Original Article

Original Article Endoscopic Evaluation of Dyspeptic Patients Sarker MRA1, Islam MA2, Habibullah M3, Ali SM4, Rana AHMS5, Sarker MR6, Aziz MZA7, Ali ML8 Abstract: Conflict of Interest: None Background: Dyspepsia is a common gastrointestinal problems affecting all age groups & Received: 15.02.2020 social classes. Accepted: 30.03.2020 Objectives: The purpose of the study was to determine the endoscopic findings of dyspeptic www.banglajol.info/index.php/JSSMC patients & to observe the demographic characteristics (age, sex, residence, education, socioeconomic condition) of the patients presented with dyspepsia. Methodology: This was a cross-sectional study conducted at Department of Medicine, Rangpur Medical College Hospital, Rangpur over a period of 1 year from 1st June 2010 to 31st May 2011. 150 dyspeptic patients of 18 or > 18 years old irrespective of sexes and suffering from one or more of the five symptoms (flatulence, food intolerance, epigastric pain, heartburn and aerophagia) for at least 6 months duration were recruited for the study from outpatient and in- patient department who were met the inclusion & exclusion criteria. Data were collected by using a structured questionnaire after taking written consent & upper GI Endocopy were done following meticulous history & through physical examination. Result: Over one-third (36%) of the patients were below 30 years, 17% between 30 – 40 years old, predominantly were rural residents, having primary to secondary level of education with monthly income below Taka 10000. Males to females ratio were 2:1. More than half (50.6%) of the patients was smoker, 32.7% had habit of taking tea, 10% were tobacco chewing and rest 6.7% used to take spicy meal.. Epigastric discomfort, flatulence and heartburn were the common complaints in both male and females but vomiting were proportionately higher in male dyspeptics compared to the female dyspeptics. Common associated symptoms like constipation and weight loss were equally in both sexes. Upper GI endoscopy revealed 17.3% of male and 11.5% of female with abnormal findings.Others abnormal findings included gastric ulcer, gastritis and duodenal ulcers (17.6 vs. 33.3%; 23.6 vs. 50% and 17.6 vs. 16.7% in male and female respectively). Majority (nearly 90% in either sex) of patients does not show any lesions on endoscopic examination and hence can be considered as non-ulcer dyspepsia. Conclusion: The study concludes that majority of patients with complaints of dyspepsia have no lesion on the gastric or duodenal mucosa and can be considered non-ulcer dyspepsia. The Key Words: study findings also suggest that dyspepsia is a disease of young and early middle aged people Dyspepsia, Non- ulcer dyspepsia with males being more likely to develop the disease than the females. However, large-scale community survey is recommended for further evaluation of dyspepsia. (NUD), Endoscopy. [J Shaheed Suhrawardy Med Coll 2020; 12(1): 9-14] DOI: https://doi.org/10.3329/jssmc.v12i1.51612 1. Dr. Md. Ruhul Amin Sarker. Assistant Professor, Department of Introduction: Medicine, Rangpur Medical college, Rangpur. 2. Dr. Md. Atiqul Islam, Assistant Professor, Department of Medicine, Dyspepsia is defined as constellation of symptoms that Pabna Medical College, Pabna. include upper abdominal pain or discomfort which is 3. Dr. Mohammad Habibullah. Assistant Professor, Department of intermittent or constant and may be associated with Medicine, Pabna Medical College,Pabna. additional symptoms of nausea and vomiting. Although 4. Dr. Saleh Mohammad Ali. Senior Consultant, Department of Medicine, Pabna sader Hospital, pabna. these symptoms may be associated with a wide range of 5. Dr. Abu Hena Md. Shohel Rana. Assistant Professor, Department specific clinical diagnoses (peptic ulcer disease, gastric of Gastroenterology, Pabna Medical College, Pabna. cancer, and gastro esophageal reflux among others), often 6. Dr. Mokhlesur Rahman Sarker. Associate Professor, Department no organic cause is found (functional dyspepsia). of Medicine, Rangpur Medical college, Rangpur. 7. Dr. Mohammad Zakaria Al-Aziz. Assistant Professor, Department Endoscopic examination of the upper gastrointestinal tract of Medicine, Sheikh Hasina Medical College, Tangail. remains the ‘gold standard’ initial approach in the 8. Dr. Md. Liakat Ali- Assistant Professor, Department of Medicine, management of patients with dyspepsia because of its ease, Abdur Rahim Medical College, Dinajpur. reliability, diagnostic superiority, and the ability that it Correspondence to: Dr. Md. Ruhul Amin Sarker. Assistant Professor, Department of Medicine, Rangpur Medical college, Rangpur. Email: gives the endoscopist to perform biopsies and/or [email protected] Cell No:+8801712936348. therapeutic interventions.1 J Shaheed Suhrawardy Med Coll Vol. 12 No. 1, June 2020 Dyspepsia was defined based on Rome II criteria as pain mass, jaundice, or fecal occult blood, warrant immediate or discomfort centred in the upper abdomen for at least investigations.9 12 weeks which need not be consecutive within the Bangladesh is a developing country with ever-shrinking preceding 12 months and no evidence indicates that it is health budget. Dyspepsia imposes a great burden for the exclusively relieved by defecation or associated with the family, society as well as for the nation. Dyspepsia is a onset of a change in stool frequency or stool form (i.e. not highly focused research interest in the Western country. It 2 irritable bowel syndrome). Chronic and recurrent is assumed that there will be great difference between the dyspeptic symptoms such as epigastric pain, postprandial prevalence rate, its pattern and impact of dyspepsia in fullness and early satiety are common in the general developing country like Bangladesh due to different socio- 3,4 population. It occurs in approximately 25 percent (range cultural background. A study conducted on defined 13 to 40 percent) of the population each year. Dyspepsia population in the year 1985 reported 41% point prevalence incurs substantial health care costs and considerable wage of peptic ulcer dyspepsia in Bangladesh 10. Besides the .4 loss Dyspepsia is divided into two main types: organic direct cost of medical care, these diseases lead to reduction and non-ulcer dyspepsia. Dyspepsia accounts for about in work productivity. The mean number of days per year 4-5% of all the general practitioner consultations and about the patients were absent form works due to dyspepsia 5 20-40% of all gastroenterological consultations .The ranged between 3.3 to 2.2.11,12 There is no fundamental association between dyspeptic symptoms and endoscopic study regarding the dyspepsia in the Northern territory of findings is still not well-characterized. For example, one Bangladesh. Therefore, this study was undertaken to outstanding dilemma is the frequent overlap between identify demographic profile, assess correlation between 6 dyspeptic and reflux symptoms. Dyspeptic symptoms clinical presentations and endoscopic findings, to improve with concomitant prominent heartburn or regurgitation are the quality of management of dyspeptic patients & thereby thought to be associated with gastro esophageal reflux reducing the morbidity and mortality. disease with or without esophagitis and the risk of peptic ulcer is considered to be negligible in these patients.1,7 Methodology: An organic cause is found however in only 40% of patients This cross-sectional study was conducted in the most commonly peptic ulcer disease, gastroesophageal Department of Medicine, Rangpur Medical College st reflux disease and gastric cancer.8 A number of Hospital, Rangpur, over a period of 1 year from 1 June st medications can cause severe gastrointestinal irritation like 2010 to 31 May 2011. 150 dyspeptic patients of 18 or > Non steroidal anti-inflammatory drugs (NSAIDS), aspirin, 18 years old irrespective of sexes and suffering from one potassium supplement, iron, antibiotics, corticosteroids, or more of the five symptoms (flatulence, food intolerance, narcotics, estrogens, theophylline, ACE inhibitors, loop epigastric pain, heartburn and aerophagia) for at least 6 diuretics, nitrates and leovodopa. Some foods can provoke months duration were recruited for the study from dyspepsia, including tomatoes, spicy foods, excessive outpatient and in-patient department who were met the alcohol, fatty foods and coffee. The mechanism by which inclusion criteria & gave the informed written consent to food may cause dyspepsia include overeating,delayed be included in this study were finally selected. Patient who had past documented peptic ulcer or oesophagitis, hepato- gastric emptying (cholecystokinin induced), direct mucosal biliary and pancreatic disorders, had past gastric surgery, irritation, or provocation of gastroesophageal reflux. overt gastrointestinal bleeding & Seriously ill patients were Patients who are lactose intolerant may experience excluded from this study. The study was conducted with abdominal pain followed by flatulence or diarrhoea with prior ethical clearance of Ethical committee of Rangpur larger intake. Approximately 15% of patients referred to Medical College, Rangpur. Before data collection , primary practitioners with dyspepsia have peptic (gastric informed written consent was taken from the respondent. or duodenal) ulcers. Gastric cancer is present in less than Data were collected using a structured questionnaire by 2% of patients with dyspepsia, but is rare in patients under the researcher with face to face interview. Moreover age 50.8 Most

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