DYSPEPSIA AND ITS CLINICAL PRESENTATION

Abstract: Objective: Nowadays, Upper gastro-intestinal motility disorders are very common. The exact numbers of victims in Pakistan are unknown so far; however, numerous cases are surfaced who are found normal on liver function test and endoscopy test. Research aim was the management of dyspepsia in the patients suffering from nausea, anorexia, vomiting, heartburn, upper abdominal pain and fullness etc. Design and Setting:Our research was descriptive in nature and it was carried out in Mayo Hospital Lahore in the timeframe of August, 2016 to August, 2017. Material and Methods:When emptying of the stomach is sluggish one, such disorders are said to be functional. The related symptoms can be as mentioned above. It seems as if this condition is not problematic but it can be of grave concern in some cases. From mild to severe, symptoms may differ. Questions of dyspepsia management and its assessment are not answered yet. Preliminary Diagnostic ability could be challenging one due to overlapping causes of symptoms. A distinct reason is rarely established in a number of cases. The preliminary investigation of dyspepsia related patients encompasses physical examination and a systematic history while giving particular attention to those elements implying the presence of illness. Patients having alarm symptoms i.e. weight loss, melena and anorexia etc. should be immediately given Endoscopy test. If the test is positive, a cost-effective preliminary approach to check the Helicobacter pylori, Management should be applicable individually. Empiric therapy with prokinetic agent or a gastric acid suppressant is suggested if the said test is negative. Results:Dyspepsia patients' upper gastrointestinal radiographs were collected historically. Endoscopic tests, nowadays, have lost their reliability for upper endoscopic examination in authenticating or excluding ulcers, malignancies and reflux disease. Though, diagnostic gold standard for pylori infection is endoscopy with biopsy, yet, the whole procedure may be impractical and expensive. Detection of pylori can also be made in the breath with the urea breath test (UBT), in the stool with a polymerase chain reaction (PCR) test or an antigen enzyme immunoassay (EIA), in the serum with antibody titers etc. If H. pylori is detected with the UBT, breaking down of ingested carbon labelled urea into ammonia and labelled CO2, is carried out by urease produced by the organism. It can be identified in breath of patient. The UBT is costlier, more specific and more sensitive. Cost and practicality of serology is acceptable. Its specificity and sensitivity to identify H. pylori infection render it an appropriate position in the market in comparison to UBT. Positive serology test suggests inactive infection and previous H. pylori exposure. Hence, the authenticity of elimination of organism questions the test utility. The UBT is, thus, highly recommended test in this regard. urease is not further originated once H. pylori is eliminated. In younger patients, non-invasive detection of H. pylori in the feces is of poignant significance. Sensitivities reported of PCR and EIA for H. pylori are 93.70% and 88.90%. The relevant specificities are hundred percent and 94.6 %. Conclusion:It is concluded that in such cases endoscopy should be carried out in case recurrence or persistence of symptoms. The base of this appraisal is on extensive search and clinical experience and study through “MEDLINE” on research papers, conference reports on Functional Gastro-intestinal disorders and review articles. Key Words: Diagnosis, Dyspepsia, Endoscopy and Medical Management.