Dyspepsia Indigestion

Definition

• Discomfort centered in the upper abdomen Etiologies

• Functional causes ("nonulcer dyspepsia" or NUD. -60%): some combination of visceral afferent hypersensitivity and abnormal gastric motility

• Organic causes: peptic ulcer disease (15-20%). gastric cancer (<2%), other (lactose intolerance, biliary pain, chronic pancreatitis, mesenteric ischemia)

• Alarm foaors that suggest organic cause and warrant EGD: dysphagia. ® FOBT or anemia, persistent anorexia or vomiting, weight loss, palpable mass or adenopathy, age >55 y

Treatment

• H. pylori eradication useful for PUD -» empiric Rx If ® serology (N^w 1998:339:1869)

• Functional dyspepsia: acid suppression w PPI. Hj-blocker; trials of prokinetic agents.TCAs

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