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DYSPEPSIA
DEFINITION
The term dyspepsia derives
from the Greek dys
meaning bad and pepsis
meaning digestion
EPIDEMIOLOGY
Prevalence of the
population : 25%
Incidence : 9% per year
CLASSIFICATIO
N
1. ORGANIC
DYSPEPSIA
2. FUNCTIONAL
DYSPEPSIA/
NON-ULCER DYSPEPSIA
The
absence
of
any
organic,
systemic,
or
metabolic disease (include
upper endoscopy) that
could
explain
the
symptoms.
2
subtype
(Rome
III
criteria) :
1. Post-prandial distress
syndrome
(bothersome post-prandial
fullness, early satiation)
2.
Epigastric
pain
PATHOGENESIS of Functional
dyspepsia
Altered
gastrointesti
nal motility :
postprandial
fullness,
nausea,
vomiting
Visceral hypersensitivity :
epigastric pain, belching,
weight loss
MULTIFACTORI
AL
Other mechanisms :
- H.pylori infection : epigastric pain
- Dietary factor : altered eating,food
intolerance
- Psychological factor : hypersensity to
gastric distention
Altered
gastric
accomodati
on :
early
satiety,
weight loss
DIAGNOSIS
Anamnesis : chronic/recurrent
pain/discomfort centered in
upper abdomen
Diagnostic study : Endoscopy
UGI as gold standard
Discomfort
refers
a
subjective
sensation
not
interpret as pain which may
characterized
by
or
associated
w/
abdominal
fullness,
early
satiety,
bloating, belching, nausea,
vomiting.
Centered refers to pain or
discomfort in or around the
midline
ALARM
SYMPTOMS
Age treshold 45 years old
Persistent anorexia/ vomiting
Bleeding UGI (haematemesis/melena) or anemia without
knowing the source
Unintentional weight loss
Dysphagia-odynophagia
jaundice
Abdominal mass or lymphadenopathy
Patients anxious because of the symptoms appearing off
and on or persistent (psychoneurosis)
DIFFERENTIAL DIAGNOSIS
1.
2.
3.
4.
5.
6.
MANAGEMENT
10
GENERAL MEASURES
1.
2.
-
PHARMACOTHERAPY
11
- Low-dose Antidepressants
Tricyclic antidepressant (amytriptylin, fluoxetin, desipramine)
affect how the brain and nerves process pain, improve stomach emptying and expansion to
accommodate food (these potential effects are being studied).
PROGNOSIS
12
- Clinical course :
1.5-10 years prospective study
5-27 years retrospective study
- Asymptomatic or improve after 1 to several years
- Poor prognosis :
history of GERD treatment, peptic ulcer, use of aspirin,
longer clinical course (>2 years), lower education,
psychological vulnerebility
- Functional dyspepsia + H.pylori infection, less likely to be
symptoms free at 2 years
FOLLOW UP
GUIDELINES FOR
MANAGING
DYSPEPSIA IN
PRIMARY CARE
Dyspepsia, without
heartburn
Hp test and
treat
Or empirical
therapy
Empirical
therapy,
a.
Lifestyle
modification
b. Empiric therapy
:
PPI or H2RA x24 wk
Adequate
respons
Follow up
No adequate
respons
Modify
therapy
Step up
therapy
:
Increase dose or shift
to another drug class
- Prokinetic therapy
No adequate
Adequate
respons
respons :
Specialist
Follow up
referral
Alarm
symptoms
Or > 45 y.o
Specialist
referral
Endoscopy
Hp test
and
treat
Hp
negati
ve
Hp +ve
(Eradicati
on)
Follow up
treatment
succesfull
Follow up
not
succesfull
Altern
ative
regime
No
Succesf n
succesful
ull
l:
treatme
Specialist
nt