Journals Watch - Dyspepsia, asthma and pregnancy

Too busy to catch up on the latest research? Let Dr Lizzie Croton update you on recent papers.

Functional dyspepsia Gut 2008. doi:10.1136/gut.2008.158162

Gastric sensorimotor dysfunction, psychosocial factors and somatisation are all implicated in the symptom generation of functional dyspepsia.

A total of 201 consecutive tertiary care patients with functional dyspepsia (mean age 40.1 years) had their gastric sensorimotor function assessed. This was combined with self-reported questionnaires examining depression, perceived stress, abuse history, somatisation and co-morbid conditions.

These variables were correlated with dyspepsia symptom severity (DSS) and weight loss. Hierarchical multiple linear regression was then used to identify determinants of DSS and weight loss.

The results concluded that symptom severity and weight loss in functional dyspepsia are determined by psychosocial factors and somatisation, and only to a lesser extent by gastric sensorimotor function.

Psychosocial factors and somatisation determine symptom severity and weight loss in dyspepsia patients

Inhaled corticosteroids in childhood asthma Arch Dis Child 2008; 93: 654-9

Over a period of 18 months, two inhaled budesonide regimens were compared with a control group using fixed-dose disodium cromoglicate.

One regimen involved daily use of inhaled corticosteroids with the second regimen using inhaled corticosteroids for exacerbations (as needed).

The study aimed to assess both the efficacy of inhaled steroids and the systemic effects of daily versus as-needed corticosteroids. A total of 176 children aged 5-10 years were studied.

Children receiving budesonide showed improved lung function and fewer exacerbations (0.97, versus 1.69 in the 'as needed' group and 1.58 in the control group) at the expense of a small decline in growth velocity. As-needed corticosteroids had fewer systemic effects but afforded poorer asthma control.

Dietary patterns and attainment at school J Epidemiol Community Health 2008; 62: 734-9
The quantity and content of food eaten is related to childhood development.

This study used data from the Avon Longitudinal Study of Parents and Children to test the impact of dietary intake at several points in childhood on school attainment, in terms of set curricula at certain stages.

Differences in attainment were then evaluated between children who ate packed lunches or school meals to ascertain if they were due to their pre-school dietary patterns or to what they ate at school.

Three indicators of school assessment were used: ages four to five entry assessments, ages six to seven key stage 1 and ages 10 to 11 key stage 2.

The main findings were that a 'junk food' dietary pattern at age three had a negative effect on school attainment, regardless of subsequent changes to diet. There was no association between packed lunch or school meals and school attainment.

Patient actions prior to emergency admission Emerg Med J 2008; 25: 424-7
A&E visits and subsequent hospital admissions are rising in the UK and the reasons for this are unclear.

This study used a semi- structured interview for adult patients admitted with a medical or surgical illness to Bristol Royal Infirmary to determine the patient's reasons for attending A&E.

A total of 200 patients were recruited over four weeks in October and November 2005. Direct attendance at A&E was more common when help was sought from bystanders or people little known to the patient.

Fifty-seven patients attended A&E directly, of which 45 called an emergency ambulance.

Most of those attending A&E did so because they perceived their condition as urgent. There was incomplete awareness of GP out-of-hours services.

Most patients sought help from primary care in the first instance with problems perceived to be less urgent.

Antidepressant-associated sexual dysfunction JAMA 2008; 300:395-404
Antidepressant-associated sexual dysfunction is a common side-effect that can result in non-compliance and distress.

This was a randomised, double-blind, placebo-controlled trial conducted over four years. The 98 participants were premenopausal women who had experienced sexual dysfunction secondary to SSRIs.

In all these women, depressive symptoms had resolved. They were randomised to take either sildenafil 50-100mg or placebo prior to sexual activity.

The results indicated that women taking sildenafil had a mean improvement in clinical global impression sexual function score (where 1=normal and 7=extreme sexual dysfunction) of 1.9 compared with those taking placebo, whose improvement was 1.1. This suggested a reduction of adverse sexual effects in treated women.

Inter-arm BP differences in pregnant women BJOG 2008; 115: 1,122-30
This cross-sectional observational study involved 5,435 pregnant women at 11-14 weeks of gestation. All women had their BP taken from both arms simultaneously. Measured end-point was inter-arm BP difference (IAD) of 10mmHg.

The IAD in systolic and diastolic BP was 10mmHg or more in 8.3 per cent and 2.3 per cent of the women, respectively. The systolic IAD was related to systolic BP. Interestingly, diastolic IAD was related to age and diastolic BP. Both systolic and diastolic IADs were higher in hypertensive women.

Around 31 per cent and 23.9 per cent of cases of hypertension would have been under- reported if the left arm and the right arm, respectively, were used in measuring BP.

Dr Croton is a salaried GP in Birmingham and a member of our team who regularly reviews the journals.

THE QUICK STUDY

  • Functional dyspepsia is affected by psychosocial factors.
  • Asthma is better controlled with regular budesonide compared with control, but at the expense of systemic side-effects.
  • Pre-school 'junk food' in the diet is associated with poorer school attainment.
  • A&E patients attend directly because they perceive their condition as urgent.
  • Sildenafil reduces antidepressant-associated sexual dysfunction in women.
  • Pregnant women should have their BP measured in both arms at antenatal booking to provide guidance for measurements through the remainder of pregnancy.

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