Dyspepsia

Question 1

Definition

Answer 1

Dyspepsia is a syndrome of collective symptoms where there’s early satiety, abdominal distention, and fullness are often
described in addition to epigastric or substernal burning
discomfort or pain

Question 2

causes

Answer 2

1) Organic:

• Peptic ulcer disease (10%)
• Gastric cancer (less than 1%)
• Pancreaticobiliary diseases
• Medications
• Parasites

2) Functional (Non-ulcer or
idiopathic)
is defined as dyspeptic symptoms in patient who has no abnormalities on physical exam and upper GI endoscopy and/or other evaluation (e.g. lab tests, imaging)
• Celiac disease

stress diet depression anxiety

Question 3

Functional Dyspepsia (Rome IV Criteria)

Answer 3

is a condition of impaired digestion defined as the presence of
dyspeptic symptoms as
• PDS mainly composed of early satiation or postprandial fullness
and
• EPS, mainly composed of pain or burning in the epigastric region
in the absence of an organic disease that is likely to explain these
symptoms
• affects up to 16% of otherwise healthy individuals in the general
populati

Question 4

Risk factors of functional dyspepsia

Answer 4

Infection: H. Pylori, Escherichia coli O157, Campylobacter jejuni,
and Salmonella
• Recent antibiotic use
• Female sex
• Being overweight
• Smoking
• Use of NSADs
• Psychosocial dysfunction

Question 5

Pathophysiology of FD

Answer 5

remains incompletely understood, but it is probably related to disordered
communication between the gut and brain
CNS modulation (stress, anxiety)
(other: food intolerances, medications, genetic factors, postinfectious)
Visceral hypersensitivity –
lowered threshold for induction of pain in the presence of normal gastric
compliance
(H+, wall distension)
Gastric and duodenum motility disorders (decreased fundic
accommodation, abnormal distribution of gastric contents, rapid or
delayed gastric emptying, gastric dysrhythmias, antral hypomotility,
abdominal vagal dysfuncti

Question 6

symptoms

Answer 6

epigastric pain burning at least once a week
early satiation-feeling of fullness
heartburn

epigastric bloating
• belching
• nausea
NB! vomiting is unusual

Symptoms duration is at least 3 months, with onset at least 6
months before diagnosis

Question 7

Red flag symptoms (“Alarm features”)

Answer 7

Red flag symptoms (“Alarm features”)
Prevalence -from 33% to 61%
Sensitivity - from 0% to 100%
 Age more than 45-50
 Acute episode with dyspnea, diaphoresis, or tachycardia
 Family history of gastrointestinal (GI) cancer, palpable abdominal mass
or lymphadenopathy
 Anorexia
 Vomiting
 Weight loss
 Blood in the stool, «unexplained» anemia
 Dysphagia or odinophagia
 Failure to respond to therapy with H2 blockers or PPIs within 7-10 days

Question 8

Diagnosis

Answer 8

Xray barium
Ph of stomach
Ultrasound
Stool test
Blood test
Endoscopy
Etiology: Н. pylori; psychosocial dysfunction; visceral
hypersensitivity, GI dysmotility
• Structural changes: NO evidence of organic, systemic,
metabolic or structural pathology likely to explain symptoms
Including on upper endoscopy
• Development of disease: for 3 months prior with symptom
onset ≥ 6 months ago – FD is chronic and relapsing disease
• Efficacy of treatment: eradication of HP and PPI

Question 9

Treatment of Dyspepsia

Answer 9

Life style changes
B12 vitamin therapy
Epigastric pain syndrome: antacids, acid suppressing drugs
for at least 4 weeks, eradication therapy (HP can create a
cascade of events leading to gastric inflammation and
immune activation)
• Postprandial distress syndrome: medications which increase
emptying of stomach (“prokinetics”)
If symptoms persist treatment with tricyclic antidepressants,
psychotherapy, acupuncture, etc.
Despite treatment the symptoms may persist for months or
years before disappeari