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

Drossman DA, Gastroenterology 2016;150:1262–1279

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

Talley et al., Gut 1999; 45(Suppl II): II37–42.

Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392

Diagnostic Challenges :

Symptoms Identification Overlap syndromes

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

Yarandi SS and Christie J., Gastroenterol Res Pract 2013, http://dx.doi.org/10.1155/2013/351086

Umbilicus

Gut 1997; 41: 753–757

Functional Dyspepsia (ROME IV)

Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392

Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392

Talley NJ & Ford AC, N Engl J Med 2015;373:1853-63

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