Post on 03-Dec-2019
dr.Putut Bayupurnama
SpPD-KGEH(Internist-
Gastroenterohepatologist)Member of International Working Group for :
International Consensus on Underwater
Colonoscopy Examination and Polypectomy(International-WATERS [Water-Aided Technique
Endoscopy Research Society])
DIAGNOSTIC CHALLENGES IN FUNCTIONAL DYSPEPSIA
PUTUT BAYUPURNAMA
DIVISI GASTROENTEROLOGI & HEPATOLOG- DEPT. PENYAKIT DALAM ,
FAKULTAS KEDOKTERAN-KMK, UNIVERSITAS GADJAH MADA/RSUP
DR. SARDJITO, YOGYAKARTA, INDONESIA
3
Talley, J Clin Gastroenterol 2001; 32: 286–93.
Locke, Ballieres Clin Gastroenterol 1998; 12: 435–42.
Paré, Can J Gastroenterol 1999; 13: 647–54.
van Bommel et al., Postgrad Med J 2001; 77: 514–18.
Talley et al., BMJ 2001; 323: 1294–7.
15–25% of the general population experience
dyspepsia within a 12-month period
Much more common than peptic ulcer
Up to 5% of primary care visits are due to dyspepsia
Most patients have no detectable abnormality on
radiological upper GI series or endoscopy
Endoscopy findings and symptoms do not correlate
Dyspepsia:
the size of the problem
Dyspepsia:
the size of the problem
5
Talley et al., Gut 1999; 45(Suppl II): II37–42.
Malfertheiner, Eur J Gastroenterol Hepatol 1999; 11(Suppl 1): S25–9.
Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392.
Definition of dyspepsia (Rome II)Definition of dyspepsia (Rome II)
Centered implies that the pain or discomfort is mainly in or around the midline.
Pain in the right or left hypochondrium is not considered to be representative of
dyspepsia
Dyspepsia refers to pain or discomfort centered in the upper
abdomen
Definition of Functional Dyspepsia (Rome IV)
Functional dyspepsia is a medical condition that significantly
impacts on the usual activities of a patient and is characterized by
one or more of the following symptoms: postprandial fullness, early
satiation, epigastric pain, and epigastric burning that are unexplained after a routine clinical evaluation
ORGANIC
UNINVESTIGATED
FUNCTIONAL(or idiopathic)
(use of the term ‘non-ulcer’
is discouraged)
INVESTIGATED
Talley et al., Gut 1999; 45(Suppl II): II37–42.
Dyspepsia covers a range of symptomsDyspepsia covers a range of symptoms
DYSPEPSIAPAIN OR DISCOMFORT
centred in upper abdomen
IBSGERD
PENEMUAN GERD BERDASARKAN INDIKASI ENDOSKOPIdi RSUP SARDJITO YOGYAKARTA
Frekuensi Persen (%)
Dyspepsia 54 49,1
GERD 35 31,8
Hematemesis 6 5,5
Melena 9 8,2
Hematemesis Melena 1 0,9
Anemia 1 0,9
Gastropathy oains 2 1,8
Dysfagia 2 1,8
Adyarini DD, KOPAPDI 2015 Bandung
Diagnostic Criteria for Irritable Bowel
Syndrome (ROME IV)
Recurrent abdominal pain, on average, at least 1 day per
week in the last 3 months, associated with 2 or more of
the following criteria:
1. Related to defecation
2. Associated with a change in frequency of stool3. Associated with a change in form (appearance) of stool
Criteria fulfilled for the last 3 months with symptomonset at least 6 months before diagnosis.
IBS with predominant diarrheaIBS with predominant constipationIBS with mixed bowel habitsIBS unclassified
Lacy BE et al, Gastroenterology 2016;150:1393–1407
Gejala-gejala gastrointestinal atas pada pasien-pasien dengan IBS- constipation
predominant dan IBS-diarrhea predominant
(Cremonini F & Talley NJ, 2004)
Level of evidence dari mekanisme patofisiologi yang sering terdapat pada
dispepsia fungsional dan IBS
(Cremonini F & Talley NJ, 2004)
Interaksi antara Kebiasaan Browsing Internet dan Sindrom Dispepsia pada Adolesent
Putut Bayupurnama1, Noor Asyiqah Sofia2, Angelin Utami Cahyani3
1 Division of Gastroenterology & Hepatology,Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital,
Yogyakarta, Special Region of Yogyakarta, Indonesia2Division of Psychosomatic Disorders, Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital,
Yogyakarta, Special Region of Yogyakarta, Indonesia3 Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital, Yogyakarta, Special Region of Yogyakarta,
Indonesia
Accepted for ACG 2019Meeting abstract, San Antonio, Texas, USA ,October 2019
Did you ever browse
information about
diseases in the internet?
Dyspepsia syndrome
Total
(n)
p value
Yes
n(%)
No
n(%)
Never 60(65.9) 31(34.1) 91 <0.001
Only once 296(79.4) 77(20.6) 373
More than once 128(63.7) 73(36.3) 201
Total 484(72.8) 181(27.2) 665
Did you ever browse
information about your
medical complaint in the
internet?
Dyspepsia syndrome
Total
(n)
p value
Yes
n(%)
No
n(%)
Never 77(63.6) 44(36.4) 121 0.002
Only once 263(78.5) 72(21.5) 335
More than once 144(68.9) 65(31.1) 209
Total 484(72.8) 181(27.2) 665
Table 1. The role of internet browsing about diseases information in developing dyspepsia
syndrome
Table 2. The role of internet browsing about medical complaint information in developing
dyspepsia syndrome
Perbedaan Kualitas Hidup antara Pasien dengan Dispepsia Fungsional
Sesudah Endoskopi dengan Terapi Empirik dan Plasebo
Sumardjo, Putut Bayupurnama, Neneng Ratnasari,
(Diterima dan akan dipresentasikan pada ACG Meeting2019, San Antonio, Texas, USA, October 27, 2019)
EGD tanpa sedasi + placebo (22 patients) vs EGD tanpa sedasi +PPI+Prokinetic (20 patients) Randomized Controlled Trial Lama terapi : 2 minggu
Kesimpulan penelitian :Tidak terdapat perbedaan bermakna penurunan skor Nepean Dyspepsia index antara kelompokplacebo dan empiric sebelum dan sesudah pemeriksaan endoskopi atas
Summary
Dyspepsia refers to pain or discomforts mainly in or around the midline of the upper abdomen
Diagnostic challenges in functional dyspepsia is depend on symptoms identification and overlap
symptoms especially with GERD and Irritable Bowel Syndrome
Considering the probable overlap symptoms may improve the accuracy of
functional dyspepsia diagnosis