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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 history She use no drug

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slide1

Dyspepsia

MAHSA KHODADOOSTAN-- GASTROENTROLOGIST

slide2

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 history

She use no drug

Her physical examination is normal

approach to the patient with dyspepsia

Approach to the patient with dyspepsia

It occurs in approximately 25 percent of the population each year,

most affected people do not seek medical care

definition rome iii committee
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
alarm symptoms
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 approach
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 dyspepsia
  • Physical examination :usually normal
    • Carnett test
    • A palpable mass
routine laboratory tests
Routine laboratory tests

 Routine blood counts and

blood chemistry

S/E

endoscopy
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
endoscopy1
Endoscopy
  • Disadvantage:
  • Expensive
  • Invasive
  • Not cost-effective in young patients without alarm symptoms
  • Rarely, endoscopic complications
empiric treatment with acid suppression
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).
empiric treatment with acid suppression1
Empiric treatment with acid suppression
  • Advantage:
  • Least expensive strategy.
  • Rapid symptom relief,
  • High response rate,
  • May reduce the number of endoscopies.
slide13

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 history

She use no drug

Her physical examination is normal

slide15

What do you do for our patient?

Endoscopy

High dose PPI

Anti HP antibody

slide17

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

slide18

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

slide19

HP serology was positive.what do you do?

You treat H.Pylori but symptoms are constant?

Test for HP eradication

UBT is negative

slide23

Patient was a 60 y/o lady who was refered to me because of constant epigastric pain

She mentioned 6kg wt loss since 3m ago

She was anemic with ferritin =5

What is the best diagnostic test?

slide25

Patient is a 57 y/o man who was refered to our centre because of epigastricpain.he complains of dysphagia too.hiswt is 67kg now and was 75kg about 3m ago

Upper gi endoscopy was performed:

slide27

Be careful

Unfortunately

age of cancer is decreasing in our population