![]() ![]() This is reasonable even if appearances are normal. If endoscopy is performed, then gastric body and duodenal biopsies should be acquired to test for Helicobacter pylori infection and to exclude coeliac disease, respectively. Endoscopy should also be performed in patients who have functional dyspepsia if alarm features develop, in patients who have severe symptoms that fail to respond to therapy and if there is an important change in symptoms during follow up. Early endoscopy is indicated to exclude a life-threatening pathology in this group. 2, 10Ģ0–40% of patients with functional dyspepsia report clinically relevant weight loss (>5% body weight) at initial assessment. Prospective trials and meta-analyses indicate that the presence of alarm symptoms is associated with a 5–10% risk of serious disease, compared with the 1–2% risk in patients who have no alarm symptoms. Alarm features include: dysphagia, weight loss, an abdominal mass or lymphadenopathy, evidence of gastrointestinal blood loss or iron deficiency anaemia, recurrent vomiting, and the recent onset of dyspeptic symptoms (or a change in bowel habit) in patients who are over 45 or 55 years old (depending on local guidelines). ![]() One of the major challenges in the proper management of patients with dyspepsia is to correctly identify when an oesophagogastroduodenoscopy is indicated. Here, I discuss 10 common and/or high-impact mistakes that are made in the diagnosis and treatment of patients with dyspeptic symptoms: five related to diagnosis, five related to treatment. Notwithstanding the constructive advice provided by published reviews and guidelines, the broad definition of dyspepsia, lack of diagnostic investigations, uncertain cause of disease, psychosocial issues and paucity of specific treatments make the management of dyspepsia challenging. ![]() anxiety or somatization disorder) and/or psychosocial stress are also present in a significant proportion of patients who seek medical attention. irritable bowel syndrome ) and chronic pain syndromes (e.g. fibromyalgia). 6 There is an important overlap between functional dyspepsia and other functional gastrointestinal diseases (e.g. 5 Other patients have an epigastric pain syndrome in which discomfort is independent of food intake and gastrointestinal function. 3, 4 In many cases symptoms are increased after meal ingestion (postprandial distress syndrome), being triggered by impaired gastric accommodation and visceral hypersensitivity to gastric distension. gastroparesis or gastric dumping).Ĭlinical guidelines recommend that endoscopy is not always required for diagnosis a positive diagnosis of GORD and functional dyspepsia can be based on clinical presentation in the absence of alarm symptoms or features (see below). 2 Dyspeptic symptoms may also result from other problems, such as medication intolerance, pancreatitis, biliary tract disease or motility disorders (e.g. 1 The symptoms of dyspepsia are nonspecific, but most commonly result from one of four underlying disorders: functional (nonulcer) dyspepsia, gastro-oesophageal reflux disease (GORD 10–20% erosive esophagitis), peptic ulcer disease (5–15%) and malignancy (~1%). Symptoms include epigastric pain or discomfort, bloating, early satiety and/or fullness after meals, repeated belching or regurgitation (often rumination), nausea and heartburn. Dyspepsia refers to upper abdominal discomfort that is thought to arise from the upper gastrointestinal tract. ![]()
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