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. A prospective study of Helicobacter pylori nonulcer dyspepsia. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. The symptomatic effect of 1-day treatment periods with cimetidine in dyspepsia. Combined results from randomized, controlled, single-subject trials. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. Lack of effect of treatment for Helicobacter pylori on symptoms of nonulcer dyspepsia. Cisapride, metoclopramide, and ranitidine in the treatment of severe nonulcer dyspepsia. A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Evaluation of therapies in the treatment of Helicobacter pylori associated non-ulcer dyspepsia. Campylobacter pylori and non-ulcer dyspepsia. Effects of cognitive-behavioral interventions on quality of life in persons with HIV. Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. A controlled trial of cimetidine for the treatment of nonulcer dyspepsia. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial
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 Helicobacter pylori has been recognized as a contributing factor in gastrointestinal disease . A prospect i ve study was done to evaluate the treatment response of H. pylori nonulcer dyspepsia versus H. pylori-associated gastroduodenal ulcer . Eighty patients were prospect ively studied with esophagogastroduodenoscopy . The presence of H. pylori was determined by biopsy . Treatment for H. pylori was amoxicillin , metronidazole , and colloid bismuth with an anti-secretory drug . H. pylori was eradicated in 78.9 % of patients . Eighty percent of patients with nonulcer dyspepsia  symptomatically improved , compared to 100 % of ulcer patients ( p = 0.037 ) . Using stepwise logistic regression , H. pylori eradication was an independent predictor of symptomatic improvement . Therefore , this antibiotic regimen was less likely to lead to improvement in patients with nonulcer dyspepsia ; however , patients in whom the organism could be eradicated were more likely to benefit PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review 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 BACKGROUND The relation between Helicobacter pylori infection and nonulcer dyspepsia is uncertain . We tested the hypothesis that curing the infection will relieve symptoms of dyspepsia . METHODS We r and omly assigned 170 H. pylori-infected patients with nonulcer dyspepsia to receive twice-daily treatment with 20 mg of omeprazole , 1000 mg of amoxicillin , and 500 mg of clarithromycin for 14 days and 167 such patients to receive identical-appearing placebos ; all patients were then followed through regular visits for 12 months . Symptoms were scored on diary cards for seven days before each visit . A carbon-13 urea breath test was performed at base line and repeated at 1 and 12 months , and endoscopic biopsy was performed at 12 months to determine H. pylori status . Treatment was considered successful if the patient had only mild pain or discomfort or none at all . RESULTS The rate of eradication of H. pylori infection was 90 percent in the active-treatment group and 2 percent in the placebo group at four to six weeks ( P<0.001 ) . At 12 months , there was no significant difference between groups in the rate of successful treatment ( 46 percent in the active-treatment group and 50 percent in the placebo group ; relative likelihood of success with active treatment , 0.93 ; 95 percent confidence interval , 0.73 to 1.18 ; P=0.56 ) . There was also no significant difference in the rate of successful treatment at 12 months between patients who were H. pylori-negative and those who were H. pylori-positive ( 48 percent vs. 49 percent ) . The rates of successful treatment were also similar when patients were analyzed according to the type of dyspepsia ( ulcer-like , reflux-like , or dysmotility-like ) and changes in the quality of life . There was no significant association between treatment success and histologic improvement in chronic gastritis at 12 months ( P=0.68 ) . CONCLUSIONS We found no evidence that curing H. pylori infection in patients with nonulcer dyspepsia leads to relief of symptoms BACKGROUND Prior studies have yielded conflicting results on whether or not Helicobacter pylori causes nonulcer dyspepsia .  PATIENTS AND METHODS We enrolled 100 consecutive patients with nonulcer dyspepsia into a r and omized , double-blind , placebo-controlled trial . Patients with peptic ulcer disease , esophagitis , hepatobiliary disease , irritable bowel disease , or predominantly reflux-related symptoms were excluded by history and upper endoscopy . Helicobacter pylori infection was determined by biopsy and histologic examination . Serum H. pylori IgG antibodies and CagA status were determined by Western blot . Enrolled patients were r and omized to a 14-day regimen of omeprazole ( 20 mg twice daily ) and clarithromycin ( 500 mg three times daily ) or placebo .  Dyspeptic symptoms were assessed by use of a visual analog scale at baseline and at 1 , 3 , 6 , and 12 months after treatment . Follow-up upper endoscopy with biopsy was performed 4 weeks after treatment . Compliance was measured by tablet counts . RESULTS At 1 year , the change in dyspeptic symptoms was -24.0 ( 95 % confidence interval , -69.0 to 21.0 ) in the omeprazole and clarithromycin group and -24.2 in the placebo group ( 95 % confidence interval , -70.0 to 21.6 ) . Furthermore , patients with persistent H. pylori infection demonstrated a greater , but not significant , improvement in symptoms ( -40 + /- 144 [ mean + /- SD ] , -65 + /- 142 , -45 + /- 138 , and -39 + /- 163 ) than those with successful eradication ( -26 + /- 126 , -26 + /- 148 , -12 + /- 126 , and -25 + /- 151 ) at months 1 , 3 , 6 , and 12 , respectively . CONCLUSION Patients with nonulcer dyspepsia should not routinely be treated for H. pylori , since it is not a cause of this condition in most patients Cisapride , a prokinetic drug with a novel mechanism of action , was compared with another prokinetic drug , metoclopramide , and an H2-blocker , ranitidine , in the treatment of nonulcer dyspepsia . In a double-blind study , 60 patients with severe dyspeptic symptoms received cisapride 5 mg TID , metoclopramide 10 mg TID , or ranitidine 150 mg BID for 8 weeks . Symptoms were evaluated during treatment and 4 weeks after the end of therapy . All three drugs effectively controlled the symptoms of chronic functional upper gastrointestinal tract disorders . The prokinetic drugs , particularly cisapride , were significantly better than ranitidine in controlling symptoms , especially reflux symptoms . All three drugs were generally well tolerated ;  cisapride in particular was associated with fewer adverse effects Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress . Following baseline assessment , subjects were r and omly assigned to receive either hypnosis , non-hypnotic distraction/relaxation , or attention placebo ( control ) during the subsequent identical chemotherapy course . Observational and interview measures of anticipatory and postchemotherapy nausea , vomiting , distress , and functional disruption served as outcome data . Results indicated that treatment condition was the single best predictor of change from baseline to intervention , with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms . The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better , while children in the control group had symptoms that consistently became worse over time . Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms . While the efficacy of hypnosis in the management of chemotherapy distress is supported , the complexities of interacting biologic and psychologic factors are highlighted This r and omised double blind placebo controlled study evaluated the effectiveness of colloidal bismuth subcitrate ( CBS ) , ampicillin and their combination in the treatment of Helicobacter Pylori in non-ulcer dyspepsia ( NUD ) and assessed if elimination of this organism is associated with improvement of gastritis and the symptoms .  Forty-eight NUD patients with H. pylori and histologic gastritis were r and omly allocated to one of the three regimens for 28 days . Symptoms were assessed before and after treatment . Forty-three patients completed the trial . Repeat endoscopy within 48 hours of completing treatment showed suppression of H. pylori in 6 of 7 patients ( 85.7 % ) on combined therapy and one of 8 patients ( 12.5 % ) on CBS therapy ( p = 0.0205 ) . There was no suppression of the bacteria in patients treated with ampicillin . Repeat endoscopy performed 2 weeks after completing treatment showed suppression of H. pylori in 3 of 7 patients ( 42.9 % ) on combined therapy and none in the other two groups . Patients on combined therapy who had suppression of H. pylori , 48 hours or 2 weeks after completing treatment were noted to have historical improvement of their gastritis ( p = 0.0001 and p = 0.05 respectively ) . This was also associated with improvement of symptoms in these patients 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 This study explored the effects of cognitive-behavioral interventions on quality of life in persons with HIV . In a r and omized , 3 x 3 block design , 69 participants were assigned to a guided imagery , progressive muscle relaxation or control group . Following brief instruction , subjects practice d their respective intervention over six weeks . Post intervention , perceived health status , but not quality of life , was significantly different across treatment groups . Findings suggested differential effects for guided imagery and progressive muscle relaxation , with larger effects for those at mid-stage disease and for low frequency users of guided imagery Gastric motor dysfunction and concomitant gastric stasis have been implicated in the pathogenesis of nonulcer dyspepsia , but a cause- and -effect relationship is not established . Essential dyspepsia refers to a subgroup of nonulcer dyspepsia patients who have no evidence of irritable bowel syndrome , gastroesophageal reflux , or pancreaticobiliary disease . In 32 patients with essential dyspepsia , and 32 r and omly selected dyspepsia-free community controls of similar age and sex , we measured  gastric emptying of solids using Tc99m-Sulphur Colloid in a fried egg s and wich .  Subjects with neuromuscular or other diseases that may alter gastric emptying were excluded . Symptoms were assessed by a st and ard question naire . Data processing was carried out " blinded " to the subjects ' clinical status . Female patients took significantly longer to empty half the initial stomach activity ( mean 90 min ) than female controls ( mean , 73 min ; p = 0.02 ) . The rate of emptying at 25 min was also significantly less in female patients than in controls . Female and male controls , and male patients , had similar emptying times . Delayed emptying was not associated with the occurrence of postpr and ial pain , belching , or nausea ; there was a trend for the half-time rate of emptying to be greater in patients with abdominal distention . While gastric emptying of solids is slightly delayed in females with essential dyspepsia as a group , this may not explain their symptoms Sixty patients with nonulcer dyspepsia took cimetidine 1 g daily or a placebo for 5 weeks in a double-blind trial . Thirty-four men and 26 women with normal double-contrast barium meals were included . Five percent had the endoscopic appearances of duodenitis . Symptoms improved during treatment in 62 % of those taking cimetidine and in 54 % of the placebo group ( NS , p = 0.5 ) . We suggest that significant duodenitis is uncommon in the absence of active or quiescent duodenal ulcer disease . From this study there is no evidence that cimetidine benefits those patients with normal double-contrast barium meals and no duodenitis endoscopically who nonetheless have symptoms similar to those of peptic ulcer disease & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief
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 ) .