Abstract: Gastroenterologists frequently encounter patients who report vague epigastric discomforts or sensations of fullness, bloating, and distention in the upper abdomen. The discomfort is neither burning in character nor severe in intensity; there is no nocturnal pain. The epigastric location of discomfort and lack of radiation may help to exclude biliary tract and pancreatic diseases. Nausea may be present, but there is little or no vomiting. After these patients ingest liquids or solid foods, the symptoms of easy filling or early satiety and increasing discomfort and nausea are almost always present. The patient may only report "indigestion," but a specific chief complaint, such as pain, discomfort, nausea, or bloating may be elicited with further inquiries. Solid foods usually provoke more symptoms than do liquids. Symptoms of early satiety, nausea, bloating, and abdominal discomfort may culminate in the vomiting of undigested food. These vague upper gastrointestinal (GI) symptoms have been termed "dyspepsia." When peptic diseases of the stomach are excluded, the symptom complex has been called "nonulcer" dyspepsia, a vague syndrome with symptoms attributed to stomach dysfunction. Nonulcer dyspepsia has been reviewed recently. Such symptoms, commonly attributed to a "functional" disorder, are very common in clinical practice, with an incidence of 30% of patients. In this review, we will discuss an approach to the evaluation and treatment of patients with symptoms of nausea, early satiety, bloating, and vague epigastric discomfort--dyspeptic symptoms associated with functional stomach disorders. We will review the anatomy and motility of the stomach and suggest potential neuromuscular malfunctions of the stomach that may result in epigastric symptoms. The potential role of stress and other brain-gut interactions, which may underlie these symptoms, will also be reviewed.

Abstract: We applied a sensitive diagnostic test for Giardia lamblia infection to 218 patients with a chief complaint of chronic fatigue. Sixty-one patients were infected with Giardia. All had minor gastrointestinal symptoms: bloating (61%), flatulence (62%), loose bowel movements (56%) and constipation (50%). All patients also complained of other systemic symptoms: depression (61%), myalgia (34%), headache (41%), muscle weakness (46%) and flu-like feelings (34%). The median duration of the illness was 3.2 years. Treatment of giardiasis produced a complete cure of fatigue in 13/48 patients, marked improvement in 21/48 patients, some benefit in 8/48 and no benefit in 6/48 patients. ‘Viral’ symptoms such as fever, myalgia and sore throat were much more common in fatigued patients with giardiasis than in fatigued patients without giardiasis. Giardia infection may be an important cause of chronic fatigue and myalgic encephalomyelitis (ME) in patients with minor digestive disturbances. Dysfunctional immune activation or...

Abstract: Just as gastrointestinal functional diseases affect the thyroid, so thyroid disfunction affects the structure and function of almost all parts of the gastrointestinal tract. Hypothyroidism has frequently been associated with various gastrointestinal manifestations, including constipation, bloating, flatulence, atrophic gastritis, ileus, atony and dilatation of the oesophagus, stomach, gallbladder, small intestine and colon. Characteristic intestinal hypomotility in a severe hypothyroidism may progress to intestinal pseudoobstruction, paralytic ileus and megacolon. These rare but potentially serious complications must be recognized and treated promptly with adequate doses of thyroid hormone replacement therapy. The case history of a 64-year-old woman with hypothyroidism and intestinal pseudoobstruction is described.