Dyspepsia: who and when to endoscope?

Introduction: One quarter of the population in the Western countries suffer from dyspepsia. Thus, if every patient with dyspepsia were to be endoscoped, then the cost to community and the individual would be substantial and the work load of the endoscopist would be large. In this article, I hope to address the evidence for and against endoscopy as first line investigation for dyspepsia vis-à-vis other modalities of treatment such as trial PPI (proton pump inhibitor) therapy and H.Pylori eradication.

Definition: The Rome III committee defined dyspepsia as one or more of the fol- lowing :a) postprandial fullness, b) early satiety, or c) epigastric pain or burning. Dyspeptic symptoms are most commonly caused by non-ulcer dyspepsia, peptic ulcer, reflux oesophagitis or rarely malignancy. However, the same symptoms can be caused by medication side effects, biliary or pancreatic disorder and motility disorder.

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To stop or not to stop Clopidogrel, to bridge or not to bridge Warfarin, that is the question: Antithrombotic Therapy and Endoscopy.

There is increasing use of warfarin and antiplatelet agents in the aging population for various indications. These patients are often referred for endoscopy for investigation of abdominal pain, dyspepsia, change of bowel habit, family history of bowel cancer, positive faecal occult blood, anaemia, polyp surveillance etc.

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