| ID | 10 |
|---|---|
| Name | DYSPEPSIA1,2,3 (Indigestion) |
| Cause | The causes of dyspepsia may be organic or functional. A. Organic causes: Upper gastrointestinal disorders- peptic ulcer disease, acute gastritis, gastric carcinoma, peptic oesophagitis, oesophageal spasm; Other gastrointestinal disorders- chronic cholecystitis, cholelithiasis, hepatic disease, pancreatic disease, crohn’s disease, irritable bowel symdrome, colonic carcinoma; Systemic diseases- renal failure, hypercalcemia; Some drugs like NSAIDs, corticosteroids, antibiotics, digoxin, iron & potassium supplements, alkohol abuse etc. B. Functional causes: For detail, see below. |
| Signs Symptoms | Pain or burning in the stomach, bloating, excessive belching, or nausea after eating. An early feeling of fullness when eating |
| Diagnosis | Diagnosis: A. Careful history taking is very important2. This may help in eliciting- i. Typical symptoms’ of specific disorder (e.g peptic ulcer); ii. ‘Alarming symptoms’ (such as, weight loss, anemia, hematemesis/ melena, dysphagia, palpable abdominal mass), requiring urgent investigations; iii. ‘Atypical symptoms’ suggestive of other systemic disorders. B. Investigations: 1. Routine investigations to be done. 2. Endoscopy: Upper endoscopy is the choice of diagnosis in suspected ‘typical gastro-intestinal disorders & in alarming features’. It is also indicated in all patients of dyspepsia over age 45 years’ (or 55 years2). 3. Liver function tests & Ultrasonogram: In suspected hepatobiliary & pancreatic problems. 4. For other systemic disorders: Renal function tests, (urea, creatinine), Electrolytes, Ca++, ECG, X-ray chest etc. 5. Serological test for H. pylori. |
| Investigations | 1. Routine investigations to be done. 2. Endoscopy: Upper endoscopy is the choice of diagnosis in suspected ‘typical gastro-intestinal disorders & in alarming features’. It is also indicated in all patients of dyspepsia over age 45 years’ (or 55 years2). 3. Liver function tests & Ultrasonogram: In suspected hepatobiliary & pancreatic problems. 4. For other systemic disorders: Renal function tests, (urea, creatinine), Electrolytes, Ca++, ECG, X-ray chest etc. 5. Serological test for H. pylori. N.B: In young patients (<45 yrs1 or <55 yrs2) with dyspepsia endoscopic examination is usually not necessary, because significant g.i pathology is very uncommon in them. But, serological test for H. pylori should be done & if positive, a course of eradication therapy should be adviced. On the otherhand, older patients (>45 yrs) with persistent dyspepsia (treated with H. pylori eradication therapy) & all patients with ‘alarm symptoms’ must be examined with endoscopy to exclude any significant organic disorder. |
| Management | 1. Explanation regarding the problem and reassurance. 2. Treatment of specific organic disease (if any). 3. Preventive measures- a) Overeating, excessive sweets & faulty foods should be avoided. Meals should be taken regularly. b) Food items those produce allergy should be avoided. c) Gas forming foods like cauliflower, cabbage, beans, melons, cucumbers, onions, green peppers etc, should be omitted from the menu. 4. Patients with anxiety and tension should have rest and relaxation. 5. Antacid (I tablet t.i.d after meal) and anticholinergic drugs (e.g hyoscine butylbromide 20mg or I tablet ti.d before meal) sometimes may be helpful. Or, Carminative preparations (tablet or mixture) 2-3 times daily may be helpful. 6. Prokinetic drugs such as metaclopramide (10mg t.i.d) may be given. 7. H2 receptor antagonist drugs or proton pump inhibitors may be given if there are complaints of night pain &/or heart burn. 8. A small proportion of patients may get benefit from H. pylori eradication therap |
| Introduction | Dyspepsia is the most common gastrointestinal complaint encountered by the general physicians and specialists in their routine practice. Although dyspepsia is a layman term, it refers to an acute, chronic, or recurrent ‘pain or discomfort centered in the upper abdomen’, may be associated with a number of symptoms such as, anorexia, nausea, vomiting, fullness, bloating, early satiety, belching, regurgitation, or simply ‘indigestion’. An international committee of clinical investigators has defined dyspepsia as epigastric pain or burning, early satiety, or postprandial fullness1. Etiologically some symptoms of dyspepsia are arising outside the digestive system. The symptoms are often found stress-related & in many cases no ulceretion could be detected. Dyspeptic symptoms which are related to peptic ulcer, are often termed as ulcer dyspepsia. |
| History | |
| Etiology | pain, a burning feeling, or discomfort in your upper abdomen. feeling full too soon while eating a meal. feeling uncomfortably full after eating a meal. bloating. burping. |
| Clinical Features | Bloating. Gas. Nausea. Burping. Regurgitation (when swallowed food comes back up). Acid reflux. Heartburn. |
| Preventions | |
| Treatment | See under management |
| Complications | |
| Prognosis | |
| Types | |
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| Observation | |
| Pathology |
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