A clinical study of upper gastrointestinal endoscopy findings in patients presenting with dyspepsia

INTRODUCTION: Dyspepsia is affecting about 25% of general population in developed nations and it is a major cause for medical visits. New patients comprise about 10% of population every year. Dyspepsia majorly affects quality of life and it is a major burden in view of social costs. Directly the expenses are for laboratory tests, medical consultation and drugs and indirectly by absence from work. Dyspepsia refers to spectrum of diseases and heterogeneous group of symptoms confined to upper abdomen. Dyspepsia is a vague term used to explain upper abdominal collection of symptoms like indigestion, fullness, early satiety (not able to complete the meals), bloating, belching, nausea, epigastric discomfort or pain and anorexia. Indigestion is very common in general population; almost all have had indigestion at some time in their lifetime. Sometimes patients will include constipation and undigested food particles in the stool. Rome II working team defined dyspepsia as discomfort or pain in upper abdomen. Central abdominal pain is considered to be a vital symptom. Pain which is present in other regions or associated to defecation is not considered. Non ulcer dyspepsia, this description comprises a group of symptom complex simulating peptic ulcer in patients who have no provable or objective evidence of an ulcer. Based on analysis of problems individuals with non ulcer dyspepsia categorized into two types. Pseudo ulcer syndrome—with classic symptoms of ulcer disease Functional dyspepsia—with post prandial fullness, belching and bloating, occasionally associated with pyloroduodenal irritability and prolonged gastric emptying. Usually this functional component is attributed to uncoordinated motor activity and afferent hyper reactivity. Gastro-oesophageal reflux disease is a condition, defined as abnormal entering of gastric juice into oesophagus and causes symptoms due to tissue damage. The principal pathophysiological problem is the presence of unusual amount of gastric juice in the lumen of oesophagus. Symptoms thought to suggest of gastro-oesophageal disease , such as heart burn or regurgitation are very much prevalent in general population and many individuals do not seek medical advice. The presence of symptoms doesn’t correlate well with the tissue damage. For instance the significant problem like Barrett’s oesophgus, even in early adenocarcinoma, can occur without symptoms. Gastro-oesophageal reflux disease is most commonly treated by physicians, this is substantiated by amount of revenue recorded by many pharmacteutical company. The symptoms are due to failure of protective antireflux mechanisms. A clear understanding of the normal anatomy and physiology of esophagus is mandatory to decide the surgical and medical management. OBJECTIVES: 1. To study the endoscopic presentation of dyspepsia. 2. Early detection of esophagogastroduodenal carcinoma. 3. To study the age and sex prevalence in patients presenting with dyspepsia. 4. To study the common site of lesion in patients presenting with dyspepsia. METHODOLOGY: A prospective clinical study was undertaken at Tirunelveli Medical College Hospital, Tirunelveli to know the various upper gastro-intestinal endoscopic findings in patients presenting with dyspepsia. The study was conducted from march 2011 to October 2012. The patient selection was by convenience sampling. Dyspeptic patients were included in this study with their informed consent. A detailed clinically history was elucidated, followed by careful clinical examination, which were recorded as per the proforma. All the patients included in the study underwent upper gastrointestinal endoscopy and the findings were noted. The inclusion and exclusion criterias were as follows: Inclusion criteria: 1. Patients above 13 years of age. 2. Patients showing symptoms of dyspepsia for 4 or more than 4 weeks. 3. Patients with uncomplicated and uninvestigated dyspepsia. Exclusion criteria: 1. Patients below 10 years of age. 2. Pregnant and lactating women. 3. Patients on proto-pump inhibitors. 4. Patients who are known cases of chronic pancreatitis and liver disease. 5. Patients on NSAID’s for more than one month duration. 6. Unwilling or unfit patients for endoscopy. SUMMARY A prospective clinico-pathological study was undertaken in Tirunelveli Medical College Hospital to know the various endoscopic findings in patients presenting with dyspepsia and early detection of oesophagogastroduodenal malignancy in these patients. 140 patients presenting with dyspepsia were evaluated. The following were the observations: 1. Highest prevalence of dyspepsia in the age group of 30-39years. 2. Most common presenting complaint was epigastric pain and discomfort. 3. Dyspepsia was more common in males (58%) when compared to Females (42%) 4. Most common endoscopic finding was normal study followed by gastritis. 5. Malignancy was diagnosed in 5.7% patients with dyspepsia. 6. Stomach is the common site of lesion in patients presenting with dyspepsia 7. Gastritis, duodenitis and gastric ulcer is common in males while malignancy/growth is more common in females presenting with dyspepsia. 8. Incidence of malignancy increases as the age advances. CONCLUSION: From the present study of “A clinical study of various findings in upper gastro-intestinal endoscopy in patients presenting with dyspepsia”. On endoscopic examination gastritis accounted for the majority of the cases. Incidence of malignancy in the present study was observed to be 5.7% (gastric malignancies). Clinically significant endoscopic findings were observed in 52.14% 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. Prevalence of large number of inflammatory lesions as a result of increased acid production and low incidence of malignancy in the study group suggests that the uninvestigated patients with dyspepsia may be initially managed medically with acid suppressive therapy.