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Page 1: Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST.

Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST

Page 2: Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST.

Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m ago

She complains of bloating and early satiety too

There is no alarm symptom in her historyShe use no drugHer physical examination is normal

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IT OCCURS IN APPROXIMATELY 25 PERCENT OF THE POPULATION EACH YEAR,

MOST AFFECTED PEOPLE DO NOT SEEK MEDICAL CARE

Approach to the patient with dyspepsia

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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

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ETIOLOGY

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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%

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CLINICAL APPROACH

History Ulcer-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 normal

Carnett test A palpable mass

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Routine laboratory tests

 Routine blood counts and blood chemistryS/E

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Endoscopy

Advantage: 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 patients

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Endoscopy

Disadvantage:Expensive Invasive Not cost-effective in young patients without

alarm symptoms Rarely, endoscopic complications

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Empiric treatment with acid suppression

Disadvantage: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).

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Empiric treatment with acid suppression

Advantage:Least expensive strategy.Rapid symptom relief, High response rate, May reduce the number of endoscopies.

Page 13: Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST.

Patient is a 34 y/o lady who comes to your clinic because of epigastric pain since 5m ago

She complains of bloating and early satiety too

There is no alarm symptom in her historyShe use no drugHer physical examination is normal

Page 14: Dyspepsia MAHSA KHODADOOSTAN-- GASTROENTROLOGIST.

Initial management of dyspepsia

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What do you do for our patient?

EndoscopyHigh dose PPIAnti HP antibody

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HP serology was positive.what do you do?

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HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

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HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

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HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

UBT is negative

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Management of dyspepsia based on age and alarm features

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Endoscopy in patients who have failed empirical therapy

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Management of functional dyspepsia

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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?

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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 ago

Upper gi endoscopy was performed:

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Be careful

Unfortunately

age of cancer is decreasing in our population

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