This document discusses dyspepsia, defined as epigastric pain, burning, postprandial fullness, or early satiety. Dyspepsia can be caused by organic diseases like peptic ulcers, GERD, or malignancies. It can also be functional in nature. The evaluation of dyspepsia involves history, physical exam, and testing for H. pylori infection or structural abnormalities. Treatment depends on identified causes, but may include H. pylori eradication therapy, PPIs, or endoscopy.

1. Melaku Yitbarek(M.D)
Internal Medicine Unit
March,2018

2.  Introduction
 Definition
 Etiology
 Initial Evaluation
 Diagonostic Evaluation and
 Intial Management

3.  Dyspepsia is a common symptom with an
extensive differential diagnosis and a
heterogeneous pathophysiology.
 It occurs in approximately 25 percent of the
population each year, but most affected
people do not seek medical care
 Although dyspepsia does not affect survival,
it is responsible for substantial health care
costs and significantly affects quality of life

4.  Dyspepsia describes a wide and common
clinical entity which presents in one of the
three ways:
1. Epigastric pain/burning (epigastric pain
syndrome)
2. 2. Postprandial fullness
3. 3. Early satiety

5.  Dyspepsia Secondary to Organic Disease
 Peptic ulcer disease
 Gastroesophageal reflux
 Gastroesophageal Malignancy
 Drug induced dyspepsia:NSAIDs
Other causes: Like crohn’s disease, Chronic Pancreatitis
 Functional dyspepsia

6.  Upper abdominal pain or discomfort is the most
prominent symptom in patients with peptic ulcers
 While classic symptoms of duodenal ulcer occur when
acid is secreted in the absence of a food buffer (i.e,
two to five hours after meals or on an empty
stomach), peptic ulcers can be associated with food-
provoked symptoms
 Peptic ulcers can also be associated with postprandial
belching, epigastric fullness, early satiation, fatty
food intolerance, nausea, and occasional vomiting

7.  The most common symptoms of
gastroesophageal reflux disease (GERD) are
retrosternal burning pain and regurgitation
 GERD should be suspected when these
symptoms accompany dyspepsia and are the
predominant complaints

8.  Uncommon cause of chronic dyspepsia
 The incidence of malignancy also increases
with age.
 When present, abdominal pain tends to be
epigastric, vague and mild early in the
disease but more severe and constant as the
disease progresses

9.  Classic biliary pain is characterized by
episodic acute and severe upper abdominal
pain, usually in the epigastrium or right
upper quadrant
 The pain typically lasts for at least one hour
and may persist for several hours.
 The pain may radiate to the back or scapula

10.  Functional (idiopathic or nonulcer) dyspepsia
is defined as the presence of one or more of
the following:
 postprandial fullness, early satiation,
epigastric pain or burning,
 and no evidence of structural disease to
explain the symptoms

11.  A history, physical examination, and
laboratory evaluation are the first steps in the
evaluation of a patient with new onset of
dyspepsia
 A detailed history is necessary to narrow the
differential diagnosis and to identify GERD
and NSAID-induced dyspepsia, as well as
patients with alarm features

12.  A dominant history ofheartburn,regurgitation, or
cough is suggestive of GERD
 NSAID use raises the possibility of NSAID
dyspepsia and peptic ulcer disease
 Significant weight loss, anorexia, vomiting,
dysphagia, odynophagia, and a family history of
gastrointestinal cancers suggest the presence of
an underlying malignancy
 The presence of severe episodic epigastric or
right upper quadrant abdominal pain lasting
more than an hour or pain that occurs at any
time is suggestive of symptomatic cholelithiasis

14.  The physical examination in patients with
dyspepsia is usually normal, except for
epigastric tenderness
 Other findings on physical examination may
include: a palpable abdominal mass (eg,
hepatoma) or lymphadenopathy (eg, left
supraclavicular or periumbilical in gastric
cancer), jaundice (eg, secondary to liver
metastasis) or pallor secondary to anemia

16.  CBC
 H. Pylori test- IgG serology or stool antigen
or 13C-urea test
 stool for occult blood-when indicated
 Liver enzymes
 Upper GI Endoscopy when indicated

17. Patients with alarm features:
Upper GI endoscopy:
 Upper endoscopy provides a gold standard
for establishing a specific cause in patients
with upper abdominal pain.
 Biopsies of the stomach should be obtained
to rule out Helicobacter pylori .
 Patients with H. pylori should receive
eradication therapy in addition to treatment
based on the underlying diagnosis

18. Patients with no alarm features:
Test for H.Pylori:
 If evidence of H.pylori infection: Eradication
therapy
 If no evidence of of H.Pylori: Treat with anti
acid secretary agents: PPIs

19.  Triple therapy
• Omeprazole+ Amoxicillin+ Clarithromycin
• BSS+ Metronidazole+ TTC
 Quadruple therapy
• Omeprazole+ BSS+ Metronidazole+ TTC

20.  Harrison’s Principles of Internal Medicine,19th
Edition
 Standard treatment guideline for general
Hospital,2014
 Uptodate 21.6

21. Thank You...