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MORPOT
Monday, 11 Desember 2017
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DYSPEPSIA
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DEFINITION The 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)
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The term of dyspepsia are not used if the symptoms occur outside of UGI disorders, such
as :
Biliary disease
Pancreatitis
Malabsorbsion syndrome
Metabolic syndrome
 z CLASSIFICATION
1. Organic Dyspepsia
Peptic ulcer, GERD, gastroduodenitis, UGI cancer
2. Functional Dyspepsia / non-ulcer
dyspepsia
The absence of any organic, systemic, or
metabolic disease (include upper endoscopy)
that could explain the symptoms.
2 subtype (based on Rome III criteria) :
- post-prandial distress syndrome
-epigastric pain syndrome
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Pathogenesis
multifactor
1. Visceral hypersensitivity :
epigastric pain, belching, weight loss
2. Altered gastrointestinal motility :
postprandial fullness, nausea, vomiting
3. Altered gastric accomodation :
early satiety, weight loss
4. Other mechanisms :
- H.pylori infection : epigastric pain
- Dietary factor : altered eating,food intolerance
- Duodenal eosinophilia
- psychological factor : hypersensity to gastric distention
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DIAGNOSIS
Anamnesis

Diagnostic study : Endoscopy UGI as gold standard

ENDOSCOPIC examination was using an

Alarm Symptoms as criteria guide
z ALARM SYMPTOMS

Age treshold 45 years old

Persistent anorexia/ vomiting
Bleeding UGI (haematemesis/ melena) or anemia without knowing
the source
Unintentional weight loss
Dysphagia-odynophagia
jaundice
Abdominal mass or lymphadenopathy
Patients anxious because of the symptoms appearing off and on
or persistent (psychoneurosis)
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z MANAGEMENT

 General measures

1. 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
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 Pharmacotherapy

- Antisecretory agents
H2 receptor antagonis (ranitidine, cimetidine, famotidine)
Proton Pump Inhibitor (omeprazole,lansoprazole, rabeprazole, pantoprazole,
esomeprazole) > H2RA

- Promotility agents (Prokinetic)

Metoclopramide, domperidone, cisapride, tegaserod

-Antidepressant s & anxiolitic agents

Tricyclic antidepressant (amytriptylin, desipramine)
 Management of Dyspepsia
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DYSPEPSIA without GERD or NSAID

< 55 y.o & alarm symptoms  > 55 y.o or alarm symptom 

H.Pylori Testing
 
Eradication PPI trial 4-6 weeks
Fails ENDOSCOPY UGI

PPI trial 4 weeks

Fails
Fails
REASSURANCE, REASSES

consider ENDOSCOPY UGI

Talley NJ;American Gastroenterological Association.

AGA Medical position statement :
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Management
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of Functional Dyspepsia
H.Pylori  (normal endoscopy) and failed an adequate PPI trial

1. Reevaluated symptoms & diagnosis

2. Consider other source of abdominal pain (pancreas, colon,
biliary tract)
3. Symptoms of delayed gastric emptying?
4. IBS?
5. Panic disorder or other psycological issues?
Persistent symptoms,
no other cause established

Consider : antidepressants,hypnotherapy, behavior therapy, prokinetic agents

Talley NJ;American Gastroenterological Association.

AGA Medical position statement :
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Differential
z Diagnosis

1. GERD and Nonerosive reflux disease

2. Peptic ulcer disease
3. Upper GI malignancy
4. Chronic intestinal ischemia
5. Pancreatobiliary disease
6. Motility disorders
7. Systemic disorders
8. Infections
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Prognosis
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- Clinical course :
1.5-10 years prospective study
5-27 years retrospective study

- Asymptomatic or improve after 1 to several years

- Poor 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 years