Sponsors

You're browsing as an anonymous user. Join the community today to view notes at your university, edit pages, and share knowledge!

Dyspepsia

From Mediwikis


Overview[1][2][3]

Definition

Dyspepsia, from the Greek duspeptos meaning "difficult to digest", is a broad term defined as one or more of:

  1. post-prandial fullness (after a meal)
  2. early satiety (unable to finish a meal)
  3. epigastric pain or burning
  4. heartburn (retrosternal pain or burning)

Dyspepsia vs. Indigestion

Dyspepsia must not be confused with indigestion, which is a vague term used by patients to describe dyspepsia, bloating, nausea or vomiting. Find out exactly what your patient means!

The Stomach

The stomach is a battlefield between the forces of attack and defence. Managing dyspepsia is about maintaining the balance of power, a careful equilibrium between the two sides:

Attack Defence
- gastric acid

- pepsin

- Helicobacter pylori

- bile salts

- mucin

- cellular mucous

- bicarbonate

- mucosal blood flow

- cello turnover

Signs & Symptoms[1][3][4]

  • post-prandial fullness
  • early satiety
  • epigastric pain, tenderness or burning, often related to hunger, specific food or time of day
  • heartburn
  • reflux
  • bloating
  • ALARM Symptoms:
    • Anaemia (iron deficiency)
    • Loss of weight
    • Anorexia
    • Recent onset/progressive symptoms
    • Melaena/haematemesis
    • Swallowing difficulty

Investigations & Management[1][3][4]

OGD: oesophagogastroduodenoscopy (upper GI endoscopy)

Drugs which cause dyspepsia: NSAIDs e.g. ibuprofen

Lifestyle changes: stop smoking, decrease alcohol intake, avoid aggravating foods, avoid stress

Antacids: available over-the-counter e.g. magnesium trisilicate

Test for H. pylori: urea breath test, stool antigen, serology etc

PPI: proton pump inhibitor e.g. omeprazole, lansoprazole

H2 blocker: Histamine H2-receptor antagonist e.g. ranitidine

Triple therapy: omeprazole 20 mg + amoxicillin 1g + clarithromycin 500 mg OR lanzoprazole 30 mg + metroidazole 400 mg + clarithromycin 250 mg BD for one week

Causes[1][3][5]

What might you find on OGD?

References

  1. 1.0 1.1 1.2 1.3 Longmore M et al. Oxford Handbook of Clinical Medicine. 9th ed. Oxford: Oxford University Press, 2014.
  2. Martin EA (ed.). Concise Medical Dictionary. 8th ed. Oxford: Oxford University Press, 2010.
  3. 3.0 3.1 3.2 3.3 Ah-See KW et al. BNF 65. London: BMJ Group, 2013.
  4. 4.0 4.1 Sadowski DC et al. Five Things to Know About... Dyspepsia. CMAJ 2015;187(4):doi:10.1503/cmaj.141606.
  5. Holtmann G, Talley NJ. Functional dyspepsia. Curr Opin Gastroenterol 2015;31(6):492-8.