Dispepsia (Dr.ali)

7/30/2019 Dispepsia (Dr.ali)

1/22

FUNCTIONAL DYSPEPSIA

Dolvy Girawanand

H Ali Djumhana


2/22

DEFINITION

Dyspepsia refers to pain or discomfortcentered in the upper abdomen


3/22

Centered implies that the

pain or discomfort is mainlyin or around the midline.

Pain in the right or lefthypochondrium is not

considered to be

representative of dyspepsia


4/22

Dyspepsia

Discomfort may be characterized by or

associated with upper abdominal fullness,

early satiety, bloating , or nausea

These symptoms typically are

accompanied by a component of upperabdominal distress


5/22

Spectrum of Dyspepsia


6/22

Dyspepsia

The painful or uncomfortable symptoms

may be intermittent or continuous , andmay or may not be related to meals


7/22

Causes of dyspepsia

Those with an identified cause for the

symptoms

Those with an identifiable of

pathophysiological or microbiological

abnormalities, however the clinical

relevance is uncertain

Those with no identifiable explanationfor the symptoms


8/22


FD is a clinical syndrome which is defined by

chronic or recurrent upper abdominalsymptoms without a cause that is identifiableby conventional diagnostic means such asendoscopy, radiology or histology.


9/22

Diagnostic approach

Symptom alone are unable to discriminate

organic dyspepsia from non organic

dyspepsia

Patients need to have further examination

to rule out relevant organic disease

Functional dyspepsia is a diagnosis of

exclusion


10/22

Definition of Functional Dyspepsia


11/22

CLASSIFICATION

(Based 0n Clinical symptoms)

Ulcer like dyspepsia

Pain is the predominant symptom Dysmotility like dyspepsia

Discomfort is the predominant symptom and

accompanied with abdominal fullness , early

satiety, bloating, or nausea

Unspecified ( non specific) dyspepsia

The symptom is not fulfill the criteria for ulcer-

like or dysmotility-like3 dyspepsia


12/22


Dyspepsia is a very common complaint.In western country:

The prevalence rate of FD :10-40%.

The remission rate :10-20% annually

The recurrence rate :20-55%


13/22

PATHOPHYSIOLOGY OF FUNCTIONALDYSPEPSIA

Pathophysiology of FD is poorly understood

The symptoms can be associated with

Motility abnormality of the stomach

Visceral hyperalgesia/hypersensitivityHp gastritis

Psychosocial factor


14/22

PATHOPHYSIOLOGY OF FUNCTIONALDYSPEPSIA

In such a group of patient the symptoms are

associated with abnormal motor function of thestomach:

Impairment of gastric accommodation

Delayed gastric emptying

Antral hypomotility

Bradygastria / Tachygastria

Intragastric maldistribution of solid and liquid food

small bowel dysmotility

(Malagelada etal.1985;Camilleri etal.1986;Waldron etal.1991;Hveem etal.1996;Stanghellini etal.1996)


15/22

Disorders of gastric neuromuscular function:

myoelectrical and contractile abnormalitiesImpaired fundic relaxation

Abnormal fund ic empty ing

Weak 3 cpm rhythm

Dilated gastric antrum

An tral hypom ot i l ity

Gastroparesis

Gastric dysrhythmias

Small bowel

dysmotility


16/22

DIAGNOSTIC APPROACHCareful history taking and Physical examination Alcohol, smoking, drugs (NSAID), weight loss, abdml

surgery , intractable pain,dysphagia, recurrent vomitingGI bleeding, pallor, jaundice abdominal mass, abdominal

scar.Laboratory examination CBC, Liver function test, Renal function test, ECG, Test

for Hp

X ray examination and USG upper abdomenEndoscopy examination and biopsy

EGG, Gastric emptying study, Manometry, 24 h

pH monitoring


17/22

Treatment

Empirical treatment could be started to the patientwith uninvestigated dyspepsia without alarm

symptoms. The treatment should be individualize

First line treatment is prokinetic agent or anti

secretory drug. However the placebo response ishigh (20-60%)

Some patients should be avoid precipitating food or

drink

Other patients may be need anti anxiety or anti

depressant drugs


18/22

Uninvestigated vs Investigated

Dyspepsia

It is important to distinguish the patient who

presents dyspepsia that has not beeninvestigated (uninvestigated dyspepsia )

from patients with diagnostic label after

investigation, with either a structural

diagnosis ( such as Peptic ulcer or GERD) or

Functional dyspepsia


19/22


20/22

Alarm symtomsWeight loss

Anaemia

DysphagiaRecurrent vomiting

Haematemesis and or maelena

Abdominal mass


21/22

Pharmacologic Treatment for FD

Prokinetic agent Dopaminergic ( Metoclopramid , Domperidone)

Serotonergic ( Cisapride, Ondansetron, Granisetron)

Anti secretion H2 blockers(Cimetidin,Ranitidin,Nizatidin,Famotidin,Roxatidin)

PPI ( Omeprazole,Mesomeprazole,Lansoprazole,Rabeprazole,Pantopprazole)

Antacid

Cytoprotector agent Sucralfate

Rebamipide

Trepenon

Anti anxiety or Anti depression


22/22

Documents

Dispepsia (Dr.ali)