Dyspepsia

Dr. Kinar Kh. Saeed

 Definition :
 Dyspepsia is defined as a pain or
discomfort felt to arise in upper
gastrointestinal tract with symtoms on
greater than 25% of the days over the
past 4 weeks .
 Dyspepsia is a common condition and
usually describes a group of symptoms
rather than one predominant symptom.
Classification
 Functional dyspepsia

 Secondary dyspepsia
 Functional dyspepsia
Presence of one or more of the
following with no evidence of
structural disease to explain the
symptoms
 Epigastric pain associated with
fullness and heaviness
 Blenching and regurgitation
 Bloating
 Early satiety
 Heartburn
 Food intolerance
 Nausea and vomiting
 Drugs causes dyspepsia
 Nonsteroidal  Narcotics
antiinflammatory drugs  Colchicine
(NSAIDs)  Quinidine
 COX-2 selective inhibitors  Estrogens
 Calcium channel blockers  Levodopa
 Methylxanthines  Acarbose
 Alendronate  Niacin
 Orlistat  Gemfibrozil
 Potassium supplements  Narcotics
 Certain antibiotics  Colchicine
including
erythromycinCorticosteroi  Quinidine
ds  Estrogens
 Niacin  Levodopa
 Gemfibrozil  Acarbose
Evaluation of patients with dyspepsia

History :
 acute or recurrent
 worsning factors : food, excertion, alcohol.
 Relieving factors : eating, antacids.
 Nocturnal symptoms are also common with PUD.
The symptoms are often gradual in onset and present
for weeks or months.
 Associated symtoms: anorexia, nausea, vomiting, weight
loss, hematemesis, melena.
 Past medical history :- GIT or cardiac disease
 ALARM” SYMPTOMS FOR WHICH EARLY
UPPER GI ENDOSCOPY IS RECOMMENDED.
 “

 Weight loss.
 Progressive dysphagia.
 Odynophagia
 Recurrent vomiting.
 Gastrointestinal bleeding.
 Family history of cancer.
 Unexplained anemia
 History of gastric surgery
 Jaundice
Alarm Features of Dyspepsia:
 Weight loss.

 Dysphagia.

 Vomiting.

 GI bleeding.

 Palpable abdominal mass.

 Anemia.
 Examination.

 Vital signs ( pulse more than 120 bpm)or postural

hypotention may indicate significant blood loss.
 Pallor
 Lemphadenopathy
 Jaundice
 Abdominal tenderness: PUD often will only have the
examination finding of epigastric tenderness.
 The presence of GI bleeding may be documented by
stool occult blood testing.
 Pelvic infections, pelvic pathology, and even
ectopic pregnancy must be considered as possibilities
in women.
 Palpable mass
 Ascites may indicate the presence of peritoneal
carcinomatosis.
 Muscle wasting, loss of subcutaneous fat, and
peripheral edema due to weight loss.
 Laboratory tests
 H pylori test: non invasive tests like ( serology, urea
breath test, urine and stool based antigen test) or
invasive like ( rapid urease test or biopsies obtained at
time of upper endoscopy)
 Contrast study: double contrast technique
 Upper GI endoscopy
 Intraesophageal ph monitoring
 If PUD suspected CBC , liver enzymes , lipase ,
amylase tests indicated
 ECG to exclude any cardiac disease
 Upright chest xray for anyabdominal visceral
perforation
 Abdominal ultrasound when gallstones are
suspected
 Pregnancy test to exclude pregnancy in childbearing
aged women
 Management
 Presence or absence of alarm features
 Patient age
 Local prevalence of Helicobacter pylori (H. pylori)
infection
Patient with alarm features or age
>55 years
 Early upper endoscopy
 If the upper endoscopy is normal, patients with alarm
features or persistent symptoms of dyspepsia should
undergo further evaluation to exclude other etiologies.
 Most patients with a normal upper endoscopy and
routine laboratory tests have functional dyspepsia.
Patient without alarm features and age ≤55
years

 Test and treat for H. pylori

 Antisecretory therapy
 Treatment
 Treatment for indigestion depends on what is causing it
and how severe symptoms are.
 Diet and lifestyle changes - if symptoms are mild
and your indigestion is not occurring often, some
lifestyle changes will probably ease symptoms.
 less fatty foods
 less caffeine
 stop smoking
 less alcohol and chocolates
 sleeping at least 7 hours every night
 avoiding spicy foods.
 raise the head of your bed 6 to 8 inches by
putting extra pillows
 Medications for treatment of dyspepsia

 H2 blocker :
Cimetidine 400 mg twice daily
Famotidine 20 mg once or twice daily
Ranitidine 150 mg twice daily

 PPIs
Esomeprazole 20 _ 40 mg once daily
Lansoprazole 15_30 mg once daily
Omeprazole 20 mg twice daily
Pantoprazole 40 mg once daily
Rabeprazole 20 mg once daily
 Cytoprotective agents :
Sucralfate 1gm 4 times daily
Misoprostol 100 to 200 microgram 2-4 times
daily

 Prokinetic agent
Metochlopromide 10- 15 mg 30 min before
each meal and at bedtime
First-Line Regimens for Helicobacter pylori Eradication

 Standard-dose of PPI (Esomeprazole, Clarithromycin500 mg,

or Amoxicillin 1000 mg for 10 to 14 days
 Standard-dose PPI Clarithromycin 500 mg, or Metronidazole
500 mg for 10 to 14 days
 Bismuth subsalicylate 525 mg , Metronidazole
250 mg, Tetracycline 500 mg, Ranitidine 150 mg or standard-
dose PPI .
 PPI + Amoxicillin 1 g
 PPI + Clarithromycin 500 mg, Tinidazole 500 mg
 The most efficacious therapy for H. pylori eradication
consists of 14-day triple therapy with a PPI,
Clarithromycin, and Amoxicillin or Metronidazole,
yielding eradication rates of 70% to 85% .
THANK YOU