Campylobacter-like organisms and gastric ulcer.
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Analgesics↗
Biomedical subjects
D W Piper
Publications and source records attributed to D W Piper.
Influence of the site of a duodenal ulcer on its mode of presentation.
The aims of this study were to define the localization of duodenal ulcer and to determine whether the site influenced the initial presentation. Eight hundred eighty-four duodenal ulcer patients diagnosed by endoscopy in Singapore and Sydney were studied. The ulcer was situated on the anterior wall of the bulb in 49% and the posterior wall of the bulb in 23%. The distribution was not influenced by sex, age, or the center of diagnosis. Those situated posteriorly in the bulb were more likely to present with hemorrhage than those situated elsewhere.
Adult↗
Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia.
Nonulcer dyspepsia remains a difficult disorder to treat because it is a heterogeneous syndrome. Once patients with the irritable bowel syndrome, esophagitis, and other organic diseases are excluded, there remain patients with dyspepsia of unknown cause (termed "essential dyspepsia") and patients with dyspepsia plus symptoms of gastroesophageal reflux without esophagitis. The aim of this study was to determine whether cimetidine or pirenzepine is efficacious in relieving the symptoms of these latter subgroups. Sixty-two consecutive patients were studied who had chronic upper abdominal pain or nausea where endoscopy had shown no evidence of peptic ulceration, esophagitis, or malignancy; 47 had essential dyspepsia, and 15 had dyspepsia plus gastroesophageal reflux. They were initially randomized to either cimetidine or placebo, or pirenzepine or placebo. Patients continued each medication for 1 mo, and, after a washout period, crossed over when again symptomatic; 51 patients completed cimetidine and placebo, and 50 completed pirenzepine and placebo. The results showed that cimetidine was superior to placebo in decreasing the number of upper abdominal pain episodes weekly and the severity of pain, but the absolute improvement was small. Pirenzepine was not superior to placebo in decreasing symptoms.
Adult↗
Ventilatory function in chronic peptic ulcer. A controlled study of ventilatory function in patients with gastric and duodenal ulcer.
The aim of this study was to determine if a defect in ventilatory function is present in patients with chronic peptic ulcer and if so, is it present in both gastric and duodenal ulcer and is it related to smoking. Fifty-six patients with peptic ulceration (27 gastric ulcer, 29 duodenal ulcer), together with 56 healthy controls matched for age, sex, and smoking status, were studied. Ventilatory function was measured and the ABH blood group antigen secretor status was determined. Vital capacity and forced expiratory volume in 1 s were significantly reduced in both smokers and nonsmokers with gastric ulcer when compared with controls; total lung capacity was lower than controls only in smokers with gastric ulcer. In duodenal ulcer patients, a trend similar to that observed in gastric ulcer patients was present. It is concluded that a defect in ventilatory function is present in patients with chronic gastric ulcer; a lesser defect is present in patients with duodenal ulcer.
ABO Blood-Group System↗
Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case-control study.
Non-ulcer dyspepsia, also termed "nervous dyspepsia," is a heterogeneous syndrome: ulcerlike symptoms can occur with the irritable bowel syndrome, gastroesophageal reflux, and other disorders. In addition, there is a significant subgroup of non-ulcer dyspepsia sufferers who have no disorder associated with, and no known cause for, their dyspepsia, and the dyspepsia in this subgroup is given the provisional name of "essential dyspepsia." The aim of this study was to assess if psychological factors are associated with patients who present with essential dyspepsia. Psychometric testing was carried out on 76 essential dyspepsia patients (including 18 patients with gastroduodenitis), 76 randomly selected dyspepsia-free community controls (matched for age, sex, and social class), and 66 duodenal ulcer controls. Essential dyspepsia patients were retested a mean of 3.6 mo later. Using stepwise regression analysis, the initial scores of essential dyspepsia and duodenal ulcer subjects showed them to be more neurotic, anxious, and depressed than community controls; these abnormalities persisted in essential dyspepsia patients on retesting and were not affected by the symptom status. It is concluded that essential dyspepsia patients who present for investigation with symptoms are more likely to be persistently neurotic, anxious, and depressed than dyspepsia-free controls, and this is unrelated to the presence of symptoms, but the association may not be of major clinical significance, as the numerical differences observed between groups were small and the correlation coefficients were low.
Adult↗
Comparison of the clinical features and illness behaviour of patients presenting with dyspepsia of unknown cause (essential dyspepsia) and organic disease.
The aim of this study was to describe the clinical features of patients with chronic unexplained dyspepsia and compare the symptoms with peptic ulcer and biliary pain, and determine the prevalence of symptoms that may indicate psychoneurotic traits and measure chronic illness behaviour (days lost from work and doctor visits). Studied were: 113 patients with essential dyspepsia, defined as endoscopically confirmed non-ulcer dyspepsia where gallstones, the irritable bowel syndrome and gastro-esophageal reflux have been excluded and there is no ascertainable cause for the dyspepsia; 55 patients with dyspepsia and peptic ulceration at endoscopy; and 53 patients with diagnosed biliary pain and cholelithiasis, proven at cholecystectomy. All patients completed a detailed structured history questionnaire in the presence of one investigator. More patients with peptic ulcer than with essential dyspepsia experienced night pain, pain relieved by food, and vomiting, while more patients with essential dyspepsia than with cholelithiasis experienced epigastric pain, lack of radiation of pain, continuous pain, mild to moderate pain, pain before meals, pain relieved by food and antacids, pain aggravated by food and alcohol, and an absence of vomiting (all p less than 0.01). Symptoms suggesting psychoneurosis, aerophagy symptoms, and chronic illness behaviour were similar in all groups. We conclude that certain symptoms may be of value in diagnosing the underlying cause of dyspepsia.
Adolescent↗
Major life event stress and dyspepsia of unknown cause: a case control study.
Stress is purported to be a major cause of non-ulcer dyspepsia, defined here as dyspepsia where peptic ulcer, oesophagitis, and cancer are excluded by endoscopy. There is a subgroup of non-ulcer dyspepsia patients who have no definite cause for their dyspepsia, provisionally termed essential dyspepsia. The aim of the present study was to determine if stress, as measured by major life events, was associated with essential dyspepsia. The frequency of life events during the year before the diagnosis of essential dyspepsia in 68 consecutive patients was compared with the frequency of these events over the same time period in 68 randomly selected age and sex-matched community controls. The mean number of events and the associated life change and distress scores were similar for both groups. Concerning individual events, patients reported more minor personal illness (p = 0.008). When events were broadly categorised, only one difference was found - more controls reported bereavements (p = 0.008). Age, sex, social class, and the duration of dyspepsia did not influence the number and nature of events. Although the study suggests that stress, as measured by major life events, is not associated with dyspepsia of unknown cause, it does not exclude the fact that other forms of stress, especially that associated with chronic difficulties, may be relevant.
Adult↗
Life events and gastrointestinal symptom.
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Gastrointestinal Diseases↗
Bacteria, gastritis, acid hyposecretion and peptic ulcer.
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Campylobacter Infections↗
Environmental factors in aetiology of chronic gastric ulcer: a case control study of exposure variables before the first symptoms.
The aim of the present study was to determine whether there is indication that either smoking, alcohol ingestion, or ingestion of analgesic or non-salicylate non-steroidal anti-inflammatory drugs plays any role in the development of chronic gastric ulcer disease. A group of 104 patients with gastric ulcer was compared with an age, sex and social grade matched community control population as regards exposure to the above factors during three time periods--the lifetime, five year and one year periods before the initial onset of the patients' ulcer symptoms. In all three study periods a statistically significant risk of gastric ulcer was found to be associated with smoking, and the daily use of aspirin, indomethacin and of other non-salicylate non-steroidal anti-inflammatory drugs as a group, but not with alcohol or daily use of paracetamol. As exposure to the environmental factors preceded the initial onset of ulcer symptoms, causal relationships are suggested. Assuming the association are causal, it can be calculated that possibly up to 80% of gastric ulcer disease is attributable to smoking and the daily ingestion of analgesic and anti-inflammatory drugs.
Acetaminophen↗
Factors relevant to the prognosis of chronic duodenal ulcer.
The aim of the study was to define the effects of sex, age, smoking, alcohol, analgesic ingestion, and treatment method whereby healing was initially induced on the prognosis of patients with a chronic duodenal ulcer (DU). 122 patients were assessed 1 year after the endoscopic demonstration of a DU. Two outcome variables for this 1-year period were studied - freedom from symptoms, and proven recurrence of the DU. Additionally, the outcome groups were compared to a community control population as regards the exposure variables. The results of the study indicate that each increase in smoking by 10 cigarettes daily increased the risk of DU recurrence within 1 year by 40%. Comparisons between patients and community controls revealed that smoking was significantly associated with DU and this association was present whether the ulcer was in exacerbation or in remission.
Age Factors↗
The association between non-ulcer dyspepsia and other gastrointestinal disorders.
Non-ulcer dyspepsia (NUD) is defined as dyspepsia in which investigation shows no evidence of focal gastroduodenal disease or oesophagitis. The aim of the present study was to determine the proportion of NUD patients with other identifiable diseases. We interviewed 327 consecutive patients who had at least 1 month of dyspepsia before a panendoscopy that showed no evidence of oesophagitis, malignancy, or peptic ulcer. Symptoms were assessed by a structured history questionnaire. The existence of gallstones was excluded radiologically. Of the subjects studied, 75 (23%) had irritable bowel syndrome and 71 (22%) gastro-oesophageal reflux, whereas 63 (19%) had both, 25 (8%) had aerophagy, and 14 (4%) had gallstones. Of the remaining 79 patients (24%) 6 had duodenitis and 10 gastritis, whereas 1 had both. Sixty-two subjects (19%) had entirely normal endoscopic results and no ascertainable cause of their dyspepsia (termed provisionally essential dyspepsia). It is concluded that, whereas three-quarters of NUD patients have diseases that fall into other diagnostic categories, nearly one-quarter have essential dyspepsia.
Cholelithiasis↗
Perception of life event stress in patients with chronic duodenal ulcer. A comparison of the rating of life events by duodenal ulcer patients and community controls.
Stress is often claimed by doctors and patients to be an aetiological factor in peptic ulcer disease. The aim of the present study was to investigate whether ulcer patients perceive that they would react more strongly than normal to life event stress. Seventy-three patients with duodenal ulcer and their sex- and age-matched controls rated 81 events for the amount of distress and life change they considered the events would cause them personally. With regard to individual events, only one difference emerged: female patients rated promotion at work significantly lower for distress than did controls, when event experience was taken into account. There was a systematic tendency for ratings of male patients to be lower than those of controls. These observations suggest that duodenal ulcer patients do not perceive that their reaction to life events would be in excess of normal.
Adolescent↗
New South Wales--the ulcer state.
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Duodenal Ulcer↗
Smoking, alcohol, analgesics, and chronic duodenal ulcer. A controlled study of habits before first symptoms and before diagnosis.
The aim of the study was to investigate the role of smoking and alcohol and analgesic ingestion in the aetiology of chronic duodenal ulcer (DU). Exposure to these variables was studied during the lifetime and 1 year before the first ulcer symptom and 1 month before a diagnosis. The ulcer group of 100 patients was compared with 100 community controls matched for age, sex, and social grade. In men there was an increased risk of DU associated with smoking and alcohol ingestion both during the lifetime and 1 year before the first symptom. In women, there was an increased risk associated with smoking during the lifetime before the first symptom and with alcohol ingestion during the year before the first symptom. Analgesic ingestion was not a risk factor. In the month before diagnosis only smoking was commoner in the DU group. The data indicate that smoking and alcohol ingestion are risk factors for DU.
Age Factors↗
Treatment of chronic duodenal ulcer.
The cause of peptic ulcer is unknown but the authors calculate that 70 per cent of duodenal ulcers are due to environmental factors. Acid secretion appears to be an essential component: although two thirds of patients with duodenal ulcer have a normal rate of acid secretion, 90 per cent of ulcers respond to its reduction. The case against the role of acid has been argued by Cleave.
Antacids↗
Comparison of colloidal bismuth subcitrate tablets and liquid in duodenal ulcer healing.
A double-blind trial using 51 outpatients was aimed at comparing the effectiveness of colloidal bismuth subcitrate (C.B.S.) in tablet and liquid form in the healing of duodenal ulcer. Criteria of entry included endoscopically proven duodenal ulcer, duration of symptoms greater than 4 weeks, and the absence of other major systemic disease. Patients were given either C.B.S. tablets (1 four times daily) or C.B.S. liquid (5 ml four times daily) for 4 weeks. Ulcer symptoms and their relief were recorded by patients, along with data on cigarette, alcohol, and drug intake. Endoscopy was performed after 4 weeks to assess healing. By 4 weeks, 18 of 26 patients taking tablets (69%) and 19 out of 25 patients taking liquid (76%), had healed (p = 0.82). Symptomatic improvement was similar with both tablets and liquid. Smoking and analgesic ingestion did not influence healing rate. We conclude that C.B.S. tablets and liquid are equally effective in healing duodenal ulcer.
Adult↗
HLA antigens and peptic ulcer disease.
The aim of this study was to investigate the association of HLA antigens with chronic duodenal and gastric ulcer. 104 patients with chronic peptic ulcer, 52 with duodenal ulcer, and 52 with gastric ulcer were studied, and HLA antigens of the A, B and DR series were sought using the microlymphocytotoxicity test. In duodenal-ulcer patients, no significant differences were observed. In the gastric-ulcer group, Bw49 was increased in both sexes, with an adjusted odds ratio of 10.2. However, when corrected for the number of comparisons made, this difference failed to reach statistical significance. It is concluded that if HLA antigens make any contribution to the aetiology of ulcer disease, this contribution is small and the proportion of cases of gastric ulcer that can be explained by the presence of HLA antigen Bw49 is less than 10%.
Female↗