Functional Dyspepsia - Mosby · 2020. 10. 7. · and upper abdominal pain/reflux/dyspepsia...
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Gut–brain axis dysfunction Alterations in gastrointestinal microbiota Immune dysfunction Gastrointestinal sensory & motor dysfunction Pathophysiology Management Treatment Testing Abnormal endoscopy Normal endoscopy Trial of TCA or prokinetics Non-invasive test for H pylori H pylori-positive H pylori-positive H pylori-negative Aged <55 years without alarm symptoms H pylori-negative Eradication therapy Symptoms persist: review diagnosis, consider endoscopy Symptoms resolve Treat relevant pathology Symptoms resolve Aged ≥55 years or alarm symptoms present Evidence quality Very low Moderate High Symptoms resolve Discharge. Continued monitoring appropriate if still TCA still in use Discharge Wean PPI to lowest possible dose and discharge Consider psychological therapy Oesophagitis, peptic ulcer, or gastro-oesophageal cancer Symptoms persist: review diagnosis, consider endoscopy Symptoms persist: review diagnosis, consider endoscopy PPI therapy Management Endoscopy with biopsies for H pylori Age/symptom check Prokinetics might be more beneficial in postprandial distress syndrome and TCAs in epigastric pain syndrome. Urgent endoscopy: dysphagia or aged ≥55 years with weight loss and upper abdominal pain/reflux/dyspepsia Non-urgent endoscopy: haematemesis, treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin, raised platelet count with nausea/ vomiting/weight loss/reflux/dyspepsia/upper abdominal pain, or nausea and vomiting with weight loss/reflux/dyspepsia/upper abdominal pain. Stool antigen/13-carbon UBT F u n ct i o n a l D y s p e p s i a Epigastric pain syndrome Postprandial distress syndrome Epigastric pain Epigastric burning Postprandial fullness Early satiety Symptoms Bothersome symptoms in past 3 months, onset ≥6 months before diagnosis. Patient needs to have a structurally normal endoscopy. Female sex Risk factors Helicobacter pylori infection Psychological comorbidity Smoking Non-steroidal anti-inflammatory drugs Acute gastroenteritis Functional Dyspepsia For full details, read the Lancet Series: Functional Gastrointestinal disorders 2, Functional Dyspepsia
Transcript of Functional Dyspepsia - Mosby · 2020. 10. 7. · and upper abdominal pain/reflux/dyspepsia...
Gut–brain axisdysfunction
Alterations in gastrointestinal
microbiota
Immunedysfunction
Gastrointestinal sensory & motor
dysfunction
Pathophysiology
Management
Treatment
Testing
Abnormalendoscopy
Normal endoscopy
Trial of TCA orprokinetics
Non-invasive test for H pylori H pylori-positive
H pylori-positive
H pylori-negative
Aged <55 years without alarm
symptoms
H pylori-negative
Eradicationtherapy
Symptoms persist: review diagnosis,
consider endoscopySymptoms resolve
Treat relevant pathology
Symptomsresolve
Aged ≥55 years or alarm symptoms
present
Evidence qualityVery low Moderate High
Symptoms resolve
Discharge.Continued monitoring appropriate if still TCA
still in use
DischargeWean PPI to lowest
possible dose anddischarge
Considerpsychological
therapy
Oesophagitis, peptic ulcer, orgastro-oesophageal cancer
Symptoms persist: review diagnosis,
consider endoscopy
Symptoms persist: review diagnosis,
consider endoscopyPPI therapy
Management
Endoscopy with biopsies for
H pylori
Age/symptomcheck
Prokinetics might be more beneficial in postprandial distress syndrome and TCAs in epigastric pain syndrome.
Urgent endoscopy: dysphagia or aged ≥55 years with weight loss and upper abdominal pain/reflux/dyspepsia
Non-urgent endoscopy: haematemesis, treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin, raised
platelet count with nausea/ vomiting/weight loss/reflux/dyspepsia/upper abdominal pain, or nausea and
vomiting with weight loss/reflux/dyspepsia/upper abdominal pain.
Stool antigen/13-carbon UBT
Functional Dyspepsia
Epigastric pain syndrome
Postprandial distress
syndrome
Epigastricpain
Epigastricburning
Postprandialfullness
Earlysatiety
SymptomsBothersome symptoms in past 3 months, onset ≥6 months before diagnosis. Patient needs to have a
structurally normal endoscopy.
Female sex
Risk factors
Helicobacter pylori infection
Psychological comorbidity
Smoking
Non-steroidal anti-inflammatory drugs
Acute gastroenteritis
Functional Dyspepsia
For full details, read the Lancet Series: Functional Gastrointestinal disorders 2, Functional Dyspepsia
