Author: MaineGeneral Gastroenterology
Summary: Dyspepsia is defined as having one or more of the following symptoms:
|Possible underlying causes of dyspepsia|
|Peptic ulcer disease and H. Pylori infection
Biliary pain: gallstones, sphincter of Oddi dysfunction, functional gallbladder disorder
Chronic abdominal wall pain
Intra-abdominal cancer: Gastric or esophageal cancer, pancreatic cancer, hepatocellular carcinoma
Medications: potassium, digitalis, iron, theophylline, antibiotics [especially ampicillin and erythromycin], NSAIDs, glucocorticoids, niacin, gemfibrozil, narcotics, colchicine, quinidine, estrogens, levodopa
Infiltrative diseases of the stomach (e.g., Crohn disease, eosinophilic gastroenteritis, sarcoidosis)
Metabolic disturbances (hypercalcemia, hyperkalemia)
Ischemic bowel disease, celiac artery compression syndrome, superior mesenteric artery syndrome
Systemic disorders (diabetes mellitus, thyroid and parathyroid disorders, connective tissue disease)
Intestinal parasites (Giardia, Strongyloides, Anisakis)
Diagnostic strategies and initial management:
*5-biopsy Sydney System (lesser and greater curvature of antrum, lesser and greater curvature of body, incisura angularis) plus duodenal biopsy if indicated.
**Stool antigen assay preferred. Urea breath testing optional. Do not use serology testing. Test should be done 2-4 weeks (preferred 4 weeks) after stopping PPI, antibiotics, bismuth.
- Endoscopy should be considered for patients in whom there is a clinical suspicion of malignancy even in the absence of alarm features.
- A negative endoscopy may reduce patient’s anxiety and increase patient satisfaction.
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