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The clinical assessments of patients with gastrointestinal symptoms can be time-consuming, and the symptoms captured during the consultation may be influenced by a variety of patient and non-patient factors. To facilitate standardized symptom assessment in the routine clinical setting, we developed the Structured Assessment of Gastrointestinal Symptom (SAGIS) instrument to precisely characterize symptoms in a routine clinical setting.We aimed to validate SAGIS including its reliability, construct and discriminant validity, and utility in the clinical setting.Development of the SAGIS consisted of initial interviews with patients referred for the diagnostic work-up of digestive symptoms and relevant complaints identified. The final instrument consisted of 22 items as well as questions on extra intestinal symptoms and was given to 1120 consecutive patients attending a gastroenterology clinic randomly split into derivation (n = 596) and validation datasets (n = 551). Discriminant validity along with test-retest reliability was assessed. The time taken to perform a clinical assessment with and without the SAGIS was recorded along with doctor satisfaction with this tool.Exploratory factor analysis conducted on the derivation sample suggested five symptom constructs labeled as abdominal pain/discomfort (seven items), gastroesophageal reflux disease/regurgitation symptoms (four items), nausea/vomiting (three items), diarrhea/incontinence (five items), and difficult defecation and constipation (2 items). Confirmatory factor analysis conducted on the validation sample supported the initially developed five-factor measurement model ([Formula: see text], p 0.0001, χThe SAGIS instrument has excellent psychometric properties and supports the clinical assessment of and symptom-based categorization of patients with a wide spectrum of gastrointestinal symptoms.

Table of Medical Literature Search Results for Randomized Controlled Trials of Enteric-Coated Peppermint Oil for the Irritable Bowel Syndrome. We searched the medical literature for randomized controlled trials of enteric-coated peppermint oil for the treatment of the irritable bowel syndrome. Our search methodology yielded 102 reports in PubMed, 396 in Embase, 201 in Web of Science, and 60 in the Cochrane library. (PDF 265 kb)

Table of Excluded Studies. Ten of twenty-two included randomized controlled trials (RCTs) were eliminated for reasons shown. Five studies for data that was shown in other publications, four RCTs were cross-over trials without sufficient washout period, and an RCT was permitted rescue medication without sufficient data to permit analysis. (PDF 369 kb)

Unter funktionellen Osophagus-, Magen- oder Darmerkrankungen wird ein breites Spektrum von Erkrankungen des Verdauungstrakts subsumiert. Diese sind charakterisiert durch bestimmte, auf den Verdauungstrakt bezogene Symptome. Bei Patienten mit funktioneller Dyspepsie stehen auf den Oberbauch bezogene Symptome wie Schmerz, Vollegefuhl im Vordergrund, bei Patienten mit funktionellen Osophaguserkrankungen Sodbrennen oder Schluckbeschwerden. Eine funktionelle Erkrankung des Verdauungstrakts wird diagnostiziert, wenn mit den routinemasig verfugbaren Untersuchungstechniken keine strukturelle oder biochemische Abnormalitat nachweisbar ist, die die Symptome mit hinreichender Wahrscheinlichkeit erklart. Bemerkenswert ist die Uberschneidung dieser Krankheitsbilder: Patienten weisen oft beide Krankheitsbilder kombiniert auf. Zudem besteht eine Uberschneidung mit Symptomen des Reizdarmsyndroms. Weiterhin ist insbesondere bei Patienten mit schwerwiegenden, die Lebensqualitat nachhaltig beeintrachtigenden Symptomen eine psychiatrische Komorbiditat mit Depressivitat und Angststorungen feststellbar. Wahrend die Pathophysiologie dieser Krankheitsbilder bis heute nicht abschliesend geklart ist, spielen Storungen der gastrointestinalen Motilitat und Sensorik eine zentrale Rolle in der Pathogenese. Neueren Untersuchungen zufolge sind bei vielen Patienten minimale entzundliche Veranderungen nachweisbar, deren Ursache bislang nicht geklart ist. Veranderungen des gastrointestinalen Mikrobioms sind moglicherweise an der Manifestation dieser entzundlichen Storungen beteiligt. Es erscheint indes wenig aussichtsreich, die Bedeutung des Mikrobioms fur die Manifestation funktioneller Erkrankungen des Verdauungstrakts durch „einfache“ Stuhluntersuchungen zu ergrunden. Technische Entwicklungen wie der „Brisbane Biopsy Device“ stellen vielversprechende Ansatze dar, die in Kombination mit entsprechenden molekularbiologischen Techniken in der Zukunft wichtige neue Erkenntnisse liefern durften.

Clinical observations and uncontrolled single case experiments have suggested an effect of psychological stress on gastrointestinal motility. These observations encouraged a large number of experimental studies focusing on the influence of psychological stress on gastrointestinal motility. These controlled studies have shown that different kinds of stressors increase esophageal motor activity and induce secondary (nonpropulsive) esophageal contractions. Cold pressor test and transcutaneous electrical stimulation inhibited gastric emptying, auditory feedback and performance tasks inhibited the occurrence of interdigestive migrating motor complexes, and a noise stressor increased intestinal transit time. Furthermore, psychological stress (psychological stress interview, frustrating cognitive tasks, and anger) and physical stress (cold pressor test) stimulated large-bowel contractions and electrical spiking activity. The present studies give some evidence that patients with functional motility disorders respond differently to stressors as compared to healthy controls. In spite of these findings with short-acting stressors, there is no proof that stress has an effect on the manifestation of functional motility disorders. Nevertheless, this does not allow the conclusion that stress does not play any role in the manifestation of motility-related gastrointestinal disorders. In particular, there are no studies on the action of chronic stress on gastrointestinal motility. Thus further research is needed to elucidate the influence of stress, especially of chronic stress, on gastrointestinal motility.

Bei 186 in der urologischen Abteilung des Marienhospitals Gelsenkirchen von 1978–1994 tumornephrektomierten Patienten betrug die 5-Jahres-Uberlebensrate 77,2 %. Der mittlere Tumordurchmesser lag bei 7,3 cm. In Abhangigkeit von der lokalen Tumorausbreitung ergaben sich 5-Jahres-Uberlebensraten von 80,9 % fur T2- (n = 97), 79,3 % fur T3a- (n = 58) und 65,6 % fur T3b-Tumoren (n = 25). Von den Patienten im Stadium T4 (n = 6) uberlebte keiner 5 Jahre. 78,3 % der Patienten ohne Lymphknotenmetastasen (n = 152) uberlebten 5 Jahre im Vergleich zu 83,3 % im Stadium N1 (n = 8). Kein Patient mit Lymphknotenfiliae im Stadium N2 (n = 13) uberlebte 20 Monate. Entsprechend dem Differenzierungsgrad ergaben sich 5-Jahres-Uberlebensraten von 95,4 % (G1, n = 46), 71,2 % (G2, n = 130), und 71,4 % (G3, n = 8).

Diagnosis of esophageal motility disorders is difficult due to the large physiologic variability of bolus transport. With the help of a parametric multiple swallow technique (introduced by Tatsch), using "condensed images" of each single swallow action before creating a "mean image" of six swallows, this problem can be solved. For testing this relatively new method, 12 patients underwent 16 pairs of parametric esophageal scintigraphy and esophageal manometry. This collective of patients consisted of 4 with achalasia and secondary hypomobility of the tubular esophagus, 7 with unspecific esophageal dysfunction confirmed by manometry and 1 with clinical dysphagia and normal status in manometry. Fourteen of 15 pathological manometric findings could be confirmed with parametric scintigraphy. Esophageal manometry was false negative in one case and esophageal scintigraphy in another one case. The calculated emptying rates 10 and 12 s after beginning of swallowing are (mean +/- SD) 56 +/- 34% and 60 +/- 34% respectively for solid meal and 54 +/- 25% 57 +/- 22% respectively for liquid meal. Of 60 emptying rates, 48 are in the pathologic range of less than 80%. As expected, no significant difference was found between emptying rates after 10 and 12 s (two-tailed matched pairs t-test. 5% significance level). In conclusion, parametric esophageal multiple swallow scintigraphy has been proven to be a non-invasive and sensitive tool for pre- and posttherapeutic care of patients with esophageal motility disorders. It should be mentioned that esophageal scintigraphy can give additional information in some cases of normal esophageal manometry.

We posit that larger employers possess greater information than smaller employers about the effects of on-the-job training (OJT) investments on the productivity of their workers. As a result, larger employers pay a greater percentage of OJT costs, and OJT is effectively more firm-specific at larger firms. Supporting our model, we find: (1) the positive effect of productivity growth on wage growth is smaller in larger plants; (2) the adverse effect of minimum wage on wage growth is smaller in larger plants; and (3) the negative effect of initial OJT investments on starting wages is smaller in larger plants.

This paper deals with the factors that influence plans to retire from the labour force. We use a theoretical model to explain the empirical findings from a bivariate probit model relating economic, demographic, and social characteristics to retirement plans for over 7000 women and men between the ages of 40 and 64. The results of the analysis concerning retirement intentions suggest that personal, economic and household characteristics are more important determinants of retirement plans for women than men.

Recently, promulgated inflammatory bowel disease (IBD) guidelines seek to decrease the need for surgery by improving disease control. However, resection rates remain static.We therefore sought to determine the proportion of patients coming to surgery where preoperative management was not optimal according to guidelines.Case notes of all patients with resection surgery for IBD from January 2007 to March 2008 at a metropolitan teaching hospital were retrospectively reviewed. Judgement was made as to whether preoperative management was optimal or suboptimal depending on whether it met guidelines.A total of 22 subjects with IBD-related resections were identified (15 males and seven females). In total, 17 had Crohn's disease (CD) (11 males) and five ulcerative colitis (UC) (four males). There were 10 smokers (nine CD and one UC). The two most common indications for surgery were inflammatory mass/abscess (n= 8) and refractory to medical therapy (n= 7). While all patients with known IBD (20/22) had seen a gastroenterologist in the past, five known IBD patients had resections undertaken without preoperative gastroenterologist input. Overall preoperative management was judged as optimal in only (9/22) 41%. Of those whose therapy did not meet guidelines (n= 13), five had azathioprine at doses2 mg/kg, one declined therapy and nine with CD were current smokers.Over 50% of IBD resection patients had suboptimal preoperative management, with sub-therapeutic thiopurine dosing and smoking in CD the main problems. Thus, there are significant gains to be made with better use of standard therapies, as it appears that ∼50% of resection surgery was 'potentially avoidable'.

Summary Background A trial of empirical PPI therapy is usual practice for most patients with symptoms of gastro-oesophageal reflux disease (GERD) in primary care. Aim To determine if the 4-week efficacy of rabeprazole 20 mg for resolving heartburn and regurgitation symptoms is non-inferior to esomeprazole 40 mg or 20 mg. Methods In all, 1392 patients were randomized to rabeprazole 20 mg, esomeprazole 20 mg or 40 mg once daily. Patients, doctors and assessors were blinded. Symptom resolution data were collected on days 0–7 and day-28 using the Patient Assessment of Upper Gastrointestinal Disorders Symptom Severity Index with a shortened version used on days 8–27. Results Rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete resolution of regurgitation and satisfactory resolution of heartburn and regurgitation. For complete heartburn resolution, the efficacy of rabeprazole 20 mg and esomeprazole 40 mg was statistically indistinguishable, although the non-inferiority test was inconclusive. Rabeprazole 20 mg was non-inferior to esomeprazole 20 mg for all outcomes. Conclusions In uninvestigated GERD patients, rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete and satisfactory relief of regurgitation and satisfactory relief of heartburn, and not different for complete resolution of heartburn.

The past four decades have seen the develop ment of an enormous literature on the effects of education on earnings (for example, see Mincer, 1974; Becker, 1975). Numerous researchers have also investigated the determinants of individuals' decisions to invest in postsecondary schooling (for example, see Fuller, Manski, and Wise, 1982; Catsiapis, 1987), and the functioning of admis sion processes (see Olmstead and Sheffrin, 1981). With the average annual cost of attending a pri vate university approaching $20,000, including tuition, room and board, and supplies, and the annual cost for a public university approaching $10,000, and with private and federal aid becom ing more problematic, educational scholarships become increasingly important in a family's plan ning for financing a child's education.1 At the same time, however, there are time and psycho logical costs of entering a scholarship competi tion, a competition characterized by uncertainty of one's chances of winning. To the extent that we can provide more information about "how a winner is selected," the more efficient will con sumers be in their decisions to allocate their time and money to enter such a contest.2 Further, the increasing real cost of higher education increases the importance of scholarships in determining ed ucational decisions, so that it is also important to see how the selection process may favor, either explicitly or implicitly, candidates with particu lar attributes and thereby affect the composition of the college population. Though the personal characteristics needed for selection are often described in a scholarship application, the exact nature of the decision making process is sometimes unknown to the institution providing the scholarship. As in the case of the particular contest to be described later, an independent panel is sometimes estab lished, which has full discretion concerning the award of scholarships. Hence, when a scholar ship competition is announced, there is rarely a clear production process that leads from an individual's characteristics to the probability that the individual would be successful in winning an award. A process does, nevertheless, emerge as awards are determined. It would be most helpful for those applying for awards, and for those making awards, if this process could be better understood. The purpose of this paper is to increase our understanding of the awards process in general by engaging in a detailed analysis of a particular scholarship competition. Before turning to the specific scholarship competition, we develop a theoretical model of the contestant's problem when entering a competition that offers uncertain returns to the contestant's expenditures on activities that contribute to the "profits" from winning.

Health-related quality of life (HRQOL) is a marker of disease severity. Data on the relative impairment of HRQOL in chronic liver disease (CLD) and functional gastrointestinal disorders are lacking and no studies have assessed the link between impairment of HRQOL and psychosocial factors yet.To assess predictors for, and the impairment of, HRQOL in CLD and FD.In 181 functional dyspepsia (FD) patients, 204 CLD patients and 337 healthy blood donors, HRQOL was assessed with the Short Form-36 (mental and physical component), and anxiety and depression utilizing the Hospital Anxiety and Depression Scale.Compared with HC, HRQOL is significantly lower in FD and CLD (P-value for all0.001). The mental but not physical component of HRQOL was significantly more impaired in FD compared with CLD (P0.05). After adjusting for confounders, impairment of mental (P0.001) and physical (P = 0.005) component of HRQOL was associated with the severity of CLD and FD. In FD, the multivariate analysis revealed depression and severity of symptoms as the most important predictors of HRQOL (R2 = 21.9 and 7.1). In CLD, the mental component of HRQOL was associated with depression and anxiety (R(2) = 9.9 and 9.7).In tertiary care, HRQOL is more severely impaired in FD compared with CLD. Co-morbid psychiatric conditions significantly contribute to the impairment of HRQOL.

Gastro-oesophageal reflux disease (GERD) is associated with a variety of typical and atypical symptoms. Patients often present in the first instance to a pharmacist or primary care physician and are subsequently referred to secondary care if initial management fails. Guidelines usually do not provide a clear guidance for all healthcare professionals with whom the patient may consult.To update a 2002-treatment algorithm for GERD, making it more applicable to pharmacists as well as doctors.A panel of international experts met to discuss the principles and practice of treating GERD.The updated algorithm for the management of GERD can be followed by pharmacists, for over-the-counter medications, primary care physicians, or secondary care gastroenterologists. The algorithm emphasizes the importance of life style changes to help control the triggers for heartburn and adjuvant therapies for rapid and adequate symptom relief. Proton pump inhibitors will remain a prominent treatment for GERD; however, the use of antacids and alginate-antacids (either alone or in combination with acid suppressants) is likely to increase.The newly developed algorithm takes into account latest clinical practice experience, offering healthcare professionals clear and effective treatment options for the management of GERD.

In a prospective randomized, controlled trial, to compare the long-term outcome of intensive medical therapy (with or without cognitive-behavioural or muscle relaxation therapy) vs. standard medical therapy in patients with refractory functional dyspepsia (FD), referred to a tertiary referral medical center.A total of 100 consecutive FD patients were allocated to a standardized symptom-oriented 4 month therapy (SMT, n = 24), intensive medical therapy (IMT, medical therapy with testing-for and targeting-of abnormalities of motor-and-sensory function, n = 28) or IMT plus psychological interventions (either progressive-muscle relaxation (IMT-MR, n = 20) or cognitive-behavioural therapy (IMT-CBT, n = 28). The symptom intensity (SI) and health-related quality-of-life (HRQoL) after 12 months were prespecified primary outcome parameters.After 12 months, significantly greater improvement of SI occurred in patients with IMT-all (with or without psychological interventions) compared with SMT (P0.025 vs. IMT-all). IMT, IMT-MR and IMT-CBT alone also resulted in significantly better improvement of the primary outcome parameters (P all0.025 vs. SMT). HRQoL significantly improved in all groups with intensive medical therapy but not standard medical therapy. Differences between intensive medical therapy-all and standard medical therapy were not significant. Concomitant anxiety and depression was improved significantly by IMT-CBT (vs. SMT) but not other treatments.In FD patients with refractory symptoms, intensified medical management involving function testing and psychological intervention yields superior long-term-outcomes. Additional CBT may be effective for the control of concomitant anxiety and depression.

Dyspepsia comprises a broad spectrum of predominantly upper abdominal symptoms, such as pain, indigestion, nausea, early satiety and bloating. While these symptoms are highly prevalent, in less than 50% of patients presenting with dyspepsia, structural lesions or biochemical abnormalities are found that explain the symptoms when routine clinical tests are used. In patients without structural lesions the diagnosis of functional dyspepsia is justified. Exclusion of life-threatening disorders as the cause of symptoms and reassurance of the patient as well as proper explanation of the diagnosis and its underlying disease mechanisms (i.e. symptoms are due to a sensitive gut) is crucial and can be considered as an essential element of treatment. Since there is a remarkable comorbidity of anxiety and depression, psychosomatic interventions might be necessary in selected patients. Based on controlled clinical trials few drugs, such as proton pump inhibitors, prokinetics, tricyclic antidepressants, simethicone and selected herbal preparations have been found to be effective for treatment of functional dyspepsia. Effects of H. pylori eradication, even though strongly advocated, are most likely due to undiagnosed peptic ulcer disease in a very small group of patients. While there is currently no therapy that cures functional dyspepsia, the therapeutic target is to control symptoms.

Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.

Patients with irritable bowel syndrome (IBS) are highly prevalent among subjects seeking medical attention at the general practitioner or specialist level. While IBS lacks any disease associated excess mortality, this disorders is relevant to the affected subjects due to the considerable burden with regard to the symptoms and an impaired quality of life. Furthermore, this disease has a substantial impact on society due to the economical consequences. In recent years substantial progress has been achieved regarding our pathophysiological understanding. However, as usual, there has been a substantial delay between the discovery of disease mechanisms and its translation into improved patient care. For diagnosing IBS standardized criteria have been established (i. e. Rome II- or the DGVS-criteria). Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the "little psychotherapy" (addressing patients concerns and anxiety regarding the symptoms) are considered essential. However, the overall response rate is disappointing. Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists. At present no cure for patients with IBS exists. Thus, all currently available treatments target palliation of symptoms. This, however, may change in the future.

Gastro-oesophageal reflux disease (GERD) is a highly prevalent disorder in all Western countries. Interestingly, prevalence rates appear to be increasing in these countries, with a remarkable increase of GERD-related lethal and nonlethal complications. However, these complications are rare on a global scale. This review aims to summarize the current concepts of genetic, lifestyle and environmental factors that need to be considered whilst caring for patients with these disorders. GERD is defined by the augmented exposure of oesophageal mucosa to acidic content, and is associated with specific symptoms or mucosal lesions. A number of factors may contribute to the manifestation of GERD. Although recent studies emphasize the role of genetic factors, there are many other risk factors that play a pivotal role in the development of GERD and GERD complications. Some nutritional factors are believed to aggravate acidic reflux either by delaying gastric emptying or diminishing the pressure of the lower oesophageal sphincters. Patients are often advised to sleep with their heads elevated, but this advice is not easy to follow and has not been proven effective with regard to long-term outcome. Other lifestyle modifications include changes to the patient's diet, which are important but not frequently sufficient. Thus, medication is usually necessary for symptom control. Proton pump inhibitors are now mainstream treatment for the reduction of acid secretion in patients with severe manifestations and 4-week healing rates are approaching 90%.

The major oesophageal complications associated with persistent gastro-oesophageal reflux disease (GERD) include erosive oesophagitis, ulceration, strictures and gastrointestinal (GI) bleeding. Although the causes of these complications are uncertain, studies indicate that erosive oesophagitis may progress to the development of ulcers, strictures and GI bleeding. Pharmacological treatment with proton pump inhibitors is favoured over that with H(2)-receptor antagonists for the treatment of strictures. The treatment of strictures is accomplished with dilation and many favour the concomitant use of proton pump inhibitors. Most gastroenterologists are seeing far fewer oesophageal strictures these days since the introduction of proton pump inhibitors. In addition, research has shown that oesophageal complications have a greater impact on patients suffering from night-time GERD than on those suffering from daytime GERD. Barrett’s oesophagus is a significant complication associated with persistent GERD and those at risk generally experience a longer duration of symptoms, especially those with a high degree of severity. In addition, there is a strong relationship between Barrett’s oesophagus and oesophageal adenocarcinoma. This is in part due to the association of obesity and the development of hiatal hernias. Furthermore, endoscopic screening is being used to detect Barrett’s oesophagus and oesophageal adenocarcinoma in persons suffering from chronic GERD, even though screening may not have an impact on outcomes (Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett’s esophagus: The AGA Chicago Workshop. Gastroenterology 2004; 127: 310–30.).

The ultimate goal of this paper is to determine the differential effects of health insurance and health status on earnings. We believe that employment-based health insurance serves two purposes. First, health insurance provides protection against catastrophic financial losses associated with illness. Second, health insurance encourages consumption of health care services, which may ultimately improve a person’s health and productivity. To determine how health insurance and health status affect earnings, we estimate an empirical model that specifically examines the relationship between health insurance, health status, and earnings. We find the following. Earnings positively affect the likelihood of having health insurance. Having health insurance improved health status for women, but not for men. Higher earnings resulted in lower health status for women, but had no effect on the health status of men, and better health status and having health insurance increased earnings for both women and men. Our analysis implies that there are some returns to employment-based health insurance that go beyond the basic purpose of insurance.

Herbal medications have been used in many countries for the treatment of patients with irritable bowel syndrome. Controlled data supporting the efficacy of these treatments in patients with irritable bowel syndrome are lacking.To assess the efficacy and safety of a commercially available herbal preparation (STW 5) (nine plant extracts), the research herbal preparation STW 5-II (six plant extracts) and the bitter candytuft mono-extract in patients with irritable bowel syndrome.Two hundred and eight patients with irritable bowel syndrome were recruited after standardized diagnostic work-up into a double-blind, placebo-controlled, multi-centre trial and were randomly assigned to receive one of four treatments: commercially available herbal preparation STW 5 (n = 51), research herbal preparation STW 5-II (n = 52), bitter candytuft mono-extract (n = 53) or placebo (n = 52). The main outcome variables were the changes in total abdominal pain and irritable bowel syndrome symptom scores.Two hundred and three patients completed the trial. STW 5 and STW 5-II were significantly better than placebo in reducing the total abdominal pain score (intention-to-treat: STW 5, P = 0.0009; STW 5-II, P = 0.0005) and the irritable bowel syndrome symptom score (intention-to-treat: STW 5, P = 0.001; STW 5-II, P = 0.0003) at 4 weeks. There were no statistically significant differences between the bitter candytuft mono-extract group and the placebo group (P = 0.1473, P = 0.1207).The commercially available herbal preparation STW 5 and its research preparation STW 5-II are both effective in alleviating irritable bowel syndrome symptoms.

Hintergrund und Ziele: Fur Erkrankungen, die nicht durch eine erhohte Mortalitat gekennzeichnet sind, ist die gesundheitsbezogene Lebensqualitat (HRQOL) ein wichtiger Indikator der Schwere der Erkrankung. Ziel war die Untersuchung der Bedeutung der HRQOL adjustiert nach Angst und Depression bei Patienten mit funktioneller Dyspepsie (FD) oder chronischer Lebererkrankung (CLD). Methodik: 100 konsekutive Patienten mit FD und 195 Patienten mit CLD wurden an zwei tertiaren Versorgungszentren untersucht. FD wurde anhand der gultigen Rom-II-Kriterien diagnostiziert. CLD wurde klinisch und histologisch diagnostiziert und klassifiziert (53,6% mit Zirrhose, 21,4% Child-Pugh A, 14,8% Child-Pugh B, 17,3% Child-Pugh C). Der Short Form Health Survey (SF-36) zur Erfassung der HRQOL und die Hospital Anxiety and Depression Scale (HADS) zur Erfassung von Angst und Depression wurden benutzt. Ergebnisse: Es gab keine signifikanten Unterschiede bezuglich Depression, aber FD-Patienten waren deutlich angstlicher als CLD-Patienten (9,6–2,6 vs. 7,0–4,7, p≤0,0001). FD-Patienten hatten eine bessere Korperfunktion (75,8–21,8 vs. 59,5–29,7, p≤0,0001), aber deutlich hohere Schmerzscores als CLD-Patienten (39,5–24,0 vs. 56,1–31,5, p≤0,0001). Soziale Rollenfunktion (56,6–26,7 vs. 67,0–30,4, p≤0,004) und mentaler Gesundheitsstatus (52,3–19,4 vs. 61,7–21,7, p≤0,0001) lagen bei FD- deutlich unterhalb der CLD-Patienten. Der mentale Gesamtscore war bei FD- im Vergleich zu CLD-Patienten deutlich reduziert (38,8–11,8 vs. 43,0–12,1, p≤0,0007). Diese Scores lagen bei FD- noch unterhalb derjenigen von Child-C-CLD Patienten. Diese Unterschiede blieben auch nach Adjustierung fur Alter, Geschlecht und HADS deutlich signifikant. Schlussfolgerung: Die HRQOL ist bei FD- im Vergleich zu CLD-Patienten, auch im fortgeschrittenen Erkrankungsstadium, deutlich reduziert. Angst scheint unabhangig mit FD assoziiert zu sein.

Peptic ulcer bleeding is associated with substantial morbidity and mortality. The goals of management are to control any active bleeding and prevent re-bleeding and then to heal the ulcer and prevent its recurrence. Initial management strategies are guided by the patient's clinical condition and endoscopic findings. Thus, treatment may consist of endoscopic and medical therapy and, sometimes, surgery. Control of acid secretion, preferably with proton pump inhibitor therapy in the initial management continues to evolve; it has also been used as both an adjunct to endoscopic therapy and as primary treatment. These agents have been found to be effective in some trials in the reduction of re-bleeding and the need for surgery, although there is no clear benefit demonstrated for overall mortality. Proton pump inhibitors have been administered either intravenously or orally in different trials. The long-term management of patients with peptic ulcer, after the initial bleeding episode, should include patient stratification based upon risk factors for ulcer recurrence (i.e. Helicobacter pylori infection, use of aspirin or nonsteroidal anti-inflammatory drugs). Elimination or modification of these risk factors reduces the risk of ulcer recurrence and, hence, of recurrent ulcer bleeding.

This study aimed to assess the efficacy of artichoke leaf extract (ALE) in the treatment of patients with functional dyspepsia (FD).In a double-blind, randomized controlled trial (RCT), 247 patients with functional dyspepsia were recruited and treated with either a commercial ALE preparation (2 x 320 mg plant extract t.d.s.) or a placebo. The primary efficacy variable was the sum score of the patient's weekly rating of the overall change in dyspeptic symptoms (four-point scale). Secondary variables were the scores of each dyspeptic symptom and the quality of life (QOL) as assessed by the Nepean Dyspepsia Index (NDI).Two hundred and forty-seven patients were enrolled, and data from 244 patients (129 active treatment, 115 placebo) were suitable for inclusion in the statistical analysis (intention-to-treat). The overall symptom improvement over the 6 weeks of treatment was significantly greater with ALE than with the placebo (8.3 +/- 4.6, vs. 6.7 +/- 4.8, P0.01). Similarly, patients treated with ALE showed significantly greater improvement in the global quality-of-life scores (NDI) compared with the placebo-treated patients (- 41.1 +/- 47.6 vs. - 24.8 +/- 35.6, P0.01).The ALE preparation tested was significantly better than the placebo in alleviating symptoms and improving the disease-specific quality of life in patients with functional dyspepsia.

Appropriate guidelines for clinical trials in irritable bowel syndrome are needed because of the inadequacy of previously performed trials, the use of new and more adequate patient definition, new emerging pathophysiological models and the unique requirements related to the assessment of treatment outcome that, in the absence of a biological marker, can rely only on the evaluation of clinical manifestations. This consensus report highlights the following points. (a) A 4-week period is considered to be adequate to assess drug efficacy for the control of symptoms. (b) For the cyclic and non-life-threatening nature of the disease, a long-term study of 4-6 months or more of active treatment to establish efficacy is considered to be inappropriate in the large majority of patients. (c) In the initial assessment phase of drug efficacy, the withdrawal effect of treatment can be ascertained during a follow-up period prolonged for a sufficient time (4-8 weeks) after stopping treatment. Subsequent trials with proper withdrawal phase design and duration can then ascertain the drug post-treatment benefit. (d) Considering the intermittent clinical manifestations of irritable bowel syndrome, designing trials with on-demand or repeated cycles of treatment could be envisaged. However, the lack of a definition of what constitutes an exacerbation is a major obstacle to the design of such trials. In the absence of an established gold standard, appropriately justified novel trial designs are welcome. (e) Patients eligible for inclusion should comply with the Rome II diagnostic criteria for irritable bowel syndrome. (f) The main efficacy outcome of the treatment should be based on one primary end-point. (g) The primary efficacy end-point could combine, in a global assessment, the key symptoms (abdominal pain, abdominal discomfort, bowel alterations) of irritable bowel syndrome or rate any single symptom for drugs considered to target specific symptoms. (h) A 50% improvement in the primary efficacy end-point seems to be a reasonable definition of a responder.

We aimed to assess the efficacy and safety of a herbal preparation STW 5-II containing extracts from bitter candy tuft, matricaria flower, peppermint leaves, caraway, licorice root and lemon balm for the treatment of patients with functional dyspepsia.120 patients with functional dyspepsia were randomly assigned to 1 of 4 treatment groups. Each patient received the treatment for three consecutive 4-week treatment blocks. The first two treatment blocks were fixed. For the third treatment period, medication was based upon the investigator's judgement of symptom improvement during the preceding treatment period. In patients without adequate control of symptoms, the treatment was switched, or if symptoms were controlled, the treatment was continued. The primary outcome measure was the improvement of a standardized gastrointestinal symptom score (GIS).During the first 4 weeks, the GIS significantly decreased in subjects on active treatment compared to the placebo (p0.001). During the second 4-week period, symptoms further improved in subjects who continued on active treatment or who switched to the active treatment (p0.001), while symptoms deteriorated in subjects who switched to placebo. After 8 weeks 43.3% on active treatment and 3.3% on placebo reported complete relief of symptoms. (p0.001 vs. placebo).In patients with functional dyspepsia, the herbal preparation tested improved dyspeptic symptoms significantly better than placebo.

Visceral pain is characterized by a subjectively painful perception located in the abdominal area. Distinct structural lesions or biochemical abnormalities which could serve as explanation for these painful sensations can be only detected in a proportion of patients. In the absence of precise causes for visceral pain, the symptoms are attributed to functional disorders. The two major single entities among functional disorders of the gut are functional dyspepsia and irritable bowel syndrome. Patients with functional dyspepsia characteristically localize the symptoms in the upper abdomen. Functional gastrointestinal disturbances which are localized in the lower abdomen are summarized as irritable bowel syndrome. Interestingly,both functional dyspepsia and irritable bowel syndrome may overlap.

Abdominal pain syndromes can be categorised into acute or chronic manifestations. In general, diagnostic work-up is targeted upon identification of structural lesions that cause the symptoms and allows therapeutic measures that permanently cure the cause of symptoms. If no structural or biochemical abnormality can be identified upon utilising the necessary diagnostic measures, a functional disorder as the cause of symptoms is assumed. For these disorders no cure is currently available and treatment is targeted towards relief of symptoms only.

To compare the efficacy of simethicone with placebo and the prokinetic cisapride in patients with functional dyspepsia.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).At 2, 4 and 8 weeks, treatment with simethicone and cisapride yielded significantly (all P values0.0001) 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.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.

Gastrocolic fistula is a rare clinical disorder which in the past most often occurred after gastric surgery or carcinoma of the gastrointestinal tract. However, during the last decade an increasing number of cases after benign gastric ulcers have been described. Most common symptoms have been weight loss, abdominal pain, diarrhea and copremesis. A 49-year-old cachectic patient presented with a 2-year history of abdominal discomfort and diarrhea. He reported a weight loss of 32 kg during this period and was finally unable to move because of exhaustion. Furthermore, he suffered of burning paresthesia of the legs and the abdomen. His medical history included a Billroth II operation because of recurrent ulcer disease in 1987. Barium enema revealed a gastrocolic fistula which caused small bowel bacterial overgrowth with villous atrophy and malabsorption and development of polyneuropathy. The fistula was surgically resected, and postoperatively, the patient improved and regained his weight. Gastrocolic fistula is a rare cause of diarrhea and should be considered in clinical practice. Barium enema is superior to endoscopy in detecting gastrocolic fistula.

Rabeprazole has a faster onset of antisecretory action than omeprazole, and it is of interest to determine whether this translates into faster symptom relief in patients with gastro-oesophageal reflux disease.To assess the relief from heartburn after 3 days of treatment with standard-dose rabeprazole or high-dose omeprazole (primary end-point). Secondary end-points included the decrease in score for other symptoms of gastro-oesophageal reflux disease, healing rates and quantification of antacid use.Patients with endoscopically confirmed erosive oesophagitis were randomized to receive 4 weeks of double-blind treatment with rabeprazole (20 mg) or omeprazole (40 mg). Patients who were not healed after 4 weeks received a further 4 weeks of treatment.Two hundred and seventy-four patients were screened, 251 patients were randomized and 230 patients completed the trial. The numbers of patients with relief from heartburn on day 4 were similar in the two groups (84% for rabeprazole; 95% confidence interval, 76-90%; 83% for omeprazole; 95% confidence interval, 75-89%). There were no significant differences between the treatments in the relief from other gastro-oesophageal reflux disease symptoms or in healing rates. The number of reports of severe heartburn during the first 3 days was higher in the omeprazole group (daytime heartburn: 4.7% for rabeprazole vs. 10.3% for omeprazole, P=0.005; night-time heartburn: 4.7% for rabeprazole vs. 9.8% for omeprazole, P=0.01; statistical comparisons defined post hoc).Standard-dose rabeprazole was as effective as high-dose omeprazole in relieving symptoms by day 4 of treatment and in healing oesophageal lesions, but had a faster onset of action in patients with severe heartburn. This suggests that the improved pharmacological properties of rabeprazole translate into a clinically relevant advantage.