Dyspepsia Disease

BASICS

DESCRIPTION

An ill-defined condition characterized by the presence of chronic intermittent symptoms of epigastric pain and fullness, early satiety, nausea and/or vomiting without mucosal lesions or other structural abnormalities of the gastrointestinal tract

System(s) affected: Gastrointestinal
Genetics: N/A
Incidence/Prevalence in USA: Common, affecting 15-20% of patients referred to gastroenterologists
Predominant age: Adults, but can be seen in children
Predominant sex: Females > Males

SIGNS AND SYMPTOMS

Belching
Aerophagia, gaseousness, abdominal distension
Borborygmus
Epigastric pain, gnawing or burning; eating may improve or worsen symptoms
Substernal pain, gnawing or burning
Anorexia, nausea, or vomiting
Change in bowel habits
Abdominal tenderness
No anatomic abnormalities

CAUSES

Often unknown, may be of several different etiologies
Evanescent ulcers (20-30% go on to develop ulcers)
Gastric motility disorder
Adverse drug effects
Helicobacter pylori may be causative in some patients, but this is controversial

RISK FACTORS

Other functional disorders
Anxiety
Depression

DIAGNOSIS

LABORATORY

CBC
Chemistry panel
Stool for occult blood

Drugs that may alter lab results: Too many to list
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

None (by definition)

SPECIAL TESTS

Esophageal manometry (rarely needed)
24-hour intra-esophageal pH monitoring (rarely needed)

IMAGING

Recommended in:
- Patients over 45 years of age at onset of symptoms
- Patients with symptoms and signs suggesting more serious disease
- Patients who need added reassurance
- Younger patients who do not respond rapidly to empiric treatment
Usual:
- Endoscopy, or
- Upper GI series
Sometimes:
- Barium enema
- Gallbladder studies (e.g., ultrasound or oral cholecystogram)
- Nuclear medicine gastric emptying study (in selected cases)

DIAGNOSTIC PROCEDURES

Careful history and physical
Normal studies of esophagus, stomach and duodenum (particularly in patients over 45)

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Supportive measures
- Reassurance
- Do not investigate excessively
- Dietary changes (see below)
- Elevate head of bed (where applicable)
- Maintain ideal body weight
- Explore psychological issues

SURGICAL MEASURES

N/A

ACTIVITY

Stress reduction
- Relaxation techniques
- Physical exercise
- Reflux precautions where applicable

DIET

Avoid foods known to exacerbate symptoms
Frequent small meals
Avoid regular and decaffeinated coffee
Avoid tea, cocoa, chocolate
Avoid heavy alcohol use
Avoid cigarette smoking
Avoid aspirin containing compounds and NSAIDs

PATIENT EDUCATION

See Web site

FOLLOW UP

PREVENTION/AVOIDANCE

Continued health habits suggested under Treatment (i.e., avoid activities known to exacerbate problems, maintain healthy lifestyle, continue stress reduction techniques)

POSSIBLE COMPLICATIONS

Undiagnosed serious pathology

EXPECTED COURSE AND PROGNOSIS

Long-term or chronic symptoms with periods that are symptom free

MISCELLANEOUS

ASSOCIATED CONDITIONS

Other functional bowel disorders

AGE-RELATED FACTORS

Pediatric: Look for family system dysfunction
Geriatric: Cancer risk is higher
Others: N/A

PREGNANCY

May exacerbate

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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