dyspepsia
DYSPEPSIA

Dyspepsia is having any one of the following: disturbing postprandial fullness, early satiation, epigastric pain and/or burning felt predominantly in the upper abdomen.

It is considered a symptom complex rather than a specific diagnosis.

Acid suppression is the recommended initial therapy.

History

  • A detailed medical and family history reduces the differential diagnoses
  • Review medications for possible causes of dyspepsia eg Ca antagonists, nitrates, theophyllines, bisphosphonates, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin, Acarbose, Orlistat, potassium supplements

Physical Examination

  • Often normal except for epigastric tenderness
  • Other PE findings may help diagnose or exclude other diseases eg right upper quadrant pain with cholelithiasis, palpable abdominal mass in hepatoma, lymphadenopathy in gastric malignancy

Laboratory Tests

  • Complete blood counts and chemistries (eg LFTs) may be performed to identify alarm features or metabolic diseases causing dyspepsia or to investigate patients who have been unresponsive to treatment

Complications

  • Symptoms that suggest complicated disease must be recognized and patients referred immediately for further diagnostic testing
    • GI bleeding
    • Epigastric mass
    • Iron-deficiency anemia
    • Persistent vomiting
    • Progressive dysphagia
    • Suspicious barium meal
    • Unintentional weight loss
    • Persistent nocturnal symptoms
    • Family history of upper GI cancer
    • Lymphadenopathy
    • Jaundice
    • Painful swallowing

Non-ulcer Dyspepsia or Functional Dyspepsia

  • Patients have >1 bothersome dyspepsia symptoms (eg epigastric pain or burning, early satiety, postprandial fullness) and without evidence of structural disease, including a normal upper endoscopy, that can explain the symptoms
  • Includes subcategories that can overlap: 
    • Postprandial distress syndrome (dyspepsia symptoms caused by meals): Includes 1 or both of the following for at least 3 days/week: Bothersome postprandial fullness or early satiety 
    • Epigastric pain syndrome (dyspepsia symptoms that do not occur exclusively postprandially and can be improved by meals): Includes at least 1 of the following for at least 1 day/week: Bothersome epigastric pain and/or burning   
  • Criteria must be fulfilled for postprandial distress syndrome and/or epigastric pain syndrome and fulfilled for the  last 3 months with symptoms starting at least 6 months prior to diagnosis (Rome IV criteria)
  • No evidence is documented on routine evaluation (including upper endoscopy) of organic, systemic or metabolic disease that can explain the symptoms
  • Patients with this diagnosis should be treated similarly as those with uninvestigated dyspepsia provided they meet the following criteria:
    • No heartburn
    • No NSAID or low-dose Aspirin use
    • Normal blood tests
    • No evidence of an abnormality
  • H pylori eradication therapy is effective for patients with H pylori-positive functional dyspepsia 
    • Patients without symptoms 6-12 months following H pylori eradication therapy can be classified as H pylori-associated functional dyspepsia 
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