Evaluation and Management of Dyspepsia

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1、EvaluationandManagementofDyspepsiaR.ChristopherHarmon,DavidA.PeuraTherAdvGastroenterol. 2010;3(2):87-98. AbstractandIntroductionAbstractDyspepsiaisacommonclinicalproblemseenbybothprimarycarephysiciansandgastroenterologists.Initialevaluationshouldfocuso

2、ntheidentificationandtreatmentofpotentialcausesofsymptomssuchasgastroesophagealrefluxdisease(GERD),pepticulcerdisease,andmedicationsideeffectsbutalsoonrecognizingthoseatriskformoreseriousconditionssuchasgastriccancer.Thismanuscriptdiscussestheevaluatio

3、nandmanagementofdyspepsiaincludingtheroleofproton-pumpinhibitors,treatmentofHelicobacterpylori,andendoscopy.Finally,treatmentofrefractoryfunctionaldyspepsiaisaddressed.IntroductionOfalladults30–40%experiencesymptomsofupperabdominalpainordiscomfortbutan

4、organiccauseisfoundinonlyaminoritywhoseekmedicalcare[El-SeragandTalley,2004;Talley etal. 1998b].Theremaininggroupislabeledashavingfunctionaldyspepsia.Individualswithfunctionaldyspepsiasuffersignificantmorbidityandexpendsignificantresourcesthroughbothdi

5、rectandindirectcosts.Despiteperiodsofremission,patientswillusuallyhavecontinuedintermittentsymptomslong-term[Agreus etal. 1995;Talley etal. 1987];withapproximately50%consultingahealthcareproviderfortheirsymptomsatsometimeintheirlife[Koloski etal. 2001]

6、.Dyspepsiaisdefinedashavingoneormoresymptomsofepigastricpain,burning,postprandialfullness,orearlysatiation[Tack etal. 2006].Bloatingandnauseaoftencoexistwithdyspepsiabutarenonspecificandarethusnotincludedinitsdefinition.Heartburnisalsoexcludedfromdiagn

7、osticsymptomcriteriafordyspepsiasinceitisthoughttoprimarilyarisefromtheesophagusanditissuggestiveofgastroesophagealrefluxdisease(GERD)althoughittoomayoccurconcomitantly[Talley etal. 1993;Klauser etal. 1990].Similarly,retrosternalpainsuggestiveofesophag

8、ealoriginsuchasthatembracedbythetermnoncardiacchestpainislikewisedistinguishedfromdyspepsia.DifferentialDiagnosisPatientspresentingwithpredominantepigastricpainordiscomfortwhohavenotundergoneanyinvestigationsaredefinedashavinguninvestig