Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (130 page)

Other
: Laboratory findings due to conditions preceding acute pancreatitis are noted (e.g., alcoholism, trauma, duodenal ulcer, cholelithiasis), infection, perforation, and hemorrhage by erosion of blood vessel or into a viscus.

DYSPEPSIA AND PEPTIC ULCER DISEASE

   Definition

   Dyspepsia encompasses any or all of a great variety of upper abdominal symptoms, including upper abdominal pain or discomfort, nausea, bloating, heartburn, early satiety, regurgitation, and belching.

   Nonulcerative dyspepsia is defined as persistent or recurrent abdominal pain or discomfort centered in the upper abdomen without definite structural or biochemical explanation. By definition, nonulcerative dyspepsia is a diagnosis of exclusion. Possible mechanisms include dysmotility of the stomach or small intestine, heightened visceral sensitivity, altered intestinal or gastric reflexes, and psychological distress.

   Peptic ulcer disease (PUD)

   Epigastric abdominal pain is the most common symptom. Pain is nonradiating and is described as a “gnawing” or “hunger pain.” Pain occurs 1–2 hours postprandially and is relieved characteristically by food or antacids.

   Nocturnal pain is more specific for PUD and is due to the physiologic increase in acid secretion, which occurs in the early morning hours.

   Asymptomatic:

   Patients with PUD induced by NSAIDs are frequently asymptomatic.

   As many as 60% of patients who develop bleeding as a complication of PUD are also asymptomatic.

   Dyspepsia is typically a chronic relapsing condition. Between 65% and 86% of patients with dyspepsia will experience dyspeptic symptoms, at least intermittently, 2 to 3 years after the initial presentation. Long duration of symptoms and intermittent symptoms can also occur in PUD and esophagitis; therefore, these characteristics are not reassuring as to the absence of pathology.

   Gastroesophageal reflux disease (GERD) and dyspepsia have similar symptoms. Gastroesophageal reflux is a normal physiologic process that occurs daily in all individuals. GERD (expressed clinically as heartburn).

   
Helicobacter pylori
infection is clearly implicated in the etiology of recurrent PUD, yet its role in nonulcerative dyspepsia remains unclear. Between 30% and 60% of patients with nonulcerative dyspepsia have
H. pylori
. However, the background prevalence in the general population is also high.