Dyspepsia عسر الهضم الاسباب والعلاج
Dyspepsia
This is described as persistent or recurrent abdominal discomfort in the upper abdomen.
Of patients presenting with dyspepsia:
عسر الهصم
• 50% have an underlying cause.
• 20% have physical abnormalities.
• 30% have no underlying cause or physical abnormality.
Management for dyspepsia
1- Symptom evaluation and history:-
1- alarmingمفزعه symptoms or age > 50 years:
endoscopy
2- no alarming symptoms, age < 50 years ,symptoms < 4 weeks: treat and monitor.
Alarm symptoms in the presentation of gastrointestinal disorders
• Anaemia
• Dysphagia
• Epigastric mass
• Gastrointestinal bleeding
• Jaundice
• Odynophagiaوجع البلع
• Persistent vomiting
• Previous history of peptic ulceration
• Use of NSAIDs
• Weight loss.
2- Test for Helicobacter pylori :-
– positive result: eradication therapy : triple therapy
– negative result: empirical مجربtherapy: H2-receptor antagonists , or proton pump inhibitors.
Peptic ulcer
This is the occurrence of discontinuity in the entire thickness of the gastric or duodenal mucosa that persists and results from acid and pepsin in the gastric juice
Epidemiology
1- Diseases associated with peptic ulcer include :-
• chronic pulmonary disease
• cirrhosis of liver
• chronic renal failure
• pancreatic insufficiency.
2- Potential risk factors are :-
• cigarette smoking
• psychological stress
• genetic factors
• diet
• H. pylori infection.
3- Pathogenesis
H. pylori infection: 95% of duodenal ulcers and 80–85% of gastric ulcers are due to the occurrence of this microorganism in the gastrointestinal tract.
4- Use of NSAIDs may cause:
– superficial erosions and haemorrhages
– silent ulcers
– ulcers causing clinical symptoms and complications..
Clinical manifestations of peptic ulcer :-
• Upper abdominal pain
• Anorexia
• Weight loss
• Nausea and vomiting
• Heartburn and eructationتجشأ
• Haemorrhage, chronic iron deficiency anaemia, perforation .
Investigations
• Endoscopy: very sensitive and reliable test, invasive and some patients refuse to undergo this investigation
• Radiology: using double-contrast barium radiography
• H. pylori detection: using serological tests to detect antibodies or by faces.
Goals of therapy in uncomplicated peptic ulcer disease
• To provide relief from pain and other ulcer symptoms.
• To promote healing.
• To prevent complications of peptic ulcer disease.
• To maintain adequate nutrition.
• To prevent recurrence.
Drugs used in the treatment of peptic ulcer
1- Antacids: to counteract symptoms
2- Drugs that inhibit acid secretion:
– H2-receptor antagonists
– proton pump inhibitors
– prostaglandin analogues
3- Drugs that do not inhibit acid secretion but have cytoprotective effect:
– chelated bismuth salts
– sucralfate.
Antacids
• These products are weak alkalis that bring about neutralisation of the acidic pH in the stomach.
• They provide symptomatic relief in dyspepsia peptic ulceration and gastro-oesophageal reflux.
• Antacids may be used when symptoms occur and provide relief generally within 5–15 minutes of administration.
• They should be administered between meals and at bedtime (relief duration ranges from 1 hour to 3 hours).
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