Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions Helicobacter pylori eradication treatment does not benefit patients with nonulcer dyspepsia Bismuth subsalicylate suppression ofHelicobacter pylori in nonulcer dyspepsia: A double-blind placebo-controlled trial Long-term outcome of triple therapy in Helicobacter pylori-related nonulcer dyspepsia: a prospective controlled assessment. Campylobacter pylori--a role in non-ulcer dyspepsia? Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia. Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy 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. A study of gastric emptying in non-ulcer dyspepsia using a new ultrasonographic method.
Nonulcer dyspepsia ( NUD ) is a common syndrome , but the optimal treatments have yet to be established . This study was performed to determine the most effectivetreatment for NUD . Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms . When no organic lesions werefound , the patients were directed to consult ourdepartment ( Psychosomatic Medicine ) ; 194 consecutive NUD patients were studied . All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID ) . Patients with serious NUD were hospitalized , and r and omly divided into control(N = 42 ) and experimental groups ( N = 86 ) . The controlswere treated with physical treatment alone . Theexperimental group received psychiatric treatment inaddition , based on the results of SCID . The experimentalgroup showed a significant improvement compared with thecontrols ( P < 0.0001 ) . The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective OBJECTIVES : The aim of this study was to assess the still controversial role of treatment of Helicobacter pylori ( H. pylori ) infection in patients with nonulcer dyspepsia . METHODS : We conducted a double-blind , r and omized , placebo-controlled , multicenter trial comparing the efficacy of 7 days of eradication treatment ( lansoprazole 15 mg b.i.d . , amoxicillin 1 g b.i.d . , and clarithromycin 500 mg b.i.d . ) with a control treatment ( lansoprazole 15 mg b.i.d . and placebo ) in H. pylori-infected patients with nonulcer dyspepsia .  13C breath tests were performed at baseline and during follow-up . We assessed patient symptoms , health status ( based on the SF-12 question naire ) , patient satisfaction , drug consumption , health care consultation behavior , and absenteeism related to dyspepsia over a 1-yr period . RESULTS : A total of 74 patients r and omized to eradication treatment and 70 patients r and omized to placebo were compared . The rate of eradication of H. pylori infection was 75 % in the active treatment group and 4 % in the placebo group ( p < 0.005 ) . The symptom score improved to a similar extent in the group receiving active treatment ( −4.0 ; 95 % CI = − 5.0 to −3.0 ) and placebo ( −3.6 ; 95 % CI = − 4.5 to −2.7 ) . Treatment response was not related to the severity or duration of initial symptoms or to the severity of gastritis on histology . Quality of life scores were comparable at 12 months . There was no significant difference in dyspepsia-related absenteeism or satisfaction with management of NUD . Patients receiving active treatment were more likely not to have had to use any dyspepsia treatment over the 12 months ( 60.8 % vs 44.3 % ; p = 0.047 ) . CONCLUSIONS : This study did not demonstrate any substantial benefit of curing H. pylori infection in patients with nonulcer dyspepsia . The study adds further evidence that H. pylori is not the main pathogenetic or therapeutic target in these patients 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 OBJECTIVE To ascertain whether triple therapy alters the history of Helicobacter pylori (HP)-related nonulcer dyspepsia ( NUD ) . METHODS Forty-one young ( < 45 yr ) dyspeptic patients were confirmed to be HP-related NUD by serology , rapid urease test , and antral biopsy . Endoscopy excluded the presence of ulcer . These cases were r and omly plotted into control ( n = 21 ) and triple therapy ( n = 20 ) groups . In the former group , H2 blocker was given for 2 months and then intermittent antisecretory agents for up to 1 yr . In the latter group , 20 patients received a course of triple therapy and then were treated like the control group . The symptom scores ( range : 0 - 10 ) were collected on enrollment , and at the end of 2nd , 6th , and 12th months . Each case had serial tests of HP IgG ELISA titer on start , at weeks 2 , 4 , and 8 , at the 6th month , and at the end of the 1st yr . The second endoscopy was done in the 9th wk for eradication survey , and the third endoscopy , at the end of the 1st yr to resurvey the HP status . The histological gradings of biopsy specimens , sample d on each endoscopy , were compared . RESULTS In the triple therapy group , the rate of eradication of HP was 75 % . At he end of the 2nd month , the HP-eradicated cases of the triple therapy group improved the symptom score more significantly then the noneradicated cases ( 2.42+/-1.37 vs.4.76+/-1.58 , p < 0.001 ) . At the ends of the 6th month and 1st yr , the symptom scores of the eradicated cases improved more significantly than those of the control group ( 6th month , 0.61+/-1.18 vs. ] 2.66+/-2.06 ; 1st yr , 0.82+/-1.17 vs. ] 3.56+/-2.89 , p < 0.001 ) . The decline trend of ELISA titers occurred only in eradicated cases and became significantly evident from the 4th wk ( 0.30+/-0.15 vs. ] 0.49+/-0.07 , p < 0.05 ) and thereafter . Both acute and chronic pathological grading was improved in the triple group at the end of the 1st yr ( acute , 1.95 - 0.46 ; chronic , 1.9 - 0.92 ; p < 0,01 ) CONCLUSION Compared with control therapy at 1 yr , triple therapy showed greater symptomatic , serological , and histological improvements . Therefore , triple therapy is beneficial to symptomatic HP-related NUD 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 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 Nonulcer dyspepsia remains a difficult disorder to treat because it is a heterogeneous syndrome . Once patients with the irritable bowel syndrome , esophagitis , and other organic diseases are excluded , there remain patients with dyspepsia of unknown cause ( termed " essential dyspepsia " ) and patients with dyspepsia plus symptoms of gastroesophageal reflux without esophagitis . The aim of this study was to determine whether cimetidine or pirenzepine is efficacious in relieving the symptoms of these latter subgroups . Sixty-two consecutive patients were studied who had chronic upper abdominal pain or nausea where endoscopy had shown no evidence of peptic ulceration , esophagitis , or malignancy ; 47 had essential dyspepsia , and 15 had dyspepsia plus gastroesophageal reflux . They were initially r and omized to either cimetidine or placebo , or pirenzepine or placebo . Patients continued each medication for 1 mo , and , after a washout period , crossed over when again symptomatic ; 51 patients completed cimetidine and placebo , and 50 completed pirenzepine and placebo . The results showed that cimetidine was superior to placebo in decreasing the number of upper abdominal pain episodes weekly and the severity of pain , but the absolute improvement was small . Pirenzepine was not superior to placebo in decreasing symptoms Background : Breast cancer patients frequently experience psychological distress during the chemotherapy period . Objectives : This study aim ed to evaluate the effect of relaxation with guided imagery on patients with breast cancer . Patients and Methods : A two-group , pretest-posttest , quasi-experimental design with a r and omized controlled trial was conducted . Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study . These patients were r and omly assigned to the experimental group ( n = 32 ) or to the control group ( n = 33 ) . Both groups received chemotherapy self-care education , but the experimental group also received relaxation with guided imagery training . The training on relaxation with guided imagery was conducted before chemotherapy , and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy . Results : The experimental group showed significant decreases in insomnia ( -0.34 ± 0.83 , P < 0.05 ) , pain ( -0.28 ± 0.58 , P < 0.05 ) , anxiety ( -3.56 ± 2.94 , P < 0.00 ) , and depression ( -2.38 ± 2.70 , P < 0.00 ) between the pretest and the posttest . Comparing the two groups , statistically significant differences were found in the overall symptom distress ( B = 0.11 , P < 0.05 ) , insomnia ( B = 0.50 , P < 0.05 ) , depression ( B = 0.38 , P < 0.05 ) , and numbness in physical symptoms ( B = 0.38 , P < 0.05 ) , as well as in anxiety ( B = 3.08 , P < 0.00 ) and depression ( B = 1.86 , P < 0.00 ) in psychological distress . One week of relaxation with guided imagery can significantly improve the overall symptoms of distress , insomnia , depression , physical symptoms , and anxiety , and can decrease psychological distress . Conclusions : Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients 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 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 studies highlighted problems with recruitment and compliance .
CONCLUSIONS : There was insufficient evidence on the efficacy of psychological therapies in NUD .
OBJECTIVES : We conducted a systematic review to determine the effectiveness of psychological interventions including psychodrama , cognitive behavioral therapy , relaxation therapy , guided imagery , or hypnosis in the improvement of  dyspepsia symptoms in patients with nonulcer dyspepsia ( NUD ) .