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Biomedical subjects

N J Talley

Publications and source records attributed to N J Talley.

At least 19 recordsLinked to original sources
PubMed1996

Association between H. pylori, duodenal mechanosensory thresholds, and small intestinal motility in chronic unexplained dyspepsia.

Alterations of small intestinal sensory thresholds and small intestinal dysmotility are associated with functional dyspepsia. Because gastric and duodenal afferents partly project to the same areas, we postulated that patients with functional dyspepsia and H. pylori infection would be characterized by lower duodenal sensory thresholds. We evaluated 16 patients with functional dyspepsia and 16 age- and sex-matched controls. All patients had undergone an extensive diagnostic work-up to exclude organic lesions. Mechanosensitive function was tested in the third portion of duodenum utilizing a barostat device, and small intestinal motility was assessed before and during duodenal nutrient infusion with a five-channel low-compliance perfusion system. H. pylori status was assessed by a validated serological test. Small intestinal sensory thresholds (first perception and maximal tolerated pressure) were significantly lower in patients (21.1 +/- 2.1 and 30.9 +/- 1.8 mm Hg) compared to controls (33.0 +/- 2.2 and 38.8 +/- 0.9 mm Hg, all P < 0.003). Nine of 16 patients compared with five of 16 controls were H. pylori positive (P = 0.15). Thresholds for H. pylori-negative (28.7 +/- 2.8 and 36.5 +/- 1.1 mm Hg) or -positive subjects (25.0 +/- 3.0 and 32.7 +/- 2.4 mm Hg) were overall not significantly different (P > 0.3). However, in patients with defined high H. pylori titers (>50 units/ml) defined a priori, thresholds for first perception were significantly lower (14.7 +/- 2.9 mm Hg, N = 5) compared to patients with H. pylori titers below this threshold (24.3 +/- 2.9 mm Hg, N = 4) or without H. pylori infection (23.8 +/- 3.4 mm Hg, P < 0.05). During duodenal nutrient infusion, the duodenal motility index increased (P < 0.03). This increase was not significantly different in patients and controls or in H. pylori-negative or -positive subjects. Sensory abnormalities are present in patients with functional dyspepsia. In a small subgroup of patients with high H. pylori titers, sensory abnormalities may be linked to H. pylori infection.

Adult↗
PubMed1996

Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: a decision analysis.

BACKGROUND & AIMS: Empirical therapy has been proposed for initial management of dyspepsia. The aim of this study was to evaluate initial endoscopy, empirical therapy, and testing for Helicobacter pylori in the management of patients with a new onset of dyspepsia. METHODS: Decision analysis was used to compare the direct medical charges in the first year after the onset of dyspepsia for patients managed by initial endoscopy or empirical therapy, with or without initial testing for H. pylori. RESULTS: Medical care charges were $2162.50 for initial endoscopy and $2122.60 for empirical therapy, a difference of 1.8%. For a 55-year-old adult, life expectancy was 23.49 years for initial endoscopy compared with 23.48 years for empirical therapy. Empirical therapy has lower charges than initial endoscopy when H2-receptor antagonists are used to prevent recurrence of dyspepsia. Initial noninvasive testing for H. pylori has lower charges than initial endoscopy if patients with dyspepsia with H. pylori receive antimicrobial therapy without endoscopy but would have higher charges if patients with H. pylori routinely have endoscopy. CONCLUSIONS: Surprisingly, the choice of optimal management strategy was a "toss-up." Only modest savings may result from practice guidelines that recommend empirical therapy in the management of patients with dyspepsia.

Adult↗
PubMed1996

Methods for studying intestinal sensitivity and compliance: in vitro studies of balloons and a barostat.

The aim of this study was to compare in vitro various methods for recording intestinal sensitivity and compliance. Relationships between volume and pressure were determined in segments of penrose tubing and pig gut ("artificial intestine') using pressure increments of 2 mmHg (0-24 mmHg). We tested two direct methods of distension of the entire segments (by syringe inflation and the Mayo barostat); we also used three different balloon devices for indirect distension (a 10 cm polyethylene barostat bag, a 10 cm latex condom balloon and a 6 cm latex condom balloon). Maximal distending diameters of the recording systems were measured by injecting from 0 to 160 mL of air. The elastic properties of the balloons were also tested by distensions in air and in rigid tubes. All recording systems accurately detected a lesser compliance of the penrose drain as compared to pig gut. In absolute terms, only the compliance measured with a polyethylene barostat bag distended with a syringe was not different from the compliance of the segment as measured directly. The bellows of our barostat and the latex balloons had significant intrinsic compliances which interfered with the recorded pressure-volume curves. On the other hand, highly compliant plastic bags recorded most faithfully the compliance of artificial gut and that of non-compliant rigid tubes. For comparable volumes of distension, external diameters were larger with the 6 cm latex balloon than with the 10 cm latex balloon or the 10 cm polyethylene barostat balloon. A polyethylene bag distended with a non-compliant air injector (syringe) reflected most accurately the pressure-volume relationships of tubular structures. The different maximal diameters assumed by the three distending devices may explain, in part, why lower volumes of distension are required to elicit symptoms with smaller distending balloons in vivo.

Animals↗
PubMed1996

Constipation in an elderly community: a study of prevalence and potential risk factors.

OBJECTIVE: The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. METHODS: An age and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). RESULTS: The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. CONCLUSIONS: In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.

Age Distribution↗
PubMed1996

Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials.

OBJECTIVE: We aimed to determine the efficacy of psychological treatments in irritable bowel syndrome. METHODS: A systematic review of the literature on psychological treatments of IBS was performed using Medline (1966-1994) and Psychlit (1974-1994) and secondary references. Fully published studies in English were selected if they compared any type of "psychological" treatment of irritable bowel syndrome with a control group. Studies without any comparable control group, studies in which the subject group was not confined to irritable bowel syndrome sufferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded. Each study was reviewed using a structured format to examine methodological issues. A quality algorithm was developed a priori based on eight key requirements. RESULTS: Eight studies (57%) reported that a psychological treatment was superior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior. By the quality algorithm, only one study (a hypnotherapy trial) exceeded the preset cutoff score of 6, but this study was poorly generalizable due to sample selection. CONCLUSION: The efficacy of psychological treatment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these design limitations.

Algorithms↗
PubMed1996

Modern management of dyspepsia.

Dyspepsia affects one in four Australians; of those who present in general practice, the majority will have functional or non-ulcer dyspepsia, with no structural explanation for their symptoms. Older patients who present for the first time with dyspepsia, and those with 'alarm features' deserve immediate investigation (preferably by upper endoscopy), to exclude cancer, peptic ulcer or oesophagitis. Other patients may be given empiric therapy (for example, a prokinetic or H2 blocker) initially, but require investigation if this fails. The role of Helicobacter pylori infection in functional dyspepsia is uncertain.

Adult↗
PubMed1996

Do commercial serological kits for Helicobacter pylori infection differ in accuracy? A meta-analysis.

OBJECTIVES: To compare the accuracy of common commercial serological kits for Helicobacter pylori and to ascertain factors affecting accuracy. METHODS: A comprehensive MEDLINE and manual search strategy was used to identify all articles comparing two or more kits. Each article was critically appraised for sample characteristics, study design, and data handling. The data comparing accuracy of the kits was analyzed by standard statistical methods as well as summary receiver operator characteristic curves (sROCs). A sROC also was used to estimate overall test accuracy and to identify factors affecting the measurement of accuracy. RESULTS: The 21 studies identified were of varying quality, but our analyses suggested that different commercial kits did not have significantly different accuracy. Overall, at a sensitivity of 85%, specificity was estimated to be 79%. Test accuracy measured was significantly higher in studies with smaller proportions of infected patients. CONCLUSIONS: There is little evidence in the literature to suggest that any one of the common commercial serological kits is more accurate than any other. The overall accuracy of these kits may not be adequate for clinical decision-making in all patient groups.

Helicobacter Infections↗
PubMed1996

Drug treatment of functional dyspepsia: a systematic analysis of trial methodology with recommendations for design of future trials.

OBJECTIVES: To evaluate drug treatment of functional dyspepsia (including Helicobacter pylori) and provide guidelines for future trials based on a critical systematic overview of published studies. METHODS: Data sources were a Medline search for articles published in English going back to 1966 and a manual search of four GI journals going back to 1980. Original randomized, double-blind, placebo-controlled trials were selected that enrolled at least 20 patients. Using a standardized, pretested data extraction form, studies were evaluated independently by two observers for study design, outcome measures, and results. RESULTS: Fifty two eligible studies were evaluated. Many studies suffered from important weaknesses in study design and execution. Only five studies used previously validated outcome measures. CONCLUSIONS: Because of suboptimal design and/or unclear presentation of the data, none of the trials provided unequivocal evidence that there is efficacious therapy for the treatment of functional dyspepsia.

Double-Blind Method↗
PubMed1996

Helicobacter pylori and non-ulcer dyspepsia.

The role of Helicobacter pylori in non-ulcer dyspepsia continues to be controversial. While there is general agreement that incident infection with H. pylori can induce self-limited symptoms, the evidence linking the infection to chronic upper abdominal pain or discomfort in the absence of peptic ulceration is equivocal. The prevalence of H. pylori is at most only slightly increased in non-ulcer dyspepsia over the background population taking into account age, socioeconomic status and past ulcer history. However, it is yet to be convincingly shown that H. pylori precedes the onset of non-ulcer dyspepsia. It is now accepted that H. pylori is not associated with a specific symptom profile. Recent evidence suggests that a subgroup with H. pylori and non-ulcer dyspepsia have increased acid secretion in response to gastrin-releasing peptide, but gastric motor and sensory function appears not to be affected by the infection. The most persuasive evidence for a causal relationship between the infection and non-ulcer dyspepsia will come from ongoing large multicentre randomized placebo controlled trials, as the relatively small therapeutic trials to date have been unconvincing.

Acute Disease↗
PubMed1995

Sexual and physical abuse and gastrointestinal illness. Review and recommendations.

OBJECTIVES: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral. DATA SOURCES: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings. STUDY SELECTION: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search. DATA EXTRACTION: Independent extraction by multiple observers. DATA SYNTHESIS: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals. CONCLUSIONS: The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.

Domestic Violence↗
PubMed1995

Helicobacter pylori and gastric neoplasia: evolving concepts.

There is evidence that Helicobacter pylori infection is associated with gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma and possibly with non-ulcer dyspepsia. Eradication therapy for confirmed H. pylori infection may therefore become mandatory in patients with non-ulcer dyspepsia severe enough to warrant endoscopy and in first-degree relatives of patients with gastric cancer. However, routine treatment of asymptomatic carriers awaits confirmation of the association with cancer.

Adenocarcinoma↗
PubMed1995

Irritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization.

The clinical relevance of subdividing the irritable bowel syndrome (IBS) into subgroups based on bowel habit is largely unknown. We therefore obtained an age- and sex-stratified random sample of Olmsted County, Minnesota, residents aged 20-95 years. All subjects were mailed a valid self-report questionnaire during the years 1988-1993; the response rate was 74% (n = 3,022). Among subjects with IBS (n = 536), four symptom-based subgroups of similar size were identified: constipation predominant, diarrhea predominant, alternating constipation and diarrhea, and neither. The prevalence of IBS was significantly greater in females, primarily because of a higher prevalence of constipation-predominant IBS in women. Of persons > or = 60 years of age, 23% reported the initial onset of IBS in the previous year compared with 10% in younger subjects; the age at onset of IBS was similar among the subgroups. Marital status, education level, smoking, and alcohol use were not significantly different among the subgroups. Of those with IBS, 25% reported visiting a physician for abdominal pain or disturbed defecation in the prior year compared with only 8% of persons without IBS. Female sex, an increased number of Manning's symptom criteria, and the individual IBS subgroups were not associated with higher rates of physician visits. We conclude that the onset of IBS may not be limited to early adulthood and that subgroups of IBS based on bowel patterns may not identify clinically distinct entities.

Adult↗