DR Medhat MRCP

سؤال مهم : dyspepsia Drug-induced
o NSAIDS.
o Bisphosphonates.
o Steroids.
The following drugs may cause reflux by reducing lower esophageal sphincter (LOS)
pressure
• Calcium channel blockers* although they are used in TTT of achalasia, they
• Nitrates*
themselves can cause dyspepsia due to their
Effect on LOS.
• Theophyllines
• Investigations :
I. Routine blood tests :
o CBC :
to R/O iron deficiency anaemia.
o RFT :
to R/O renal impairment as a cause.
o LFT :
to R/O biliary disease e.g obstructive jaundice.
o S.Amylase : to R/O acute pancreatitis.
o H.Pylori serology (Abs) : for patients who are not treated from H.pylori before.
II. Decide about urgency of upper GI endoscopy referral (NICE guidelines):
Alarming signs in a patient with dyspepsia (referral criteria)
1. GI bleeding.
2. Progressive weight loss.
3. Progressive dysphagia..
4. Persistant vomiting.
5. Epigastric mass.
6. Anemia (Iron deficiency /pernicious)
7. H/O Barret`s oesophagus
8. Family H/O GIT cancer or past H/O GIT surgery > 20 years
Dyspepsia without
alarming signs &not
investigated before )
If any of alarming signs regardless the age.
Or
Age > 55 years + dyspepsia which is :
1) Recent onset (rather than recurrent)
2) Unexplained (no PPting factors).
3) Persistant ( > 4-6 weeks)
If dyspepsia with acute
or severe GI bleeding.
Treat as uninvestigated
dyspepsia (see later)
Urgent endoscopy within 2 weeks
15
Immediate
endoscopy (within 24 hrs)