DyspepsiaDr. Atakan Yeşil

Yeditepe Unıversity Department of Gastroenterology

Dyspepsia 40% of all adults

Aproximately 25 percent

of patients with dyspepsia

have an underlying

organic cause.However,

up to 75 percent of

patients have functional

(idiopathic or nonulcer)

dyspepsia with no

underlying cause on

diagnostic evaluation

Gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common functional gastrointestinal conditions with significant impact on the daily lives of individuals. When diagnosing patients with GERD, FD and IBS, physicians should keep in mind that these patients could be suffering from more than one of these conditions

Scand J Gastroenterol. 2014 Dec 19:Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population. Rasmussen S

Antrum: Pylor:G cells:gastrin:stimulates acid secretion

D cells:somostatin:inhibits gastrin secretion, Goblet cells:secrete mucus to coat and protect the stomach from corozive injury

Fundus:pariatal cells:secrete Hcl chief:secrete pepsinojen-pepsin by HCL , pepsin:can damage the gastric epitelium

Which One is not diagnostic criteria for functional dyspepsia?

A.Postprandial fullness

B.Early satiation

C.Epigastric pain

D.Epigastric burning

E.Bloating

Which one dosn’t have a role ın dyspepsıa pathogenesis?

A. Gastric motility and compliance

B. Visceral hypersensitivity

C. Helicobacter pylori infection

D.Altered gut microbiome

E.Malabsorpition

PATHOPHYSIOLOGY 

1. Gastric motility and compliance 

Several motility disorders have been reported in patients with dyspepsia. These include delayed gastric emptying, rapid gastric emptying, antral hypomotility, gastric dysrhythmias, and impaired gastric accommodation in response to a meal

2. Visceral hypersensitivity — Visceral hypersensitivity is characterized by a lowered threshold for induction of pain in the presence of normal gastric compliance.

3. Helicobacter pylori infection — Although there are several hypotheses with regard to the role of Helicobacter pylori infection in the pathogenesis of functional dyspepsia, the mechanism remains unclear.

Helicobacter Pylori

4.Altered gut microbiome — Alterations in the upper gastrointestinal tract microbiome may result in the development of dyspepsia, although this has not been directly, formally evaluated.

5. Psychosocial dysfunction: Functional dyspepsia may result from a complex interaction of psychosocial and physiological factors. Dyspepsia has been associated with generalized anxiety disorder, somatization, and major depression

Which is most of underlying organic cause of dyspepsia?

A.Reflux oesophagitis

B.Duodenal ulcer

C.Gastric ulcer

D.Gastric carcinoma

E.Oesophageal carcinoma

Causes

Reflux oesophagitis 12%

Duodenal ulcer 10%

Gastric ulcer 6%

Gastric carcinoma 1%

Oesophageal carcinoma 0.5%

Which is not alarm symptom for dyspepsia?

A.GI bleeding

B.Persistent vomiting

C.Weight loss Dysphagia

D.Anaemia

E.Reflux

Alarm Symptoms/ Signs*GI bleeding (same day referral)

Persistent vomiting

Weight loss (progressive unintentional)

Dysphagia

Epigastric mass

Anaemia due to possible GI blood loss

Thus all patients with new-onset dyspepsia should have abdominal examination and FBC

First Approach to DyspepsiaConsider possible causes outside upper GI tract

-Heart, lung, liver, gall bladder, pancreas, bowel

Consider drugs and stop if possible

- Aspirin / NSAIDs, calcium antagonists, nitrates,

theophyllines, etidronate, steroids

Refer if dyspepsia in 55+* year old

Alarm symptoms/signs (2 week referral)

GI bleeding (same day referral)

Persistent vomiting

Weight loss (progressive unintentional)

Dysphagia

Epigastric mass

Anaemia due to possible GI blood loss

Routine Endoscopic InvestigationPatients of any age, presenting with dyspepsia and

without alarm signs, is not necessary.

However, in patients aged 55 years and older with unexplained and persistent recent-onset dyspepsia alone, an urgent referral for endoscopy should be made.

Management of simple dyspepsiain those aged < 55 years

Stress benign nature of dyspepsia

Lifestyle advice

– Healthy eating

– Weight reduction

– Stop smoking

– Use of antacids

Helicobacter Pylori95% Duodenal ulcers

70% Gastric ulcers

10% Non-ulcer dyspepsia

Treatment benefits gastritis more than reflux

symptoms

Which one is best for diagnosing H. pylori?

A.Urea breath test

B.Stool antigen test

C.Serology

D.Endoscopy – CLO test

E.Hydogen breath test

Diagnosing H. pyloriUrea breath test 95% sensitive & specific

Stool antigen test 92% sensitive & specific

Serology 80% sensitive & specific

Endoscopy – CLO test 98% sensitive & specific

(urea and phenol red, a dye that turns pink in a pH of 6.0 or

greater)

H. pylori eradication Treatment failure may be due to

- Resistance to antibacterial drugs

- Poor compliance

DrugDrug Side effectsSide effects

BismuthBismuth n&v, unpleasant taste, darkening of tongue & n&v, unpleasant taste, darkening of tongue & stools, caution in renal diseasestools, caution in renal disease

MetronidazolMetronidazolee

n&v, unpleasant taste, n&v, unpleasant taste, ↓effectiveness OCP, care ↓effectiveness OCP, care with lithium/warfarinwith lithium/warfarin

Amoxicillin Amoxicillin

& tetracycline& tetracyclineGI side effects, GI side effects, ↓ effectiveness OCP, ↓ effectiveness OCP, pseudomenbranous colitispseudomenbranous colitis

LansoprazoleLansoprazole ↓ ↓ effectiveness OCPeffectiveness OCP

Rx of H. Pylori

Use a carbon-13 urea breath test, stool antigen test or, when performance has been validated, laboratory based serology.

If re-testing for H. pylori use a carbon-13 urea breath test.*