DYSPEPSIA

Fardah Akil

Centre of Gastroentero-Hepatology, Internal Medicine

Faculty of Medicine Hasanuddin University
Makassar

“Upper & Lower GI Diseases” Lecture of Gastroentero-Hepatology System, FKUH 2009

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
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
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
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)
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)

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Management of Dyspepsia
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 :10
Management 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 :11
Differential 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
- 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
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