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Biomedical subjects

N J Talley

Publications and source records attributed to N J Talley.

At least 73 records · Page 4Linked to original sources
PubMed2003

Clinical and pathological implications of IgG antibody responses to Helicobacter pylori and its virulence factors in non-ulcer dyspepsia.

AIM: To determine whether pre-treatment antibody response to Helicobacter pylori virulence factors predicts eradication success and symptom relief 12 months after triple therapy in non-ulcer dyspepsia. METHODS: H. pylori-positive patients with non-ulcer dyspepsia received 1-week omeprazole-based triple therapy, or omeprazole plus placebos. Symptoms were assessed using a validated Likert scale. Gastric biopsies taken before and 12 months after treatment were used for histological examination. Pre-treatment blood samples were used for the detection of anti-H. pylori immunoglobulin G (IgG) antibodies, and specific IgG antibodies to 19.5-, 26.5-, 30-, 35-, 89- (VacA) and 116-kDa (CagA) antigens of H. pylori. RESULTS: IgG antibodies to the six antigens were detected in 62%, 96%, 88%, 47%, 54% and 78% of patients, respectively. The presence of antibody to 19.5-, 26.5- or 30-kDa antigen was associated with an increased anti-H. pylori IgG absorbance index. IgG absorbance indices were greater in those with H. pylori eradication (vs. persistent infection). The prevalence of antibodies to the six antigens was not significantly different between those with symptom relief vs. those without. The 19.5-kDa antigen (P = 0.018) and VacA (P = 0.001) were independent risk factors for body gastritis. CONCLUSIONS: An increased pre-treatment anti-H. pylori IgG absorbance index may be a useful predictor of the success of eradication therapy. Although the 19.5-kDa antigen and VacA were associated with body gastritis, none of the six antigens tested predicted symptom relief after triple therapy.

Adult↗
PubMed2003

Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia.

BACKGROUND: The drivers of conventional and, especially, alternative health care use for irritable bowel syndrome and functional dyspepsia are not clear. AIM: To determine the predictors of conventional and alternative health care use for irritable bowel syndrome and functional dyspepsia. METHODS: Two hundred and seven subjects with irritable bowel syndrome or functional dyspepsia, identified from a previous population survey, were included in the study. Individuals with irritable bowel syndrome/functional dyspepsia were defined as consulters (n = 103) if they had visited their doctor for gastrointestinal symptoms more than once in the past year. Controls (n = 100) did not report having any abdominal pain. Subjects were given structured interviews to assess the Diagnostic and Statistical Manual - version IV (DSM-IV) and International Classification of Disorders - version 10 (ICD-10) psychiatric diagnosis for anxiety, depression, somatization or any psychiatric diagnosis, aspects of health care use and symptom factors. RESULTS: About one-half (n = 103, 49.8%) of community subjects with irritable bowel syndrome/functional dyspepsia had sought conventional care for gastrointestinal symptoms in the past 12 months. Lifetime rates for alternative health care use for gastrointestinal symptoms were 20.8% (n = 43). Independent predictors of conventional health care use were more frequent abdominal pain, greater interference of gastrointestinal symptoms with work and activities and a greater satisfaction with the physician-patient relationship. Being female independently predicted alternative health care use. CONCLUSIONS: Psychological morbidity did not predict conventional or alternative health care use for gastrointestinal symptoms. Other factors were more important.

Adolescent↗
PubMed2003

The effect of new diagnostic criteria for irritable bowel syndrome on community prevalence estimates.

The 'Rome' criteria for irritable bowel syndrome (IBS) have evolved over 15 years with four published versions. The impact of these changes on community prevalence rates is not known. Study aims were to estimate the prevalence of IBS using the four Rome criteria and agreement between Rome II and previous criteria. Questionnaires were mailed to a random sample of Olmsted County, Minnesota residents in 1992. Age- and gender-adjusted prevalence estimates were calculated for Rome II (1999), Rome I (1992), Rome (1990), and Rome (1989) criteria. Per cent agreement and kappa values were calculated to assess agreement. Of 892 eligible subjects, 643 (72%) responded. The age- and gender-adjusted prevalence of IBS was 5.1% [95% confidence interval (CI): 3.1, 7.0], 6.8% (95% CI: 4.7, 8.9), 5.1% (95% CI: 3.2, 7.1) and 27.6% (95% CI: 23.6, 31.5), respectively. In comparison with Rome II criteria, per cent agreement and kappa values were 97.2% and 0.78 (95% CI: 0.69, 0.88), 96.4% and 0.68 (95% CI: 0.55, 0.80), and 79.0% and 0.29 (95% CI: 0.19, 0.40), respectively. Thus, although differences were seen with the older criteria, compared with the Rome I criteria, good agreement was seen and community prevalence estimates were similar with the Rome II criteria.

Adult↗
PubMed2003

Overview: initial and long-term management of gastro-oesophageal reflux disease.

Initial management of gastro-oesophageal reflux disease aims to confirm a symptom-based diagnosis, to relieve symptoms, to reassure the patient as to the treatable nature of reflux disease, and to initiate risk management and healing of oesophagitis. The aims of long-term management include adequate control of symptoms, prevention of complications, and improvement of quality of life. Management options in terms of use of proton pump inhibitors are either daily therapy (maintenance), intermittent courses of therapy (for example, 4 weeks, then cease and observe), or on-demand therapy. This overview discusses the advantages and disadvantages of these different strategies for the management of reflux disease.

Decision Making↗
PubMed2003

Familial aggregation of irritable bowel syndrome: a prospective study.

BACKGROUND: Patients with irritable bowel syndrome (IBS) often report family members with similar symptoms, but family studies are lacking. We hypothesised that if there is familial aggregation, there would be an increased frequency of IBS in first degree relatives of IBS patients compared with relatives of controls (the patient's spouse). METHODS: A valid self report bowel disease questionnaire (BDQ) that recorded symptoms, the somatic symptom checklist (a measure of somatisation), and a family information form (FIF) to collect the names and addresses of all first degree relatives were mailed to two groups of patients and their spouses (patients attending an IBS educational programme and residents of Olmsted County, Minnesota, who had been coded as IBS on a database). A BDQ was then mailed to all first degree relatives of subjects identified from the FIF. IBS diagnosis in the relatives was based on the Manning criteria. RESULTS: The BDQ was sent to a total of 355 eligible relatives; 71% responded (73% relatives of patients, 67% relatives of spouses). Relatives were comparable in mean age, sex distribution, and somatisation score. IBS prevalence was 17% in patients' relatives versus 7% in spouses' relatives (odds ratio adjusted for age and sex 2.7 (95% confidence interval (CI) 1.2, 6.3)). When also adjusted for somatisation score, the odds ratio was reduced to 2.5 (95% CI 0.9, 6.7). CONCLUSIONS: Familial aggregation of IBS occurs, supporting a genetic or intrafamilial environment component, but this may be explained in part by familial aggregation of somatisation.

Adolescent↗
PubMed2002

Review article: dyspepsia: how to manage and how to treat?

Recent guidelines for dyspepsia, defined as pain or discomfort centred in the upper abdomen, emphasize that in younger patients with no alarm features and not taking nonsteroidal anti-inflammatory drugs, testing for Helicobacter pylori and treatment of the infection if present is a standard of care. If H. pylori is not present, empirical management (e.g. acid suppression) is often prescribed. It is further recommended that if patients relapse or fail to respond to treatment then upper endoscopy be undertaken. However, these guidelines have become controversial for a number of reasons. Firstly, the prevalence of H. pylori infection is falling as is the incidence of peptic ulcer disease due to the infection. Idiopathic peptic ulcer disease is also being increasingly recognized. Furthermore, the cost-effectiveness of endoscoping treatment failures has been questioned, as the yield is low and patient management is usually not altered. Finally, it remains controversial whether the treatment of H. pylori infection in functional dyspepsia is of value, and two recent high quality meta-analyses have reached diametrically opposite conclusions. Alternative strategies, such as initially treating with acid suppression and then considering H. pylori infection in those who fail have been suggested, as has in low H. pylori prevalent regions the abandonment of a test-and-treat strategy. However, appropriate management trials of these alternative strategies in primary care are lacking. The management of patients with functional dyspepsia who fail initial antisecretory therapy is now difficult; prokinetics have fallen into some disrepute. Tricyclic antidepressants (at a low dose) may be useful in a subset, but adequate trials are lacking.

Dyspepsia↗
PubMed2002

Review article: the burden of illness of non-cardiac chest pain.

BACKGROUND: Non-cardiac chest pain is a common condition affecting approximately one-quarter of the population during their lifetime, but the long-term economic costs of non-cardiac chest pain are poorly defined. METHODS: A MEDLINE and Current Contents search was performed from 1991 to 2002 using specific keywords. All major articles on the subject of non-cardiac chest pain in this period were reviewed and their reference lists searched. RESULTS: Limited studies suggest that the majority of those with non-cardiac chest pain do not consult a doctor regarding their symptoms; the drivers of health care seeking are not known. The impact on the quality of life in consulters can be severe, with as many as 36% reporting much lower quality of life levels. The diagnosis of non-cardiac chest pain can be difficult due to the heterogeneous nature of the condition, with significant overlap of gastro-oesophageal reflux disease, chest wall syndromes and psychiatric disease, which may drive up the costs of management. The prognosis appears to be good, but there are conflicting results in long-term studies. CONCLUSIONS: The costs of non-cardiac chest pain to the health care system are likely to be large and represent a significant proportion of each Western country's health care budget. Further studies are required to determine methods of reducing health care costs.

Adult↗
PubMed2002

A randomized placebo-controlled trial of simethicone and cisapride for the treatment of patients with functional dyspepsia.

AIM: To compare the efficacy of simethicone with placebo and the prokinetic cisapride in patients with functional dyspepsia. METHODS: One hundred and eighty-five patients with functional dyspepsia were randomized and treated in a double-dummy technique with simethicone (105 mg t.d.s.), cisapride (10 mg t.d.s.) or placebo (t.d.s.). The primary outcome measure was the O'Brien global measure of the patients' rating of 10 upper gastrointestinal symptoms (graded as absent = 0, moderate = 1, severe = 2 or very severe = 3). Outcome measures were assessed at baseline and after 2, 4 and 8 weeks of treatment (intention-to-treat). RESULTS: At 2, 4 and 8 weeks, treatment with simethicone and cisapride yielded significantly (all P values < 0.0001) better improvement of symptoms compared to placebo. Simethicone was significantly better than cisapride after 2 weeks (P = 0.0007), but the differences were not statistically significant after 4 and 8 weeks. Patients treated with simethicone judged the efficacy of their treatment as very good in 46% of cases, compared to 15% and 16% receiving cisapride and placebo, respectively. CONCLUSIONS: Simethicone and cisapride were significantly better than placebo for symptom control in patients with functional dyspepsia after 2, 4 and 8 weeks of treatment. Simethicone was also superior to the prokinetic cisapride in the first 2 weeks of treatment.

Adult↗
PubMed2002

Foetal intrauterine growth restrictions with Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori infection has been associated with growth restriction in young children. AIM: To determine whether there is an association between H. pylori infection and intrauterine growth restriction. METHODS: Four hundred and forty-eight consecutive pregnant women (aged 15-44 years), attending for routine examinations in the third trimester, were enrolled. Clinical, demographic and previous obstetric data, as well as smoking history, were collected. At delivery, the weight, height, gender and status of the neonate were recorded; intrauterine growth restriction was defined if the birth weight was below the 10th percentile according to the gestational age for infants born in Australia. RESULTS: Eighty-nine (20%) women were seropositive for H. pylori. The prevalence of H. pylori was significantly lower in Caucasians (17%) vs. non-Caucasians (42%, P < 0.0001). There were 34 (7.5%) cases of intrauterine growth restriction (7% Caucasians, 16% Asians, 12% Aborigines and 0% Pacific Islanders). Intrauterine growth restriction was more common in H. pylori-seropositive women than in H. pylori-seronegative women [13.5% vs. 6%; odds ratio (OR) = 2.41; 95% confidence interval (CI), 1.14-5.08; P = 0.018]. A multiple logistic regression model revealed that smoking (OR = 3.55; 95% CI, 1.62-7.79; P = 0.002), maternal height (OR = 0.48; 95% CI, 0.28-0.80; P = 0.005) and H. pylori seropositivity (OR = 2.59; 95% CI, 1.12-5.95; P = 0.025) were all independent risk factors for intrauterine growth restriction. CONCLUSIONS: H. pylori infection in pregnant women may affect foetal intrauterine growth.

Adolescent↗
PubMed2002

Review article: Helicobacter pylori and nonulcer dyspepsia.

Although up to 50% of patients diagnosed with nonulcer dyspepsia (NUD) have Helicobacter pylori infection and underlying chronic gastritis, it remains controversial whether any causal relationship exists. The results of worldwide epidemiological studies have been unconvincing. No clear-cut link has been documented between H. pylori and any specific symptom profile or pathophysiological mechanism in NUD. In the randomized controlled trials, methodological weaknesses may explain in part the conflicting results, but even in the well-conducted trials controversy persists. Although meta-analyses have attempted to resolve the issue, inherent methodological difficulties with meta-analysis remain a problem. Moreover, even the methodologically sound meta-analyses have reported conflicting results. In addition, predictors of treatment response remain obscure, and there continue to be theoretical concerns about the treatment of H. pylori infection in all patients with NUD. Hence, the management of these patients is challenging, but eradication of H. pylori infection may be beneficial in a small subgroup of cases with NUD that cannot be identified before treatment.

Drug Therapy, Combination↗
PubMed2002

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.

Dyspepsia↗
PubMed2002

Combined analysis of the ORCHID and OCAY studies: does eradication of Helicobacter pylori lead to sustained improvement in functional dyspepsia symptoms?

Currently, one of the most important unresolved questions concerning Helicobacter pylori is whether eradication of the organism leads to a sustained improvement in symptoms in patients diagnosed with functional (non-ulcer) dyspepsia. Recently, two very similar studies, the ORCHID and OCAY studies, have been completed and the combined results of these two multicentre, multinational, randomised, double blind, controlled clinical trials are reviewed.

Adolescent↗
PubMed2002

The potential role of acid suppression in functional dyspepsia: the BOND, OPERA, PILOT, and ENCORE studies.

Dyspepsia is a common condition in the general population but data are lacking on the benefits of effective acid inhibition with proton pump inhibitors in functional dyspepsia. The results of the large, randomised, double blind clinical trials, BOND and OPERA, the Scandinavian PILOT study, and a follow up study, ENCORE, are reviewed. BOND, OPERA, and PILOT aimed to address the question of whether effective acid inhibition with the proton pump inhibitor omeprazole relieves symptoms in patients with functional dyspepsia. ENCORE followed on from this, addressing the consequences of relieving symptoms in patients with functional dyspepsia once they are off therapy.

Adult↗
PubMed2002

Dyspepsia: management guidelines for the millennium.

The annual prevalence of dyspepsia in Western countries is approximately 25%, and the condition accounts for 2-5% of all primary care consultations, yet optimal management remains a subject of considerable debate. Some of the outstanding issues and considerations in the management of dyspepsia are discussed, providing an overview of current thinking and recommendations on patient management by primary care physicians and specialists.

Decision Support Techniques↗
PubMed2001

Serotoninergic neuroenteric modulators.

Irritable bowel syndrome (IBS) is common and can be disabling. Several drugs that modulate serotonin (5HT) and other neurotransmitters in the gut (neuroenteric modulators) have either become available or are in development, but progress has been slowed by toxicity. Blockade of 5HT(3) receptors slows colonic transit, increases fluid absorption and increases left colon compliance. Alosetron, a potent 5HT(3) receptor antagonist, has, in women but not in men, a clinically significant but modest therapeutic gain over placebo in the relief of abdominal pain and discomfort and bowel-habit disturbance (but not bloating) in diarrhoea-predominant IBS. However, the drug unexpectedly was associated with ischaemic colitis and, very rarely, severe constipation-induced complications, and alosetron has been withdrawn. Cilansetron may have similar efficacy in men and women. 5HT(4) receptor stimulation results in accelerated colonic transit, and tegaserod, a partial 5HT(4) receptor agonist, has modest but clinically significant advantage over placebo in constipation-predominant IBS; the benefit seems to be confined to females. Long-term published data are lacking and safety concerns have been raised. Prucalopride, a full 5HT(4) agonist that has been promising in idiopathic chronic constipation, may also be limited by toxicity. Other 5HT receptor antagonists and agonists are under development for IBS. However, for modulators of single receptors to achieve a substantial therapeutic gain, and to do so safely, drug targets based on the pathophysiology of IBS need to be better defined.

Benzofurans↗