Dyspepsia Centre of Gastroentero-Hepatology, Wahidin
Sudirohusodo Hospital TeachingDepartment of Internal Medicine,
Medical Faculty , Hasanuddin University
Upper & Lower GI Diseases Lecture of Gastroentero-Hepatology
System, FKUH 2009Level of competent : 41DEFINITIONThe term
dyspepsia derives from the Greek dys meaning bad and pepsis meaning
digestion
A board spectrum of symptoms consist of pain or discomfort
centered in the upper abdomen (UGI tract), for at least 12 weeks in
the last 12 months (ROME II Criteria)2
The term of dyspepsia are not used if the symptoms occur outside
of UGI disorders, such as : Biliary disease
PancreatitisMalabsorbsion syndromeMetabolic syndrome
3EPIDEMIOLOGY
Data from Centre of Gastroentero-Hepatology, Wahidin
Sudirohusodo General Hospital.Prevalence of the population :
25%Incidence : 9% per year4CLASSIFICATION1. ORGANIC DYSPEPSIAPeptic
ulcer, GERD, Gastroduodenitis, UGI cancer2. FUNCTIONAL
DYSPEPSIA/NON-ULCER DYSPEPSIAThe absence of any organic, systemic,
or metabolic disease (include upper endoscopy) that could explain
the symptoms. 2 subtype (Rome III criteria) :1. Post-prandial
distress syndrome(bothersome post-prandial fullness, early
satiation)2. Epigastric pain syndrome(pain & burning
intermitten-localized to the epigastrium)
5PATHOGENESIS of Functional dyspepsia 6DiagnosisAnamnesis :
chronic/recurrent pain/discomfort centered in upper abdomen
Diagnostic study : Endoscopy UGI as gold standard
ENDOSCOPIC examination was using an Alarm Symptoms as criteria
guide
Discomfort refers a subjective sensation not interpret as pain
which may characterized by or associated w/ abdominal fullness,
early satiety, bloating, belching, nausea, vomiting.Centered refers
to pain or discomfort in or around the midline
7Age treshold 45 years oldPersistent anorexia/ vomiting Bleeding
UGI (haematemesis/melena) or anemia without knowing the
sourceUnintentional weight loss Dysphagia-odynophagia
jaundiceAbdominal mass or lymphadenopathy Patients anxious because
of the symptoms appearing off and on or persistent
(psychoneurosis)Alarm Symptoms89DIFFERENTIAL DIAGNOSIS1. GERD and
Nonerosive reflux disease2. Peptic ulcer disease3. Upper GI
malignancy4. Chronic intestinal ischemia5. Pancreatobiliary
disease6. Motility disorders
9MANAGEMENTGENERAL MEASURES1. Education & reassurance 2.
Diet alteration and lifestyle modification- avoid fatty or heavilly
spiced food & excessively large meal- smaller, more frequent
meals- minimize alcohol and caffein intake- reguler exercise &
adequate restful sleep- cognitive behavioral therapy (CBT),
psychotherapy
10
10PHARMACOTHERAPY
- Antisecretory agents (4-8 weeks)H2 receptor antagonis
(ranitidine, cimetidine, famotidine) Proton Pump Inhibitor
(omeprazole,lansoprazole, rabeprazole, pantoprazole, esomeprazole)
>> H2RAblock acid secretion, suppress acid production-
Promotility agents (Prokinetic) Metoclopramide, domperidone,
cisapride, tegaserodhelp increase stomach emptying or relaxation.-
Low-dose AntidepressantsTricyclic antidepressant (amytriptylin,
fluoxetin, desipramine) affect how the brain and nerves process
pain, improve stomach emptying and expansion to accommodate food
(these potential effects are being studied).
11
1112PROGNOSISClinical course :1.5-10 years prospective study5-27
years retrospective studyAsymptomatic or improve after 1 to several
yearsPoor prognosis :history of GERD treatment, peptic ulcer, use
of aspirin, longer clinical course (>2 years), lower education,
psychological vulnerebility - Functional dyspepsia + H.pylori
infection, less likely to be symptoms free at 2 years12FOLLOW
UPOffer low dose w/limited number of prescriptions or stopping
treatmentdyspepsia is remitting & relapsing disease, continuous
medication is not necessary after eradication of symptoms unless
there is an underlying condition requiring treatmentContinue to
avoid known precipitants of dyspepsia including smoking, alcohol,
coffee,chocolate, fatty food and weight bearingMonitor for
appearance of alarm sign/symptoms13GUIDELINES FOR MANAGING
DYSPEPSIA IN PRIMARY CARE14 If prompt investigation is required
(such as recent onset of alarm symptoms) Severe pain Failure of
symptoms to resolve or substantially improve after appropriate
treatment Progressive symptomsWhen to consider referring adyspeptic
patient to a specialist
15
Dyspepsia is not new and has been known throughout
history(Indigestion by Cruickshank
(1792-1872))16Chart10.8470.565
Prevalence of Dyspepsia
Sheet1Prevalence of Dyspepsia200785%200856.50%To resize chart
data range, drag lower right corner of range.