Birinci Basamakta Dispepsi Şikayeti Olan Erişkin Hastaya Klinik Yaklaşım

Abstract

Dispepsi; üst abdominal veya retrosternal bölgede ağrı, rahatsızlık duygusu olarak tanımlanır, kapsamlı ayırıcı tanılara sahip ve çok bileşenli patofizyolojik mekanizmaları olan yaygın bir semptom veya semptomlar birlikteliğidir. Birinci basamak sağlık merkezine başvuran hastaların en sık başvuru nedenleri arasında dispepsi vardır. Çoğunluğunda altta yatan organik bir neden bulunamaz. Dispepsi vakalarının %40’ında fonksiyonel dispepsi tanısı varken %60’ında organik nedenli dispepsi tanısı vardır. Bazı hastalıklar sadece dispepsi şikayeti ile ortaya çıkabilir, ve birinci basamak hekimleri tarafından şüphenilen durumda mutlaka endoskopik değerlendirme ve ileri tetkik için üst basamağa ilgili branş hekimine yönlendirilmelidir.

Keywords

• Dispepsi
• Birinci Basamak Sağlık Merkezi
• Aile Hekimliği

Clinical Approach to Adult Patients with Dyspepsia in Primary Health Care

Abstract

Dyspepsia is defined as pain and discomfort in the upper abdominal or retrosternal region and  combination of symptoms with comprehensive differential diagnoses and multicomponent pathophysiological mechanisms.Dyspepsia is one of the most common reasons for patients applying to primary health care center. In the majority, an underlying organic cause cannot be found. While 40% of dyspepsia cases have functional dyspepsia, 60% have organic cause dyspepsia. Some diseases can only occur with the complaint of dyspepsia, and in case of suspected by primary care physicians, they should be directed to the upper health care provider for endoscopic evaluation and further examination.

Keywords

• Dyspepsia
• Primary Health Center
• Famiy Medicine

References

1. Talley NJ, Silverstein MD, Agreus L, Nyren O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. Gastroenterology 1998;114:582–595.
2. Uslan İ, Ellidokuz E. Birinci Basamakta Dispepsiye Güncel Yaklaşım. Sürekli Tıp Eğitimi Dergisi 2003; 12(6):216.
3. Lacy BE, Weiser KT, Kennedy AT, et al. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther 2013; 38:170.
4. Bytzer P, Talley NJ. Dyspepsia. Ann Intern Med 2001; 134:815.
5. Özden A. Roma IV-2016, Dispepsi Tedavisine Yaklaşım. Güncel Gastroenteroloji 2017; 21(1): 19-24.
6. Kavitt RT, Lipowska AM, Anyane-Yeboa A, Gralnek IM. Diagnosis and Treatment of Peptic Ulcer Disease. Am J Med 2019; 132:447.
7. Feinle-Biset C, Vozzo R, Horowitz M, et al. Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia. Am J Gastroenterol 2004; 99:170-81.
8. Talley NJ, Vakil NB, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology 2005; 129:1756.

9. Hallas J, Bytzer P. Screening for drug related dyspepsia: an analysis of prescription symmetry. Eur J Gastroenterol Hepatol 1998; 10:27.
10. Brito-Zerón P, Bari K, Baughman RP, Ramos-Casals M. Sarcoidosis Involving the Gastrointestinal Tract: Diagnostic and Therapeutic Management. Am J Gastroenterol 2019; 114:1238.
11. Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer Control 2018; 25:1073274818778256.
12. Lacy BE, Talley NJ, Locke GR 3rd, et al. Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther 2012; 36:3.
13. Moayyedi P, Axon AT. The usefulness of the likelihood ratio in the diagnosis of dyspepsia and gastroesophageal reflux disease. Am J Gastroenterol 1999; 94:3122.
14. Thistle JL, Longstreth GF, Romero Y, et al. Factors that predict relief from upper abdominal pain after cholecystectomy. Clin Gastroenterol Hepatol 2011; 9:891.
15. Hunt RH, Xiao SD, Megraud F, et al. Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline. J Gastrointestin Liver Dis 2011; 20:299.
16. Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56:772.
17. Ford AC, Marwaha A, Lim A, Moayyedi P. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8:830.
18. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut 2012; 61:646.
19. Moayyedi P, Lacy BE, Andrews CN, et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol 2017; 112:988.
20. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 112:212.
21. Jones RH, Baxter G. Lansoprazole 30 mg daily versus ranitidine 150 mg b.d. in the treatment of acid-related dyspepsia in general practice. Aliment Pharmacol Ther 1997; 11:541.
22. Mason I, Millar LJ, Sheikh RR, et al. The management of acid-related dyspepsia in general practice: a comparison of an omeprazole versus an antacid-alginate/ranitidine management strategy. Compete Research Group [corrected]. Aliment Pharmacol Ther 1998; 12:263.
23. Talley NJ, Lauritsen K. The potential role of acid suppression in functional dyspepsia: the BOND, OPERA, PILOT, and ENCORE studies. Gut 2002; 50 Suppl 4:iv36.
24. Köksal A, Oğuz D, Özden A. Türkiye'de birinci basamak sağlık kurumlarına başvuran hastalarda dispepsi görülme sıklığı. Akademik Gastroenteroloji Dergisi 2008; 7(1): 11-17.
25. Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2006;(4): CD001960.
26. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician 2007;75(7): 1027-30.
27. Holtmann G, Gschossmann J, Mayr P, Talley NJ. A randomized placebo-controlled trial of simethicone and cisapride for the treatment of patients with functional dyspepsia. Aliment Pharmacol Ther 2002;16(9): 1641-8.