Dispepsija u primarnoj zdravstvenoj zaštiti - prikaz slučaja

Abstract

Dyspepsia is a term originated from the Greek prefix dys-(bad) and the word pepsis (digestion) and it means indigestion. Dyspepsia is a symptom which indicates occasional or constant pain in the region of the upper abdomen or discomfort which is described in the form of early satiety or a feeling of fullness in the stomach. Sometimes it can be accompanied by nausea, vomiting and heartburn. The symptoms of dyspepsia are not specific enough to indicate a particular disease. And if indicated, additional diagnostics are performed in order to prove or rule out a physical disorder. Dyspepsia is a frequent reason for visiting the doctor. About 40% of the world's population has symptoms of dyspepsia, most often the working population aged between 20-40 years, equally in both sexes. About 25% of patients seek doctor's help, while the rest seek help for their problems at a pharmacy. Dyspepsia is the reason for 40% of performed gastroenterology consultations. This article presents the clinical picture, therapeutic and diagnostic course, as well as the outcome of the treatment of a 53-year-old patient who came to the doctor with symptoms of dyspepsia. The symptoms of dyspepsia had lasted for several years before coming to the doctor. During the first examination, an anamnesis was taken, the review of systems was performed, and a basic blood test done in the local Health center. Given that there was no data on the existence of alarming symptoms in this patient, symptomatic therapy and advised change of habits were included, as well as a planned checkup in one month. At the checkup, the patient reported a decrease in frequency and intensity of abdominal pain, so it was decided to perform additional diagnostics: test for Helicobacter pylori, fecal occult blood test, and ultrasound examination of the abdomen. Requested result of FOBT was negative, but the test for Helicobacter pylori was positive. Ultrasound examination revealed the presence of small calculi in the gallbladder, but there were no other significant clinical findings. Eradication therapy for helicobacter infection was included, and an examination by a gastroenterologist for further diagnostics (esophagogastroduodenoscopy) was planned. Gastroscopy findings were described as chronic non-atrophic gastritis, predominantly antral. A follow-up gastroscopy was planned in five-year interval, the patient was given the proton pump inhibitors therapy, as well as dietary instructions. Given that dyspepsia often occurs in clinical practice, it was necessary to make a proper assessment regarding further diagnostics, on the one hand for economic reasons and on the other hand for medical reasons. Here, the decision was made to carry out further diagnostics considering the duration of the health problems, the presence of the problems during symptomatic therapy, the age of the patient and his concerns. Given the absence of alarming symptoms, appointments were scheduled for all examinations, so a complete diagnosis of organic dyspepsia was reached after 13 months.