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Clinical Pathway for Dyspepsia

Patients<55yearsold Patients55yearsoldandaboveorwithalarmfeatures
Duringclinicvisit Duringclinicvisit
Assessment Stronglyconsideredbasedonhistoryandphysical Stronglyconsideredbasedonhistoryandphysical
examination examination
Ageofpatient55yearsoldandaboveconsidered
Presenceofthefollowingalarmsymptomsnoted:
1. FamilyhistoryofupperGIcancer
2. Unintendedweightloss
3. GIbleeding,unexplainedanemia
4. Progressivedyspepsia,odynophagia
5. Persistentvomiting
6. Palpablemassorlymphadenopathy
7. Jaundice

Diagnosis None Endoscopy


CBC
Bloodtypingandcrossmatching
Helicobacterpyloritests(rapidurease,serological,urea
breathtest,stoolantigentest)
Imagingasadditionalinvestigativeoption

Treatments Assurancegiventopatient Protonpumpinhibitors


Empirictherapyisoftenprescribed H2receptorantagonists
Prokineticagentsaloneorincombination
Cytoprotectiveagentsasadjuncttotherapy

Teaching Educatepatientthattheincidenceofdyspepsiaisvery Educatepatientandrelativesthatthesymptomsneed


commoningeneralpopulation investigationbecauseofmoreseriouspossibilitieslikepeptic
Symptomsareofshortdurationandmildlysevere ulcers,GERD,malignanciesandinfections
Onlyaminorityhavepepticulcersandevenfewerhave IncaseofHelicobacterpyloriinfection,antibioticsaregiven
cancer for7to10days,orevenupto14days
Formalignancies,additionaltestsinthebloodmaybe
requested
Imagingstudies(UTZ,CTscanorMRI)
Surgeryand/orchemotherapyareoptions
Forrefluxdisease,medicationswillsufficeformostofthe
timeinadditiontolifestylechanges

Prepared by Section of Gastroenterology; Oct, 2009

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