Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST

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Transcript of Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST

Approach to the patient with dyspepsia

Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m agoShe complains of bloating and early satiety tooThere is no alarm symptom in her historyShe use no drugHer physical examination is normalIt occurs in approximately 25 percent of the population each year,

most affected people do not seek medical careApproach to the patient with dyspepsia

DEFINITION ( Rome III Committee )one or more of the following symptoms :Postprandial fullness (termed postprandial distress syndrome) Early satiation (meaning inability to finish a normal sized meal or postprandial fullness)Epigastric pain or burning (termed epigastric pain syndrome)

Heartburn is the point of contraversy

ETIOLOGY

Alarm symptoms Unintended weight loss Persistent vomiting Progressive dysphagia Odynophagia unexplained anemia or iron deficiency Hematemesis Palpable abdominal mass or lymphadenopathy Family history of upper gastrointestinal cancer Previous gastric surgery Jaundice NPV=99%

CLINICAL APPROACHHistoryUlcer-like or acid dyspepsia (eg, burning, epigastric hunger pain with food, antacid, and antisecretory agent relief) Dysmotility-like dyspepsia (with predominant nausea, bloating, and anorexia) Unspecified dyspepsiaPhysical examination :usually normalCarnett test A palpable mass

Routine laboratory testsRoutine blood counts and blood chemistryS/E

EndoscopyAdvantage: Gold standard test to exclude gastroduodenal ulcers, reflux esophagitis, and upper gastrointestinal cancers. Beneficial because up to 40 percent of patients have an organic cause of dyspepsia. It also provides reassurance to patientsEndoscopyDisadvantage:ExpensiveInvasive Not cost-effective in young patients without alarm symptoms Rarely, endoscopic complications

Empiric treatment with acid suppressionDisadvantage:Cost advantage is lost with symptom recurrence or lack of response. High rate of symptom recurrence may promote inappropriate long-term medication use. May delay diagnostic testing, may mask the symptoms of malignant ulcers. Likely to provide the least patient reassurance. Rarely, serious side effects (gynecomastia, hematologic disorders).

Empiric treatment with acid suppressionAdvantage:Least expensive strategy.Rapid symptom relief, High response rate, May reduce the number of endoscopies.

Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m agoShe complains of bloating and early satiety tooThere is no alarm symptom in her historyShe use no drugHer physical examination is normal

Initial management of dyspepsia

What do you do for our patient?

EndoscopyHigh dose PPIAnti HP antibody HP serology was positive.what do you do?

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

UBT is negative

Management of dyspepsia based on age and alarm features

Endoscopy in patients who have failed empirical therapy

Management of functional dyspepsia

Patient was a 60 y/o lady who was refered to me because of constant epigastric pain She mentioned 6kg wt loss since 3m agoShe was anemic with ferritin =5What is the best diagnostic test?

Patient is a 57 y/o man who was refered to our centre because of epigastric pain.he complains of dysphagia too.his wt is 67kg now and was 75kg about 3m agoUpper gi endoscopy was performed:

Be careful

Unfortunately

age of cancer is decreasing in our population