dr.

Putut Bayupurnama
SpPD-KGEH
(Internist-
Gastroenterohepatologist)
Member of International Working Group for :
International Consensus on Underwater
Colonoscopy Examination and Polypectomy
(International-WATERS [Water-Aided Technique
Endoscopy Research Society])
DIAGNOSTIC CHALLENGES IN
FUNCTIONAL DYSPEPSIA

PUTUT BAYUPURNAMA
DIVISI GASTROENTEROLOGI & HEPATOLOG- DEPT. PENYAKIT DALAM ,
FAKULTAS KEDOKTERAN-KMK, UNIVERSITAS GADJAH MADA/RSUP
DR. SARDJITO, YOGYAKARTA, INDONESIA
 Dyspepsia:
the size of the problem

15–25% of the general population experience

dyspepsia within a 12-month period
Much more common than peptic ulcer
Up to 5% of primary care visits are due to dyspepsia
Most patients have no detectable abnormality on
radiological upper GI series or endoscopy
Endoscopy findings and symptoms do not correlate

Talley, J Clin Gastroenterol 2001; 32: 286–93.

Locke, Ballieres Clin Gastroenterol 1998; 12: 435–42.
3
Paré, Can J Gastroenterol 1999; 13: 647–54.
van Bommel et al., Postgrad Med J 2001; 77: 514–18.
Talley et al., BMJ 2001; 323: 1294–7.
Drossman DA, Gastroenterology 2016;150:1262–1279
 Definition of dyspepsia (Rome II)
Dyspepsia refers to pain or discomfort centered in the upper
abdomen

Centered implies that the pain or discomfort is mainly in or around the midline.
Pain in the right or left hypochondrium is not considered to be representative of
dyspepsia

Definition of Functional Dyspepsia (Rome IV)

Functional dyspepsia is a medical condition that significantly
impacts on the usual activities of a patient and is characterized by
one or more of the following symptoms: postprandial fullness, early
satiation, epigastric pain, and epigastric burning that are unexplained
after a routine clinical evaluation
Talley et al., Gut 1999; 45(Suppl II): II37–42.
Malfertheiner, Eur J Gastroenterol Hepatol 1999; 11(Suppl 1): S25–9.
Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392. 5
Talley et al., Gut 1999; 45(Suppl II): II37–42.
Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392
Diagnostic Challenges :

 Symptoms Identification
 Overlap syndromes
Dyspepsia covers a range of symptoms

DYSPEPSIA
GERD PAIN OR DISCOMFORT IBS
centred in upper abdomen

UNINVESTIGATED INVESTIGATED

ORGANIC FUNCTIONAL
(or idiopathic)
(use of the term ‘non-ulcer’
is discouraged)

Talley et al., Gut 1999; 45(Suppl II): II37–42.

 PENEMUAN GERD BERDASARKAN INDIKASI ENDOSKOPI
di RSUP SARDJITO YOGYAKARTA
Frekuensi Persen (%)
Dyspepsia 54 49,1
GERD 35 31,8
Hematemesis 6 5,5
Melena 9 8,2
Hematemesis Melena 1 0,9
Anemia 1 0,9
Gastropathy oains 2 1,8
Dysfagia 2 1,8
Adyarini DD, KOPAPDI 2015 Bandung
Yarandi SS and Christie J., Gastroenterol Res Pract 2013, http://dx.doi.org/10.1155/2013/351086
Umbilicus
Gut 1997; 41: 753–757
Functional Dyspepsia (ROME IV)

Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392

Stanghellini V et al. ,Gastroenterology 2016;150:1380–1392
Talley NJ & Ford AC, N Engl J Med 2015;373:1853-63
Diagnostic Criteria for Irritable Bowel
Syndrome (ROME IV)
Recurrent abdominal pain, on average, at least 1 day per
week in the last 3 months, associated with 2 or more of
the following criteria:

1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of
stool

Criteria fulfilled for the last 3 months with symptom

onset at least 6 months before diagnosis.

IBS with predominant diarrhea

IBS with predominant constipation
IBS with mixed bowel habits
IBS unclassified
Lacy BE et al, Gastroenterology 2016;150:1393–1407
Gejala-gejala gastrointestinal atas pada pasien-pasien dengan IBS- constipation
predominant dan IBS-diarrhea predominant

(Cremonini F & Talley NJ, 2004)

Level of evidence dari mekanisme patofisiologi yang sering terdapat pada
dispepsia fungsional dan IBS

(Cremonini F & Talley NJ, 2004)

 Interaksi antara Kebiasaan Browsing Internet dan Sindrom Dispepsia pada Adolesent

Putut Bayupurnama1, Noor Asyiqah Sofia2, Angelin Utami Cahyani3

1 Divisionof Gastroenterology & Hepatology,Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital,
Yogyakarta, Special Region of Yogyakarta, Indonesia
2Division of Psychosomatic Disorders, Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital,

Yogyakarta, Special Region of Yogyakarta, Indonesia

3 Department of Internal Medicine, Gadjah Mada University/Sardjito General Hospital, Yogyakarta, Special Region of Yogyakarta,

Indonesia

Accepted for ACG 2019Meeting abstract, San Antonio, Texas, USA ,October 2019
Table 1. The role of internet browsing about diseases information in developing dyspepsia
syndrome
Did you ever browse Dyspepsia syndrome p value
Total
information about (n)
Yes No
diseases in the internet?
n(%) n(%)

Never 60(65.9) 31(34.1) 91 <0.001

Only once 296(79.4) 77(20.6) 373

More than once 128(63.7) 73(36.3) 201

Total 484(72.8) 181(27.2) 665

Table 2. The role of internet browsing about medical complaint information in developing
dyspepsia syndrome
Did you ever browse Dyspepsia syndrome p value
Total
information about your (n)
Yes No
medical complaint in the
n(%) n(%)
internet?
Never 77(63.6) 44(36.4) 121 0.002
Only once 263(78.5) 72(21.5) 335
More than once 144(68.9) 65(31.1) 209
Total 484(72.8) 181(27.2) 665
 Perbedaan Kualitas Hidup antara Pasien dengan Dispepsia Fungsional
Sesudah Endoskopi dengan Terapi Empirik dan Plasebo

Sumardjo, Putut Bayupurnama, Neneng Ratnasari,

(Diterima dan akan dipresentasikan pada ACG Meeting2019, San Antonio, Texas,
USA, October 27, 2019)

 EGD tanpa sedasi + placebo (22 patients) vs EGD tanpa sedasi +PPI+Prokinetic (20 patients)
 Randomized Controlled Trial
 Lama terapi : 2 minggu

Kesimpulan penelitian :
Tidak terdapat perbedaan bermakna penurunan skor Nepean Dyspepsia index antara kelompok
placebo dan empiric sebelum dan sesudah pemeriksaan endoskopi atas
Summary
 Dyspepsia refers to pain or discomforts mainly in or around the midline of the upper abdomen

 Diagnostic challenges in functional dyspepsia is depend on symptoms identification and overlap

symptoms especially with GERD and Irritable Bowel Syndrome

 Considering the probable overlap symptoms may improve the accuracy of

functional dyspepsia diagnosis