​Dyspepsia - Key Points
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Dyspepsia is defined as epigastric pain with the following:
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early satiety, epigastric burning, nausea, and post-prandial pain or bloating
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What are the two most common conditions of dyspepsia?
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Peptic ulcer disease (PUD)
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GERD
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note: if there is NO organic cause of dyspepsia, then it's termed functional dyspepsia
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For a patient who is less than 60 yo and has dyspepsia symptoms, what’s the primary intervention?
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H. Pylori test and treat
What are the two preferred non-invasive tests for H Pylori diagnosis?
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C-urea breath test and monoclonal stool antigen
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avoid H Pylori antibody test [blood test]
For a patient who is more than 60 years old and has dyspepsia symptoms, what’s the primary intervention?
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Upper endoscopy​​
​Functional Dyspepsia [based on Rome 4 Diagnostic Criteria]
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One or more of the following (w/o evidence of structural disease, including endoscopic findings):
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Bothersome post-prandial fullness
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Bothersome early satiation
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Bothersome epigastric pain
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Bothersome epigastric burning
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If there is no symptomatic relief with once-daily PPI, the next-line options are tricyclic antidepressants (TCAs) or prokinetic agents (metoclopramide).
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There are two types:
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Epigastric pain syndrome - tend to benefit more from a TCA (like amitriptyline)
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Post-prandial distress syndrome - consider buspirone (causes stomach relaxation)
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