dyspepsia mahsa khodadoostan-- gastroentrologist
TRANSCRIPT
Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST
Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m ago
She complains of bloating and early satiety too
There is no alarm symptom in her historyShe use no drugHer physical examination is normal
IT OCCURS IN APPROXIMATELY 25 PERCENT OF THE POPULATION EACH YEAR,
MOST AFFECTED PEOPLE DO NOT SEEK MEDICAL CARE
Approach to the patient with dyspepsia
DEFINITION ( Rome III Committee )
one or more of the following symptoms : Postprandial fullness (termed postprandial distress syndrome) Early satiation (meaning inability to finish a normal sized meal or
postprandial fullness) Epigastric pain or burning (termed epigastric pain syndrome)
Heartburn is the point of contraversy
ETIOLOGY
Alarm symptoms
Unintended weight loss Persistent vomiting Progressive dysphagia Odynophagia unexplained anemia or iron deficiency Hematemesis Palpable abdominal mass or lymphadenopathy Family history of upper gastrointestinal cancer Previous gastric surgery Jaundice NPV=99%
CLINICAL APPROACH
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 dyspepsiaPhysical examination :usually normal
Carnett test A palpable mass
Routine laboratory tests
Routine blood counts and blood chemistryS/E
Endoscopy
Advantage: Gold standard test to exclude gastroduodenal
ulcers, reflux esophagitis, and upper gastrointestinal cancers.
Beneficial because up to 40 percent of patients have an organic cause of dyspepsia.
It also provides reassurance to patients
Endoscopy
Disadvantage:Expensive Invasive Not cost-effective in young patients without
alarm symptoms Rarely, endoscopic complications
Empiric treatment with acid suppression
Disadvantage:Cost advantage is lost with symptom
recurrence or lack of response. High rate of symptom recurrence may promote
inappropriate long-term medication use. May delay diagnostic testing, may mask the
symptoms of malignant ulcers. Likely to provide the least patient reassurance. Rarely, serious side effects (gynecomastia,
hematologic disorders).
Empiric treatment with acid suppression
Advantage:Least expensive strategy.Rapid symptom relief, High response rate, May reduce the number of endoscopies.
Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m ago
She complains of bloating and early satiety too
There is no alarm symptom in her historyShe use no drugHer physical examination is normal
Initial management of dyspepsia
What do you do for our patient?
EndoscopyHigh dose PPIAnti HP antibody
HP serology was positive.what do you do?
HP serology was positive.what do you do?
You treat H.Pylori but symptoms are constant?
HP serology was positive.what do you do?
You treat H.Pylori but symptoms are constant?
Test for HP eradication
HP serology was positive.what do you do?
You treat H.Pylori but symptoms are constant?
Test for HP eradication
UBT is negative
Management of dyspepsia based on age and alarm features
Endoscopy in patients who have failed empirical therapy
Management of functional dyspepsia
Patient was a 60 y/o lady who was refered to me because of constant epigastric pain
She mentioned 6kg wt loss since 3m agoShe was anemic with ferritin =5What is the best diagnostic test?
Patient is a 57 y/o man who was refered to our centre because of epigastric pain.he complains of dysphagia too.his wt is 67kg now and was 75kg about 3m ago
Upper gi endoscopy was performed:
Be careful
Unfortunately
age of cancer is decreasing in our population