Early Endoscopy of Oesophagus, Stomach and Duodenal Bulb in Patients Presenting with Dyspepsia

Uninvestigated dyspepsia is common in surgical out patient department. The prevalence of clinically significant upper gastrointestinal findings in adult uninvestigated dyspepsia patients and their predictability based on history is unknown. So a study was undertaken in SMIMER Hospital, Surat to study the endoscopic findings in dyspeptic patients, prevalence of H.pylori infection in dyspeptic patients and to detect the esophagogastroduodenal carcinoma in early stages.After informed consent 120 patients aged more than 13 years presenting with uninvestigated, untreated and uncomplicated dyspepsia were enrolled and evaluated in the study. Patients aged less than 13 years, pregnant and Lactating women, patients on chronic Proton pump inhibitors (greater than8weeks), patients who are known cases of chronic pancreatitis and liver disease, patients on NSAID’s for more than one month duration, patients who had received Anti-Helicobacter pylori treatment and unwilling or unfit patients for endoscopy were excluded from the study. All patients underwent upper gastro-intestinal endoscopy to document the various findings. Biopsies were taken in every patient from the gastric antrum and pathological site. The biopsy specimen was subjected to histopathological examination for confirmation and to detect the prevalence of H.pylori infection by using rapid urease test and by Giemsa staining. The findings were documented and analyzed. Clinically significant endoscopic findings were observed in 84.5 % of patients with uninvestigated dyspepsia. Most patients presented with a complex of three or more dyspeptic symptoms and the symptom profile was not predictive of the endoscopic findings. A larger number of inflammatory lesions as a result of increased acid production, a remarkable prevalence of H.Pylori infection and low incidence of malignancy in the study group. It is suggested that the uninvestigated patients with dyspepsia may be initially managed medically with acid suppressive therapy or H.