Abstract
Aims and Objectives: One of the common condition presenting in the surgical outpatient department is uninvestigated dyspepsia. The prevalence and predictability of the upper gastrointestinal findings in a case of uninvestigated dyspeptic patient is unknown by history. A study was undertaken using upper GI endoscopy as a diagnostic tool to find various causes of dyspepsia / Gastro eosophageal reflux disease prevailing in our rural locality aiming to study the outcome of Upper GI endoscopy in dyspeptic patients and the co-relation of alarm symptoms with GI endoscopy finding.
Materials and Methods: Prospective observational study was conducted on 150 patients aged between 18 – 80 years presenting with untreated, uninvestigated and uncomplicated dyspepsia admitted with upper gastrointestinal symptoms. After obtaining ethical committee approval, and getting informed and signed consent from the patients upper gastro-intestinal endoscopy was performed and documented.
Results: Most common presenting complaint was epigastric pain and discomfort; and most common endoscopic finding was gastritis followed by GERD. 71.3% of patients had clinically significant endoscopic findings with un-investigated dyspepsia.
Conclusion: In the study conducted it was found that 71.3% of them with un-investigated dyspepsia had clinically significant upper GI endoscopic findings. Most of them had three or more dyspeptic symptoms. Low incidence of malignancy and larger number of inflammatory lesions were noted in the study group. Based upon this study it is suggested that un- investigated dyspeptic patients who present to the outpatient department can be safely treated conservatively initially with acid suppressive therapy, diet and life-style modification. Review endoscopy may be undertaken in patients with recurrent symptoms or in whom drug therapy fails.
Keywords: Upper GI endoscopy; dyspepsia; GERD.
References
- Talley NJ. Dyspepsia: how to manage and how to treat?. Aliment Pharmacol Ther. 2002;16 (4) :95-104.
- Drossman DA, Corazziari E, Talley NJ et al. The functional gastrointestinal disorders. 2nd In: Diagnosis, Pathophysiology and Treatment: a Multinational Consensus. Degon: McLean, Virginia; 2000.
- Westbrook JI, McIntosh JH, Talley NJ. The impact of dyspepsia definition on prevalence estimates: considerations for future researchers. Scand J Gastroenterol. 2000; 35:227–33.
- Talley NJ, Holtmann G. New concepts in functional gastrointestinal diseases: functional dyspepsia and its link to other disorders. In: Textbook of Gastroenterol. Philadelphia, Lippincott Williams and Wilkins; 2001.
- Choomsri P et al. Upper gastrointestinal endoscopic findings in patients presenting with dyspepsia. Thai J Surg. 2010; 31:7-12.
- Khan N et al. Upper gastrointestinal endoscopic assessment of patients presenting with dyspepsia. JPMI. 2007; 21(3):212-6.
- Thomson A B R et al. The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: The Canadian Adult Dyspepsia Empiric Treatment- Prompt Endoscopy (CADET-PE) study. Aliment Pharmacol Ther. 2003; 17: 1481-91.
- Sandler RS, et al: The burden of selected digestive diseases in the United States. Gastroenterol. 2002; 122:1500.
- Owen DA: Gastritis and carditis. Mod Pathol. 2003;16:325. National Institute for Health and Clinical Excellence: Clinical guideline Dyspepsia. London; 2004:17.
- Hungin A, Thomas P, Bramble M, et al. What happens to patients following open access gastroscopy? An outcome study from general practice, Br J Gen Pract. 1994;44:519-21.
- Mary Maish. Esophagus.18th ed. In: Sabiston Textbook of Surgery (2) Townsend, Beauchamp eds. Philadelphia. Saunders. 2008: 1049-107.
- Jeffrey Esophagus and Diaphragmatic Hernia, 8th ed. In: Schwartz’s Principles of Surgery, U.S.A, McGraw- Hill; 2005:pp 835-931.
- Ganong W F. Regulation of gastrointestinal function. 20th ed. In: Review of Medical Physiology,Ganong WF, ed. USA. McGraw-Hill Company; 2001: pp 439.
- Brzozowski, Tomasz MD, Konturek et al. Involvement of Endogenous Cholecystokinin and Somatostatin in gastroprotection induced by intraduodenal fat. J Clin Gastroenterol. 1998; 27(1):125-37.
- Kenneth A. History and Development of Flexible Endoscopy. In: Mastery of Endoscopic and Laparoscopic Surgery, Eubanks, Swanstrom, Soper, USA, Lippincott Williams and Wilkins; 2000:pp 3-6.
- Bruce V. Diagnostic Upper Gastrointestinal Endoscopy, Mastery of Endoscopic and Laparoscopic Surgery, Eubanks, Swanstrom, Soper, eds. USA,Lippincott Williams and Wilkins; 2000;115-22.
- Mitsuo, Sotaro. Fibergastroscopic Examination. 1st In:Fiberscopy of diseases, Tsuneoka, Kenji, eds. Tokyo ,Igaku Shoin Ltd;1973: pp
- Talley NJ, Vakil N. "Guidelines for the management of dyspepsia". Am J Gastroenterol. 2005;100 (10):2324-37. National Institute for Health and Clinical Excellence. Dyspepsia. 2004,August.
- Talley NJ, Stanghellini V, Heading RC, Koch KL, Malagelada JR, Tytgat GN. "Functional gastroduodenal disorders". Gut. 1999; 45 (2): 1137–42.
- Talley NJ, Phung N, Kalantar JS . ABC of the upper gastrointestingal tract: Indigestion: When is it functional?. Br Med J. 2001; 323 (7324): 1294–7.
- Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR (1993). "Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy". Gastroenterol. 105 (5): 1378–86.
- American Gastroenterology Association Technical Review on the Evaluation of Dyspepsia. Gastroenterol. 2005;129:1756-80.
- Sarwar M et al. Endoscopic assessment of Dyspepsia. Pak Armed Forces Med J. 2004;54: 48-50.
- Ziauddin. Endoscopic findings in Dyspepsia a prospective study of 200 cases J Postgrad Med Inst. 2003;17 (2) :235-9.
Corresponding Author
Dr Kamal Kumar. K
Junior Resident, Rajah Muthiah Medical College & Hospital, Annamalai University,
Tamil Nadu, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i11.01
