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Doctor's Write Up
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How common is Upper Abdominal Pain or Dyspepsia?
The complaint of upper abdominal pain or dyspepsia encompasses a wide variety of clinical presentations and diagnoses, ranging from mild gastrointestinal inflammation / infections to such life-threatening conditions as perforated duodenal ulcer and pancreatic cancer. This can make it challenging to identify the specific cause of upper abdominal pain-even more so in primary care practice because the various conditions that cause abdominal pain do not always present with classic findings.
Typical Presentation
Most patients with dyspeptic syndromes, by definition, present with pain above the umbilicus. However, pain may not be a consistent presenting complaint. Other symptoms that may or may not be presented include heartburn, bloating, nausea, vomiting, hiccupping and/or belching.
Causes of Dyspepsia
Common
* Nonulcer Dyspepsia
* Gastroesophageal Reflux Disease (GERD)
* Gastritis
* Peptic Ulcer Disease (duodenal or gastric)
* Cholelithiasis
Uncommon
* Gastroparesis
* Gastric Cancer
* Pancreatitis
* Acute Myocardial Infection
* Perforated Duodenal Ulcer
* Abdominal Aortic Aneurysm
In addition, patients with dyspeptic symptoms should always be questioned about the use of painkillers such as the Non Steroidal Anti Inflammatory Drugs (NSAIDSs). These medications are the second-most common cause of peptic ulceration after Helico Bacter Pylori infection.
Helico Bactor Pylori is a bacteria that is now recognized as a major cause of dyspepsia, gastro duodenitis, gastric/duodenal ulcerations and in the long term even gastric cancer.
To determine the underlying cause of dyspepsia, the following are important:
* History of presenting complaint and medications (ie NSAIDs)
* Physical Examination
* Ancillary Tests to detect serious conditions or complications
* Endoscopic Tests
ENDOSCOPY
For most patients in whom examination of the upper gastrointestinal tract is needed, endoscopy is the preferred test. Endoscopy can reliably diagnose gastritis and is more sensitive and specific than is radiographic imaging for diagnosing ulcers and GERD.
In fact, endoscopy is considered the gold standard for diagnosing ulcers, gastritis, and esophageal injury from GERD. In addition, the ability to obtain biopsies during endoscopic procedures permits identification of H.Pylori infection.
Endoscopy is now a very sophisticated procedure using the latest flexible video endoscopes which makes it a relatively safe and comfortable procedure in expert hands.
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