Dyspepsia

 

RESPONDING TO SYMPTOMS OF MINOR AILMENTS

3) DYSPEPSIA

INTRODUCTION

• The term dyspepsia is derived from the Greek word meaning “improper digestion.”
• It refers to upper abdominal discomfort usually related to:
• Food intake
• Alcohol consumption
• Common causes include:
• Certain drugs: NSAIDs, antibiotics, digoxin, bisphosphonates, theophylline
• Smoking
• Stressful lifestyle

TYPES

1. Acute (Infrequent) Dyspepsia

• Usually self-limiting
• Associated with:
• Irregular eating habits
• Alcohol intake
• Smoking
• Stress

2. Chronic Dyspepsia

• Recurrent symptoms such as:
• Epigastric pain
• Bloating
• Belching
• Nausea, vomiting
• Early satiety

CAUSES OF DYSPEPSIA

• Peptic ulcer disease
• Gastroesophageal reflux disease (GERD)
• Helicobacter pylori infection
• Gastric malignancy
• Functional (idiopathic) dyspepsia

Functional dyspepsia = No structural abnormality but persistent symptoms

PATHOPHYSIOLOGY

• Visceral hypersensitivity
• Impaired gastric accommodation
• Delayed gastric emptying
• Antral overdistension
• Abnormal gastroduodenal motility

CLINICAL FEATURES

Common Symptoms

• Epigastric discomfort
• Bloating
• Nausea
• Belching
• Early satiety

Alarm Symptoms (Require Endoscopy)

• Unexplained weight loss (>10%)
• Persistent vomiting
• Severe continuous pain
• Dysphagia
• Hematemesis or melena
• Anemia
• Jaundice

INVESTIGATION

·        Patients <55 years without alarm symptoms:

• Test for H. pylori (urea breath test)

·        Patients >35–55 years or with alarm symptoms:

• Upper GI endoscopy

MANAGEMENT OF DYSPEPSIA

1. NON-PHARMACOLOGICAL THERAPY

• Dietary modifications (bland diet)
• Avoid:
• Alcohol
• Smoking
• Caffeine
• Fatty foods
• Weight reduction
• Stress management

2. PHARMACOLOGICAL THERAPY

A. ANTACIDS

·        Example: Aluminum + Magnesium salts

·        Mechanism:

• Neutralize gastric acid
• Provide mucosal protection

·        Dose:

• 15 mL, 3–4 times daily

·        Note:

• Suspensions are more effective than tablets

B. H2 RECEPTOR ANTAGONISTS

·        Drugs:

• Ranitidine
• Famotidine

·        Mechanism:

• Block histamine (H2 receptors) → ↓ acid secretion

·        Dose:

• Famotidine: 20 mg BID or 40 mg OD
• Ranitidine: 150 mg BID or 300 mg OD

C. PROTON PUMP INHIBITORS (PPIs)

·        Drugs:

• Omeprazole 20 mg OD
• Rabeprazole 20 mg OD
• Lansoprazole 30 mg OD
• Pantoprazole 40 mg OD

·        Mechanism:

• Irreversibly inhibit H⁺/K⁺ ATPase (proton pump)

·        Key Point:

• Take 30–60 minutes before meals

D. MUCOSAL PROTECTIVE AGENT

Sucralfate

·        Mechanism:

• Forms protective barrier over ulcer
• Protects against acid, pepsin, bile

·        Dose:

• 1 g QID or 2 g BID

E. PROKINETIC AGENTS

Metoclopramide

·        Dose:

• 5–10 mg, three times daily

·        Mechanism:

• Dopamine (D2) receptor blockade
• ↑ Acetylcholine → ↑ gastric motility

·        Caution:

• Can cause neuropsychiatric side effects
• Use only under medical supervision

F. H. PYLORI ERADICATION

• Indicated if infection present
• Improves long-term symptoms

3. ALTERNATIVE THERAPIES

• Herbal options:
• Peppermint
• Caraway oil

SUMMARY (FOR QUICK REVISION)

• Dyspepsia = Upper abdominal discomfort
• Causes: Drugs, lifestyle, GERD, ulcers, H. pylori
• First step: Lifestyle modification
• Drugs:
• Antacids → Immediate relief
• H2 blockers → Moderate effect
• PPIs → Most effective
• Alarm symptoms → Endoscopy required