GuidelineThe role of endoscopy in dyspepsia
Section snippets
Definition
Dyspepsia is a poorly characterized syndrome thought to originate from anatomic or functional disorders of the upper GI tract.7, 8, 9 Dyspepsia encompasses a variety of symptoms including epigastric discomfort, bloating, anorexia, early satiety, belching or regurgitation, nausea, and heartburn. Rome III criteria define dyspepsia as 1 or more of the following 3 symptoms for 3 months within the initial 6 months of symptom onset10: (1) postprandial fullness, (2) early satiety, and (3) epigastric
Patients with alarm features
Symptoms of dyspepsia do not reliably identify individuals with malignancy or other important upper GI pathology. Therefore, patient age and alarm features (Table 2)18 have been used to categorize patients with dyspepsia who may harbor true pathology that may be found with endoscopy or other examinations. Patients with new-onset dyspepsia after 4518 to 5519 years of age (average age 50 years) and those with symptoms or signs that suggest structural disease are advised to undergo initial
Patients without alarm features
Dyspeptic patients younger than 50 years of age and without alarm features are commonly evaluated by 1 of 3 methods: (1) noninvasive testing for Helicobacter pylori, with subsequent treatment if positive (the “test and treat” approach), (2) an empiric trial of acid suppression, or (3) initial endoscopy.
Recommendations
- 1.
We recommend initial endoscopy for new-onset dyspepsia in patients 50 years of age of older or those with alarm features. ⊕⊕⊕○
- 2.
We recommend that dyspeptic patients younger than 50 years of age and without alarm features undergo either an initial “test and treat” approach for H pylori or empiric therapy with a PPI, depending on the prevalence of H pylori infection in their population. For H pylori prevalence greater than 20%, “test and treat” is recommended. ⊕⊕⊕○
- 3.
We suggest that dyspeptic patients
Disclosures
Dr Fanelli is the owner and director of New Wave Surgical Inc, is an advisor for and receives royalties from Cook Medical, is a consultant for EndoGastric Solutions, and is an owner of Allurion Technologies Inc and Mozaic Medical Inc. Dr Khashab is a consultant for and on the advisory board of Boston Scientific, a consultant for Olympus, and has received research support from Cook Medical. Dr Muthusamy is a consultant for Boston Scientific and Covidien GI Solutions and a stockholder in
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2021, Journal of Taibah University Medical SciencesCitation Excerpt :Dyspeptic symptoms can be associated with different gastrointestinal diseases such as esophagitis, gastritis, peptic ulcer, and gastric cancer, which are the main causes of gastrointestinal morbidity and mortality worldwide.3 Western endoscopy societies,4,5 Asian recommendations,6 and current Brazilian7 guidelines recommend investigation of these symptoms through upper gastrointestinal endoscopy, also known as esophagogastroduodenoscopy (EGD) to detect organic diseases that cause the patient's symptoms and, more importantly, to exclude upper gastrointestinal malignancies. EGD is one of the most common endoscopic procedures used for the investigation of digestive symptoms, and it provides information for the diagnosis and treatment of gastrointestinal disorders.5,8
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2021, Journal of Ayurveda and Integrative MedicineCitation Excerpt :Pregnant/lactating mothers. Patient with alarm features [3] as Family history of upper GI malignancy in a first-degree relative, Unintended weight loss more than 5% of normal body weight over last 6–12 months, Occult (elicited by past history) or overt GI bleeding (recent history of past 15 days to one month) or iron deficiency anemia, Dysphagia, Odynophagia, Persistent vomiting –considered when there was more than 3 episodes of vomiting in 24 h in past 15 days to one month An elaborative case taking proforma (Annexure 1) was designed for taking a history of dosha involvement and assessing the Nidan (causative factor).
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This document was reviewed and approved by the governing board of the American Society for Gastrointestinal Endoscopy.