Prevalance Of Disease With Epigastric Pain With Reference To Gastric Pathology

Abstract

Back ground:Epigastric pain pain in the mid-upper abdomen. The differential diagnosis of epigastric pain is broad. Pain in this area can be due to gastroenterological, pancreaticobiliary and other causes, including non-gastroenterological disease. The prevalence of gastric pathology has been studied in detail and incidence of Helicobacter Pylori in peptic ulcer disease has been analysed.Methods:All the patients attending the OPD with epigastric pain has been examined and those cases with pathology affecting organs other than stomach have been excluded. The remaining patients has been subjected to routine endoscopic biopsy and screening for H.Pylori (by Rapid Urease Test).Results:Prevalence of disease with epigastric pain with reference to gastric pathology in this community is 83.3%.Incidence of helicobacter pylori among the patients with acid peptic ulcer disease symptoms was up to 74% which correlate with the world wide prevalence.Conclusion:Patients attending hospital with epigastric pain are mostly due to gastric pathology-acid peptic ulcer disease with high incidence of Helicobacter pylori. Hence patients attending hospital with epigastric pain, after excluding the causes of pain due to organs other than stomach should be subjected to routine upper gastro intestinal endoscopy, endoscopic biopsy and should be screened for Helicobacter pylori. Which highly prevent the patients more susceptible for carcinoma stomach. More over promotion of health education and awareness of the disease makes the patients present to hospital at earlier stage and prevents devastating complications. INTRODUCTION EPIGASTRIC PAIN PAIN IN THE MID-UPPER ABDOMEN The differential diagnosis of epigastric pain is broad. Pain in this area can be due to gastroenterological, pancreaticobiliary and other causes, including nongastroenterological disease .Gastrointestinal causes of epigastric pain include: Ulcers (stomach or duodenum), Non-ulcer dyspepsia/indigestion, Irritable bowel syndrome, Gastro oesophageal reflux disease (GERD), Stomach cancer, and abdominal wall hernias. Pancreaticobiliary causes of epigastric pain include: Acute pancreatitis, Chronic pancreatitis , Cholecystitis ,Gallbladder dyskinesia, Sphincter of Oddi dysfunction, Pancreatic cancer,Pancreatic cysts and pseudocysts,Cholangitis,Bile duct stones, Pancreas divisum. Non-gastroenterological causes of epigastric pain include: Atypical manifestation of coronary heart disease/angina, Myocardial infarction, especially that of the posterior wall of the heart other causes are also possible. The most common gastroenterological cause is “Peptic ulcer disease (PUD)” Peptic ulcer disease (PUD) is defined as an erosion in the lining of the stomach or duodenum.” peptic” alludes to pepsin, a proteolytic enzyme that catalyzes the hydrolysis of proteins. About 4-10% develops PUD at some point.PUD incidence increases with age, with PUD most common in those older than 40yrs. The major forms of peptic ulcer are duodenal ulcer (DU) and gastric ulcer (GU).There exists incomplete knowledge regarding the cause of peptic ulcer disease. Available information, however, supports a central role for H. pylori and a necessary role for acid and pepsin. Despite the focus on the role of infection with H. pylori, an understanding of basic gastric physiology remains central to a consideration of ulcer pathogenesis. Although PUD has a variety of causes, including stress, NSAID use, smoking...it is most frequently associated with HELICOBACTER PYLORI this accounts for 90% of diagnosed cases. AIM OF THE STUDY To identify the causes of epigastric pain of gastric origin in this community. Prevalance Of Disease With Epigastric Pain With Reference To Gastric Pathology 2 of 6 To correlate mainly the peptic ulcer disease with the presence of H.Pylori incidence. MATERIALS AND METHODS To examine all the patients attending the OPD with epigastric pain and to exclude those cases with pathology affecting organs other than stomach by USG (ultrasound abdomen), biochemical analysis, ECG, Chest X ray as per the case. To subject the remaining patients to routine endoscopic biopsy and screening for H.Pylori (by Rapid Urease Test). INCLUSION AND EXCLUSION CRITERIA’S