Fatty Food Intolerance Research Articles

Outcomes of Laparoscopic Cholecystectomy in Elderly Patients

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for both symptomatic gallstones and acute cholecystitis. Laparoscopic cholecystectomy is the surgical procedure to remove the gallbladder. While historically challenging in cases of acute cholecystitis, advancements in laparoscopic techniques have made it a viable and preferred treatment option for this condition. Objective: Our study’s objective was to evaluate the efficacy of LC in elderly individuals. Methods: This prospective observational study was conducted at the general surgical department of Mymensingh Medical College Hospital from January 2023 to December 2023. A total number of 70 elderly patients who had acute cholecystitis (symptomatic gallstone disease) were included in this study. Based on physical examination, general conditions, laboratory investigation, and radiographic results, gallstone disease was diagnosed. All cases provided a signed, informed consent form. The research was done after approval of the ethical committee. Results: Among the 70 patients the majority of patients (87.14%) fall within the 60-69 years age range. A smaller proportion of older patients: A smaller percentage (12.86%) of patients are aged 70 years or older. The majority of the patients (68.30%) were male and (32.70%) were female. Hypertension is the most prevalent comorbidity among the patients, approximately 15.6% of the patients. Diabetes mellitus follows as the second most common comorbidity, with 11.1% of patients Cardiac disease is the third most frequent comorbidity, present in 6.7% of the patients. Peripheral vascular disease is the least common comorbidity among those presented, affecting 4.4% of the patients. Regarding the symptoms and clinical presentation, patients exhibited a variety of the usual gallbladder disease symptoms, including epigastric pain (51.30%), fatty food intolerance (37.14%), nausea and vomiting (24.29%), Murphy’s sign (14.29%), biliary colic (32.86%), right upper ......

The gallbladder in diabetes

The gallbladder in diabetes

Cholelithiasis- persistent & new symptoms post cholecystectomy

Background: A Significant proportion of individuals undergoing cholecystectomy for symptomatic cholelithiasis persist with symptoms even after surgery This study focuses on the specificity of symptoms in relation to gall stone disease improvement of symptoms after cholecystectomy, persistence of symptoms & if there is development of any new symptoms. Material & Method: 90 patients with diagnosis of symptomatic gall stone disease undergoing elective cholecystectomy were followed through detailed history for assessment of symptoms. Same set of questionnaire (scale) as well as psychometric analysis were used both pre-operative & post operative period of 1, 3 & 6 month. 10 patients refused to participate so 80 patients were followed up.Results: The mean age (mean + S.D.) of the patient was 43.50 + 10.9 with range of 19 to 70 years ratio of male to female was approximately 1 : 2.5 . 20 patient were under went open cholecystectomy because of all associated co-morbidities. 6 patient were converted to open Cholecystectomy because of adhesion & unclear anatomy Upper abdominal pain (88.8%) fatty food intolerance (82.6%) and nausea & vomiting (72.5%) improved significantly after 6 months (P<0.01) however no significant improvement was observed for dyspepsia (75%).Conclusion :Upper abdominal pain, fatty food intolerance and nausea & vomiting together can be considered as the symptoms specific to gall stone disease these are the symptoms which improve significantly after cholecystectomy . Symptoms of dyspepsia heartburn, regurgitation , abdominal bloating & flatulence are not likely to improve significantly after cholecystectomy though there can be decreases in severity , so patient with more dyspeptic symptoms should be explained about the persistence of symptoms before taking them up for cholecystectomy .

Safra kesesi agenezi; safra yollarının nadir görülen bir anomalisi

Dear Editor;&#x0D; A 44-year-old man visited our outpatient clinic for a routine checkup with no complaint. He was not using any medications or alcohol. His vital signs and physical examination were normal. Liver enzymes were all within normal range, but cholestatic enzymes were mildly elevated: alkaline phosphatase: 124 (30-120 U/L), gamma-glutamyl transferase: 81 (0-55 U/L), and total bilirubin: 1.10 (0.3-1.2 mg/dL). Hepatobiliary ultrasonography (US) revealed a liver of slightly elevated size (16 cm) with normal structure and parenchymal echogenicity. Intra- and extra-hepatic bile ducts were not dilated. US did not visualize the gallbladder clearly (Figure 1). The patient was anxious when he learned that US showed an invisible gallbladder. Two months later, he visited our outpatient clinic again. He was still anxious. We learned that he sought medical attention at other hospitals, and repeated US revealed an invisible gallbladder, but doctors suspected a contracted or porcelain gallbladder. Computer tomography was performed, which confirmed the absence of a visible gallbladder with normal intra- and extra-hepatic bile ducts similar to suspected contracted or porcelain gallbladder. We performed magnetic resonance cholangiopancreatography (MRCP), which revealed normal intra- and extra-hepatic bile ducts and pancreatic duct with no dilation or filling defect. The gallbladder was not detected (Figure 2).&#x0D; Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system with an estimated incidence of 13-65 individuals per 100 000 cases (1). Three groups of GA were identified in 1988 (2): asymptomatic (35%), which comprised individuals diagnosed at autopsy or laparotomy; symptomatic (50%), whose symptoms were chronic right upper quadrant pain (90%), dyspepsia (30%), nausea/vomiting (66%), fatty food intolerance (37%), and jaundice (35%); and foetal anomalies (15%), which indicated congenital anomalies incompatible with life. The most common clinical presentation is right upper quadrant pain mimicking biliary colic. Most cases of symptomatic GA are scheduled for surgery with a misdiagnosis of cholecystitis or choledocholithiasis. If the diagnosis of GA is made intraoperatively, patients often are exposed to complications from prolonged exploration. Aborting the procedure rather than complete further exploration is recommended (3). US is the most sensitive technique for imaging the biliary system. Most cases of GA have been reported as “contracted/fibrotic gallbladder” on ultrasound. The main method to establish GA is MRCP, which is a noninvasive and well-demonstrated imaging method in the evaluation of the biliary tract. It can also demonstrate an excluded and/or ectopic gallbladder (4,5).&#x0D; MRCP enables the correct diagnosis to be made by a noninvasive examination, thereby suppressing our patient’s anxiety. The patient was informed about his congenital malformation to avoid possible unnecessary surgical exploration in the future. GA should be considered whenever the gallbladder is not visualized in routine imaging methods in patients with or without symptoms to reduce misdiagnosis and unnecessary surgeries.

The Mini-Gastric Bypass original technique

IntroductionMini-Gastric Bypass (MGB) is becoming more and more popular as shown by the numerous articles published over the past 15 years, supporting the operation as a short and simple procedure with excellent outcomes and low complication rates. There is still confusion amongst surgeons on the technique of the operation. The purpose of this paper is to review and describe the technique of MGB by its originators. MethodsWith 20 years of experience of performing the original MGB, the authors present the details of the MGB. ResultsThe MGB consists of a long conduit from below the crow's foot extending up to the left of the angle of His. It is similar to, but importantly, not the same as the pouch of the Sleeve Gastrectomy. MGB has a wide gastro-jejunal anastomosis to an anti-colic loop of jejunum 150–200 cm distal to the ligament of Trietz. The power of MGB comes from the fact that it is both a “Non-Obstructive” restrictive procedure and it also has a significant fatty food intolerance component with minimal malabsorption. ConclusionIn this article we describe the original Rutledge technique of Mini-Gastric Bypass. Notably this is neither a “Single Anastomosis bypass”, nor an “Omega Loop Bypass” and also not the “One Anastomosis Bypass of Carbajo”. It is a particular technique first created by Rutledge in 1997 and associated with low risk and excellent outcomes. The goal of this manuscript is to help avoid complications and problems seen when the operation deviates from some of the basic principles of general surgery used in the original operation.

What Medical Nutrition Therapy Guideline Is Recommended Post-Cholecystectomy?

What Medical Nutrition Therapy Guideline Is Recommended Post-Cholecystectomy?

The Clip That Got Away: A Migrated Cholecystectomy Clip as a Nidus for Distal Common Bile Duct Obstruction and Stone Formation

Purpose: 43 year old male presented with a one week history of fatty food intolerance, clay colored stools, and right upper quadrant pain. He underwent cholecystectomy 2 years ago for cholelithiasis and similar pain. A right upper quadrant ultrasound showed no ductal dilation, no intraductal lesion, and confirmed a previous cholecystectomy. Within 6 hours of admission, his bilirubin and alkaline phosphatase were double the normal values and his transaminases were seven times the normal values. A CT scan of the abdomen and pelvis with IV contrast showed no abnormalities from the AP view. Based on his clinical picture, ERCP was performed. The initial endoscopic image showed a clip encased in a stone at the ampulla (A). After wire cannulation past the stone, bile and pus began to flow out of the ampulla. A sphincterotomy was performed and the stone and clip were removed by balloon sweeps (B). Upon further review of the CT, a metal object was seen at the ampulla on sagital images (C)(box). Within 24 hours, the patient was back to his baseline and was discharged home. One similar case of a cholecystectomy clip causing obstruction and cholangitis was published in OVID (1).FigureFigureFigure

GS30P YOUNGER PATIENTS ARE MORE LIKELY TO SUFFER POST‐CHOLECYSTECTOMY DIARRHOEA

Purpose Fatty food intolerance and diarrhoea (PCD) are increasingly being recognised as distressing postoperative sequels in a proportion of patients undergoing laparoscopic cholecystectomy. Understanding of PCD, its predisposing factors and associated symptoms is important for both consent and postoperative management.Methodology 100 consecutive patients underwent chart review and telephone contact. A standardised questionnaire was used to collect data on age; sex; weight/BMI; pre‐ and post‐operative bowel habits, bloating, pain, dietary intolerance, dietary modification and patient satisfaction. Patients were divided into two categories, those with and those without PCD. Groups were compared using t‐test and univariate analysis to determine significance at p‐value of 0.05.Results Two patients were excluded due to preoperative diarrhoea (2%). PCD, defined by changes in consistency and frequency of bowel actions (p = 0.0004), was observed in 17 of 98 patients (17%). PCD was associated with younger age (p = 0.014), higher weight (p = 0.041), less bloating preoperatively (p = 0.045) and higher likelihood of bloating postoperatively (p = 0.048). There was no statistically significant correlation with dietary intolerance, dietary modification or patient satisfaction. 7 patients (7%) reported postoperative constipation or resolution of pre‐existing diarrhoea.Conclusions Subjective PCD and dyspeptic symptoms correlate with measurable differences in bowel habits. Younger patients are significantly more likely to develop PCD and should specifically be warned of this possibility.

Increased cholecystectomy rate in the laparoscopic era

It has been suggested that an increased cholecystectomy rate in the laparoscopic era may be due to a reduced threshold for surgery or diagnostic confusion with irritable bowel syndrome (IBS). This study aims to determine the validity of these suggestions. Questionnaires were sent to patients who had undergone cholecystectomy between 1988-1990 (open) and 1998-2000 (laparoscopic). Patients were asked about abdominal pain, fatty food intolerance, jaundice, and indigestion pre- and postoperatively. Questionnaires included Rome II criteria for the diagnosis of IBS and SF-36 quality-of-life data. Histological severity of gallbladder disease was assessed using a standard scoring system. A total of 124 of 196 patients in the open group and 264 of 400 patients in the laparoscopic group replied. There was no difference between the groups in gender, age at surgery, IBS incidence, or quality-of-life scores. The laparoscopic group reported a lower incidence of preoperative fat intolerance (45.8 vs 58.1%, p < 0.05) and a higher incidence of persistent postoperative abdominal pain (27.3 vs 17.7%, p < 0.05). Mean histopathology severity scores were higher in the open group (4.42 vs 3.95, p < 0.01). Increased cholecystectomy rate in the laparoscopic era cannot be attributed to diagnostic confusion with IBS. However, a reduction in the threshold for surgery may have contributed to the increased rate of cholecystectomy.

Biliary dyskinesia in pediatrics

Biliary dyskinesia is a potential cause for acalculous biliary colic in pediatric patients. A triad of symptoms and signs, consisting of abdominal pain (with or without associated nausea or fatty food intolerance), absence of gallstones, and an abnormally low cholecystokinin-stimulated gallbladder ejection fraction is used to diagnose the disorder. In several small pediatric case series, cholecystectomy resulted in symptomatic improvement in a majority of patients with biliary dyskinesia. However, the diagnosis of biliary dyskinesia and appropriate management remain controversial. This review discusses the purported pathophysiology of biliary dyskinesia and the data available regarding diagnosis and treatment of this entity in the pediatric population.

Agenesis of the gallbladder: A dangerously misdiagnosed malformation

Isolated agenesis of the gallbladder is a rare anomaly, often asymptomatic. However, one patient out of four presented with right upper abdominal pain, nausea, and fatty food intolerance. The condition is frequently mistaken with an excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG often leads to unnecessary and potentially dangerous laparoscopic surgery as described in a few case reports over the last 10 years. The aim of this study is to clarify the diagnostic and therapeutic approach of this unusual pathology. Two cases seen in our institutions were retrospectively reviewed, together with a review of the American and European literature. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to expose and dissect the triangle of Callot increases the risk of iatrogenic injury to biliary or portal structures. Depending on the experiment of the surgeon in laparoscopic procedure, this has to be taken into account to decide a conversion to laparotomy. A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRI-cholangiography is mandatory. Because of possible inherited transmission, relatives with a history of biliary symptoms should be investigated.

Symptoms before and after Laparoscopic Cholecystectomy for Gallstones

Between 1989 and 1995, 1380 patients underwent laparoscopic cholecystectomy for symptomatic cholelithiasis by a single surgical group at a large private teaching hospital. Thirteen hundred surveys were mailed, and 573 (44.3%) were completed at least 6 months postoperatively. Pain and nonpain symptoms were present preoperatively in 432 (75%) and 457 (80%) patients, respectively. Postoperatively, pain and nonpain symptoms were present in 141 (25%) and 247 (43%) patients, respectively (P < 0.05). All nonpain symptoms were significantly reduced postoperatively except for diarrhea (P < 0.05). Longer duration of pain, age < 40, frequent episodes of pain, postprandial pain, and increased sites of pain preoperatively were all predictive of a higher incidence of persistent postoperative pain (P < 0.05). Persistent nonpain symptoms were more likely if diarrhea, fatty food intolerance, age < 40, or both pain and nonpain symptoms were present preoperatively (P = 0.05) and less likely if only pain symptoms were present preoperatively (P = 0.0001). This series quantifies symptom-specific outcomes for the surgeon. While most symptoms improve, a significant number of pain and nonpain symptoms persist after laparoscopic cholecystectomy. With these data, surgeons can modulate postoperative expectations and advise on the possible persistence of symptoms.

Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children.

Biliary dyskinesia is defined as symptomatic biliary colic without cholelithiasis, and is diagnosed during cholescintigraphy by assessing gallbladder emptying with cholecystokinin (CCK) stimulation. Unfortunately, gallbladder emptying is not routinely assessed during cholescintigraphy in pediatric patients. The purpose of this review is to assess the effectiveness of cholecystectomy in patients with chronic abdominal pain and delayed gallbladder emptying and to assess whether these findings correlate with the histologic evidence of chronic cholecystitis. We retrospectively reviewed the medical records of all patients ( n=16) at our institution from October 1997 to August 2001 who underwent quantitative cholescintigraphy with CCK stimulation that demonstrated delayed gallbladder emptying (< 35% at 60 min) and who subsequently underwent cholecystectomy. Laparoscopic cholecystectomy was performed in 16 patients with chronic abdominal pain. All 16 patients had delayed gallbladder emptying (mean ejection fraction: 15+/-8%, range: 3-32%). The mean age was 12+/-2 years (range: 8-17 years). Presenting symptoms included abdominal pain (86%), fatty food intolerance (27%), emesis (13%), and diarrhea (13%). Mean duration of abdominal pain before operation was 11+/-19 months (range: 2 weeks-6 years). One patient's symptoms persisted postoperatively, but abdominal pain resolved in all other patients. Histologic evidence of chronic cholecystitis was demonstrated in 86% of surgical specimens. Five patients underwent concurrent appendectomy, and all had normal appendiceal histology. Our experience suggests that children with chronic abdominal pain and delayed gallbladder emptying on CCK-stimulated cholescintigraphy are likely to benefit from cholecystectomy and to have histologic evidence of chronic cholecystitis.

Hypokinetic gallbladder disease: A cause of chronic abdominal pain in children and adolescents

Background/Purpose: Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy.Methods: Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK). On ultrasound studies, gallbladder volume was measured before injection and 15 minutes after injection. Measures of gallbladder emptying by scintigraphy were taken at least 30 minutes after CCK injection. A study was classified as abnormal for contractility less than 50%. Cholecystectomy was performed and outcomes were evaluated during office visits and by telephone interview.Results: Abdominal pain and fatty food intolerance were the predominant symptoms. Patients were treated by open (n = 2) or laparoscopic (n = 40) cholecystectomy. In 20 cases the gallbladder showed chronic inflammation on pathology. Response to surgical therapy was excellent in 41 patients (mean follow-up, 20.4 months).Conclusions: Children and adolescents with persistent abdominal pain should undergo functional assessment of gallbladder contractility. Patients with abnormal gallbladder contractility benefit from cholecystectomy.

Chronic acalculous cholecystitis: laparoscopic treatment.

From 1990 through 1993, we treated 36 patients with recurrent typical biliary colic but who showed no ultrasonic evidence of cholelithiasis by laparoscopic cholecystectomy. Associated symptoms included nausea (75%), bloating (56%), fatty-food intolerance (53%), vomiting (17%), weight loss (31%), bowel irregularity (28%), reflux or dyspepsia (25%), and fever (17%). Diagnostic evaluation included ultrasound (100%), upper gastrointestinal series (36%), oral cholecystogram (14%), computed tomographic scan (39%), endoscopic retrograde cholangiopancreatography (17%), upper gastrointestinal endoscopy (14%), and hepatobiliary scan (92%). Quantitative hepatobiliary scans in 33 patients revealed a low gallbladder ejection fraction (EF) of less than 35% in 29 patients (88%; mean EF = 9%), and 13 patients experienced reproducible pain after cholecystokinin provocation. All patients underwent attempted laparoscopic cholecystectomy; one case of unsuspected acute acalculous cholecystitis was converted to open laparotomy because of unclear anatomy. Gross and histological examination of the gallbladders revealed chronic inflammation (83%), cholesterolosis (31%), cholesterol crystals or small stones (17%), acute inflammation (8%), polyps (6%), and normal histology (6%); however, blind retrospective scoring of gallbladders revealed significant chronic inflammation in only 38%. In the 2 to 40 months (mean, 14 months) since operation, there have been no deaths (97% follow-up). Laparoscopic cholecystectomy relieved pain in 93% of patients with a low preoperative EF compared with 75% of patients with a normal EF (nonsignificant p value). Persistent abdominal or gastrointestinal complaints included flatulence (31%), loose stools or fecal urgency (29%), belching (29%), indigestion (20%), nausea (11%), and "typical" gallbladder pain (9%). We conclude that many patients with symptoms of biliary colic and scintigraphic evidence of biliary dyskinesia have histologic findings of chronic cholecystitis. Although laparoscopic cholecystectomy usually eliminates biliary colic, persistent nonbiliary complaints are frequent.

GASTROENTEROLOGIC DISORDERS PRESENTING AS FOOD INTOLERANCE

Adverse reactions to foods may be divided broadly as food allergy (an immune-mediated phenomena) or food intolerance. 2 With the possible exception of anaphylaxis, most adverse reactions to foods can be confused with primary gastrointestinal disorders and vice versa. Symptoms mimicking gastroenteritis, including nausea, vomiting, crampy abdominal pain, watery diarrhea, and flatulence, may be provoked by specific foods in patients with true allergy; they may also experience concomitant urticaria, flushing, rhinitis, asthma, and possibly anaphylaxis. Most food allergies are IgE-mediated immediate hypersensitivity reactions, but immune complex formation and cell-mediated immune reaction account for a minority of cases. 9 Although the pathophysiologic basis of celiac sprue is not fully understood, it is usually classified as a food allergy. 2 Many patients who report food intolerance may in fact be suffering from gastrointestinal disorders. Individuals with lactase deficiency develop abdominal pain, bloating, and diarrhea after excessive intake of milk or dairy products; similarly, malabsorption of fructose and sorbitol may present as intolerance to fruits or “sugar-free” foods. Gastroesophageal reflux, pancreatitis, or delayed gastric emptying may be misdiagnosed as fatty food intolerance. Gastrointestinal toxicity from additives or chemical constituents of different foods may be confused with food intolerance. Finally, many patients (usually with functional bowel disease) seek medical care for a complex array of gastrointestinal and systemic symptoms erroneously attributed to food intolerance. In order that the reader may become familiar with the interactions between adverse food reaction and gastrointestinal diseases, we briefly discuss food allergy, gastrointestinal disorders presenting as food intolerance, and food intolerances commonly mistaken for gastrointestinal diseases.

What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature

The increasing application of cholecystectomy has increased the need to assess the effects of cholecystectomy on presenting symptoms. Three surgeon-derived and two patient-derived data forms were collected for each patient in a series of 225 laparoscopic cholecystectomies. Eighty-two percent of patients had documented gallstones preoperatively, 91% had biliary pain, and 77% had both biliary pain and documented gallstones prior to surgery. Fifteen percent of patients were believed to have acalculous cholecystitis. Eighty-two percent also had bothersome nonpain symptoms (gassiness, bloating, indigestion, fatty-food intolerance, and nausea). The cure rate for biliary colic was 82% if stones were documented preoperatively, and 52% when they were not (P = 0.002). Atypical pain was cured 80% of the time, and nonpain symptoms, 44% of the time. Most patients (82%) with biliary colic and gallstones have complete relief of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculous cholecystitis was only 52%. Nonpain symptoms were common preoperatively (82%) and were relieved in 44% of patients.

Importance of Family History in Adolescent Gallbladder Disease

Sir .—As medical students, we all learned the Rule of Fs in relation to gallbladder disease, ie, its predilection for fat, fecund, females aged 40 to 50 years with a fatty food intolerance. As an adolescent medicine specialist, I have always taught that the rules for gallbladder disease in teenagers are the same: a fat, fecund female aged 15 years with fatty food problems is most at risk, but I suggest adding an extra F for family history of early gallbladder disease. For this reason I was disturbed that there was no mention of family history in the review of cases of childhood gallbladder disease in the January 1991 issue of AJDC. 1 I would be very interested in those data, particularly for the idiopathic cases that accounted for one fifth of the sample, and also for the pregnant teenagers. In teenagers, it is always better, in my opinion, to

Gallstone symptoms

Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder will relieve only these symptoms. Making this determination is a challenge, however, because the classic picture of biliary colic may be inaccurate and the connection between gallstone disease and flatulent dyspepsia is questionable at best. Descriptions of both these conditions are based on anecdotal evidence or reports of uncontrolled surgical series. A review of recent controlled trials suggests that the pain of biliary colic is constant and infrequent, comes in episodes lasting 1 to 5 hours, is located in the epigastrium or right upper quadrant of the abdomen, and characteristically occurs at night. There are few additional symptoms other than nausea or vomiting, and colic is not induced by eating fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the right upper quadrant, fatty-food intolerance, and bloating--is probably not related to the presence of gallstones in the majority of patients.

Endoscopy in the Evaluation of Dyspepsia

Position Paper1 February 1985Endoscopy in the Evaluation of DyspepsiaHEALTH AND PUBLIC POLICY COMMITTEEHEALTH AND PUBLIC POLICY COMMITTEESearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-2-266 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDyspepsia, frequently seen in the general population by primary care physicians and gastroenterologists, has been a common indication for esophagogastroduodenoscopy. Any recommendations regarding the use of this technique in patients with dyspepsia depend on a precise definition of the symptom. The term "dyspepsia," however, represents a vague grouping of upper abdominal symptoms that may be manifested by various underlying illnesses and pathophysiologic findings. The basic element of dyspepsia is epigastric pain or discomfort, accompanied by fullness, burning, belching, bloating, nausea, vomiting, fatty food intolerance, or difficulty completing a meal; bowel habits generally remain unaltered. Despite the difficulties in precisely defining...