What is Dyspepsia ?

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What is Dyspepsia ?

• Clinical features of Upper GI origin
• More than 4 weeks duration
• Pain induced or worsened by food
• 40 of adults have in a life time
• Generally benign promote self care
• Symptoms are poor predictors
• Employ a broader definition

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Alarm Signs

• GI Bleeding (same day endoscopy)
• Progressive Weight loss
• Progressive Dysphagia
• Persistent Vomiting
• Iron Deficiency Anemia (IDA)
• Mass in the Epigastrium
• Suspicious Barium meal images
• Patient may be of any age

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Symptoms

• Dyspepsia
• Abdominal pain
• Bloating
• Nausea
• Early satiety
• Burping
• Boriborygmi

• Reflux Disorder
• Acid regurgitation
• Heartburn
• Epigastric pain
• Burping
• Water brash
• Dysphagia

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Goals of Treatment
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First Step
UGI Endoscopy
UID Rx Empirical
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Second Step
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Third Step
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Fourth Step
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Rx. of UID
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Rx. of NUD
Persistent Sx, low dose PPI, self-care
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Complications of GERD

• Esophagitis
• Peptic stricture
• Barretts Esophagus
• Esophageal ulceration
• Upper GI bleed
• Adenocarcinoma

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Rx. of GERD
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H.pylori testing
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Rx. of PUD
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Treatment of H.pylori

• Combination therapy is the rule
• Eradication of H.pylori essential
• Ulcers dont heal if infection persists
• Regimen consists of 3 drugs for 7-14 d
• Full dose PPI BID
• Clarithromycin 500 mg BID
• Amoxycillin 1 g BID / Metro 400 BID
• Combination packs improve compliance

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Non Healing PUD
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Rx. of FD
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Medications

• NSAIDs (not low dose aspirin)
• Steroids (oral - not inhalations)
• Theophyllines (all types)
• Bisphosphonates (calcium metabolism)
• Calcium Antagonists
• Immediately suspend medicines
• Or reduce to minimum required dose
• Selective COX 2 - Celecoxibe