High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

Association between functional dyspepsia and serum levels of brain-gut peptides in children / 中国当代儿科杂志

OBJECTIVES@#To study the association between functional dyspepsia (FD) and serum levels of brain-gut peptides including calcitonin gene-related peptide (CGRP), nesfatin-1, and ghrelin in children.@*METHODS@#A total of 38 children with FD who attended Shengjing Hospital of China Medical University from November 2019 to December 2020 were enrolled as the FD group. Thirty-four healthy children were enrolled as the control group. Serum samples were collected from all of the children. Enzyme-linked immunosorbent assay was used to measure serum levels of CGRP, ghrelin, and nesfatin-1 for comparison between the two groups. The scores of clinical symptoms were determined for the children with FD. Spearman rank correlation analysis was used to investigate the correlation of symptom scores with the serum levels of brain-gut peptides.@*RESULTS@#The FD group had significantly higher serum levels of nesfatin-1 and CGRP than the control group (P<0.05), while there was no significant difference in the serum level of ghrelin between the two groups (P>0.05). The serum level of nesfatin-1 was positively correlated with the symptom score of early satiety (rs=0.553, P<0.001), but was not significantly correlated with the total score of FD (rs=0.191, P=0.250). The serum level of CGRP was positively correlated with the scores of abdominal pain (rs=0.479, P=0.002) and belching (rs=0.619, P<0.001) and the total score of FD (rs=0.541, P<0.001).@*CONCLUSIONS@#CGRP and nesfatin-1 may play an important role in the pathophysiological process of FD.

Histórico familiar de câncer gástrico em pacientes dispépticos indicados à triagem endoscópica / Antecedentes familiares de cáncer gástrico en pacientes dispépticos derivados a triaje endoscópico / Family history of gastric cancer in dyspeptic patients referred for endoscopic screening

Resumo Objetivo Identificar o histórico familiar de primeiro grau de câncer gástrico em pacientes com sintomas dispépticos atendidos em um serviço público de endoscopia. Métodos Estudo transversal, realizado com pacientes dispépticos que tinham indicação para realizar o exame de endoscopia digestiva alta. A associação entre o histórico familiar de câncer gástrico e os resultados do exame endoscópico foi verificada por meio dos testes de Qui-quadrado ou Fisher, e medida seu efeito por meio da razão de chance e intervalo de confiança em analises uni e multivariadas. Utilizou-se regressão logística na análise dos dados. Resultados Observou-se que dos 751 pacientes dispépticos investigados, 44 (5,9%) possuíam histórico familiar de câncer gástrico, destes a maioria era do sexo feminino (70,5%), com idade maior ou igual a 45 anos (56,8%). Os pacientes com histórico familiar de câncer gástrico tinham maiores chances de não apresentarem diagnostico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Além de maiores chances de alterações na mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infecção pela Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39) mesmo após ajustes nas análises. Conclusão A alteração endoscópica da mucosa gástrica e a infecção pela Helicobacter pylori em pacientes com sintomas dispépticos, mostraram associação independente com o histórico familiar de câncer gástrico. Diante disso, faz-se necessário a elaboração de protocolos de assistência à saúde para melhor investigação e vigilância dos familiares de câncer gástrico, bem como ações de educação em saúde para orientar os pacientes a respeito do rastreio e prevenção do câncer gástrico.

Resumen Objetivo Identificar los antecedentes familiares de primer grado de cáncer gástrico en pacientes con síntomas dispépticos atendidos en un servicio público de endoscopía. Métodos Estudio transversal llevado a cabo con pacientes dispépticos que habían sido derivados a realizar un estudio de endoscopía digestiva alta. La relación entre los antecedentes familiares de cáncer gástrico y los resultados del estudio endoscópico fue verificada mediante la prueba χ2 de Pearson o de Fisher, y su efecto fue medido a través de la razón de momios y del intervalo de confianza en análisis uni y multivariados. Se utilizó la regresión logística en el análisis de los datos. Resultados Se observó que de los 751 pacientes dispépticos investigados, 44 (5,9 %) tenían antecedentes familiares de cáncer gástrico, de los cuales la mayoría era de sexo femenino (70,5 %), de 45 años o más (56,8 %). Los pacientes con antecedentes familiares de cáncer gástrico tenían mayores chances de no presentar diagnóstico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Además de mayores probabilidades de alteraciones en la mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infección por Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39), inclusive después de ajustes en los análisis. Conclusión La alteración endoscópica de la mucosa gástrica y la infección por Helicobacter pylori en pacientes con síntomas dispépticos mostraron relación independiente con los antecedentes familiares de cáncer gástrico. Ante este escenario, es necesaria la elaboración de protocolos de atención a la salud para una mejor investigación y observación de los familiares de cáncer gástrico, así como también acciones de educación en salud para orientar a los pacientes sobre la detección y prevención del cáncer gástrico.

Abstract Objective To identify first-degree relative history of gastric cancer in patients with dyspeptic symptoms receiving care at a public endoscopy service. Methods A cross-sectional study, performed with dyspeptic patients referred for an upper gastrointestinal endoscopy. The association between the family history of gastric cancer and the findings of the endoscopic examination was verified using the Chi-square or Fisher tests, and its effect was shown using odds ratio and confidence interval in univariate and multivariate analyses. Logistic regression was used to analyze the data. Results Among the 751 dyspeptic patients enrolled, 44 (5.9%) had a family history of gastric cancer, mostly females (70.5%) aged 45 years or older (56.8%). Patients with a family history of gastric cancer were more likely to have no endoscopic diagnosis of peptic ulcer (p=0.05; OR=2.33; CI=0.99-5.48). In addition, higher chances of gastric mucosal changes (p=0.05; RC=1.06; CI=1.04-1.08) and Helicobacter pylori infection (p=0.04; RC=1.79; CI=0.94-3.39) were found, even after adjusting the analyses. Conclusion The endoscopic gastric mucosal changes and Helicobacter pylori infection in patients with dyspeptic symptoms showed an independent association with family history of gastric cancer. Therefore, it is necessary to develop health care protocols for better investigation and surveillance of gastric cancer relatives, as well as health education actions to guide patients regarding screening and prevention of gastric cancer.

Acurácia diagnóstica entre teste rápido da urease e estudo histopatológico para detecção de Helicobacter pylori / Diagnostic accuracy of urease quick test compared to histopathological study for Helicobacter pylori detection

Objetivo: Analisar a acurácia do teste rápido da urease para detecção de Helicobacter pylori comparado com o exame histopatológico. Métodos: Estudo prospectivo e descritivo realizado de abril de 2018 a maio de 2019 em um Serviço de Endoscopia e Biliopancreática e em um laboratório de patologia. A amostra foi composta de 64 pacientes, de ambos os sexos, com idade de 35 a 81 anos, que apresentavam queixas dispépticas. Foram realizados exame histopatológico e teste rápido da urease. Os dados foram analisados pelo R Core team 2019 e submetidos a análises descritivas (variáveis categóricas) e inferenciais (teste de associação de qui-quadrado de Pearson e teste de Mann-Whitney). O nível de significância adotado foi de 5%. Resultados: O teste rápido da urease demonstrou que dez pacientes foram verdadeiros-positivos, 39 verdadeiros-negativos, três falsos-positivos, 12 falsos-negativos, com sensibilidade de 45,4% (25,1% a 67,3%), especificidade de 92,9% (79,4% a 98,1%), valor preditivo positivo de 76,9% (45,9% a 93,8%), valor preditivo negativo de 76,5% (62,2% a 86,7%), acurácia de 76,6% (64,0% a 85,9%), razão de chance diagnóstica 10,8 (2,56 a 45,9), índice de Youden 0,38 (0,16 a 0,60) e taxa de erro de 23,4% (14,1% a 36,0%). Conclusão: O teste rápido da urease apresentou baixa capacidade de detectar pacientes infectados, menor acurácia em relação ao estudo anatomopatológico e alta especificidade. O teste pode ser útil no momento da realização da endoscopia, por fornecer resultado rápido e barato para detectar H. pylori. O diagnóstico da bactéria apresenta maior confiabilidade com a realização dos dois métodos para pesquisa de H. pylori.

Objective: To analyze the accuracy of the rapid urease test for Helicobacter pylori detection when compared with the histopathological examination. Methods: This is a prospective and descriptive study conducted from April 2018 to May 2019, at an Endoscopy and Biliopancreatic Service and in a pathology laboratory. The sample consisted of 64 male and female patients aged 35 to 81 years old with dyspeptic complaints. Histopathological examination and rapid urease test were performed. Data were analyzed by R Corel team 2019 and underwent descriptive (categorical variables) and inferential (Pearson's Chi-squared association test and Mann-Whitney test) analyzes. The significance level adopted was 5%. Results: The rapid urease test showed that ten patients were true positive, 39 true negative, three false-positive, and 12 false-negative, and sensitivity was of 45.4% (25.1% to 67.3%), specificity 92.9% (79.4% to 98.1), positive predictive value of 76.9% (45.9-93.8%), negative predictive value of 76.5% (62.2% to 86.7%), accuracy of 76.6% (64.0% to 85.9%), diagnostic odds ratio of 10.8 (2.56% to 45.9), Youden index 0.38 (0.38% to 0.60), and error rate 23.4 (14.1% to 36.0%). Conclusion: The rapid urease test showed low ability to detect infected patients, lower accuracy compared to the pathological study, and high specificity. The test may be useful at the time of endoscopy, as it provides a quick and inexpensive result to detect H. pylori. The diagnosis of the bacterium is more reliable when both methods for H. pylori investigation are performed

Erradicación de Helicobacter pylori en pacientes con dispepsia funcional / Helicobacter pylori eradication in patients with functional dyspepsia

La dispepsia constituye un motivo de consulta frecuente en atención primaria. A propósito de un paciente con diagnóstico de dispepsia funcional, la autora se plantea si el tratamiento de erradicación del Helicobacter pylori podría mejorar los síntomas. Luego de una búsqueda rápida se encontró evidencia que señala que el tratamiento de la infección por este germen podría ser beneficiosa para aliviar los síntomas de la dispepsia funcional a largo plazo, aunque con mayor riesgo de efectos adversos, por lo que otros tratamientos alternativos continúan siendo ser una opción válida en el manejo de los pacientes con este problema de salud. (AU)

La derivación protocolizada a endoscopía asociada a la detección de Helicobacter pylori mediante antígeno en deposiciones disminuye lista de espera para endoscopía y optimiza la detección de lesiones pre-malignas y cáncer gástrico incipiente / Protocolized referral to endoscopy and Helicobacter pylori detected in stools aimed to decrease endoscopy waiting lists

Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.

Enfoque diagnóstico y terapéutico de dispepsia y dispepsia funcional: ¿qué hay nuevo en el 2019? / Diagnostic and therapeutic approach to dyspepsia and functional dyspepsia: what's new in 2019?

La dispepsia abarca un conjunto de síntomas que se originan en la región gastroduodenal. Se caracteriza por dolor o ardor epigástrico, saciedad precoz y llenura pos-prandial. Según la relación de los síntomas con las comidas se divide en síndrome de dolor epigástrico y síndrome de malestar pos-prandial. Sin embargo, en la práctica clínica, frecuentemente se sobreponen. En los últimos años se ha cambiado el paradigma de las alteraciones fisiológicas gástricas y han aumentado las evidencias que apoya a la eosinofilia duodenal, como una alteración primaria que altera la fisiología gástrica y puede inducir la sintomatología. Así mismo, cada día hay mayor interés en la alteración de la microbiota. El tratamiento se basa en la supresión de ácido, procinéticos, neuromoduladores, psicoterapia, terapias alternativas y complementarias. Ningún tratamiento es universalmente eficaz en todos los pacientes.

Dyspepsia encompasses a set of symptoms that originate in the gastroduodenal region. It is characterized by pain or epigastric burning, early satiety and post-prandial fullness. According to the relationship of symptoms with meals, it is divided into epigastric pain syndrome and postprandial distress syndrome. However, in clinical practice, they frequently overlap. In recent years the paradigm of gastric physiological alterations has been changed and evidence supporting duodenal eosinophilia has increased, as a primary alteration that alters gastric physiology and can induce symptomatology. Every day there is more interest in the alteration of the microbiota. The treatment is based on the suppression of acid, neuromodulators, prokinetics, psychotherapy, alternative and complementary therapies. No treatment is effective in all patients.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Helicobacter pylori eradication: influence of interleukin-1beta -31 C/T polymorphism

ABSTRACT Aim To analyze the influence of the -31 C/T polymorphism of the interleukin-1β gene on Helicobacter pylori eradication therapy success in patients with functional dyspepsia. Methods Functional dyspepsia was diagnosed according to the Rome III criteria. All patients underwent upper gastrointestinal endoscopy, and gastric biopsies were obtained at screening and 12 months after randomization (last follow-up visit). Urease test and histological examination were performed to define the H. pylori status. Patients received twice-daily amoxicillin, clarithromycin and omeprazole for 10 days. Genotyping of the interleukin-1beta -31 C/T polymorphism (rs1143627) was performed using polymerase chain reaction-restriction fragment length polymorphism. Results One hundred forty-nine patients received treatment with triple therapy for H. pylori eradication. Only one patient was lost to follow-up, and adherence to study medication was 94.6%. A total of 148 patients (mean age 46.08 ± 12.24 years; 81.8% women) were evaluated for the influence of the interleukin-1beta -31 C/T polymorphism on the outcome of H. pylori eradication therapy. After treatment, bacteria were eradicated in 87% of patients (129/148). Genotype frequencies of the polymorphism were as follows: CC, 38/148 (25.7%); CT, 71/148 (47.9%); and TT, 39/148 (26.4%). Successful eradication rate was 78.9%, 94.4% and 82.1% for the CC, CT and TT genotypes, respectively. The CT genotype was significantly associated with successful H. pylori eradication (p= 0.039). Conclusion This study suggests that the CT genotype of the interleukin-1beta -31 C/T polymorphism plays a role in the successful eradication of H. pylori among patients with functional dyspepsia.

Risk factors of helicobacter pylori infection in an urban community in northeast Brazil and the relationship between the infection and gastric diseases

Abstract INTRODUCTION: Helicobacter pylori, a water contaminant, is the primary pathogenic agent associated with gastric diseases in humans. Exposure to H. pylori is more likely higher in developing countries. This study aimed to evaluate the risk factors associated with H. pylori infection in patients undergoing endoscopy to validate the cause of dyspeptic symptoms in an urban population in northeast Brazil and to compare the urease test and polymerase chain reaction assay results with the histopathological findings. METHODS: We evaluated 200 of 759 individuals with dyspeptic complaints from Campina Grande, State of Paraiba, northeast Brazil. Patients underwent endoscopy, followed by gastric biopsies. Logistic regression analysis was performed to adjust for confounders and to determine significant risk factors of dyspeptic disorders. RESULTS: Women accounted for 72.5% (145/200) of the participants. Approximately 59.8% (120/200) of the samples tested positive for H. pylori based on histological examinations. The specificity of polymerase chain reaction assay was higher than that of the urease test (77% vs. 64%, p=0.034). City drinking water [odds ratio (OR): 2.6; 95% confidence interval (CI): 1.3-5.21; p=0.004] and smoking (OR: 4.0; 95% CI: 1.13-14.5; p=0.031) were the risk factors of H. pylori infection. Belching was the most common symptom associated with H. pylori infection (p=0.05). CONCLUSIONS: The increased risk of H. pylori infection associated with non-treated water consumption indicates the need for improvements in public water treatment and better sanitary conditions because these can be a source of not only H. pylori infections but also other water-borne pathogen infections.

Mexican consensus on dyspepsia / Consenso mexicano sobre la dispepsiaMexican consensus on dyspepsia

Desde la publicación de las guías de dispepsia 2007 de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed (01/2007 a 06/2016) con el fin de revisar y actualizar las guías 2007 y proporcionar nuevas recomendaciones basadas en evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron enunciados que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Treinta y un enunciados fueron redactados, votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología y fisiopatología. La endoscopia debe realizarse en dispepsia no investigada cuando hay datos de alarma o falla al tratamiento. Las biopsias gástricas y duodenales permiten confirmar infección por Helicobacter pylori y excluir enfermedad celiaca, respectivamente. Establecer una fuerte relación médico-paciente, cambios en la dieta y en el estilo de vida son útiles como medidas iniciales. Los bloqueadores H2, inhibidores de la bomba de protones, procinéticos y fármacos antidepresivos son efectivos. La erradicación de H. pylori puede ser eficaz en algunos pacientes. Con excepción de Iberogast y rikkunshito, las terapias complementarias y alternativas carecen de beneficio. No existe evidencia con respecto a la utilidad de prebióticos, probióticos o terapias psicológicas. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presenta la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

Abstract Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H. pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement. © 2017 Asociacion Mexicana de Gastroenterologiia.

Estrés laboral y su correlación con la prevalencia de dispepsia funcional en militares en actividad que acudieron al hospital geriátrico del ejército / Relationship between the frequency of work-related stress and prevalence of functional dyspepsia in Lima Geriatric Army Hospital

Objetivo: Determinar la relación existente entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en una muestra de 218 militares mayores de 50 años durante el año 2010 en el Hospital Militar Geriátrico de Lima. Materiales y métodos: Investigación descriptiva- explicativa; para la obtención de datos acerca del estrés se empleó la Escala de Sucesos Vitales de Holmes-Rahe y fichas clínicas para el registro clínico y de endoscopia alta que cumplan criterios de Roma III para dispepsia funcional. Para el procesamiento y análisis de datos se empleó el paquete de programas estadísticos SPSS (Statistical Packagefor Social Sciences). Resultados: el 100% de militares presentaron algún nivel de estrés laboral durante el año de estudio; así, el 36,7% presentó un alto nivel, el 31,2% nivel medio o moderado, y el 32,1% presentó nivel bajo de estrés; de estos porcentajes los niveles medio y alto de estrés representaron el 67,9%. Estos resultados permiten establecer que el estrés laboral es un malestar frecuente en la población estudiada (Chi2 tabular = 3,841, chi2 observado = 27,908). Con relación a la dispepsia funcional se determinó una prevalencia de 37,2%, porcentaje que indica que es una patología frecuente en dichos militares (Z tabular = 1,96, Zc = 9,163). Conclusiones: Existe una relación significativa entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en militares en actividad mayores de 50 años (Chi2 tabular= 5,991, chi2 observado =28,878, coeficiente de contingencia=0,342).

Objective: To determine the relationship between the frequency of work-related stress and prevalence of functional dyspepsia in a sample of 218 military older 50 years in 2010 in Lima Military Hospital Geriatric. Materials and methods: Descriptive and explanatory study and for the data collection on stress, were used the Vital Events Scale Holmes-Rahe and clinical records for clinical and upper endoscopy registration that comply the criteria of Rome III for functional dyspepsia. For processing and data analysis the statistical software package SPSS (Statistical Package for Social Sciences) was used. Results: 100% of military showed some level of work stress during the study year; thus, 36.7% had a high level, 31.2% medium or moderate level, and 32.1% had low stress level; these percentages medium and high stress levels accounted for 67.9%. These results establish that job stress is a common discomfort in the study population (tabulated Chi2 = 3.841, chi2 observed = 27,908). Regarding functional dyspepsia prevalence of 37.2%, which indicates that it is a common condition in those military (tabular Z = 1.96, Z c = 9.163) it was determined. Conclusions: There is a significant relationship between the frequency of work-related stress and prevalence of functional dyspepsia in military activity in older than 50 years (tabulated Chi2 = 5.991, chi2 observed = 28,878, contingency coefficient = 0.342).

Diagnostic accuracy of urea breath test for helicobacter pylori infection in children with dyspepsia in comparison to histopathology

ABSTRACT Background - Helicobacter pylori infection is the gram negative bacillus with the close association with chronic antral gastritis. Objective - In this study, we evaluate the accuracy of urea breath test (UBT) with carbon isotope 13 in comparison with histopathology of gastric antrum for detection of H. pylori infection in children with dyspepsia. Methods - This cross-sectional study was performed at specialized laboratory of Shiraz Gastroenterohepatology Research Center and Nemazee Hospital, Iran, during a 12-months period. This study investigated the sensitivity, specificity, and positive and negative predictive values of UBT in comparison with biopsy-based tests. We included a consecutive selection of 60 children who fulfilled Rome III criteria for dyspepsia. All children were referred for performing UBT with carbon isotope 13 (C13) as well as endoscopy. Biopsies were taken from antrum of stomach and duodenum. The pathologic diagnosis was considered as the standard test. Results - The mean age of the participants was 10.1±2.6 (range 7-17 years). From our total 60 patients, 28 (46.7%) had positive UBT results and 32 (53.3%) had negative UBT results. Pathologic report of 16 (57.1%) out of 28 patients who had positive UBT were positive for H. pylori and 12 (42.9%) ones were negative. Sensitivity and specificity of C13-UBT for detection of H. pylori infection were 76.2% and 69.2% respectively. Conclusion - Sensitivity and specificity of C13-UBT for detection of H. pylori infection were 76.2% and 69.2% respectively. Another multicenter study from our country is recommended.

RESUMO Contexto - A infecção por Helicobacter pylori, bacilo gram negativo, tem estreita associação com gastrite antral crônica. Objetivo - Neste estudo, avaliou-se a precisão do teste respiratório da urease (UBT) com isótopos de carbono 13 em comparação com a histopatologia do antro gástrico para detecção da infecção por H. pylori em crianças com dispepsia. Métodos - Estudo transversal realizado no laboratório especializado no Centro de Pesquisa Gastroenterológica de Shiraz e do Hospital de Nemazee, Iran, durante um período de 12 meses. Este estudo investigou a sensibilidade, a especificidade e valores preditivos positivos e negativos da UBT em comparação com testes baseados em biópsia. Incluímos uma seleção consecutiva de 60 crianças que preencheram os critérios de Roma III para dispepsia. Todas as crianças foram encaminhadas para a realização de UBT com isótopos de carbono 13 (C13) assim como endoscopia. Biópsias foram tiradas do antro do estômago e duodeno. O diagnóstico patológico era considerado o teste padrão. Resultados - A idade média dos participantes foi 10.1±2.6 (intervalo de 7 a 17 anos). Do nosso total de 60 pacientes, 28 (46,7%) tiveram resultados positivos UBT e 32 (53,3%) tiveram resultados negativos de UBT. Dezesseis (57,1%) de 28 pacientes que tiveram UBT positiva foram H. pylori positivo e 12 (42,9%) foram negativos. A sensibilidade e especificidade do C13-UBT para detecção da infecção por H. pylori foi de 76,2% e 69,2%, respectivamente. Conclusão - A sensibilidade e especificidade do C13-UBT para detecção da infecção por H. pylori foi de 76,2% e 69,2%, respectivamente. Recomenda-se outro estudo multicêntrico de nosso país.

Guía de práctica clínica para el diagnóstico y tratamiento de la dispepsia en adultos / Clinical Practice Guideline for the diagnosis and treatment of Dyspepsia in adults

Objetivo: con la evidencia más reciente, desarrollar una guía de práctica clínica para el manejo de dispepsia dirigida a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con el apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una guía cumplió con el criterio de adaptación, por lo que se adaptaron 2 de sus preguntas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el manejo de pacientes con dispepsia en Colombia. Conclusiones: el tamizaje de pacientes asintomáticos en Colombia, de forma adecuada y con estándares de calidad, tiene el potencial de impactar la carga de cáncer de colon en el país.

Objective: To provide an evidence-based clinical practice guideline for the management of dyspepsia for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated for quality and applicability. One guideline met the criteria for adaptation of two of its clinical questions. Systematic literature searches were conducted by the Cochrane STI Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the management of dyspepsia was developed for the Colombian context. Conclusions: The opportune management of dyspepsia would have an impact of the disease in Colombia.

Functional Dyspepsia - An Updated Review

Functional dyspepsia (FD) refers to upper abdominal symptoms like upper abdominal or retrosternal pain or discomfort; heart burn; nausea; etc. The symptoms are common; but often poorly understood and mistaken for conditions like chronic gastritis and peptic ulcer disease. Worldwide; the prevalence of dyspepsia is about 20-30 [1]. In the department of internal medicine at the Ruhengeri hospital; there have been 16.4 outpatient cases and 16.1 cases of admissions (Jan-June-2014). A high number of cases would be in other hospitals as well. The causes postulated are the increased production of acid; visceral hypersensitivity; H. pylori infection; emotional stress; reduced immunity; etc. The diagnosis is based on exclusion of organic causes for similar symptoms. The treatment is mainly with lifestyle modifications; and the pharmacological therapy consists of antacids; antiflatulents; prokinetic drugs; cytoprotective drugs; and proton pump inhibitors. It can be recommended that greater awareness needs to be generated among physicians regarding FD. They in turn can counsel patients and lay stress on lifestyle and preventive factors to improve this described condition

Dispepsia / Dyspepsia

Etmologicamente, a palavra dispepsia (do grego dis = difícil e pepse = digestão) significa digestão difícil. Sob o ponto de vista clínico, corresponde a uma série de sintomas de origem gastroduodenal, como dor, queimação ou desconforto epigástrico, plenitude pós-prandial ou saciedade precoce associadas ou não a náusea, vômitos e distensão em andar superior do abdome. Traduz, pois, um distúrbio funcional ou orgânico, de localização epigástrica e origem gastroduodenal...

Etymologically, the greek word dis means hard and pepse means digestion. Therefore, dyspepsia is a poor digestion. From the clinical point of view, dyspepsia corresponds to a range of symptoms originated from gastroduodenal, like pain, heartburn or epigastric discomfort, postprandial fullness or early fullness related or not to nausea, vomiting, upper abdominal distension. So, this explain that a functional or organic decline situated at the epigastric area and it is originated from gastroduodenal...

Current status of functional dyspepsia in Korea

Dyspepsia refers to group of commonly occurring upper gastrointestinal symptoms. The majority of patients with dyspepsia suffer from functional (nonulcer) dyspepsia. Although there is a lack of epidemiological data from population-based or patient cohort studies in Korea, the current understanding of this condition has been updated using data from various recent research studies, which have facilitated the development of clinical guidelines for functional dyspepsia. According to a survey using the Rome III criteria, more than 40% of respondents who visited primary clinics and tertiary hospitals were defined as having functional dyspepsia, most of who were within a subgroup of patients with postprandial distress syndrome. In addition, a population-based cross-sectional survey revealed considerable overlap between functional dyspepsia and other functional gastrointestinal disorders, including gastroesophageal reflux disease (especially nonerosive reflux disease) and irritable bowel syndrome. In contrast to the results of Western trials, there is insufficient evidence to recommend a Helicobacter pylori test-and-treat strategy as an initial management approach to functional dyspepsia in Korea, suggesting the need for early endoscopic evaluation. Additional studies are necessary to adjust the cutoff age for implementation of immediate endoscopic evaluation of patients without alarm symptoms. Considering the prevalence of H. pylori infection and the limited efficacy of symptomatic relief after its eradication, further well-qualified studies in Korea are warranted.