Dyspepsia in Clinical Practice

Transcription

1 Dyspepsia in Clinical Practice

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3 Dyspepsia in Clinical Practice Marko Duvnjak

4 Editor Marko Duvnjak Department of Gastroenterology and Hepatology University Hospital Sestre milosrdnice Medical School in Zagreb, University of Zagreb Zagreb Croatia ISBN e-isbn DOI / Springer New York Dordrecht Heidelberg London Library of Congress Control Number: Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 To my family I dedicate this book to my family, as their love and support are essential for all my work.

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7 Acknowledgments As the editor of this book, I found myself facing a challenging task having in mind that it was written in an attempt to elucidate this interesting topic from a practical point of view. If the book succeeds in its goal, and I truly believe it will, all the thanks should go to the authors who gave their best to bring in front of you an evidence-based, concise, up-to-date, and practical text on the relevant topic. I would also like to thank my colleagues who helped me in this enterprise, Marija Gomerčić, MD, Sanja Stojsavljević, MD, Lucija Virović-Jukić, MD, PhD, and Neven Baršić, MD, as well as Prof. George Y. Wu, MD, PhD and our publisher Springer Publishing Company, who gave me the idea and the opportunity for this project. Marko Duvnjak vii

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9 Contents Acknowledgments... vii Contributors... xi Introduction... Marko Duvnjak xv 1 The Definition of Dyspepsia... Daniel Schmidt-Martin and Eamonn M.M. Quigley 1 2 Subgroups of Dyspepsia... Bojan Tepeš 9 3 Epidemiology... Roland Pulanic 19 4 Structural Causes of Dyspepsia... Daniel Schmidt-Martin and Eamonn M.M. Quigley 29 5 Functional (Nonulcer) Dyspepsia... Marino Venerito, Arne Kandulski, and Peter Malfertheiner 43 6 How to Diagnose Dyspepsia... Lars Aabakken 53 7 Differential Diagnosis: Overlap Between Gastroesophageal Reflux Disease and Irritable Bowel Syndrome... Michael Häfner 8 Management of Uninvestigated Dyspepsia... Marko Duvnjak, Marija Gomerc ic, and Sanja Stojsavljevic ix 61 75

10 x Contents 9 Management of Helicobacter pylori Infection... Marko Duvnjak and Ivan Lerotic Management of Peptic Ulcer Disease Marko Duvnjak and Vedran Tomašic 11 Therapeutic Approach in Functional (Nonulcer) Dyspepsia Arne Kandulski, Marino Venerito, and Peter Malfertheiner 12 Prognosis György Miklós Buzás 13 Quality of Life Issues György Miklós Buzás 14 Economic Analyses of Present Management Strategies and Nonprescription Therapy in Treatment of Dyspepsia Mattijs E. Numans 15 Dyspepsia in Children: Epidemiology, Clinical Presentation, and Causes Oleg Jadrešin 16 Diagnostic Tests and Treatment of Dyspepsia in Children Alberto Ravelli 17 Dyspepsia in the Elderly Bojan Tepeš 18 Diabetes Mellitus and Dyspepsia Lea Smirc ic -Duvnjak Index

11 Contributors Lars Aabakken Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway György Miklós Buzás Department of Gastroenterology, Ferencváros Health Service Non-Profit Ltd, Budapest, Hungary Marko Duvnjak Department of Gastroenterology and Hepatology, University hospital Sestre milosrdnice, Medical School in Zagreb, University of Zagreb, Zagreb, Croatia Marija Gomerc ic Division of Gastroenterology and Hepatology, Department of Medicine, Sestre milosrdnice University Hospital, Zagreb, Croatia Oleg Jadrešin Department of Pediatric Gastroenterology and Nutrition, University Children s Hospital Zagreb, Zagreb, Croatia oleg.jadresin@yahoo.com Arne Kandulski Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany Arne.Kandulski@med.ovgu.de Ivan Lerotic Division of Gastroenterology and Hepatology, Department of Medicine, Sestre milosrdnice University Hospital, Zagreb, Croatia ilerotic@kbsm.hr xi

12 xii Contributors Peter Malfertheiner Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany Michael Häfner Department of Medicince, St. Elisabeth Hospital, Vienna, Austria Mattijs E. Numans Professor Innovation & Quality Academic Primary Care, Amsterdam Free University Medical Center; and Coordinator Julius Primary Care Network, University Medical Centre Utrecht, Utrecht, The Netherlands Roland Pulanic Department of Gastroenterology and Hepatology, University Department of Medicine, Zagreb University Hospital, Zagreb, Croatia Eamonn M. M. Quigley Department of Medicine, Clinical Sciences Building, Cork University Hospital, Cork, Ireland Alberto Ravelli GI Pathophysiology and Gastroenterology, University Department of Pediatrics, Children s Hospital, Spedali Civili, Brescia, Italy alberto_ravelli@yahoo.com Daniel Schmidt-Martin Alimentary Pharmabiotic Centre, Department of Medicine, Clinical Sciences Building, Cork University Hospital, Cork, Ireland danscma@yahoo.com Lea Smirc ic -Duvnjak Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Disease, University of Zagreb, School of Medicine, Dugidol 4a, Zagreb, Croatia lduvnjak@idb.hr Sanja Stojsavljevic Department of Gastroenterology and Hepatology, University hospital Sestre milosrdnice, Zagreb, Croatia sanja.stojsavljevic1@gmail.com

13 Contributors xiii Bojan Tepeš ABAKUS MEDICO d.o.o., Diagnostic ni center Rogaška, Rogaška Slatina, Slovenia Vedran Tomašic Division of Gastroenterology and Hepatology, Department of Medicine, University Hospital Sestre milosrdnice, Zagreb, Croatia Marino Venerito Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany

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15 Introduction Marko Duvnjak So simple when we bluntly translate it from its Greek origin bad digestion, dyspepsia is everything but a simple condition. Even when we try to bind it to a definition that would best suit its characteristics we find ourselves in front of a great brick wall. There are so many aspects that have to be taken into consideration when evaluating, diagnosing, and managing dyspepsia that it is not unusual for physicians to find themselves lost in the sea of conflicting information, clinical tests, and medications that are now available throughout the world. The main reason why we have chosen dyspepsia as the main character in this book is its global presence and large prevalence rate of approximately 25% (range from 13% up to 40%) in the general population from the Far East to the West. Connecting patients from every corner of the world in their adversity, physicians in their struggle to relive the aches of patients, and of course governments in their attempt to control and reduce health care expenditure, dyspepsia has unquestionably become a global health and economic problem. When presence of dyspepsia leads an individual to seek medical attention, in making the decision on the best approach, physician is often put on a crossroad whether to treat the underlying pathology as benign or life threatening. The final verdict is dependent on many aspects that the physician has to consider and satisfy, on one hand always thinking on the benefit of his patient, and on the other being careful with the expenditure of undertaken procedures. New diagnostic possibilities are enticing but very expensive, whereas unsuitably managed dyspepsia is even more costly, due to impaired quality of life and general dissatisfaction of the patient. This is one of the reasons why many countries have adapted guidelines to steer their physicians to a rightful xv

16 xvi Introduction decision, with the main goal to equilibrate the disbursements and the benefits of diagnostic strategies. However, national guidelines followed by practitioners in different countries vary in diagnostic and therapeutic approach, and because of this there is an evident need for a unique definition worldwide. This is a very dynamic and growing field, and new researches regarding this topic are being published almost daily. In this book, we sought to summarize all evidence-based information gathered so far and current guidelines to make everyday handling of dyspepsia less complex for physicians. Every chapter chips away a fragment of the challenge that dyspepsia puts in front of us, making its recognition, definite diagnosis, and treatment more simplified. We found that it was of a great importance to give the definition of dyspepsia and its division on the basis of the latest Rome III agreement first, followed by extensive description of individual diseases that lie in the background of dyspepsia, and then to guide the reader through uninvestigated dyspepsia which is irrefutably inherent in primary care, giving highlights on the epidemiology, prognosis, quality of life, economics, and finally treatment of this condition. Because we find that children, elderly, and diabetics are specific groups with their specific needs, we tried to give a perspective from that point of view and elaborate how such patients should be managed. We made all this possible by gathering a selection of worldclass experts on each of the topics previously mentioned and setting before them a challenge how to provide physicians a meaningful and practical manual to answer their questions and guide them through problems associated with the management of this condition on an everyday basis. Dyspepsia in Clinical Practice represents a summary of all relevant research data, guidelines, and practical algorithms, and we hope it will become a valuable asset to physicians whenever encountering a patient with dyspepsia symptoms all around the globe.