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Cengiz Pata
Department of Gastroenterology
Yeditepe University, Istanbul
The Case
40 year old female
6 months of intermittent epigastric burning
with occasional nausea but no vomiting
Denies weight loss
Eating does not change her symptoms
She denies any changes in her bowel
habits
The Case
PMH: HTN
SH: denies tobacco, EtOH, or IVDA
FH: DM, HTN
Meds: HCTZ
All: NKDA
Histology Diagnosis 90 90
NH2
pH change
The principle of the 13C- or 14C-urea breath test
Reproduced with permission from Mr Phil Johnson, Bureau of Stable Isotope Analysis,
Brentford, UK.
Functional Dyspepsia
Rome III- similar to Rome II but now FD
is broken down into two subgroups based
on a complex of symptom features:
1) Postprandial distress syndrome
2) Epigastric pain syndrome
Pathophysiology of FD
Increased gastric acid
H. pylori infection
GI dysmotility (antral hypocontractility)
Decreased perception threshold
Autonomic dysfunction
Decreased gastric accommodation
Gastric myoelectric activity
Psychological factors
Pharmacological Treatment of
FD
Cochrane Meta-analyses (versus placebo):
– PPIs (RRR 13%, CI 4% - 20%)
– Prokinetics (RRR 33%, CI 18% - 45%)
Cisapride, Domperidone, Metaclopramide, Tegaserod
May be affected by publication bias
– H2RAs (RRR 23%, CI 8% - 35%)
– Bismuth salts (RRR 40%, CI –3% - 65%)
– Antacids (RRR –2%, CI –36% - 24%)
– Sucralfate (RRR 29%, CI –40% - 64%)
– H. pylori eradication (RRR 10%, CI 6% - 14%)
Pharmacological Treatment of
FD
Itopride – Dopamine D2 antagonist with
acetylcholinesterase inhibitory actions
– Stimulates gastric motility
– Often used for FD in Japan
clarithromycin
2 x 250 - 500mg
PPI X 2