Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

510 Dyspepsia

tests

Specific Diagnostic Tests

■upper GI barium study (ulcers, neoplasms, gastroparesis)

■endoscopy (esophagitis, ulcers, neoplasms, gastroparesis)

■ultrasonography (cholelithiasis)

■nuclear medicine gastric emptying studies (gastroparesis)

■electrogastrography (gastroparesis)

Indirect Tests

■antibody, urea breath tests, fecal antigen tests for H. pylori

differential diagnosis

■peptic ulcer (diagnosis best made by endoscopy or UGI barium

radiography)

■gastric neoplasia (diagnosis best made by endoscopy or UGI barium

radiography)

■non-ulcer dyspepsia (diagnosed made by a negative imaging study)

■gastroesophageal reflux (diagnosis best made by endoscopy, pH

study, or response too empirical trial of therapy)

■cholelithiasis (diagnosis best made by ultrasound or CT imaging)

■gastroparesis (diagnosis best made by nuclear medicine gastric

imaging)

■medication or food-induced (diagnosis best made by withdrawing

suspected agent)

management

What to Do First

■empiric treatment vs or making a definitive diagnosis?

■this is a philosophical issue and should be decided in conjunction

with the patient’s needs

■empirical trial of therapy

➣H2RA or PPI as an anti-secretory, acid lowering agent

➣Helicobacter pyloritreatment

➣prokinetic agent, i.e. metoclopramide

■diagnostic tests for definitive diagnosis

➣endoscopy for ulcers, esophagitis, neoplasms; more accurate

than UGI but more expensive and invasive

➣UGI for ulcers, neoplasms; less accurate than endoscopy but

cheaper and less invasive

■ultrasound/CT for cholelithiasis; accurate, widely available

■nuclear medicine gastric emptying study for gastroparesis; accurate,

but current therapies for this disorder largely ineffective