Dyspepsia: Difference between revisions
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'''Dyspepsia''' (from the [[Greek language|Greek]] "δυς-" (Dys-), meaning hard or difficult, and "πέψη" (Pepse), meaning digestion) is chronic or recurrent pain or discomfort centered in the upper abdomen <ref>N. Talley, et al., "Guidelines for the management of dyspepsia", ''American Journal of Gastroenterology'' 100 (2005), pp. 2324-2337.</ref> Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. It can be accompanied by bloating, belching, [[nausea]] or heartburn. [[Heartburn]] is excluded from the definition of dyspesia in ICD 10, as it usually has a different cause and management pathway. | '''Dyspepsia''' (from the [[Greek language|Greek]] "δυς-" (Dys-), meaning hard or difficult, and "πέψη" (Pepse), meaning digestion) is chronic or recurrent pain or discomfort centered in the upper abdomen <ref>N. Talley, et al., "Guidelines for the management of dyspepsia", ''American Journal of Gastroenterology'' 100 (2005), pp. 2324-2337.</ref> Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. It can be accompanied by bloating, belching, [[nausea]] or heartburn. It may be called indigestion. [[Heartburn]] is excluded from the definition of dyspesia in ICD 10, as it usually has a different cause and management pathway. | ||
==Cause/etiology== | ==Cause/etiology== | ||
Several studies provide prevalences of underlying causes based on findings at [[gastroesophagoscopy]] (EGD).<ref name="pmid8224642">{{cite journal |author=Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR |title=Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy |journal=Gastroenterology |volume=105 |issue=5 |pages=1378–86 |year=1993 |pmid=8224642 |doi=}}</ref><ref name="pmid2904061">{{cite journal |author=Williams B, Luckas M, Ellingham JH, Dain A, Wicks AC |title=Do young patients with dyspepsia need investigation? |journal=Lancet |volume=2 |issue=8624 |pages=1349–51 |year=1988 |pmid=2904061 |doi=}}</ref><ref name="pmid2021764">{{cite journal |author=Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG |title=Prevalences of endoscopic and histological findings in subjects with and without dyspepsia |journal=BMJ |volume=302 |issue=6779 |pages=749–52 |year=1991 |pmid=2021764 |doi=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=2021764 Fulltext]</ref> | |||
{| class="wikitable" style="text-align:center" | |||
|+ Findings in various populations | |||
! !!Patients referred to gastroenterologists for dyspesia<ref name="pmid8224642"/> !! Primary care patients with dyspepsia<ref name="pmid2904061"/>!!Volunteers ''without'' dyspepsia<ref name="pmid2021764"/> | |||
|- | |||
|colspan="4"|<b>Normal</b> | |||
|- | |||
| Macroscopically normal<br>by EGD || 60% || 54% || 66% | |||
|- | |||
| Histologically normal<br>by biopsy at EGD || || || 35% | |||
|- | |||
|colspan="4"|<b>Esophagus</b> | |||
|- | |||
| Macroscopic esophagitis<br>by EGD || 14% || 12% || 22% | |||
|- | |||
| Hiatal hernia >2 cm by UGI|| 40% || || 26% | |||
|- | |||
| Hiatal hernia by EGD || || 3% || 3% | |||
|- | |||
|colspan="4"|<b>Stomach</b> | |||
|- | |||
| Peptic ulcer disease (PUD) || 20% || 8% || 4% | |||
|} | |||
==Diagnosis== | |||
Several studies indicate the need to test dyspeptic patients for ''H. pylori''.<ref name="pmid16484121">{{cite journal |author=Valle PC, Breckan RK, Amin A, ''et al'' |title="Test, score and scope": a selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referred from primary care |journal=Scand. J. Gastroenterol. |volume=41 |issue=2 |pages=161–9 |year=2006 |pmid=16484121 |doi=10.1080/00365520500286881}}</ref><ref name="pmid16771937">{{cite journal |author=Jarbol DE, Kragstrup J, Stovring H, Havelund T, Schaffalitzky de Muckadell OB |title=Proton pump inhibitor or testing for Helicobacter pylori as the first step for patients presenting with dyspepsia? A cluster-randomized trial |journal=Am. J. Gastroenterol. |volume=101 |issue=6 |pages=1200–8 |year=2006 |pmid=16771937 |doi=10.1111/j.1572-0241.2006.00673.x}}</ref><ref name="pmid16638253">{{cite journal |author=Shaw IS, Valori RM, Charlett A, McNulty CA |title=Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial |journal=The British journal of general practice : the journal of the Royal College of General Practitioners |volume=56 |issue=526 |pages=369–74 |year=2006 |pmid=16638253 |doi=}}</ref> One study found that by using "''H. pylori'' serology and a hemoglobin reading in the evaluation of dyspeptic patients under 45 years of age, the need for endoscopy can be reduced by 55%."<ref name="pmid16484121">/ | |||
==References== | ==References== | ||
Revision as of 14:10, 11 October 2007
Dyspepsia (from the Greek "δυς-" (Dys-), meaning hard or difficult, and "πέψη" (Pepse), meaning digestion) is chronic or recurrent pain or discomfort centered in the upper abdomen [1] Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. It can be accompanied by bloating, belching, nausea or heartburn. It may be called indigestion. Heartburn is excluded from the definition of dyspesia in ICD 10, as it usually has a different cause and management pathway.
Cause/etiology
Several studies provide prevalences of underlying causes based on findings at gastroesophagoscopy (EGD).[2][3][4]
| Patients referred to gastroenterologists for dyspesia[2] | Primary care patients with dyspepsia[3] | Volunteers without dyspepsia[4] | |
|---|---|---|---|
| Normal | |||
| Macroscopically normal by EGD |
60% | 54% | 66% |
| Histologically normal by biopsy at EGD |
35% | ||
| Esophagus | |||
| Macroscopic esophagitis by EGD |
14% | 12% | 22% |
| Hiatal hernia >2 cm by UGI | 40% | 26% | |
| Hiatal hernia by EGD | 3% | 3% | |
| Stomach | |||
| Peptic ulcer disease (PUD) | 20% | 8% | 4% |
Diagnosis
Several studies indicate the need to test dyspeptic patients for H. pylori.[5][6][7] One study found that by using "H. pylori serology and a hemoglobin reading in the evaluation of dyspeptic patients under 45 years of age, the need for endoscopy can be reduced by 55%."<ref name="pmid16484121">/
References
- ↑ N. Talley, et al., "Guidelines for the management of dyspepsia", American Journal of Gastroenterology 100 (2005), pp. 2324-2337.
- ↑ 2.0 2.1 Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR (1993). "Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy". Gastroenterology 105 (5): 1378–86. PMID 8224642. [e]
- ↑ 3.0 3.1 Williams B, Luckas M, Ellingham JH, Dain A, Wicks AC (1988). "Do young patients with dyspepsia need investigation?". Lancet 2 (8624): 1349–51. PMID 2904061. [e]
- ↑ 4.0 4.1 Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG (1991). "Prevalences of endoscopic and histological findings in subjects with and without dyspepsia". BMJ 302 (6779): 749–52. PMID 2021764. [e] Fulltext
- ↑ Valle PC, Breckan RK, Amin A, et al (2006). ""Test, score and scope": a selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referred from primary care". Scand. J. Gastroenterol. 41 (2): 161–9. DOI:10.1080/00365520500286881. PMID 16484121. Research Blogging.
- ↑ Jarbol DE, Kragstrup J, Stovring H, Havelund T, Schaffalitzky de Muckadell OB (2006). "Proton pump inhibitor or testing for Helicobacter pylori as the first step for patients presenting with dyspepsia? A cluster-randomized trial". Am. J. Gastroenterol. 101 (6): 1200–8. DOI:10.1111/j.1572-0241.2006.00673.x. PMID 16771937. Research Blogging.
- ↑ Shaw IS, Valori RM, Charlett A, McNulty CA (2006). "Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial". The British journal of general practice : the journal of the Royal College of General Practitioners 56 (526): 369–74. PMID 16638253. [e]