dyspepsia

Nata PH Lugito

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 Epidemiology

• 25% of the population each year

• But MOST affected people do not seek medical care
• Peptic ulcer  10% of upper gastrointestinal symptoms
• MOST patients with dyspepsia undergoing endoscopy
 functional dyspepsia.
• > 50% of patients with GERD  no evidence of
esophagitis at upper gastrointestinal endoscopy
• H. pylori is the main cause of peptic ulcers not
associated with nonsteroidal anti-inflammatory drugs
(NSAIDs)

2005 by the American Gastroenterological Association

 Definition

• chronic or
• recurrent pain or
• discomfort
• centered in the upper abdomen.

2005 by the American Gastroenterological Association

 Rome III criteria

• Postprandial fullness  postprandial distress syndrome

• Early satiation  postprandial distress syndrome
• Epigastric pain or burning  epigastric pain syndrome
 Etiologies

• Functional (Non ulcer Dyspepsia – 60%)

• Organic (40%)
– GERD
– PUD
– Gastric cancer
– Medicine
– Diabetic gastroparesias
– Lactose intolerance
– Biliary pain
– Chronic pancreatitis
– Mesenteric ischemia

2005 by the American Gastroenterological Association

Pathogenesis
Helicobacter pylori
 Functional dyspepsia

• One or more of:

– Bothersome postprandial fullness
– Early satiation
– Epigastric pain
– Epigastric burning
• AND No evidence of structural disease (including at
upper endoscopy) that is likely to explain the
symptoms.

ROME III criteria

 History

• Ulcer-like or acid dyspepsia (eg, burning, epigastric

hunger pain with food, antacid, and antisecretory
agent relief)
• Dysmotility-like dyspepsia (with predominant nausea,
bloating, and anorexia)
• Unspecified dyspepsia
 Physical examination

• Usually normal, except for epigastric tenderness

• A palpable mass usually indicates malignancy.
 Laboratory test

• Routine blood counts and blood chemistry

determinations are commonly obtained
• Selectively depending upon patient features such as
age, symptom duration, and other factors
• Help to identify patients with "alarm symptoms" (eg,
anemia) who require endoscopy or other diagnostic
testing
• The evaluation and recommendations are largely
consistent with the American Gastroenterological
Association (AGA) guideline for the evaluation of
dyspepsia
 The main strategies for managing new-onset
dyspepsia
• Empirical AH2 therapy
• Empirical PPI therapy
• H. pylori test and treat + by acid suppression (if the patient
remains symptomatic)
• Early endoscopy alone
• Early endoscopy + biopsy for H pylori and treatment if
positive
• Acid suppression + endoscopy and biopsy (if the patient
remains symptomatic)
• H. pylori test and treat with endoscopy if the patient
remains symptomatic.

2005 by the American Gastroenterological Association

 Initial management of dyspepsia

2005 by the American Gastroenterological Association

 Management of dyspepsia based on age and
alarm features

2005 by the American Gastroenterological Association

 Endoscopy in patients who have failed empirical
therapy

2005 by the American Gastroenterological Association

 Management of functional dyspepsia

2005 by the American Gastroenterological Association

2007 by the American Society for Gastrointestinal Endoscopy