FUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal

Functional Dyspepsia by Dr Maryam Iqbal
PGR
Sahiwal Teaching Hospital

1. FUNCTIONAL DYSPEPSIA DR. MARYAM IQBAL PGR MEDICAL UNIT ONE SAHIWAL TEACHING HOSPITAL SAHIWAL

2. DISCLOSURE This competition is conducted by SAMI pharmaceuticals; that is second largest pharmaceutical company in Pak with over 40 years of manufacturing excellence.

3. CASE PRESENTATION (Patient’s History) A 30 year-old male presented in OPD with complaint of epigastric pain and bloating after meals on and off for 6 months. History of Present Illness: Patient has complaint of epigastric pain and bloating after meals, worsening over the past 6 months. Pain described as dull and achy, non-radiating. Bloating and discomfort in the upper abdomen. It was associated with early satiety & nausea. Symptoms relieved by antacids and omperazole . No vomiting, hematemesis, or melena. No significant weight loss or appetite changes.

4. Past Medical History : Patient has no significant past medical history however c/o occasional heart burn. Treatment History : He’s taking omeprazole occasionally for the heart burn. Otherwise no significant drug history, such as NSAIDS abuse. Family History : Not significant. Social & personal History : Patient is a smoker with 2 packs/ month roughly, works in an office , stressful job & sedentary lifestyle.

5. EXAMINATION: -Vital signs: BP 130/80 mmHg, HR 70 bpm, RR 18/min, Temperature 98.6°F (37°C) -GPE: No remarkable positive finding. -GIT: Abdominal examination: Soft, non-tender, no organomegaly, normal bowel sounds -CNS: 15/15 gcs -RESP: NVB+ No added sounds -CVS: S1+S2+0

6. DEFINITION & CAUSES: Functional dyspepsia : Non ulcer dyspepsia OR idiopathic dyspepsia is defined by ACG and CAG as at least one month of epigastric discomfort without evidence of organic disease found during an upper endoscopy, and it accounts for 70% of dyspepsia. Rome IV diagnostic criteria : It defines functional dyspepsia as one to three days per week of symptoms of postprandial fullness, early satiety, epigastric pain, or epigastric burning without evidence of structural disease.

7. CAUSES: Pathophysiology is unknown. And its a diagnosis of exclusion. Research studies focused on: 1-Gastric motor function 2-Visceral sensitivity 3-Helicobacter pylori infection 4-Psychosocial factors Risk factors: Have a history of anxiety or depression, history of H. pylori infection, Use of NSAIDs, Smoke or use of tobacco products, females.

8. INVESTIGATIONS: 1-Blood tests ( CBC, LFTs & baselines investigations) 2-H. Pylori Testing ( IgG serology, stool antigen or urea breath test) 3-Stool for occult blood when indicated. 4-Upper GI endoscopy & biopsy: -Gold standard -Especially indicated in patients with upper abdominal pain age > 55 years with alarm features ( weight loss, hematamesis , malena , dysphagia, iron deficiency anemia, eigastric mass ) -In functional dyspepsia, its Normal mucosa, no erosions or ulcers.

9. MANAGEMENT: Life style and Dietary modifications (Smaller portions, fat restriction, diet low in FODMAPs) Psychosocial Factors (May benefit with CBT other formal psychotherapy) Proton pump inhibitor (PPI) : 20mg or 40mg daily first line treatment for 8 weeks , Then observe if symptoms improved continue for 12 weeks then discontinue after proper follow up. Antacids and simethicone as needed. TCA’s : May helpful in 2/3rd. Prokinetic drugs : such as metoclopramide (10 mg 3 times daily) or domperidone (10-20 mg 3 times daily), may be given before meals if nausea, vomiting or bloating is present.

10. FOLLOW UP: Symptoms improved by 70% after 8 weeks PPI discontinued after 12 weeks Remains asymptomatic at 6-month follow-up

11. THANKYOU 