Understanding Dyspepsia
Edited: Felix Domingo, Jr. M.D.
Translated to Tagalog by: Dr Lolita Alves
What is Dyspepsia?
What are the symptoms of Dyspepsia?
What are the kinds of Dyspepsia?
What are the causes of Dyspepsia?
How serious is Dyspepsia?
How do you diagnose Dyspepsia?
How do you treat Dyspepsia?
What is Dyspepsia?
- Dyspepsia is a term used to describe a constellation of symptoms arising from the upper abdomen.
- Dyspepsia is quite common in adults and may be chronic and recurrent often leading to medical consult.
- It is a subjective feeling most often described by patients as “upper abdominal discomfort”, “pain”, aching”, “bloatedness”, “fullness”, “burning” or “indigestion”.
Ano ang “Dyspepsia”?
- “Dyspepsia” ang tawag sa pinagsama-samang sintomas ng isanga pasyente na nararamdaman sa itaas na bahagi ng tiyan.
- Ang “dyspepsia” ay madalas nararamdaman ng mga nakatatanda at ito ay pwedeng magtagal o maging pauit-ulit na nagiging dahilan para pumunta at kumonsulta sa doktor.
- Ito ay nararamdaman ng isang pasyente na kadalasan ay sinasabing “di magandang pakiramdam sa may sikmura”, “masakit”, “mahapdi”, “punong pakiramdam” o “di natunawan”.
What are the symptoms of Dyspepsia?
Patient may complain of postprandial upper abdominal fullness, burning pain, nausea, anorexia or loss of appetite, heartburn (burning sensation felt in the chest), regurgitation, frequent burping (belching) or early satiety.
Patients presenting with predominant or frequent (more than once a week) heartburn (burning sensation felt in the chest) or acid regurgitation should be considered to have gastroesophageal reflux disease (GERD) until proven otherwise.
Anu-ano ang mga sintomas ng “Dyspepsia”?
Ang pasyente ay pwedeng magreklamo ng sobrang busog na pakiramdam pagkatapos kumain, hapdi ng sikmura, nawawalan ng ganang kumain, “heartburn” (pangangasim sa may dibdib), pakiramdam ng bumabalik na pagkain, madalas na pag-dighay o pakiramdam ng madaling mabusog.
Kung ang pasyente ay madalas (mahigit 1 beses sa isang linggo) na nakakaramdam ng “heartburn” (mahapding pakiramdam sa may dibdib) o nakakaranas ng bumabalik na maasim na likido paakyat masasabing ang pasyente ay may “gastroesophageal reflux disease” o GERD.
What are the kinds of Dyspepsia?
Uninvestigated dyspepsia refers to the new onset of or recurrent dyspepsia in a person in whom no investigations have been performed and therefore, without a specific diagnosis that explains the cause of dyspepsia. The health care provider caring for patient with uninvestigated dyspepsia must decide between a course of empirical treatment and diagnostic.
Functional dyspepsia refers to persistent or recurrent dyspepsia in patient who has undergone diagnostic investigation (including endoscopy) and has not been found to have an obvious specific cause of dyspepsia
Anu-ano ang klase ng “Dyspepsia”?
“Uninvestigated dyspepsia” and tawag sa bago o paulit-ulit na nararamdam ng isang tao na sakit sa itaas na bahagi ng tyan kung saan wala pang imbestigasyong nagagawa na maaaring magpaliwanag tungkol sa mga sintomas na kanyang nararamdaman. Ang doktor na nag-aalaga sa kanya ay maaaring mamili kung sya ay bibigyan muna ng gamot o magpapagawa ng mga laboratoryo ukol sa kanyang nararamdaman.
“Functional dyspepsia” naman ang tawag sa palagi o paulit-ulit na nararamdamang sakit sa itaas na bahagi ng tyan ng isang pasyente kung saan mayroon nang imbestigasyong nagawa katulad ng “endoscopy” pero walang nakitang dahilan na maaaring magpaliwanag sa kanyang nararamdaman.
What are the causes of dyspepsia?
It can be caused by several factors such as food, medications or drugs, diseases of the GI tract such as peptic ulcer and gastroesophageal reflux disease (GERD). Some of the causes are listed below.
Causes of Dyspepsia
GastrointestinaI Tract
- Food intolerance
- Peptic ulcer disease (PUD)
- Gastroesophageal reflux (GERD)
- Gastric or esophageal mass/cancer
- Gastroparesis (diabetes, postvagotomy, scleroderma, chronic intestinal pseudo-obstruction, postviral, idiopathic)
- infiltrative gastric disorders (Ménétrier's disease, Crohn's disease, eosinophilic gastroenteritis, sarcoidosis, amyloidosis)
- Gastric infections (cytomegalovirus, fungus, tuberculosis, syphilis)
- Parasites (Giardia lamblia, Strongyloides stercoralis)
- Chronic gastric volvulus
- Chronic gastric or intestinal ischemia
- Irritable bowel syndrome
- Functional dyspepsia
Medications
- Ethanol /Alcoholic Beverage
- Aspirin, NSAIDs (including COX-2 selective agents)
- Theophylline
- Digitalis preparations
- Glucocorticoids, Steroids, Colchicine
- Iron, potassium chloride
- Niacin, gemfibrozil
- Quinidine
- Estrogens
- Levodopa
- Nitrates
- Sildenafil
- Orlistat
- Acarbose
Pancreaticobiliary Disorders
- Chronic pancreatitis
- Pancreatic mass/cancer
- Gall stone
Systemic Conditions
- Diabetes mellitus
- Thyroid disease, hyperparathyroidism
- Renal disease (Renal insufficiency)
- Myocardial ischemia, congestive heart failure
- Intra-abdominal malignancy
- Pregnancy
- NSAIDs, nonsteroidal anti-inflammatory drugs; COX-2, cyclooxygenase-2.
Anu-ano ang maaaring maging dahilan ng “dyspepsia”?
Maraming bagay ang maaaring maging sanhi ng “dyspepsia”:GastrointestinaI Tract
- Food intolerance(Di natunawan)
- Peptic ulcer disease (PUD)
- Gastroesophageal reflux (GERD)
- Gastric or esophageal mass/cancer
- Gastroparesis (diabetes, postvagotomy, scleroderma, chronic intestinal pseudo-obstruction, postviral, idiopathic)
- infiltrative gastric disorders (Ménétrier's disease, Crohn's disease, eosinophilic gastroenteritis, sarcoidosis, amyloidosis)
- Gastric infections (cytomegalovirus, fungus, tuberculosis, syphilis)
- Parasites (Giardia lamblia, Strongyloides stercoralis)
- Chronic gastric volvulus
- Chronic gastric or intestinal ischemia
- Irritable bowel syndrome
- Functional dyspepsia
Mga Gamot
- Ethanol /Alcoholic Beverage
- Aspirin, NSAIDs (including COX-2 selective agents)
- Theophylline
- Digitalis preparations
- Glucocorticoids, Steroids, Colchicine
- Iron, potassium chloride
- Niacin, gemfibrozil
- Quinidine
- Estrogens
- Levodopa
- Nitrates
- Sildenafil
- Orlistat
- Acarbose
Pancreaticobiliary Disorders
- Chronic pancreatitis
- Pancreatic mass/cancer (Tumor o bukol sa pancreas)
- Gall stone (Bato sa Apdo)
Systemic Conditions
- Diabetes mellitus
- Thyroid disease, hyperparathyroidism (Goiter)
- Renal disease (Renal insufficiency)(Sakit sa rinyon)
- Myocardial ischemia, congestive heart failure (Sakit sa puso)
- Intra-abdominal malignancy (Tumor o bukol sa loob ng tyan)
- Pregnancy (Pagbubuntis)
- NSAIDs, nonsteroidal anti-inflammatory drugs; COX-2, cyclooxygenase-2. (Mga gamot para sa sakit o rayuma)
How serious is Dyspepsia?
Dyspepsia in most cases is not a serious condition but it may lead to much discomfort affecting general wellbeing. If it is chronic or persistent, one should seek consult to make sure there are no serious problems such as ulcer or cancer.
Cancer of the stomach or esophagus is rare among patients with dyspepsia and few arises in patients less than 45 years old unless with risk factors namely:
- Previous history of surgery in the stomach
- Family history of malignancy in the stomach or esophagus
- Patients with H. Pylori infection
Gaano kadelikado ang “Dyspepsia”?
Ito ay hindi delikadong karamdaman pero maaari itong magbigay ng sobrang sakit sa isang tao na maaaring makaapekto sa kanyang pang araw-araw na gawain. Kung ito ay paulit-ulit o palaging nararamdaman ng isang pasyente, nararapat na siya kumonsulta sa isang doktor o espesyalista para makapag-imbestiga upang alamin kung walang mas seryosong dahilan tulad ng ulcer o kanser.
Ang kanser sa tiyan ay di pangkaraniwan sa mga taong may sintomas ng “dyspepsia” lalo na sa mga may edad na mas bata sa 45 taong gulang mapuwera na lang kung mayroon sya sa isa sa mga sumusunod:
- dating operasyon sa tiyan
- lahi ng kanser sa tiyan o “esopaghus” sa pamilya
- pasyenteng may H. pylori
How do you diagnose Dyspepsia?
Dyspepsia is diagnosed based on typical symptoms and exclusion of non-functional gastrointestinal diseases (including acid-related diseases, cancer), non-gastrointestinal diseases and psychiatric illness.
Patients with dyspepsia who are 45-55 yr old or older, or those with “alarm” features (bleeding, anemia, early satiety, unexplained weight loss (>10% body weight), progressive difficulty in swallowing (dysphagia), painful swallowing (odynophagia), persistent vomiting, family history of gastrointestinal cancer, previous cancer in the stomach or esophagus, previous documented peptic ulcer, enlarged lymph nodes, or an abdominal mass) should undergo prompt endoscopy to rule out peptic ulcer disease, esophagogastric malignancy, and other rare upper gastrointestinal tract disease.
The risk of malignancy increases with age and therefore treatment without investigation is not currently recommended in individuals over 45-55 year of age who develop new symptoms of dyspepsia.
Tests to rule out serious upper gastrointestinal tract diseases:
- Gastroscopy
- Helicobacter Pylori testing
- Ultrasonography of the abdomen
- Abdominal CT Scan
- Gastric Scintigraphy
- Ambulatory esophageal PH monitoring
Paano malalaman kung ang sakit ay “Dyspepsia”?
Masasabing may “dyspepsia” ang isang tao base sa mga sintomas na kanyang nararamdaman at pagkatapos magawa ang mga imbestigasyon na makapagsasabing ito ay hindi dahil sa mas malalang dahilan sa tulad ng “ulcer” o kanser sa loob ng tyan, sakit na walang kinalaman sa tyan o sakit sa utak.
Ang mga pasyenteng may edad na 45-55 o pataas na may sintomas ng “dyspepsia”, may nakakaalarmang sintomas tilad ng pagdudugo, pamumutla, pangangayayat (>10% ng timbang), unti-unting paghirap sa paglunok, masakit na paglunok, madalas na pagsusuka, lahi ng kanser, dating [pagkakaroon ng sakit na “ulcer”, malalaking kulani or bukol sa tyan ay dapat sumailalim kaagad sa “endoscopy” upang malaman kaagad kung walang mas malalang dahilan ng karamdaman.
Ang mga paraan upang malaman ang mas malalang kadahilanan ng sakit sa tiyan:
- pagsilip sa loob ng itaas na bahagi ng tiyan o “endoscopy”
- pag-testing para sa Helicobacter pylori
- ultrasoung ng tiyan
- Ct scan ng tiyan
- gastric scintigraphy
- “ambulatory esophageal pH monitoring”
How do you treat Dyspepsia?
- Once a diagnosis of functional dyspepsia is confirmed by a negative endoscopy, an empiric trial of therapy is commonly prescribed.
- A trial of antisecretory therapy leads to resolution of symptoms in the majority of patients with underlying GERD and peptic ulcer disease, as well as approximately one third of patients with functional dyspepsia.
- Proton pump inhibitors are the preferred agents for empirical antisecretory therapy.
- Several potential disadvantages of empirical proton pump inhibitor therapy exist. After discontinuation of the proton pump inhibitor, relapse of symptoms is common. Therefore, chronic acid suppressive therapy is required in most patients. Without further evaluation, chronic proton pump inhibitor therapy may mask or delay the diagnosis of underlying peptic ulcer disease, Barrett's esophagus, or gastric carcinoma. Management must therefore be tailored to the clinical situation and needs of the individual patient.
- Most patients with functional dyspepsia have mild, intermittent symptoms that respond to reassurance and lifestyle modifications. Refractory symptoms, however, may be difficult to manage.
- Check for any recent change in diet or medications as the cause of the dyspeptic symptoms.
- Identify dietary, emotional, and environmental factors that may precipitate symptoms. Coffee, caffeine, and excessive alcohol should be avoided. In patients with meal-related bloatedness, nausea, or early satiety, frequent small, low-fat meals may reduce symptoms.
- Because most symptoms are chronic or recurrent, the patient must adapt lifestyle modifications and coping strategies. Treatment goals should be realistic and compliance is adequate.
- Provide a follow-up visit to confirm a symptomatic response.
- In patients without an obvious specific cause of dyspepsia, consider psychological or psychiatric problems such as history of physical or sexual abuse, or for refractory symptoms, referral to a psychologist or chronic pain management clinic.
Paano ginagamot ang “dyspepsia”?
- Kung ang pasyente ay masasabing may “functional dyspepsia” dahil walang nakitang abnormal sa endoscopy, ang pasyente ay pwede bigyan ng gamot para makontrol ang mg sintomas
- Ang pagbibigay ng gamot para makontrol ang acid sa loob ng sikmura ay nakakatulong para mawala ang mga sintomas sa karamihan ng mga pasyenteng may GERD, ulcer o “functional dyspepsia”
- Ang mga tinatawag na “proton pump inhibitors” o gamot para makontrol ang acid sa sikmura ang pangunahing gamot ni ibinibigay
- May mga ilang bagay na hindi maganda ukol sa mga PPI. Pwedeng bumalik ang mga sintomas kapag inihinto ang pag inom ng gamot na ito. Dahil dito, nangangailangan ng matagalang paggagamot ang mga pasyente. Kung walang gagawing pag iimbestiga sa mga sintomas, matagalang pag inom ng mga gamot na ito ay maaaring makaantala sa pagbibigay ng tamang diagnosis ng ulcer, barretʼs esophagus o cancer sa tyan. Dahil dito, ang paggagamot ay nararapat na naaangkop sa bawat pasyente.
- Karamihan sa mga pasyenteng may “functional dyspepsia” na hindi malala at pabalik-balik ang sintomas ay nagkakaroon ng pagbabago sa pamamagitan ng pagbibigay sa kanila ng assurance at payo ukol sa mga nararapat gawin upang maiwasan ang pagbalik ng mga sintomas. Mga pasyenteng may mga sintomas na di nagbabago kahit umiinom ng mga gamot ay mahirap alagaan
- Nararapat na alamin kung may mga bagong pagakain o gamot na iniinom na maaaring naging dahilan ng mga sintomas
- Alamin ang mga kinakain, mga emosyon o mga pangyayari sa kapaligirian na maaaring pagsimulan ng sintomas. Kape, mga inumin o pagkaing may caffeine at alkohol ay dapat iwasan. Sa mga pasyenteng nakakaramdam ng pagkapuno pagkakatapos kumain, dapat silang payuhan ng pakonti-konti pero madalas na pagkain
- Sabihan ang pasyente na bumalik sa klinika para malaman kung may pagbabago sa mga sintomas
- Sa pasyenteng walang makitang dahilan ng mga pabalik balik na sintomas, dapat alamin kung may mga problema sa kaisipan upang sila ay mai-refer sa isang psichiatrist