A Prospective study of Upper Gastrointestinal Endoscopic findings in patients presenting with dyspepsia

Dyspepsia is affecting about 25% of general population in developed nations and it is a major cause for medical visits. New patients comprise about 10% of population every year. Dyspepsia majorly affects quality of life and it is a major burden in view of social costs. Directly the expenses are for laboratory tests, medical consultation and drugs and indirectly by absence from work. Dyspepsia refers to spectrum of diseases and heterogeneous group of symptoms confined to upper abdomen. Dyspepsia is a vague term used to explain upper abdominal collection of symptoms like indigestion, fullness, early satiety (not able to complete the meals), bloating, belching, nausea, epigastric discomfort or pain and anorexia. Indigestion is very common in general population; almost all have had indigestion at some time in their lifetime. Sometimes patients will include constipation and undigested food particles in the stool. OBJECTIVES: 1. To evaluate the upper gastro intestinal endoscopic findings in patients presenting with dyspepsia 2. To detect esophago gastroduodenal carcinoma at an earlier stage 3. To study the age and sex prevalence in patients presenting with dyspepsia. METHODOLOGY: A prospective clinical study was undertaken at Madurai medical college hospital, Madurai to know the various upper gastro-intestinal endoscopic findings in patients presenting with dyspepsia. The study was conducted from march 2016 to August 2016. The patient selection was by convenience sampling. Dyspeptic patients were included in this study with their informed consent. A detailed clinically history was elucidated, followed by careful clinical examination, which were recorded as per the proforma. All the patients included in the study underwent upper gastrointestinal endoscopy and the findings were noted. The inclusion and exclusion criterias were as follows: Inclusion criteria: 1. Patients above 18 years of age. 2. Patients showing symptoms of dyspepsia. 3. Patients who have consented for the study Exclusion criteria: 1. Patients below 18 years of age, 2. Patients with chronic liver disease, 3. Patients who has not consented for the study. RESULTS After informed consent 110 cases of dyspepsia were included in the study and were studied clinically as per the proforma from March 2016 to August 2016. All the patients underwent upper gastro-intestinal endoscopy and various findings were noted. Out of 110 patients, 86 (78.1%) patients had epigastric pain and discomfort as their chief complaint whereas nausea and vomiting was present in 74 (67.27%) patients. The other complaints were heart burn 67 (60.9%), food intolerance 50 (45.4%), indigestion 52 (47.27%) and loss of appetite and weight 35 (31.81%). In this study 66% were male patients, 44% were female patients. The incidence of different presentations of dyspepsia were more common in males compared to females. clinically significant endoscopic findings were observed in 61 patients accounting for 55.45%. Gastritis was by far the most common finding (24.54%). The next common findings were duodenitis, and gastric ulcer accounting for 7.2% each. There were 6 patients with carcinoma stomach accounting for 5.4%, among them which 3 were male patients and 3 were female patients. Gastric malignancies were common in older age groups The following were the observations: 1. Highest prevalence of dyspepsia in the age group of 30-39 years 2. Most common presenting complaint was epigastric pain and discomfort 3. Dyspepsia was more common in males (60%) when compared to females (40%) 4. Most common endoscopic finding was normal study followed by gastritis 5. Malignancy was diagnosed in 5.4% patients with dyspepsia. 6. Stomach is the common site of lesion in patients presenting with dyspepsia 7. Gastritis, duodenitis, gastric ulcer, is more common in males than females presenting with dyspepsia. 8. Incidence of malignancy increases as the age advances. CONCLUSION From the present study of "A Prospective study of upper gastro-intestinal endoscopy findings in patients presenting with dyspepsia ". Endoscopic examination revealed gastritis which accounted for the majority of the cases. Incidence of malignancy in the present study was observed to be 5.4% (gastric malignancies). Clinically significant endoscopic findings were observed in 55.45% of patients with uninvestigated dyspepsia. Most patients presented with a complex of three or more dyspeptic symptoms and the symptom profile was not predictive of the endoscopic findings. Prevalence of large number of inflammatory lesions as a result of increased acid production and low incidence of malignancy in the study group suggests that the uninvestigated patients with dyspepsia may be initially managed medically with acid suppressive therapy