Campylobacter pylori--a role in non-ulcer dyspepsia? Role of anti-Helicobacter pylori treatment in H. pylori-positive and cytoprotective drugs in H. pylori-negative, non-ulcer dyspepsia: results of a randomized, double-blind, controlled trial in Asian Indians. Campylobacter pylori and non-ulcer dyspepsia. Distinct profiles of gastritis in dyspepsia subgroups. Their different clinical responses to gastritis healing after Helicobacter pylori eradication. Helicobacter pylori infection and non-ulcer dyspepsia: the effect of treatment with colloidal bismuth subcitrate. The symptomatic effect of 1-day treatment periods with cimetidine in dyspepsia. Combined results from randomized, controlled, single-subject trials. Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. A study of gastric emptying in non-ulcer dyspepsia using a new ultrasonographic method. The effect of cimetidine in non-ulcer dyspepsia. Experience with a multi-cross-over model. Cisapride treatment of patients with non-ulcer dyspepsia and erosive prepyloric changes. A double-blind, placebo-controlled trial. Efficacy of sucralfate in treatment of non-ulcer dyspepsia. A double-blind placebo-controlled study. Cimetidine on-demand in dyspepsia. Experience with randomized controlled single-subject trials. Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case-control study. Bismuth subsalicylate suppression ofHelicobacter pylori in nonulcer dyspepsia: A double-blind placebo-controlled trial Cure of Helicobacter pylori infection does not improve symptoms in non‐ulcer dyspepsia patients—a double‐blind placebo‐controlled study
Non-ulcer dyspepsia ( NUD ) is a common complaint in which no systematic illness or organic proximal alimentary tract disease can be identified . The pathophysiology of NUD is probably heterogeneous . Eighty-two subjects with NUD were studied in a prospect i ve r and omized placebo-controlled study to assess the efficacy of colloidal bismuth subcitrate ( CBS ) chewable tablets at a dose of four tablets daily for 1 month . The role of Campylobacter pylori and associated histological gastritis was evaluated . Sixty-one percent of NUD patients had C. pylori in the gastric antrum compared with 25 % of age-matched controls . C. pylori was associated with acute and chronic inflammation ( P less than 0.001 ) in the antrum . C. pylori was cleared in 59 % of CBS-treated subjects compared with only 4 % placebo ( P less than 0.05 ) . Both acute and chronic inflammation improved in subjects cleared of bacteria . Clearance of C. pylori and histological improvement was associated with a significant decrease in symptoms . In C. pylori negative subjects improvement in symptoms occurred in both the placebo and active treatment groups . This study would suggest that C. pylori and associated histological gastritis may play a role in non-ulcer dyspepsia BACKGROUND The efficacy of anti-Helicobacter pylori treatment and cytoprotective drugs in H. pylori-positive and -negative non-ulcer dyspepsia ( NUD ) , respectively , is debatable . METHODS In a r and omized study , the efficacy of anti-H. pylori treatment versus sucralphate was tested in patients with NUD . One hundred and twelve patients with NUD , 62 positive and 50 negative for H. pylori were studied . Of 62 patients positive for H. pylori , 32 were treated with triple therapy ( colloidal bismuth subcitrate , tetracycline and metronidazole ) for 2 weeks and the remaining 30 were treated with sucralphate ( 1 g , q.i.d . ) for 4 weeks . Of 50 patients negative for H. pylori , 25 each were treated with either sucralphate ( 1 g , q.i.d . ) or ranitidine ( 150 mg , b.d . ) for 4 weeks . RESULTS In patients with NUD and H. pylori infection , triple therapy  eradicated H. pylori in 88 % and was superior to sucralphate in producing symptom relief ( 81 vs 33 % , P = 0.0003 ) and histological improvement in gastritis ( 73 vs 30 % , P = 0.003 ) . In the H. pylori-negative group , sucralphate was superior to ranitidine with regard to symptom relief ( 68 vs 36 % , P = 0.04 ) and improvement in gastritis ( 44 vs 12 % , P = 0.09 ) . The symptomatic improvement persisted until 12 weeks after the start of treatment in triple therapy group only . CONCLUSIONS In patients with NUD associated with H. pylori , triple therapy was better than sucralphate in terms of symptomatic and histological improvement . However , sucralphate was superior to ranitidine in providing symptom relief in patients with H. pylori-negative NUD Non-ulcer dyspepsia ( NUD ) is a poorly understood syndrome often present in association with gastritis . Among patients undergoing gastroscopy  , some with NUD have a gastric mucosa colonized by the campylobacter-like organism , Campylobacter pylori . We therefore studied prospect ively 55 consecutive patients with NUD and 15 normal controls to determine the prevalence of C. pylori organisms , and to investigate their association with histological gastritis , macroscopic evidence of gastritis , sex , smoking , alcohol consumption , and dyspeptic symptoms . We found a 45.4 % prevalence in NUD patients which was statistically significantly higher than the 13.33 % prevalence in the control group ( p less than 0.05 ) . We also found a close association between C. pylori and microscopic evidence of gastritis ( p less than 0.001 ) , male sex ( p less than 0.001 ) , and postpr and ial bloating ( p less than 0.05 ) . We did not find any significant association between C. pylori and macroscopic evidence of gastritis , smoking , alcohol consumption and other dyspeptic symptoms . Our findings suggest that C. pylori may play a pathogenic role in NUD BACKGROUND A contribution of Helicobacter pylori gastritis to the pathogenesis of non-ulcer dyspepsia ( NUD ) remains uncertain . METHODS Administration of an appropriate clinical question naire followed by endoscopy allowed us to select , among 139 out patients with dyspepsia , 87 non-ulcer dyspepsia patients with more severe and group-distinctive symptoms , 35 of whom were classified as having ulcer-like ( ULD ) . 38 as dysmotility-like ( DLD ) , and 14 as reflux-like dyspepsia ( RLD ) . Biopsy specimens were evaluated for H. pylori gastritis in accordance with the Sydney system . The 70 H. pylori-positive cases were treated with omeprazole , 20 mg twice daily , and amoxycillin , 1 g three times daily for 2 weeks . RESULTS Higher rates of H. pylori colonization were found histologically in the gastric mucosa of ULD ( 91 % ) and RLD ( 86 % ) than in that of DLD ( 68 % ) or asymptomatic ( 42 % ) patients . ULD differed from RLD patients in their higher score of antritis activity . Three and 6 months after H. pylori eradication ULD ( but not DLD ) showed significant regression of dypspetic symptoms scores . CONCLUSIONS It seems likely that H. pylori gastritis , with special reference to active antritis , is among causative factors of ULD . Its role in the pathogenesis of RLD and DLD needs further investigation A study was undertaken to determine the role of Helicobacter pylori in non-ulcer dyspepsia ( NUD ) and to determine the efficacy of colloidal bismuth subcitrate ( CBS ) in the treatment of NUD . Seventy-one patients were r and omly allocated ( double blind ) to CBS or placebo , two tablets twice daily for 4 weeks . The severity of dyspepsia was scored and endoscopies performed before and after treatment , and antral biopsy specimens were taken for bacteriologic and histologic examination . Forty patients had H. pylori infection , and all had changes of chronic active gastritis .  H. pylori was cleared from 17 to 21 patients ( 81 % ) treated with CBS , whereas none of the 19 patients treated with placebo cleared the bacteria . Improvement in histology was noted in 15 of 21 patients ( 71.4 % ) treated with CBS , whereas no improvement was noted in any of the placebo controls . Thirty-one patients were negative for H. pylori . All had either normal gastric histology or minor degrees of inflammation . Seventeen of these patients received CBS , and 14 received placebo . All groups reported improvement in the symptom score ; however , the H. pylori-positive , CBS-treated group recorded a significantly higher improvement than the other groups ( p less than 0.001 ) . Relapse of H. pylori infection after initial clearance of the bacteria was high . Twelve of 16 patients evaluated relapsed 1 month after withdrawal of CBS Before endoscopy a double-blind , r and omized , controlled , single-subject trial comparing the symptomatic effect of 1-day treatment periods with cimetidine and placebo was conducted in patients with dyspepsia . Results from 339 patients were analysed . The trial lasted 12 days and consisted of 6 treatment days with 400 mg cimetidine three times daily and 6 days with placebo three times daily . The order of the treatments was r and omized within six pairs , and a r and omization test based on daily measures of global symptoms provided individual p values . Aggregation of the measures from all subjects showed that cimetidine alleviated the symptoms significantly better than placebo in peptic ulcer disease ( PUD ) ( p less than 0.0001 ) , oesophagitis ( p less than 0.001 ) , and non-ulcer dyspepsia ( NUD ) ( p less than 0.0001 ) . Twenty-seven per cent of the patients with PUD , 26 % of those with oesophagitis , and 12 % of the patients with NUD obtained individual p values of less than 0.10 and were defined as responders . The best predictors of the response to cimetidine in NUD were age above 40 years , heartburn or acid regurgitations being the worst symptom , and night pains relieved by food , milk , or antacids . In conclusion , the applied single-subject trial confirmed the overall symptomatic effect of cimetidine in dyspepsia and identified individual responders among patients with NUD with a clinical ly reasonable profile . The low proportion of responders among patients with PUD or oesophagitis suggests that the model has a low sensitivity for identification of individual responders and that the single-subject trial design in dyspepsia needs further refinement Fasting antral area was examined by ultrasonography in 40 healthy subjects and in 106 patients with non-ulcer dyspepsia ( NUD ) and erosive prepyloric changes ( EPC ) before and after treatment with cisapride or placebo .  The patients were examined twice , first after a run-in period of 14 days of placebo and then after 14 days of cisapride , 10 mg three times daily , or placebo . The relaxed width of the antral area was measured in two sections : a vertical section in which the antrum , the superior mesenteric vein , and the aorta were visualized simultaneously , and a horizontal section that included the pylorus and the middle of the antrum up to 5 cm proximal to the pylorus . The mean antral area was wider ( p less than 0.001 ) , both in vertical and horizontal sections , in patients with NUD and EPC than in controls . The antral area in NUD patients was wider ( p less than 0.05 ) in smokers than in non-smokers . The area tended to decrease during treatment with cisapride ( p = 0.08 ) . Bloating was the only symptom significantly associated with a wide antral area ( p = 0.01 ) . The results suggest a relationship between a wide fasting antral area and NUD with EPC To ascertain the effect of gastric emptying on the symptoms of non-ulcer dyspepsia ( NUD ) patients , we r and omly selected 60 NUD patients and , as control , 26 dyspepsia-free volunteers . We measured the gastric emptying time of mixed food ( 270 kcal ) , using real-time ultrasonography in two ways . NUD patients were divided r and omly into two groups and given domperidone or placebo in a double-blind trial . Of the NUD patients 48 % had delayed gastric emptying times and associated epigastric pain , bloating , early satiety , and regurgitation . A prokinetic agent not only improved emptying time but also relieved some of the symptoms of the NUD patients . Real-time ultrasonography proved a useful method for evaluating gastric emptying The symptomatic effect of cimetidine was examined in 27 patients with non-ulcer dyspepsia ( NUD ) by means of a multi-cross-over model ( MCO model ) for testing the symptomatic effect of drugs in individual patients . None of the patients showed an ulcer at the time , but 20 patients had evidence of previous peptic ulcer disease . The variant of the MCO model used included six treatment periods and three regular interchanges between cimetidine and placebo . Treatment periods lasted 2 or 4 days . The individual results were evaluated on the basis of the number of times ( X score ) cimetidine was associated with less symptoms than the preceding or following placebo . In general , cimetidine was associated with significantly ( p less than 0.02 ) less symptoms than placebo . The X-score distribution was therefore skew in favour of high scores . Five patients showed the maximal X score of 5 . The chance of getting an X score of 5 when cimetidine is not better than placebo is about 9 % . Accordingly , the risk of being wrong when defining these five patients as cimetidine responders is 9 % . The present study confirms that the MCO model may identify individual  cimetidine  responders among patients with NUD One hundred and twenty consecutive out patients with non-ulcer dyspepsia ( NUD ) and erosive prepyloric changes ( EPC ) were , after a 2-week placebo run-in period , r and omly allocated to double-blind treatment with either 10-mg cisapride tablets or placebo three times daily for 4 weeks . The patients ' global evaluation and total symptom score were significantly in favour of cisapride at 2 weeks ( p less than 0.05 ) . At 4 weeks the effect of cisapride was no longer significant ( p = 0.22 ) . Similarly , the investigators ' global evaluation showed marked to moderate symptom improvement in 47 % of the cisapride-treated patients as compared with 30 % of the placebo-treated patients at 2 weeks . The 95 % confidence interval of the difference ( 18 % ) was 0 % to 35 % . At 4 weeks the intergroup difference was only 10 % ( cisapride , 50 % versus placebo 40 % ) . Pain on awakening was the only symptom improved in favour of cisapride at 4 weeks . Thus , when patients with NUD and EPC are treated with cisapride , the therapeutic gain might vanish after the 2nd week of treatment The object of this study was to assess the efficacy of sucralfate in the treatment of non-ulcer dyspepsia ( NUD ) . The diagnosis of NUD was made by exclusion . All patients underwent an upper gastrointestinal endoscopy and abdominal ultrasound , and blood tests were done as clinical ly indicated . Patients with a history of peptic ulcer disease were not included .  Symptomatic assessment was made at the beginning and at the end of the study . The patients registered their most prominent dyspeptic symptoms and whether they improved , were unchanged , or worsened . The study was double-blind . Placebo or 1 g sucralfate four times daily was given for 3 weeks . Over a 2-year period 104 patients were included in the study ; 56 received sucralfate and 48 placebo . Nine patients were excluded because of poor compliance or side effects , six from the sucralfate group and three from the placebo group . The sucralfate and placebo groups were comparable with regard to symptom and clinical variables . Global assessment of symptoms showed that in the sucralfate group 34 improved ( 68 % ) , 11 were unchanged , and 5 were worse . In the placebo group 31 improved ( 69 % ) , 11 were unchanged , and 3 were worse . There was no statistically significant difference between the groups . The 3-week course of sucralfate in patients with NUD did not show symptomatic improvement over placebo Double-blind r and omized controlled trials in single subjects ( N of 1 RCTs ) have demonstrated a beneficial symptomatic effect of cimetidine in reflux- or ulcer-like non-ulcer dyspepsia ( NUD ) . However , spontaneous fluctuations in symptoms reduce the validity of such trials when performed as continuous trials with fixed dosages . This study was carried out to identify individual responders to cimetidine in NUD , peptic ulcer disease , and oesophagitis and to confirm the beneficial average effect of cimetidine in these clinical entities . We evaluated N of 1 multi-crossover trial design s , which compare the effects of single doses of cimetidine and placebo taken on-dem and for symptomatic relief . Each trial consisted of six cimetidine ( 400 mg or 800 mg ) and six placebo tablets r and omized in successive pairs . The symptomatic effect of each tablet was measured 1/2 - 6 h after the intake . Outcomes were assessed by individual p values and confidence intervals . A minimal clinical ly important difference was defined , to assess the clinical significance as demonstrated by the confidence intervals . Thirteen of 25 patients ( 52 % ) with reflux- and ulcer-like NUD obtained individual p values below 0.20 . Similarly , 7 of 9 patients ( 78 % ) with oesophagitis and 6 of 12 patients ( 50 % ) with peptic ulcer obtained such p values . On the basis of the 80 % confidence intervals the corresponding numbers of subjects with clinical ly significant effect were six ( NUD ) , three , and three . The combined data showed a significantly better effect of cimetidine  than of placebo ( p less than 0.0001 ) in each of the three diagnostic groups studied . Cimetidine taken on-dem and may have a rapid symptom-relieving effect in dyspepsia . ( ABSTRACT TRUNCATED AT 250 WORDS 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 r and omly 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 Gastritis caused byHelicobacter pylori ( HP ) is common in patients with nonulcer dyspepsia ( NUD ) , but an etiologic relationship between the histologic lesion and clinical symptoms is unproven . HP is inhibited by bismuth subsalicylate ( BSS ) , a traditional remedy for dyspeptic complaints . The aim of this study was to assess the short- and long-term effects of BSS on HP , gastritis , and symptoms in patients with NUD . One hundred twenty-six patients with NUD who were shown to be infected withH. pylori ( HP+ ) were enrolled . There was a two-week placebo run-in period to eliminate placebo responders . Fifty patients remained symptomatic and were r and omly assigned to therapy with either BSS liquid or a matching placebo .  EGD , biopsy , and clinical evaluations were performed at entry , at week 5 ( end of therapy ) , at week 9 ( four weeks after therapy ) , or at time of symptomatic relapse . Twenty-seven patients received placebo and 23 patients received BSS . BSS  suppressedH. pylori in 15/23 patients ( 65 % ) and eradicated it in one patient , whereas the placebo had no effect onH. pylori . Gastritis improved during therapy with BSS but relapsed by week 9 . There was no significant change in level of dyspeptic symptoms during or after treatment , although one month after the end of treatment , the patients in the BSS group consistently had lower symptom scores and fewer symptomatic days for all symptoms measured . The study confirms that BSS given for three weeks suppresses but does not usually eradicateH. pylori . Such short-term suppression ofH. pylori heals gastritis but does not result in clinical improvement It remains controversial whether the cure of H. pylori infection improves NUD symptoms .
Unadjusted data was not statistically significant .
The other problems of psychological intervention included low recruitment and high drop out rate , which has been shown to be greater in patients receiving group therapy .
There is insufficient evidence from this review to confirm the efficacy of psychological intervention in NUD
BACKGROUND Studies have also shown that non-ulcer dyspepsia ( NUD ) patients have higher scores of anxiety , depression , neurotism , chronic tension , hostility , hypochondriasis and tendency to be more pessimistic when compared with the community controls .
However , the role of psychological interventions in NUD remains uncertain .
OBJECTIVES This review aims to determine the effectiveness of psychological interventions including psychotherapy , psychodrama , cognitive behavioural therapy , relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores in patients with NUD .