevated gastrin concentrations associated with H. pylori infection may be due to a reduction in the paracrine inhibitory effect of SOM on antral gastrin release. In addition, the posttranslational processing of gastrin to the amidated forms is increased in infected subjects, explaining why the elevation in antral gastrin is confined to the amidated form.