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Biomedical subjects

D W Piper

Publications and source records attributed to D W Piper.

At least 37 records · Page 2Linked to original sources
PubMed1989

Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia.

Gastric motor dysfunction and concomitant gastric stasis have been implicated in the pathogenesis of nonulcer dyspepsia, but a cause-and-effect relationship is not established. Essential dyspepsia refers to a subgroup of nonulcer dyspepsia patients who have no evidence of irritable bowel syndrome, gastroesophageal reflux, or pancreaticobiliary disease. In 32 patients with essential dyspepsia, and 32 randomly selected dyspepsia-free community controls of similar age and sex, we measured gastric emptying of solids using Tc99m-Sulphur Colloid in a fried egg sandwich. Subjects with neuromuscular or other diseases that may alter gastric emptying were excluded. Symptoms were assessed by a standard questionnaire. Data processing was carried out "blinded" to the subjects' clinical status. Female patients took significantly longer to empty half the initial stomach activity (mean 90 min) than female controls (mean, 73 min; p = 0.02). The rate of emptying at 25 min was also significantly less in female patients than in controls. Female and male controls, and male patients, had similar emptying times. Delayed emptying was not associated with the occurrence of postprandial pain, belching, or nausea; there was a trend for the half-time rate of emptying to be greater in patients with abdominal distention. While gastric emptying of solids is slightly delayed in females with essential dyspepsia as a group, this may not explain their symptoms.

Dyspepsia↗
PubMed1988

Environmental factors and chronic unexplained dyspepsia. Association with acetaminophen but not other analgesics, alcohol, coffee, tea, or smoking.

A subgroup of patients with nonulcer dyspepsia (NUD) have no definite cause for their dyspepsia, termed essential dyspepsia. The aim of the present study was to determine if environmental factors are associated with essential dyspepsia. The patterns of ingestion of analgesic drugs (aspirin, acetaminophen, dextropropoxyphene), nonaspirin, nonsteroidal antiinflammatory drugs, alcohol, coffee, tea, and smoking in 113 essential dyspepsia patients were compared with 113 randomly selected community controls matched for age, sex, and social grade. Associations were studied in two six-month periods, before diagnosis in all patients and before the onset of NUD in those patients with a short history of dyspepsia. It was found that acetaminophen ingestion was associated with essential dyspepsia, and this association was present both before the onset of the dyspepsia (OR 3.1, 95% CI 1.3-7.1) and before diagnosis (OR 1.8, 95% CI 1.2-2.6). None of the other environmental factors were associated with essential dyspepsia.

Acetaminophen↗
PubMed1988

Smoking, nonsteroidal anti-inflammatory drugs, and acetaminophen in gastric ulcer. A study of associations and of the effects of previous diagnosis on exposure patterns.

A study was conducted in Sydney, Australia to investigate whether the use of some nonaspirin nonsteroidal anti-inflammatory (anti-arthritic) drugs was associated with gastric ulcer in patients who had had neither a gastric nor a duodenal ulcer diagnosed previously (i.e., in new cases of peptic ulcer), and whether the use of anti-arthritic drugs, aspirin, acetaminophen, and cigarettes was influenced by the diagnosis of a peptic ulcer--either gastric or duodenal. Bleeding of gastric ulcer in new cases was studied in relation to smoking, use of aspirin or anti-arthritic drugs, and age. The 417 patients in the study lived in Sydney and were interviewed between 1982 and 1985 after diagnosis of a gastric ulcer; 192 patients had had a gastric or duodenal ulcer diagnosed previously (i.e., were recurrent cases of peptic ulcer), and the remaining 225 patients were new cases to whom 411 community controls were matched on sex, age, and prestige of area of residence. In new cases, odds ratios of gastric ulcer were 5.0 for daily aspirin use and 2.3 to 5.4 for daily anti-arthritic drug use. Fewer recurrent cases than new cases had used aspirin daily (odds ratio (OR) = 0.5) or anti-arthritic drugs daily (OR = 0.5), and more recurrent than new cases had used acetaminophen daily (OR = 2.5). Among new cases, bleeding of gastric ulcer was less common in smokers (OR = 0.6), and more common in daily users of aspirin (OR = 2.1) and, to a lesser extent, in daily users of anti-arthritic drugs (OR = 1.5), and in patients aged 60 or more years (OR = 2.3) independent of usage of the above drugs. It is concluded that 1) the use of anti-arthritic drugs increases gastric ulcer risk; 2) diagnosis of a gastric or duodenal ulcer causes a decrease in the use of aspirin and anti-arthritic drugs and an increase in acetaminophen use, but does not change smoking habits; 3) aspirin use or advancing age may add to the risk of bleeding ulcer although the role of anti-arthritic drugs is less clear.

Acetaminophen↗
PubMed1988

Peptic ulcer.

Explore the source record for details and available documents.

Anti-Ulcer Agents↗
PubMed1988

Suppression of emotions in essential dyspepsia and chronic duodenal ulcer. A case-control study.

It remains controversial whether psychologic factors contribute to the onset or chronicity of non-ulcer dyspepsia (NUD) and duodenal ulcer. Although such patients on conventional psychologic testing have no clearly defined specific personality type, an inability to express emotion, which may result in excessive autonomic arousal, has been suggested to be important on theoretic grounds. The aim of this study was to assess whether the latter defect is associated with the subgroup of NUD patients with essential dyspepsia and with patients with chronic duodenal ulcer. Eighty-one patients with essential dyspepsia and 53 patients with duodenal ulcer studied after endoscopy were compared with 82 randomly selected dyspepsia-free community controls. All were assessed with the Courtauld emotional control scale, a valid and objective self-report measure. Control of anger, anxiety, unhappiness, and total emotional control over negative reactions were similar in all three groups. It is concluded that patients with essential dyspepsia and duodenal ulcer who present for investigation are unlikely to repress emotional reactions consciously.

Adult↗
PubMed1988

Psychosocial and childhood factors in essential dyspepsia. A case-control study.

A subgroup of patients with endoscopically diagnosed non-ulcer dyspepsia have no definite cause for their symptoms, termed essential dyspepsia; such patients have been considered to have 'nervous dyspepsia'. To determine whether social and environmental factors are of importance, both in childhood (before the onset of symptoms) and in adult life, 109 patients with essential dyspepsia and 109 randomly selected dyspepsia-free community controls (matched for age, sex, and one measure of social grade-suburb of residence) were studied. Socioeconomic status, marital status, childhood environment, family structure, and migration were measured. An increased risk of essential dyspepsia was associated with one aspect of social status incongruity; compared with controls, patients had a lower occupational status than their place of residence indicated (OR = 2.3; 95% CI, 1.5-3.5). There was a trend for patients to report an unhappy childhood (OR = 2.4; 95% CI, 0.9-6.7). Being unmarried, undergoing parental separation during childhood, the patient's age at parental separation, the number of siblings, birth order, country of birth, and years of residence were not significantly associated with essential dyspepsia. The importance of psychosocial and childhood factors in essential dyspepsia is probably small.

Adult↗
PubMed1988

Education and training in gastroenterology. A report from the Far East.

The Far East is a poorly defined region with enormous population density, the countries possessing divergent historical and cultural backgrounds, and in many the spectrum of disease is determined by poverty. Training in gastroenterology usually involves 3 years' training in general medicine, followed by 3-5 years' training in gastroenterology. The degree of sophistication of the program varies from country to country. The survey showed most units had 20-40 beds allocated to gastrointestinal diseases, and the number of full-time and research staff varied greatly. A need existed for overseas training for graduates doing their initial training in gastroenterology, and for more senior gastroenterologists who wish to extend their knowledge of overseas practices and techniques. Also, in many countries there was a deficiency in the availability of overseas journals and texts.

Australia↗
PubMed1987

Life event stress and chronic difficulties in duodenal ulcer: a case control study.

In a sample of consecutive ulcer (DU) patients and age, sex and social class matched normal controls, the prevalence of antecedent stressful life events in the two samples was similar. Antecedent chronic difficulties often lasting years were however significantly more common in the ulcer patients. Duodenal ulcer was more common in divorced, separated or widowed subjects; this finding was explained by the fact that these subjects had more chronic difficulties which predisposed to ulcer disease.

Adult↗
PubMed1987

Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis.

This study aims to determine whether the features of dyspepsia can discriminate a subgroup of patients who present with non-ulcer dyspepsia from other diagnostic categories. The following groups were studied: One hundred and thirteen patients with endoscopically confirmed non-ulcer dyspepsia in the absence of clinical, biochemical or radiological evidence of other gastrointestinal diseases or disorders, termed essential dyspepsia; Fifty five patients with symptomatic and endoscopically proven peptic ulceration (32 duodenal ulcers, 23 gastric ulcers); Fifty three patients admitted to hospital with biliary pain and cholelithiasis without other lesion at laparotomy. All patients completed a structured history questionnaire at personal interview. Stepwise logistic regression analysis was done on 19 predefined variables to determine if one or more of these could discriminate between the diagnostic categories. The results suggest that certain groups of symptoms may be of diagnostic value, but many are not. Upper abdominal pain aggravated by food or milk, pain severity, night pain, vomiting, weight loss, and age significantly discriminated essential dyspepsia from the other diagnostic categories. A scoring system was established based on these discriminating symptoms. Using the weighted score, at a sensitivity of 57%, the specificity for a diagnosis of essential dyspepsia was 94%, but only prospective studies will determine if this scoring system is of actual clinical value.

Cholelithiasis↗
PubMed1987

Prognosis of chronic duodenal ulcer: a prospective study of the effects of demographic and environmental factors and ulcer healing.

The aim of this prospective study of 370 community based duodenal ulcer patients was to define the effect on duodenal ulcer course (from the aspect of symptom occurrence) of demographic and environmental factors, and of proven healing of index ulcer within four months. Follow up was three monthly, for up to three years. By survival analysis, it was found that marriage breakup adversely affected duodenal ulcer course, that age 50 years and under, female sex, and aspirin use tended to do so, and that smoking, alcohol ingestion, and paracetamol use did not. Proven healing of index ulcer within four months was associated with a small and non-significant reduction in symptom occurrence over time.

Age Factors↗
PubMed1987

Do symptoms of gastric ulcer become less frequent with time?

It has been claimed that gastric and duodenal ulcer (GU and DU) symptoms decrease in frequency with time, indicating 'burn out' of ulcer. The present study was undertaken to investigate further this phenomenon in GU. The prevalence of symptom experience during 1 year was examined in 447 medically treated patients with GU diagnosed 2-20 or more years previously. When ulcer history length was measured from either first symptom onset or first ulcer diagnosis, reporting of symptoms did not become less frequent as history length increased. This remained true after adjustment for GU location, sex, age, smoking, and analgesic and non-steroidal anti-inflammatory drug ingestion. It is concluded that GU symptoms do not decrease in frequency with time.

Duodenal Ulcer↗
PubMed1987

A prospective study of social factors and major life event stress in patients with dyspepsia of unknown cause.

There is a subgroup of patients with endoscopically confirmed non-ulcer dyspepsia who have no known cause for their symptoms, provisionally termed essential dyspepsia. The aim of this study was to determine prospectively the social consequences of essential dyspepsia. Patients with essential dyspepsia (n = 111) were followed up by telephone bimonthly, after an introductory personal interview, for a mean of 17 months. Data were gathered on symptoms, daily activities, family life, going out, work status, days lost from work, physician consultations, marital status, and major life events monthly. Stepwise regression analysis was undertaken, with days of upper abdominal pain each month as the response variable, to determine whether these social factors were associated with days of pain. None of the variables studied were of biological importance (r2 = 0.08), although increasing age, male sex, being unmarried and visiting a physician because of dyspepsia were statistically associated with increased days of abdominal pain (all, p less than 0.01). Major life event stress and social activities were not associated with the course of essential dyspepsia, and patients did not display excessive illness behaviour. The impact of essential dyspepsia on the lifestyle of its sufferers appears minor.

Adult↗
PubMed1987

Prognosis of chronic unexplained dyspepsia. A prospective study of potential predictor variables in patients with endoscopically diagnosed nonulcer dyspepsia.

The aim of this study was to determine if there were predictors of the symptomatic course of patients with chronic unexplained (essential) dyspepsia. After endoscopic assessment, 111 patients with essential dyspepsia were followed up by telephone interview every second month. Data were gathered, for a mean of 17 mo per patient, on the number of days of upper abdominal pain (the response variable) each month. In the 6-mo period before entry to the study the following predetermined predictor variables were collected: demographic factors (age, sex, social grade), number of pain days in the 6 mo before diagnosis, environmental factors (analgesics, nonsalicylate nonsteroidal antiinflammatory drugs, alcohol, smoking, coffee, tea), length of dyspepsia history, and past history of peptic ulcer. Prospectively for each month of follow-up, the following additional variables were recorded: environmental factors, treatment, and development of gastroesophageal reflux symptoms. It was found that patients with more pain before diagnosis were significantly more likely to have pain over the follow-up, and the taking of medications for dyspepsia and development of gastroesophageal reflux were associated with more days of pain over the follow-up (all p less than 0.001). Demographic and environmental factors, length of dyspepsia history, and a past history of ulcer were of no significant predictive value. There was a decrease in pain over the follow-up period (p = 0.002), but this effect was limited to the first two periods after endoscopic diagnosis.

Chronic Disease↗
PubMed1986

The effect of maintenance cimetidine therapy on the medical, social and economic aspects of patients with chronic gastric ulcers. A placebo-controlled prospective study.

We studied the effect of cimetidine maintenance therapy on the socioeconomic life of patients with gastric ulcers in the year after healing and the extent to which treatment was cost-effective. One hundred and seventy patients with a healed ulcer were studied for periods of up to one year after healing; 116 patients completed one year of observation. A double-blind randomized prospective study was performed that compared cimetidine (400 mg at night) with placebo. Analysis was performed on the intention-to-treat principle. The treated group showed benefit over the placebo group; major or minor symptoms were experienced on fewer days, and more months were symptom-free. Male patients were wakened with ulcer pain on fewer nights, led a more normal social life, and had less ulcer-related sick-leave; female patients had less total sick leave. The proven ulcer recurrence rate was lower in the treated group. Fewer endoscopies were performed in this group and the resultant cost saving was equivalent to the cost expenditure on cimetidine treatment. A modest saving in wages was afforded treated patients in the workforce, due to the reduction in sick leave. The principal benefit of cimetidine treatment appeared to be the lessening of the pain and discomfort and, hence, the distress and anxiety that was associated with ulcer disease. The cost-saving due to the reduced number of endoscopies compensated for the cost-expenditure of the cimetidine treatment.

Adult↗