Mr. Al-Momtan, Tahir Abdullah is a 56 year old male who presented to our clinic with epigastric abdominal pain x 2 weeks. He describes it as a burning pain which is non-radiating and is worse after he eats. He has frequent belching with bloating sensation but denies nausea, vomiting, diarrhea, constipation, or weight loss. He has tried epicogel ® found to be composed of ( Each 5 ml contains Dried aluminium hydroxide gel 405 mg, Magnesium hydroxide 100 mg, Dimethicone 125 mg) in which he claimed, “helps a little”.
On further questioning Mr. Al-Momtan states he had similar abdominal pain three years ago and was told by his physician at that time that it was most likely due to an “ulcer”. He took “the purple pill” for a month and his symptoms resolved. He had no definitive diagnostic tests done at that time.
Group of symptoms consisting mostly upper abdominal or epigastric pain or discomfort, heartburn, or acid regurgitation.Often associated with belching, bloating, nausea or vomiting
INTRODUCTION • Dyspepsia • 40% of adult population / year, 2% consult their GPs • Substantial health care cost: - - - Medication Diagnostic evaluation Time cost from work • Out of 100 pts. 90% will be pain free after 2-3 wks without Rx • Definitive established guideline (NICE) • H.pylori & PUD – well accepted & confirmed
5 common causes of dyspepsia 1- NUD. 2- GORD 3- Gastritis 4- Gastric Ulcer. 5- Doudenal Ulcer Rare causes Gastic and oesophageal CA.
Weakness or incompetence of lower esophageal sphincter
Esophagitis, esophageal structure
Not text book presentation
1.ALARM symptoms ??
ALARM Symptoms! ALARM! • A norexia • L oss of weight (progressive & unintentional) • A naemia due to iron deficiency • R ecent onset of persistent symptoms :vomiting • M elaena, haematemesis • Dysphagia (progressive) • Epigastric mass or • Suspicious barium meal.
Endoscopy • Age < 55 years, presenting with dyspepsia and without alarm S/S, is not necessary. • Age > 55 years presenting with dyspepsia and without alarm S/S do not require routine endoscopy. Considered if : 1.ALARM signals and signs are the major determinant of the need for endoscopy, not age on its own. 2. No response to medication7-10days. 3. Symptoms persist after 6-8wks 4. Signs of systemic illness 5. Recurrence after treatment 6. Long standing G0RD 7. Unexplained weight loss, progressive dysphagia, IDA, abdominal mass on plapation