Dyspepsia guidelines & management.

1. Dyspepsia
Dr. Mohamed Shekhani
Assistant Professor
Consultant Physician & gastroenterologist

2. Rome III Committee:
One or more of the following 3
symptoms:
1. Postprandial fullness
2. Early satiety
3. Epigastric pain or burning.
The point prevalence is
25%.
Patients presenting
with predominant
or frequent (> 1
week) heartburn or
acid regurgitation
should be considered
to have (GERD) until
proven otherwise.

3. ASGE Guidelines

4. ACG Guidelines

9. The effect of H. pylori eradication on gastric cancer prevention
in younger people is excellent, but it declines along with
advancing age.
The test-and-treat strategy is being reinforced by the
accumulating data that support the increasingly accepted idea
that ‘‘the only good H. pylori is a dead H. pylori ’’.

11. Advantage of early endoscopy:
Possibility of establishing a specific diagnosis, as PUD
or erosive GERD or GC.
Many patients with early stage malignancy do not have alarm
symptoms.
The reduction in anxiety.
increase in patient satisfaction.

12. Disadvantages of early endoscopy:
Little evidence to suggest significant improvement in
outcomes by the initial endoscopy approach.
Increased cost with the initial endoscopic approach compared
with the test-and-treat method.
The risk of malignancy is quite low in young patients without
alarm features.
Some causes of dyspepsia can not be diagnosed by endoscopy.
Minimally-invasive with complications although rare.

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15. The more you go from
West-East: more H
Pylori & more GC.
So the guidelines may
differ in:
Age threshold for
endoscopy: 40 years or
less or more open
access endoscopy.
Use other screening
tests for GC in
asymptomatics: PG
level ,etc.
? The need for local
national dyspepsia
guidelines.

16. Dyspepsia-no alarm features & Endoscopy –ve : Functional
dyspepsia& overlapping functional GIT disorders.
Dyspepsia- alarm features & Endoscopy –ve: consider other
causes:
Pancreatobiliary causes by Imagings
Gastropariesis by gatric emptying studies.