Dyspepsia Dr. Atakan Yeşil Yeditepe Unıversity Department of Gastroenterology.
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Transcript of Dyspepsia Dr. Atakan Yeşil Yeditepe Unıversity Department of Gastroenterology.
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.*