Jul 28, 2017 - Background: Upper gastrointestinal distress or acid peptic disease or heartburn or a combination of ... The British Society of Gastroenterology.
International Journal of Current Medical and Pharmaceutical Research Available Online at http://www.journalcmpr.com ISSN: 2395-6429
DOI: http://dx.doi.org/10.24327/23956429.ijcmpr20170164
RESEARCH ARTICLE CLINICAL PROFILE OF OESOPHAGOGASTRODUDENOSCOPY- STUDY CONDUCTED IN TEACHING HOSPITAL BATTICALOA SRILANKA Umakanth M1 and Jeyaruban J2 1Lecturer
in Medicine Faculty of Health care Sciences, Eastern University Srilanka in Surgery Faculty of Health care Sciences, Eastern University Srilanka
2Lecturer
ARTICLE INFO
ABSTRACT
Article History:
Background: Upper gastrointestinal distress or acid peptic disease or heartburn or a combination of all symptoms is very common among the population. Population survey revealed that 44% of the population reported monthly heartburn and 19.6% suffered from heartburn or acid regurgitation at least once a week. We are going to study the clinical profile of the patients who were undergone oesophagogastroduodenoscopy (OGD). Methods and Methodology: We carried out an observational study in the University endoscopic unit. 95 patients were evaluated in the present study after they satisfy the inclusion and exclusion criteria. Results: A total of 95 patients enrolled in this study. Majority of the patients were female 59(62.1%). In our study majority of subjects 44(46.3%) were in the (>50 age) group (graph 2). The most common symptoms at presentation was epigastric pain seen in 42(44.2%) cases, followed by heartburn seen in 36(37.9%) and regurgitation seen in 31(32.6%). Conclusion: In patients with dyspepsia presence of alarm symptoms is more significantly associated with organic lesion on endoscopy. Though the incidence of malignancy was low, endoscopy in patients more than 50 years may help in early diagnosis and reduced morbidity of these patients.
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Received 19 April, 2017 Received in revised form 3rd May, 2017 Accepted 15th June, 2017 Published online 28th July, 2017 Key words: Dyspeptic symptoms, Peptic ulcer disease and Esophagogastrodudenoscopy
Copyright © 2017 Umakanth M and Jeyaruban J. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION Dyspepsia describes a range of symptoms arising from the upper gastrointestinal tract (GIT). Unfortunately, there has been confusion about the meaning of the terms dyspepsia and heartburn. Dyspepsia is defined as pain or distress centered in the upper abdomen while heartburn is a burning retrosternal pain or discomfort1. The British Society of Gastroenterology (BSG) defines dyspepsia as a group of symptoms that alert doctors to consider disease of the upper GI tract, and states that dyspepsia itself is not a diagnosis. These symptoms, which typically are present for 4 weeks or more, include upper abdominal pain or discomfort, heartburn, gastric reflux, nausea, and/or vomiting. Most of the people who has been suffering from dyspeptic symptoms , may have at least 3 or more symptoms23. In the United Kingdom prevalence depends on the definition of dyspepsia used, and ranges from 12% to 8 41%. Using the broad BSG definition, it is estimated that annually around 40% of the adult population experience dyspepsia. Dyspepsia accounts for between 1.2% and 4% of all 10 consultations in primary care in the UK, half of which are for functional dyspepsia – that is, dyspepsia of unknown aetiology
(previously known as non-ulcer dyspepsia). However, many dyspeptic patients have normal digestive motility and motor abnormalities are found in asymptomatic patients. Helicobacter pylori (H pylori) are widely present in the general population, often causing no harm, but it is strongly associated with gastric and duodenal ulcers. However, its role in functional dyspepsia and GORD is less clear. The prevalence of H pylori infection varies internationally, with over 80% of Japanese and South American people infected, compared with a rate of approximately 40% in the UK and 20% in Scandinavia 45. The aetiology of dyspepsia symptoms includes gastric and duodenal ulcers, gastro- oesophageal reflux disease (GORD), oesophagitis, and oesophageal or gastric cancers; however the cause is often unknown functional dyspepsia. In addition, certain foods and drugs (such as anti-inflammatory drugs) are believed to contribute to the symptoms and underlying causes of dyspepsia. However, other upper gastrointestinal (GI) symptoms such as nausea, belching or bloating often co-occur, although belching disorders and nausea and vomiting disorders are classified as separate functional gastroduodenal disorders67.
International Journal Of Current Medical And Pharmaceutical Research, Vol. 3, Issue, 07, pp.2108-2110, July, 2017
Gastro-oesophageal reflux disease (GORD) is a chronic condition where gastric content from the stomach flow back up into the oesophagus. It can severe enough to cause symptoms or damage the esophagus or both. It can leads to an irregularity of the cells in the lining of the oesophagus (Barrett’s oesophagus), which is itself considered the risk factor for oesophageal adenocarcinoma8.
The most common symptoms at presentation was epigastric pain seen in 42(44.2%) cases, followed by heartburn seen in 36(37.9%) and regurgitation seen in 31(32.6%). Acid reflux, dysphagia, and anemia was in 27(28.4%), 12(12.6%) and 9(9.5%) of patients respectively (Graph 3). Most of the endoscopic findings were confined to the Stomach 75(78.94%) than Duodenum 4(4.21%).
MATERIALS AND METHODS Others (LOW,LOA etc)
This observational study was conducted in the Endoscopic unit Teaching hospital Batticaloa in Sri Lanka. We collect data from all subjects who came for or admitted for oesophagogastroduodenoscopy (OGD) for a period of one year from 1st of April 2016 to 31st of April 2017. Written informed consent was obtained from all the patients after explaining them the nature and purpose of the study. Patients of either sex within age group 12-75-years were included in our study. We selected those who had dyspeptic symptoms such as retrosternal burning, pain upper abdomen, belching, and fullness after meals, anorexia, nausea, vomiting, regurgitation, alternate diarrhea and constipation loss of weight and loss of appetite of more than one month duration for the study. We excluded patients, with acute upper gastrointestinal bleeding or, bleeding disorders, patients on warfarin and unwilling patients. Finally 95 patients were enrolled in our study. Data were analyzed using SPSS software. Chi-square test, Fisher’s exact test were used wherever applicable. Results were described in percentages, means and standard deviation.
RESULTS A total of 95 patients enrolled in this study. All patients were subjected to oesophagogastroduodenoscopy over a period of one year. Majority of the patients were female 59(62.1%). Male formed 36(37.9%) of the cohort (Graph 1).
100 80 60 Frequency
40 20 0 Male
Female
Total
Graph 1 Sex distribution
In our study 44(46.3%) subjects were in the >50 age group (graph 2). 95
100 80 60
44
40 20
21 3
6
12-19
20-29
21
0 30-39
40-49
>50
Total
1
Dysphagia
12
Haematemesis
3
Regurgitation
31
Heart burn
36
Anaemia
9
Malena
2
Acid reflux
27
Pain
42 0
10
20
30
40
50
Y
Graph 3 Indications for OGD
DISCUSSION Dyspepsis is a common condition and usually describes a group of symptoms rather than one leading symptom. Dyspepsis is derivative from the greek words “dys” and “pepse” and literally means “difficult digestion”. According to the Rome III criteria, dyspepsia defined as one or more of the following symptoms Postprandial fullness, early satiety, epigastric pain or burning and no evidence of structural disease that is likely to explain the symptoms. In our study female complained more dyspeptic symptoms and leads to OGD than male counterpart. In addition to that more patients 44 (46.3%) were under age category of more than 50 years old. However, similar percentage 42(44.2%) of cases were seen between 30 to 49 age group. Similar study were conducted in India, where dyspeptic symptoms more common among male (70.8%)9. Another study conducted in India by Krithika j et al which revealed that 53(66%) were male10. However, study conducted in Australia where dyspeptic symptoms more common among female11. Furthermore, dyspeptic symptoms were common in elderly (>50 year-old ) however, a study conducted in India which revealed that prevalence is found to be common in young patients of 1840years age group12. Clinically significant dyspeptic symptoms were more prevalent in older patients (> 50 years of age) than in younger patients. Similar finding were observed in study conducted by Thomson et al in Canada and Krithika J et al, in India210. In our study, symptom of epigastric pain was the main presentation of patients. Similar presentation has been observed in couple of study conducted in India and Australia911. Among the OGD findings gastric lesions were much more common than the duodenal lesion. However, in western country this pattern was changed, where duodenal ulcers are more common than gastric ulcers.
Frequency Graph 2 Age distribution
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International Journal Of Current Medical And Pharmaceutical Research, Vol. 3, Issue, 07, pp.2108-2110, July, 2017
CONCLUSION
5.
Dyspepsia causes much morbidity and loss of productivity and hence the economic and public health implications are profound. Dyspepsia in age above 50 years is commonly associated with underlying organic lesions or malignancy. OGD endoscopy is simple procedure that can be undertaken for early diagnosis of benign as well as malignant lesions in patient presenting with dyspepsia.
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