Transcript What is Dyspepsia

• Clinical features of Upper GI origin
• More than 4 weeks duration
• Pain induced or worsened by food
• 40% of adults have in a life time
• Generally benign – promote self care
• Symptoms are poor predictors
• Employ a broader definition
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GI Bleeding (same day endoscopy)
Progressive Weight loss
Progressive Dysphagia
Persistent Vomiting
Iron Deficiency Anemia (IDA)
Mass in the Epigastrium
Suspicious Barium meal images
Patient may be of any age
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Dyspepsia
• Abdominal pain
• Bloating
• Nausea
• Early satiety
• Burping
• Boriborygmi
Reflux Disorder
• Acid regurgitation
• Heartburn
• Epigastric pain
• Burping
• Water brash
• Dysphagia
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Goals of Treatment
Relieve pain
Bleeding
Prevent
complications
Perforation
Minimize
Recurrence
Obstruction
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First Step
Dyspepsia
Alarm Signs
Present
No Alarm
Signs
Age > 55
UGI
Endoscopy
Age  55
UID Rx
Empirical
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Second Step
No Alarm Signs
Age < 55 years
UID- Rx.
Empirically
Test for
H.pylori & Rx
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Third Step
Alarm Signs
Present or > 55
Suspend NSAIDs
Review Medications
Order UGI Endo
Classify Dx.
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Fourth Step
UGI Endo Dx
NUD & CG
GERD
PUD (GU/DU)
GI Ca
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Rx. of UID
UID
Medication
Full PPI for
one month
PPI or H2RA –
one month
Lifestyle
Endoscopy
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Rx. of NUD
NUD
Medication
H.pylori test
and treat
Low dose PPI
or H2RA 1 m
Lifestyle
No repeat
Endoscopy
Persistent Sx, low
dose PPI, self-care
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Complications of GERD
• Esophagitis
• Peptic stricture
• Barrett’s Esophagus
• Esophageal ulceration
• Upper GI bleed
• Adenocarcinoma
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Rx. of GERD
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• Lifestyle and medications
• Full dose PPI for two month
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• Double dose PPI for one month
• Prokinetic in addition to PPI
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• H2RA or prokinetic for one month
• Review diagnosis if no response
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• Low dose maintenance treatment
• Return to self care with antacids
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H.pylori testing
UBT
Stool Ag
Serology
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• Acceptability
• Dx and F/up
• Rx effects it
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Accurate
Costly
Availability
Dx and F/up
Rx affects it
C13 labeled
Card test ?
ELISA IgM
Rx no effect
Not for F/up
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Rx. of PUD
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• Lifestyle and medications
• H.pylori tests– UBT, Stool Ag, Ab (IgM)
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• H.Pylori + Eradicative treatment + PPI
• Full dose PPI for 2 months + 1 month
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• Stop NSAIDs – dose, Selective drugs
• Gastro-protection - Mesoprostol
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• Repeat UGI Endo after 8 weeks
• Non healing ulcers – see next for causes
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Treatment of H.pylori
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Combination therapy is the rule
Eradication of H.pylori essential
Ulcers don’t heal if infection persists
Regimen consists of 3 drugs for 7-14 d
– Full dose PPI – BID +
– Clarithromycin 500 mg BID +
– Amoxycillin 1 g BID / Metro 400 BID
• Combination packs improve compliance
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Non Healing PUD
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• Non compliance with medicines
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• Ulcer turning malignant
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• False –ve H.pylori – empirically treat for it
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• Inadvertent NSAID or ulcerogenic drugs
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• Rare causes – ZE, MALT, Chron’s, MEN 1
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Rx. of FD
FD
Behavioural
Reassurance
Lifestyle
Suppress Acid
prokinetics
Depression
medications
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Medications
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NSAIDs (not low dose aspirin)
Steroids (oral - not inhalations)
Theophyllines (all types)
Bisphosphonates (calcium metabolism)
Calcium Antagonists
Immediately suspend medicines
Or reduce to minimum required dose
Selective COX 2 - Celecoxibe
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