DYSPEPSIA

dan
GERD
FAUZI YUSUF
RTD OZID JAMBO GEUMULOH
 Uninvestigated
dyspepsia
Investigation

Organic dyspepsia Functional dyspepsia

 Alarm symptoms :
o Melena (within 1 day)
o Hematemesis (within 1 day)
o Persistent vomiting (7-10 days)
o Anemia (7-10 days)
o Acute onset dysphagia (within 1 day)
o Weight loss greater than 5%
(involuntary) (7-10 days)
Factors Indicating Immediate
Investigation
Patients with alarm symptoms regardless of age:
o Unexplained weight loss
o Dysphagia
o GI bleeding
o Clinical signs of anaemia
o Jaundice
o Palpable mass
deserve prompt ENDOSCOPY
Advantages Early Endoscopy?

Reassures you and the patient!

o Therapy can be targeted
- Cure of peptic ulcer
- Management of GERD
- Management of gastric cancer
o Positive diagnosis of functional
dyspepsia
Overlap of subgroups of dyspepsia based on symptoms in
patients with documented functional dyspepsia
The LA classification system for reflux esophagitis
 Definition of GERD :
GERD is defined as condition that
develops when the reflux of stomach
content causes troublesome
symptoms and/or complication

Montreal classification
 The newest classification of GERD:

Vakil et al. Am J Gastroenterol 2006, 8:101-121

 Dyspepsia related GERD:
o Dyspepsia acid N / , delayed gastric
emptying.
o Delayed gastric emptying corellated
with peristaltic & overcontent of
stomach.
o Symptoms: bloating, early satiety,
nausea, vomiting, belching,
dysphagia, odynophagia (functional
dyspepsia/FD)
 Dyspepsia related GERD:
o Longstanding FD GER GERD
o Optimal management of FD,
prevalence of GERD decreased
o Refluxate content acid predominant
o Neutralized acid, to decrease
agressive factor of acid
o Used of PPI more be potent than
H2RA
 Risk factors of GERD :
o Diet high fat, food will be produced
more gas in the stomach
o Habit, alcohol, lying position after
dining, smoking
o Others: Body weight, increased intra
abdominal pressure, body position
during sleep, chronic obstipation
GERD iceberg phenomena
GERD : Goals of therapy
Use of PPIs in GERD :
Choosing between PPIs for treating GERD :
 Conclusions
o Clinical symptoms & sign FD & GERD
often overlapped
o Dysmotility is the first symptoms,
longstanding condition become GERD
o Diagnosis & treatment according to
with or without alarm symptoms
o Life style modification as non
farmacologic therapy
o Maintenance, consider to economic