Dyspepsia Management in a Resource Poor Setting

Abstract

Background: Dyspepsia has a significant impact on the quality of life of the sufferer, and results in enormous societal costs, either due to direct medical costs for physician visits, diagnostic tests, medications, or indirect costs from absenteeism or reduced productivity at work. It is therefore important to explore the management options available, especially in a resource poor setting like Nigeria, in the light of the foregoing.
Methods: Extensive internet literature search was made through Google scholar, Pubmed and HINARI. Keywords employed were dyspepsia, prevalence and management.
Result: Several approaches proposed for the management of a newly diagnosed patient with dyspepsia include: empirical trial of acid suppression for 4-8 weeks in regions with low prevalence of H. pylori ; the “test and treat” approach for H. pylori infection using a validated non-invasive test and; initial use of upper gastrointestinal endoscopy to determine the nature of the disease before treatment in patients with alarm symptoms and those who are more than 45 years. Helicobacter pylori eradication therapy without initial diagnostic testing can be used as the last result in resource poor regions of the word where diagnostic tests for H. pylori are not available or not cost-effective.
Conclusion: Considering the high cost of upper gastrointestinal endoscopy and the high prevalence of H. pylori infection in developing countries like Nigeria, it seems reasonable that the ‘test and treat’ method will be of immense usefulness in population sub-group who are less than 45 years without alarm symptoms, while those with alarm symptoms and those with onset of symptoms after 45 years will require initial upper gastrointestinal endoscopy.

Keywords: Dyspepsia, Classification, Pathophysiology and Management.