Fardah

Akil
Centre of Gastroentero-Hepatology, Internal
Medicine
Faculty of Medicine Hasanuddin University
Makassar

Upper & Lower GI Diseases Lecture of Gastroentero-Hepatology System, FKUH 2009

DEFINITION

The term dyspepsia derives

from the Greek dys
meaning bad and pepsis
meaning digestion

A board spectrum of symptoms consist of

pain or discomfort centered in the upper
abdomen (UGI tract), for at least 12
weeks in the last 12 months (ROME II
Criteria)
2

The term of dyspepsia are not used if the

symptoms occur outside of UGI disorders,
such as :
Biliary disease
Pancreatitis
Malabsorbsion syndrome
Metabolic syndrome

CLASSIFICATI
ON
1. Organic

Dyspepsia
Peptic ulcer, GERD, gastroduodenitis, UGI canc

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 (based on Rome III criteria) :
- post-prandial distress syndrome
-epigastric pain syndrome

Pathogenesis
multifactor

multifactor
1. Visceral
hypersensitivity :
epigastric pain, belching, weight loss
2. Altered gastrointestinal motility :
postprandial fullness, nausea, vomiting
3. Altered gastric accomodation :
early satiety, weight loss
4. Other mechanisms :
- H.pylori infection : epigastric pain
- Dietary factor : altered eating,food intolerance
- Duodenal eosinophilia
- psychological factor : hypersensity to gastric
distention
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DIAGNOSIS
Anamnesis
Diagnostic study : Endoscopy UGI as
gold
standard

ENDOSCOPIC examination was using

an
Alarm Symptoms as criteria guide

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)

MANAGEMENT
General measures

1. Education & reassurance

2. Diet alteration and lifestyle modification
- avoid fatty or heavilly spiced food &
excessively large meal
- smaller, more frequent meals
- minimize alcohol and caffein intake
- reguler exercise & adequate restful sleep

 Pharmacotherapy

- Antisecretory agents
H2 receptor antagonis (ranitidine,
cimetidine, famotidine)
Proton Pump Inhibitor
(omeprazole,lansoprazole,
rabeprazole,
pantoprazole, esomeprazole) > H2RA
- Promotility agents (Prokinetic)
Metoclopramide, domperidone,
cisapride,
tegaserod
-Antidepressant s & anxiolitic agents
Tricyclic antidepressant (amytriptylin,
desipramine)
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Management of Dyspepsia
DYSPEPSIA without
GERD or NSAID
< 55 y.o & alarm
> 55 y.o or alarm
symptoms
symptom
H.Pylori
Testing

Eradicat
ion
Fails
PPI trial 4
weeks
Fails

PPI trial 4-6

weeks
Fails

ENDOSCO
PY UGI

REASSURANCE,
REASSES
consider
ENDOSCOPY
UGI
Talley
NJ;American Gastroenterological Association.
AGA Medical position statement :

10

Management of Functional
H.Pylori (normal endoscopy) and failed
Dyspepsia
an adequate PPI trial

1. Reevaluated symptoms & diagnosis

2. Consider other source of abdominal
pain (pancreas, colon, biliary tract)
3. Symptoms of delayed gastric
emptying?
4. IBS?
5. Panic disorder or other psycological
Persistent symptoms,
issues?
no other cause
established

Consider :
antidepressants,hypnotherapy,
behavior
therapy,
prokinetic
agentsAssociation.
Talley
NJ;American
Gastroenterological
AGA Medical position statement :

11

Differential Diagnosis
1. GERD and Nonerosive reflux
disease
2. Peptic ulcer disease
3. Upper GI malignancy
4. Chronic intestinal ischemia
5. Pancreatobiliary disease
6. Motility disorders
7. Systemic disorders
8. Infections

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Prognosis
- 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
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