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    Current Treatment of Dyspepsia: DR Wita Kartika Nurani SP - PD

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    Aditya Rangga Fandiarta
    This document discusses the common causes, treatment approaches, and alarm signs for dyspepsia. It notes that the most common causes are reflux esophagitis, duodenal ulcers, and gastric ulcers. The first treatment approach is to consider causes outside the GI tract and stop any contributing medications. Patients exhibiting alarm symptoms like bleeding or weight loss should be referred immediately. All new dyspepsia patients should receive abdominal exams and blood tests. Those over 55 or with persistent or recent-onset dyspepsia without alarm signs may also be referred. Helicobacter pylori is a common cause that can be diagnosed via invasive or non-invasive tests and treated with a PPI and antibiotics regimen. Functional

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    Current Treatment of Dyspepsia: DR Wita Kartika Nurani SP - PD

    Uploaded by

    Aditya Rangga Fandiarta
    34 views15 pages
    This document discusses the common causes, treatment approaches, and alarm signs for dyspepsia. It notes that the most common causes are reflux esophagitis, duodenal ulcers, and gastric ulcers. The first treatment approach is to consider causes outside the GI tract and stop any contributing medications. Patients exhibiting alarm symptoms like bleeding or weight loss should be referred immediately. All new dyspepsia patients should receive abdominal exams and blood tests. Those over 55 or with persistent or recent-onset dyspepsia without alarm signs may also be referred. Helicobacter pylori is a common cause that can be diagnosed via invasive or non-invasive tests and treated with a PPI and antibiotics regimen. Functional

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    teori dispepsia

    Original Title

    Dyspepsia

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    This document discusses the common causes, treatment approaches, and alarm signs for dyspepsia. It notes that the most common causes are reflux esophagitis, duodenal ulcers, and gastric ulcers. The first treatment approach is to consider causes outside the GI tract and stop any contributing medications. Patients exhibiting alarm symptoms like bleeding or weight loss should be referred immediately. All new dyspepsia patients should receive abdominal exams and blood tests. Those over 55 or with persistent or recent-onset dyspepsia without alarm signs may also be referred. Helicobacter pylori is a common cause that can be diagnosed via invasive or non-invasive tests and treated with a PPI and antibiotics regimen. Functional

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    34 views15 pages

    Current Treatment of Dyspepsia: DR Wita Kartika Nurani SP - PD

    Uploaded by

    Aditya Rangga Fandiarta
    This document discusses the common causes, treatment approaches, and alarm signs for dyspepsia. It notes that the most common causes are reflux esophagitis, duodenal ulcers, and gastric ulcers. The first treatment approach is to consider causes outside the GI tract and stop any contributing medications. Patients exhibiting alarm symptoms like bleeding or weight loss should be referred immediately. All new dyspepsia patients should receive abdominal exams and blood tests. Those over 55 or with persistent or recent-onset dyspepsia without alarm signs may also be referred. Helicobacter pylori is a common cause that can be diagnosed via invasive or non-invasive tests and treated with a PPI and antibiotics regimen. Functional

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    Current Treatment of Dyspepsia

    Dr Wita Kartika Nurani Sp.PD


    Outline topics
    Common causes of dyspepsia
    First approach
    Alarm signs
    Referral
    Helicobacter pylori
    Functional Dyspepsia
    Common Causes of Dyspepsia

    Reflux oesophagitis 12%
    Duodenal ulcer 10%
    Gastric ulcer 6%
    Gastric carcinoma 1%
    Oesophageal carcinoma 0.5%


    Non-erosive GORD
    Functional (non-ulcer) dyspepsia
    First Approach
    1. Consider : possible causes outside upper GI tract
    -Heart, lung, liver, gall bladder, pancreas, bowel


    2. Consider drugs and stop if possible
    - Aspirin / NSAIDs, calcium antagonists, nitrates,
    theophyllines, etidronate, steroids
    ?
    Alarm Symptoms/ Signs*
    GI bleeding (same day referral)
    Persistent vomiting
    Weight loss (progressive unintentional)
    Dysphagia
    Epigastric mass
    Anaemia due to possible GI blood loss
    Thus all patients with new-onset dyspepsia should have
    abdominal examination and FBC

    Refer if dyspepsia in 55+* year old
    With Alarm symptoms/signs

    Without alarm symptom if :
    Unexplained : no cause known
    persistent : 4-6 weeks
    recent-onset : new-not a recurrent episode


    Helicobacter pylori
    Gram negative bacteria
    S-shaped, ~ 0.5 x 3 m
    the genom of Hp encode
    1500 proteins
    Some of the proteins are
    determinant of Hp
    mediated pathogenesis &
    colonization, such as :
    Hop protein
    Vac A
    Cag-PAI
    8
    introduction
    Medical community
    couldnt believe a bacteria
    could survive the acidity
    Marshall drank a petri dish
    of Hp, and 10 days later had
    endoscopy where found
    signs of gastritis and H
    pylori.
    estimated: 50% of the world
    is affected
    Developing nations:
    prevalence of adults peaks
    at more than 80% after age
    20

    2005: Marshall and Warren awarded
    Nobel Prize in Medicine
    9
    Pathogenesis Hp
    10
    Diagnosing Hp :
    -invasive
    -non invasive

    Invasive test : endoscopy :
    Culture
    Histology
    Urease test

    The preferred method of diagnosing Hp-by non invasive
    method-in pre and post treatment setting are :
    UBT
    stool antigen test

    One week triple therapy

    PPI (full dose) e.g. Omeprazole 2x20mg
    Clarithromycin 2x500mg
    Amoxycillin 2x 1000 mg





    FUNCTIONAL DYSPEPSIA
    Treatment
    Major challenge
    Most agent : limitted/no evidence of efficacy
    Testing for/eradicating Hp is a first line strategy irrespective of the
    symptom pattern
    MODALITIES OF TREATMENT
    1.Epigastric pain
    antisecretory agent are recommended
    Antacids, bismuth, sucralfat --- no better than placebo
    2.Postprandial fullness (early satiety)
    prokinetics
    Other treatment
    -psychological tx : promising (confer benefits on both pain&meal related symptoms)
    (Curr Treat opt Gastroenterol, 2007)
    WITH
    ALARM
    NO
    ALARM
    > 55 yo
    < 55 yo
    1
    month

    Thank you

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