Raeefuddin Ahmed.
Management of Dyspepsia.
Pak J Med Sci Jan ;20(1):55-60.

Upper gastro-intestinal motility disorders are not uncommon. While the exact prevalence in Pakistan is not known there are substantial number of patients who suffer from upper abdominal pain, fullness, nausea, vomiting, anorexia or heartburn and are found to be normal on endoscopy and liver function test. In such patients it appears that the disorder is a functional one with sluggish emptying of the stomach resulting in the symptoms as described above. Though this condition is not serious but can be extremely disturbing to these individuals. Symptoms may vary from mild to quite severe. Questions about the evaluation and management of dyspepsia remain unanswered. Symptoms of possible causes often overlap, which can make initial diagnosis difficult. In many patients, a definite cause is never established. The initial evaluation of patients with dyspepsia includes a thorough history and physical examination, with special attention given to elements that suggest the presence of serious disease. Endoscopy should be performed promptly in patients who have "alarm symptoms" such as melena, weight loss or anorexia. Although management should be individualized, a cost-effective initial approach is to test for Helicobacter pylori and treat the infection if the test is positive. If the H. pylori test is negative, empiric therapy with a gastric acid suppressant or prokinetic agent is recommended. If symptoms persist or recur after six to eight weeks of empiric therapy, endoscopy should be performed. This review is based on clinical experience and extensive search and study through MEDLINE on research papers, review articles and conference reports on Functional Gastointestinal disorders.

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