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Dyspepsia

Rome III Committee:One or more of the following 3 symptoms:1. Postprandial fullness2. Early satiety3. Epigastric pain or burning. The point prevalence is 25%.

Patients presenting with predominantor frequent (> 1 week) heartburn or acid regurgitation should be considered to have (GERD) until proven otherwise.

ASGE Guidelines

ACG Guidelines

The effect of H. pylori eradication on gastric cancer prevention in younger people is excellent, but it declines along with advancing age.

The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that ‘‘the only good H. pylori is a dead H. pylori ’’.

Advantage of early endoscopy: Possibility of establishing a specific diagnosis, as PUD or erosive GERD or GC.Many patients with early stage malignancy do not have alarm symptoms.The reduction in anxiety. increase in patient satisfaction.

Disadvantages of early endoscopy:Little evidence to suggest significant improvement in outcomes by the initial endoscopy approach. Increased cost with the initial endoscopic approach compared with the test-and-treat method. The risk of malignancy is quite low in young patients without alarm features.Some causes of dyspepsia can not be diagnosed by endoscopy.Minimally-invasive with complications although rare.

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The more you go from West-East: more H Pylori & more GC.So the guidelines may differ in:Age threshold for endoscopy: 40 years or less or more open access endoscopy.Use other screening tests for GC in asymptomatics: PG level ,etc.? The need for local national dyspepsia guidelines.

Dyspepsia-no alarm features & Endoscopy –ve : Functional dyspepsia& overlapping functional GIT disorders.Dyspepsia- alarm features & Endoscopy –ve: consider other causes:Pancreatobiliary causes by ImagingsGastropariesis by gatric emptying studies.