Dyspepsia

• Introduction :
 Dyspepsia is a chronic or recurrent burning
discomfort or pain in the upper abdomen that may
be caused by processes such as – Gastroesophageal
reflux , peptic ulcer and non- ulcer dyspepsia.
 Dyspepsia is a painful and difficult digestion which is
followed by nausea, vomiting , heartburn and
stomach discomfort.
• Causes / etiology :
 It can be organic or functional cause.
 Organic cause :
 Gastro-oesophageal reflux disease (GERD)
 Crohn’s disease
 Gastric cancer
 Oesophageal cancer
 Cardiac failure
 Renal failure
 Hepatic failure
 Disease of pancreas and gall bladder
 Infection : H.pylori
 Drugs : NSAIDS, Analgesic, or diabetic drugs
 Alcohol
 Pregnancy
 Systemic disease : Diabetes , thyroid disease, hyperparathyroidism
 Functional cause :
 Anxiety neurosis
 Depression
 Non-ulcer dyspepsia
 Irritable bowel syndrome

 The dyspepsia symptoms commonly encountered in

clinical practice have been found to be of psychiatric
basis rather than organic cause.
• Symptom :
o Upper abdomen pain related to food
o Heart burn
o Anorexia
o Nausea and vomiting
o Abdomen distension or bloating
o Flatuence
o Difficulty in swallowing
o Tenderness in abdomen region on palpation
o Weight loss
 Flatulent dyspepsia :
o It is a term used for symptoms of flatuence , bloating and
belching with or without abdominal pain.
• Investigations :
 Blood examination : to check any infection
 Upper gastrointestional endoscopy
 X-ray, CT- scan, USG of abdomen

• Treatment :
o Treat the cause like :
 Drugs which cause dyspepsia – should be avoided
 Life style changes –
1. Stop smoking
2. Decrease alcohol intake
3. Avoid aggravating foods
4. Avoid stress
5. Exercise regularly.
 Use :
1. Antacids : ie magnesium trisilicate
2. Proton pump inhibitor – i.e omeprazole, pantoprazole, iansoprazole.
3. H2 blocker- i.e Ranitidine, famotidine etc
4. Triple therapy – Omeprazole 20mg + amoxicilin 1g + iansoprazole 30mg + metronidazole.
5. Antibiotics – In case of H.pylori i.e metronidazole.
 Non -ulcer dyspepsia
• Introduction :
 It is defined as occurrence of dyspectic symptoms
resembling peptic ulcer without any document
evidence of organic disease on investigation.
 Mostly found in who experience indigestion are
diagnosed with NON ULCER DYSPEPSIA
 Also called as “Functional or Psycogenic Dyspepsia”.
• Causes :
o Exact cause is not known.
o But there are some predisposing condition of factors:
 Psychiatric disorder : i.e Anxiety, depression, stress.
 Drugs : i.e ibuprofen , aspirin, iron tab, calcium antagonists.
 Irritable bowel syndrome
 H.pylori – In some cases. This bacterium is found in the
stomach with functional dyspepsia.
 Smoking
 Alcohol
• Incidence :
o Age incidence – middle age group people are most common.
o Sex incidence – female are more common than male.
• Clinical feature :
o Abdominal pain
o Nausea
o Vomiting
o Fullness/ bloating after meal
o Discomfort (burning in nature)
 these presenting symptoms may occur in morning
after waking up.
 There is no physical sign except inappropriate
tenderness on abdominal palpation.
• Investigations :
 Blood test to rule out other disease.
 Endoscopy of upper GI tract
 USG of upper abdomen
 Barium meal x-ray
• Treatment :
 Explanation and reassurance :
 Patient should be reassured that there is no organic
basis of his/her symptoms
 Possible psychological factors should be explored.
 Patient is advised to avoid stress, smoking and alcohol.
 Drug therapy :
 H2 blocker : for night burn or heart burn like :
1. Famotidine
2. Rantidine
 Proton pump inhibitor : like –
1. Omeprazole
2. Pantoprazole
3. Iansoprazole
 Antacids may be prescribed for dyspeptic symptoms
 Prokinitices : To strengthen the esophageal sphincter.
Given before meal if nausea, vomiting and
bloating are prominent symptoms like :
1. Metoclopramide – 10 mg 8 hoursly
2. Domperidone – 10-20 mg 8 hoursly
 Low- dose antidepressents – Amitriptyline in low dose
may help to control intestinal pain.
 Antibiotics- if H.pylori is present.
 Psychotherapy :
 Symptoms referable to a major cause of stress may
resolve with appropriate counseling and advice.
 When a major psychiatric disorder is suspected, then
patient may be advised/ reffered to a psychiatrist for
formal psychotherapy.
 Irritable bowel syndrome
(I.B.S)
• INTRODUCTION :
 Also called as MUCUS COLITIS.
 It is functional bowel disease of intestine , characterized by
– abdominal pain associated with defecation or a change in
bowel habit with feature of incomplete bowel evacuation
and distension.
• Incidence :
 It is very common in occurrance now a days.
 Age incidence : middle age group (20-45 yrs) more common.
 Sex incidence : women are twice common than man .
• Aetiology :
 IBS comprise of wide range of symptoms having no structural,
biochemical or infectious aetiology.
 No single cause has been found out. But there are certain factors
which includes :
 Psychological factor : i.e anxiety, depression, hysteria, somatization that alter GI MOTILITY.
In some cases, there may be a history of childhood sexual or physical abuse .
 Luminal infection : About 10-20% patients, an episodes of gastroenteritis – can cause IBS.
 Food: i.e intake of spicy food, dietary components, milk, wheat , alcohol etc.
 Hormones : Hormonal change play a role in this conditions. Sign and symptoms of IBS are
worse during or around menstrual periods.
 Altered G.I. motility :
1. Alteration in bowel habit represent disordered motility of bowel.
2. The motility may be increased , normal or decreased.
3. The presence of diarrhea in patient with IBS indicate decreased transit time, rapid jejunal
or colonic contraction.
4. On the other hand, patients with predominant constipation have increased transit time
and reduced colonic contraction.
• Clinical feature :
 Common presenting symptoms –
1. Lower abdominal colicky pain which is relieved by
defecation.
2. Abdominal bloating
3. Altered bowel habbit
4. Passage of mucus along with stool is common but
rectal bleeding and weight loss does not occur.
 Patient with IBS can be catagorised into 3 catagories :
I. IBS- constipation with decreased bowel movement
II. IBS-diarrhea with increased bowel movement
III. Altering diarrhea and constipation
 Other associated symptoms are:
1. Dyspepsia
2. Urinary frequency
3. Headache
4. Backache
5. Dysparunia
6. Poor sleep
7. Fatigue
8. Insomina
9. Capricious appitide
10. Pychiatric symptoms : anxiety, depression and
decrease in libido.
• Examination :
o On palpation : Abdomen tenderness in left quadrant is elicited.
o On auscultation : Increased bowel sound
• Investigation :
o Blood examination – CBC, LFT, ESR.
o Stool examination : microscopy and culture of stool for ova , parasities etc.
Occult blood in stool in stool test.
o USG of abdomen
o Endoscopy and biopsy
o Hydrogen breath test
o Colonoscopy- In patient who has a history of colonic cancer
o If there is presistent diarrhea –Sigmoidoscopic biopsies should done.
o Use ROME III criteria for IBS :
 At least 3 months , with onset at least 6 month previously, of recurrent abdominal pain or
discomfort associated with 2 or more of following :
1. Relieved with defecation
2. Associa.ted with change in frequency of stool
3. Associated with change in consistancy of stool
• Differential diagnosis :
 Colon cancer
 Thyroid disorder
 Inflammatory bowel disease.
• Treatment :
 Reassurence and psychological support :
 It is important and effective method in majority of cases.
 Patient should be reassured that their symptons donot have any organic basis
but are result of altered bowel motility and sensation.
 Patient with intractable symptoms may get benefits with low dose of anti
depressants :
1. Amitriptyline – 10-25 mg
2. Paroxetine – 20 mg
 Non pharmacological relaxation modalities like :
1. Psychotherapy
2. Hypnotherapy - these therapy may also help in resistant cases.
 Dietary advice :
 Patient should avoid dairy products, foods beverages and medication
containing fructose.
 Excessive caffine or gas forming food such as Brown Beans , Grapes ,
Plums, Cabbages – should be avoided.
 In constipation :
 High fibre diets are most effective in patient with constipation such as – “Ispaghula
preparations”.
 Osmatic laxative should be used.
 In unrelieved patients – A prokinetic agent should used.
 Lubiprestone – should use because it increased stool frequencies.
 In Diarrhea :
 2 or 3 daily dose of an antidiarrheal agents should use. i.e.
1. Loperamide -2 to 8 mg per day
2. Codine phosphate – 30 to 90 mg per day
3. Abdominal pain – relieved by antispasmodics i.e DICYCLOMINE
4. 5-Hydroxytryptamine (5HT3) antagonists like ALOSTERON can be use in “IBS-D”
 Non absorbable antibiotics :
 Rifaximin – 400mg t.i.d can be use.
 Probiotics :
 Aleration in gut-flora by probiotics can be reduce
symptoms.
 Tranquilizer are indicated in severe anxiety cases.