Dyspepsia

Abstract

Dyspepsia is a common medical disorder that poses a diagnostic and therapeutic challenge to all healthcare providers. Clinically, patients often present with a variety of complaints including abdominal pain or discomfort, bloating, belching, early satiety, epigastric fullness, nausea, and “reflux.” Healthcare providers must determine if these symptoms meet criteria for dyspepsia or if they point toward another diagnoses, such as chronic pancreatitis or choledocholithiasis. The investigation and treatment of dyspepsia is complicated by the fact that dyspeptic symptoms are nonspecific, such that they cannot be used to reliably distinguish organic disorders from functional gastrointestinal disorders. Further complicating matters is the fact that once a patient is identified as having functional dyspepsia (FD), the pathophysiology of FD is complex and incompletely understood, and symptom response to treatment is unpredictable. Indeed, healthcare providers are often uncomfortable making the diagnosis of dyspepsia and selecting empiric therapy. Finally, dyspepsia is frequently a chronic disorder that is frustrating for patients and physicians alike.

Teaching Questions

• 1. In the evaluation of a patient with dyspepsia, upper endoscopy (EGD) helps distinguish between an organic process (e.g., gastritis) and functional dyspepsia (FD), in which the endoscopy is normal. What percentage of patients with dyspepsia have a normal endoscopy and thus are categorized as having FD?

  • (A) 10 %

  • (B) 30 %

  • (C) 50 %

  • (D) 70 %

• 2. The pathophysiology of functional dyspepsia (FD) is multifactorial. Which 2 categories are thought to account for the majority of cases?

  • (A) H. pylori infection and bile gastritis

  • (B) Impaired fundic accommodation and a mild delay in gastric emptying

  • (C) Rapid gastric emptying and gastric acid hypersensitivity

  • (D) Delayed gastric emptying and H. pylori infection

• 3. In a young patient (35 years or age or less) with symptoms of dyspepsia and no warning signs on exam or history, which tests are required before treatment can be initiated?

  • (A) Upper endoscopy.

  • (B) Laboratory tests including CBC and LFTs.

  • (C) Right upper quadrant ultrasound.

  • (D) No testing is required.

  • (E) CT scan of abdomen.

• 4. True or False—Prokinetics are generally considered the best therapy for patients with FD since this generally reflects a motility disorder of the stomach.

  • (A) True

  • (B) False