Evaluation and management of dyspepsia - current perspectives

  • KL Goh

Abstract

Key points

o Spend time taking a good history and performing a physical examination even though the majority of patients have“functional” symptoms. Exclude “non-dyspepsia” conditions and be careful in excluding a “surgical” abdomen.

o Consider gastroscopy or an ultrasound or CT scan of the abdomen, if alarm symptoms are present. The thresholdto investigate should be lower with older male patients as there is a higher chance of organic disease.

o When patients’ symptoms are unclear, a close follow-up and review is useful. Symptoms persisting over manymonths or years are unlikely to have an organic basis.

o Explore, understand and address patients’ concerns including psychological problems. Patients need to be reassured.

o Sensible advice on food/meal and lifestyle modifications is useful. Antacids often give immediate relief to acutedyspeptic symptoms. Gastroesophageal reflux symptoms may be atypical − a trial of PPI therapy may be useful.Patients with wind, bloating and discomfort often benefit from a course of prokinetic agents.

References

Moayyedi P, Mason J. Clinical and economic consequences of dyspepsia in the community. Gut. 2002; 50 Suppl 4:10-2.

Petersen H. Epidemiological and economic aspects of dyspepsia. In: Colin-Jones DG (ed). Practical approaches to the management of dyspepsia. The Medicine Group, Langhorne, Pa, 1989,2-5.

Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ. 1989; 298:30-2

Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ 3rd. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259-68.

Jones R, Lydeard SE, Hobbs FD, et al. Dyspepsia in England and Scotland. Gut. 1990;31(4):401-5

Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ 3rd. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol. 1992;136(2):165-77.

Jones R, Lydeard S. Dyspepsia in the community: a follow-up study. Br J Clin Pract. 1992;46(2):95-7.

Knill-Jones RP. Geographical differences in the prevalence of dyspepsia. Scand J Gastroenterol. 1991;26 (Suppl 182):17-24.

Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38(9):1569-80.

Schlemper RJ, Van Der Werf S DJ, Biemond I, Lamers C BHJ. Dyspepsia and Helicobacter pylori in Japanese employees with and without ulcer history. J Gastroenterol Hepatol. 1995;10(6):633-8.

Kiyota K. Epidemiology of non-ulcer dyspepsia (NUD) in Japan. Nippon Shokakibyo Gakkai Zasshi. 1992;89(9):1973-81.

Hirakawa K, Adachi K, Katsube T, et al. Prevalence of non-ulcer dyspepsia in the Japanese population. J Gastroenterol Hepatol. 1999;14(11):1083-7.

Lu CL, Lang HC, Chang FY, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: a study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol. 2005;40(4):402-11.

Talley NJ, Colin-Jones D, Koch KL, et al. Functional dyspepsia: A classification with guidelines for diagnosis and treatment. Gastroenterology International. 1991;4:145-60.

Drossman DA. The functional gastrointestinal disorders and the Rome II process. Gut. 1999;45(Suppl 2):II1–5.

Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–90.

Price WH. Gallbladder dyspepsia. BMJ. 1963;2:138-141.

Wegge C, Kjaergaard J. Evaluation of symptoms and signs of gallbladder disease in patients admitted with upper abdominal pain. Scand J Gastroenterol. 1985;20(8):933-6.

Talley NJ. Spectrum of chronic dyspepsia in the presence of irritable bowel syndrome. Scand J Gastroenterol Suppl. 1991;182:7-10.

Gotthard R. Aspects on gastric acid, bile acid and treatment in patients with peptic ulcer disease and dyspepsia of unknown origin. Linkoping University Medical Dissertations No. 261, Linkoping, 1987.

Collen MJ, Loebenberg MJ. Basal gastric acid secretion in non-ulcer dyspepsia with or without duodenitis. Dig Dis Sci. 1989;34(2):246-50.

El-Omar E, Penman I, Ardill JE, McColl KE. A substantial proportion of non-ulcer dyspepsia patients have the same abnormality of secretion as duodenal ulcer patients. Gut. 1995; 36(4):534-8.

George AA, Tsuchiyose M, Dooley CP. Sensitivity of the gastric mucosa to acid and duodenal contents in patients with non-ulcer dyspepsia. Gastroenterology. 1991;101(1):3-6.

Moayyedi P, Soo S, Deeks J, et al. Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006; 19(2):CD002096.

Stanghellini V, Ghidini G, Maccarini M, et al. Fasting and postprandial gastrointestinal motility in ulcer and nonulcer dyspepsia. Gut. 1992; 33(2):184-90.

Talley NJ, Shuter B, McCrudden G, et al. Lack of association between gastric emptying and symptoms in nonulcer dyspepsia. J Clin Gastroenterol. 1989;11(6):625-30.

Cuomo R, Sarnelli G, Grasso R, et al. Functional dyspepsia symptoms, gastric emptying and satiety provocation test: Analysis of relationships. Scand J Gastroenterol. 2001;36(10):1030-6.

Quigley EMM. Motility, heartburn and dyspepsia. Aliment Pharmacol Ther. 1997; 11 (Suppl 2):41-50.

Coffin B, Azpiroz F, Guarner F, Malagelada JR. Selective gastric hypersensitivity and reflex hyporeactivity in functional dyspepsia. Gastroenterology. 1994;107(5):1345-51.

Talley NJ, Phillips SF, Bruce B, et al. Relation among personality and symptoms in non-ulcer dyspepsia and the irritable bowel syndrome. Gastroenterology. 1990;99(2):327-33.

Jonsson BH, Theorell T, Gotthard R. Symptoms and personality in patients with chronic functional dyspepsia. J Psychosom Res. 1995; 39(1):93-102.

Hui WM, Shiu LP, Lam SK. The perception of life events and daily stress in non-ulcer dyspepsia. Am J Gastroenterol. 1991;86(3):292-6.

Haug TT, Wilhelmsen I, Berstad A, Ursin H. Life events and stress in patients with functional dyspepsia compared with patients with duodenal ulcer and healthy controls. Scand J Gastroenterol. 1995;30(6):524-30.

Richter JE. Stress and psychological and environmental factors in functional dyspepsia. Scand J Gastroenterol Suppl. 1991;182:40-6.

Ofman JJ, Maclean CH, Straus WL, et al. Meta-analysis of dyspepsia and nonsteroidal antiinflammatory drugs. Arthritis Rheum. 2003;49(4):508-18.

Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of H. pylori infection. J Gastroenterol Hepatol. 1998;13(1):1-12.

Thompson WG. Placebos: a review of the placebo response. Am J Gastroenterol. 2000;95(7):1637-43.

Wong WM, Wong BC, Hung WK, et al. Double blind, randomised, placebo controlled study of four weeks of lansoprazole for the treatment of functional dyspepsia in Chinese patients. Gut. 2002;51(4):502-6.

Talley NJ, Meineche-Schmidt V, Pare P, et al. Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies). Aliment Pharmacol Ther. 1998;12(11):1055-65.

van Zanten SV, Armstrong D, Chiba N, et al. Esomeprazole 40 mg once a day in patients with functional dyspepsia: the randomized, placebo-controlled “ENTER” trial. Am J Gastroenterol. 2006; 101(9): 2096-106.

Veldhuyzen van Zanten SJ, Jones MJ, Verlinden M, Talley NJ. Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis. Am J Gastroenterol. 2001;96(3):689-96.

Holtmann G, Talley NJ, Liebregts T, Adam B, Parow C. A placebocontrolled trial of itopride in functional dyspepsia. N Engl J Med. 2006;354(8):832-40.

Published
2012-03-31
How to Cite
GohK. (2012). Evaluation and management of dyspepsia - current perspectives. Malaysian Family Physician, 2(1), 6. Retrieved from https://www.e-mfp.org/ojs3/index.php/MFP/article/view/124
Section
Original Articles