1 Feb 2015

Management of dyspepsia or indigestion

Although dyspepsia or indigestion is common in general population detailed evalution is required in new onset dyspepsia in elderly people, young people not improving with empirical treatment . Also when alarming symptoms such as  weight loss, organomegaly, abdominal mass, or fecal occult blood are present.
Initial laboratory test should include
• Complete blood count,
• Electrolytes,such as serum sodium and potassium
• Liver enzymes,
• Calcium,
• Thyroid function tests.
Special Examinations
• Upper Endoscopy - Useful in detecting mucosal erosion, stomach ulceration and cancers. Young people test for H pylori is done noninvasive test for H pylori such as IgG serology, fecal antigen test, or urea breath test
• Abdominal imaging (ultrasonography or CT scanning), if disease of pancreas or gall bladder is suspected
Treatment of Dyspepsia
Functional Dyspepsia
Even though functional dyspepsia is benign and no organic cause is found it is difficult to control their symptoms
• General Measures
In those with mild and intermittent symptoms life style changes and reassurance will help to reduce the symptoms. In certain people it is precipitated by food and drugs. People should take precaution to avoid such food and drugs. Excessive alcohol, caffeine, fatty food should be avoided.
• Drugs
People with indigestion and heartburn get relief with H2-receptor antagonists examples ranitidine or nizatidine, famotidine, or cimetidine or proton pump inhibitors omeprazole, esomeprazole, or rabeprazole, lansoprazole or antoprazole.
Low doses of antidepressants such as desipramine is helpful in some patients
Metoclopromide may be tried, but chronic use is not advised
Anti-H pylori Treatment - A ntibiotic to treat H Pylori is given.

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