Dyspepsia manifestations and endoscopic findings at Muhimbili Medical Centre - Dar es Salaam

The mystery of dyspepsia remains unsolved up to date. However progress has been made chronologically in identifying causes of dyspepsia: Some causes are now evident but much more is what we don't know. It suffices to say at this juncture that all that we know today about dyspepsia could only be the tip of an iceberg. This field demands more exploration. Ninety six patients with epigastric dyspepsia of undetermined cause were studied between August 3rd 1988 and January 18th 1989. The source of the patients were from medical wards, refferals from other non gastroenterology clinics and from gastroenterotology clinic. The study was descriptive. Clinical manifestations and environmental and social factors were studied, these factors have then been matched with the endoscopic findings of each patient. The information was collected by questionnaire and analysed by IBM personal computer and Casio scientific calculator FX 180P. Statistical analysis was by chisquare and simple "t" test. The study gave the following results. There were 96 candidates for the study with a male preponderance over female by the ratio of 1.3:1. and Mean age 36.9 years. Dyspepsia is uncommon in young people below the age of 20 years.Of the 96 patients who entered the study 95 attended endoscopy procedure. One patient missed without trace. At Endoscopy 45 (47.3%) of the patients had lesions and the remaining 52.7% had nonulcer dypepsia. The main lesion found was peptic ulcer (35.5%). Four patients had esophageal candidiasis, two of them tested positive for HIV antibodies. Another five patients were biopsied, in two of them the histological picture was consistent with adenocorcinoma. Esophageal candidiasis and HIV can present with dyspepsia. Of the symptoms studied epigastric pain was the commonest complaint occuring in 96.6% of the patients. Other symptoms were nausea (78.1%) and heartburn (76.0%). Hematemesis occured in 18.8% and 12.6% had lesion at endoscopy. Other presenting symptoms showed little significance or no significance at all. Cigarette smoking was found to have a high association with dyspepsia, similarly smoking has showed a positive correlation with the presence of a lesion at endoscopy whether one is an ex-smoker or is presently smoking. 25.3% had exposure to active smoking and 20% showed lesion at endoscopy. Alcohol and drugs have shown loose association but are known to cause dyspepsia. Factors determining the relief of symptoms included use of antacids and stopping alcohol intake and smoking. A more accurate prediction of endoscopy outcome seems possible by combining more than one presenting feature and some factor with high association eg. smoking. A scoring system for dyspeptic patients with likehood of having a lesion has finally been proposed. It is recommended that patients presenting with dyspepsia should be worked out as per proposed management protocol, starting from the peripheral hospitals. This management protocol if well applied will reduce the time wasted "shopping" for doctors, costs incurred in doing unnecessary investigations, repeating of investigations and inappropriate use of drugs.