Verlaufsbeobachtung von Patienten mit funktionellen Oberbauchbeschwerden. Untersuchung zur klinischen Symptomatik, Gastritis und Komplikationen über einen Zeitraum von 20 Jahren.

Background: In the definition of functional dyspepsia are included upper abdominal symptoms occur in the absence of organic disease. The pathogenesis of this heterogenous gastrointerstinal disorder is manifold and the effect of helicobacter pylori infection remains unclear. Prognosis factors and the long term clinical outcome are also still unknown. Patients and Methods: In the present study 105 patients (61 males, 44 females, age 60±10 years) were included. They have already been diagnosed with functional dyspepsia between 1974-1980. At the time of diagnosis all patients had stomach and duodenal appearances without pathological findings in upper endoscopy. Biopsy was taken from all patients. At the present follow up, the patients reported their recent symptoms and the progression of these symptoms. The impact of functional dyspepsia in the quality of life 59 was evaluated with the Gastrointestinal Life Quality Index (GLQI).The present analysis incudes an upper endoscopy with biopsy, a CLO-Test (Urease Test), a 13C urease breath test and the gastrin determination in serum blood. The results were constituted with the Caplan-Meier-Curve, their statistical significance was evaluated with the Breslow test and the Log.-rank test. Results At the present follow up study (after 20,5±2,7 years) we were able to interview 99 patients (58 males, 41 females) concerning their recent symptoms, the progression of their symptoms and the impact on Quality of Life. All 99 patients underwent upper endoscopy and made a 13C-urease breath test, in which helicobacter pylori should be detected if present; from 97 patients blood for a gastrin assay in serum blood was taken. The biopsies taken in the initial endoscopy 20,5±2,7 years ago showed a histologically normal gastric mucosa without any pathological findings in 32,3% of the patients-collective. In 57,7% of the patients a gastritis was found, and 10% of the whole patients-collective showed an additional intestinal metaplasia. During the follow up examination 39% of the patients-collective were detected helicobacter pylori positive by the 13C urease breath test. In three patients the 13C urease breath test was negative, however they were tested positive for helicobacter pylori in the gastric biopsy. Eight patients were helicobacter pylori negative. They underwent an eradication therapy in the recent years; altogether there were 50 patients helicobacter pylori positive. During the follow up examination 56,4% of the patients-collective complained about a persistence or a worsening of their symptoms; 43,6% reported an improvement or even a disappearance of their symptoms. 45,8% of the male patients reported an aggravation of their symptoms, the female patients in 71,4% approximately. In the helicobacter negative patients 53,7% showed an improvement or disappearance of the symptoms. In the helicobacter positive patients this was the case for approximately 46,5%. Persistence or aggravation of symptoms was found in 53,6% of the helicobacter positive patients and in 46,4% of the helicobacter negative patients. None of the differences were statistical significant. 60 In this 20,5±2,7 years follow up 34 patients have shown gastrointestinal complications; 38% of the helicobacter positive patients and only 26% of the helicobacter negative patients developed a complication. Gastrointestinal complications occurred equally frequent over male and female patients. The Quality of Life determined by the Gastrointestinal Life Quality Index (GLQ-Index) showed a total of 101 out of 144 points for the patients with complications, while the patients without complications showed a total of 111 points. The difference was statistically not significant. The psychological factors in the GLQI test like suffering and fear showed a tendencial positive correlation with the appearance of complications. On the other hand patients with good stress management and patients with less good stress management showed no difference in the appearance of complications. The helicobacter positive patients have a higher mean gastrin level (154,7±101,2pg/l) than the helicobacter negative patients (91,1±81pg/l). Conclusions: The prognosis of functional dyspepsia according to the development of symptoms in a long term follow up for 20 years is not good. Female sex in particular has a poor prognosis. The infection of helicobacter pylori correlates positive with high gastrin levels in serum blood. Complications occur more frequently in helicobacter pylori infected patients.