Changing prevalence of Helicobacter pylori infection and peptic ulcer among dyspeptic patients.

Abstract

SIMI 2015 Dyspeptic syndrome defines a series of symptoms involving the upper GI tract. The syndrome affects about 25 % of the adult population, and is one of the most common GI problems in primary care or in gastroenterology practice [1]. In approximately 75 % of patients, dyspeptic symptoms are functional, meaning without an underlying cause on diagnostic evaluation. Authorities in the field stratify functional dyspepsia into three subgroups on the basis of the symptoms pattern: dyspepsia motility like, including symptoms such as bloating, predominant nausea, epigastric fullness, early satiety and anorexia; dyspepsia ulcer like, characterized by burning, epigastric hunger pain mitigated by antacid, antisecretory drugs and by food; finally unspecified dyspepsia [1]. The approach to and management of a patient with dyspepsia is based on the presence or absence of alarm features such as age older than 55 years, family history of upper GI cancer, weight loss with a regular diet, GI bleeding, dysphagia, jaundice, anemia, persistent vomiting and palpable mass or lymphadenopathy [1]. Because several disorders can be responsible for these symptoms including esophageal, gastroduodenal, pancreatic, and hepatobiliary diseases, for these patients, the goal will be to avoid invasive and expensive diagnostic procedures to arrive at a definitive diagnosis [1, 2]. Upper endoscopy is the gold standard for establishing a specific cause in patients with epigastric pain; however, it should be reserved only for patients with alarm features. For this reason, a detailed anamnesis and physical examination are fundamental to identify patients with gastroesophageal reflux disease, nonsteroidal anti-inflammatory drug (NSAID)-induced dyspepsia, as well as alarm features. The age cut-off also may be different among countries, depending upon the prevalence of gastroesophageal malignancy. In Europe, endoscopy is recommended in adults older than 45 years old [3]. The majority of investigated dyspeptic patients with a defined diagnosis of peptic ulcers have complained of epigastric pain, and we know that the most common causes of gastric and duodenal ulcers include Helicobacter pylori infection and NSAIDs use. Less common causes are: Zollinger‐Ellison tumors, Crohn’s disease, Curling ulcers (from stress due to serious