Double-inlet ventricle

Dyspepsia (Dyspepsia)

1) Disease Description (Causes and Symptoms)

• Definition summary: Dyspepsia is a syndrome that collectively refers to discomfort or pain in the upper abdomen occurring before or after eating. It is classified as functional (occurring without an organic cause) or organic (mechanical or inflammatory lesions such as ulcers, gastritis, or gastric cancer).
• Main causes: Helicobacter pylori infection, gastritis and peptic ulcers, gastroesophageal reflux disease (GERD), gallbladder and pancreatic diseases, medications (especially NSAIDs and aspirin), metabolic diseases (e.g., diabetes), heart disease (which may resemble chest pain), psychological stress, depression, anxiety, and others.
• Pathophysiology (briefly): Abnormal gastric motility and sensation (delayed gastric emptying and gastric hypersensitivity), abnormal acid secretion, mucosal damage, infection (Helicobacter pylori), and changes in pain regulation related to the central nervous system contribute to the mechanism of functional dyspepsia.
• Main symptoms: Postprandial discomfort (fullness and early satiety), upper abdominal pain or burning (distinct from heartburn), belching, nausea and vomiting, abdominal bloating, and weight loss (an alarm symptom).

2) Treatment Methods and Precautions

• Lifestyle modifications (basic treatment)
  • Eat regular meals, chew slowly and thoroughly, and eat small amounts frequently (avoid overeating)
  • Limit spicy and irritating foods, high-fat foods, caffeine, alcohol, smoking, and carbonated beverages
  • Do not eat 2–3 hours before bedtime, maintain an appropriate weight, exercise regularly, and manage stress
• Medication treatment (selected according to symptoms and cause)
  • Helicobacter pylori positive: Eradication therapy (combination antibiotic therapy) — eradication is recommended after testing
  • Acid-related symptoms (pain and heartburn): Proton pump inhibitors (PPIs) or H2 blockers (generally, a 4–8-week trial of a PPI)
  • Symptoms of gastric motility disorder (early satiety and belching): Gastrointestinal prokinetic agents (used at the physician’s discretion; precautions regarding side effects are necessary)
  • Refractory pain from functional dyspepsia: Low-dose tricyclic antidepressants (TCAs) or, in some cases, SSRIs/SNRIs may be considered
  • Short-term relief with antacids, gastric mucosal protectants, and other agents
• Tests and procedures/surgery
  • If alarm symptoms (weight loss, persistent vomiting, melena/hematemesis, dysphagia, persistent abdominal pain, etc.) or age criteria (generally age 55 or older, or according to regional clinical guidelines) are present, upper gastrointestinal endoscopy (gastroscopy) is recommended
  • If an organic lesion (e.g., gallbladder or pancreatic disease) is suspected, imaging tests such as abdominal ultrasonography or CT may be performed
• Precautions
  • Prioritize identifying the cause rather than prolonged self-treatment (overuse of pain relievers or antacids)
  • Prokinetic agents and antidepressants may cause side effects (including movement disorders and cardiovascular or central nervous system effects), so follow the physician’s instructions
  • If chest pain (suggesting myocardial infarction) or severe bleeding symptoms occur, visit the emergency room immediately

3) Checkpoints Before an Outpatient Visit (Including Items to Bring · Example Questions)

• Items and records to prepare
  • List of currently used medications (including OTC medications): NSAIDs, aspirin, antacids, supplements, etc.
  • Past medical and surgical history (especially involving the stomach, gallbladder, or pancreas)
  • Copies or summaries of recent test results (blood tests, abdominal ultrasonography, gastroscopy, etc.)
  • Symptom diary: when symptoms began, relationship to meals, timing of symptoms (fasting/after meals), factors that worsen or improve symptoms, weight changes, and accompanying symptoms (fever, jaundice, diarrhea, discolored stool, etc.)
• Information to tell the doctor first during the outpatient visit
  • Whether weight loss, repeated vomiting, melena/hematemesis, symptoms not improving despite dietary control, dysphagia, or chest pain are present
• Preparation related to testing
  • Before a scheduled gastroscopy, fasting for 6–8 hours is required according to the instructions (follow the testing center’s guidelines)

Example questions (for patients to check themselves)

• "When did the symptoms first occur, and what was their relationship to meals?"
• "Have you experienced any weight changes over the past 2–3 months?"

4) General Example Questions to Ask the Doctor

• "What are the possible causes of my symptoms?"
• "Do I need a Helicobacter pylori test? What testing methods are available, and how will treatment be determined based on the results?"
• "What are the expected effects and side effects of the medications (e.g., PPIs and prokinetic agents)?"
• "When should I undergo endoscopy (or additional testing)?"
• "What should I change first in my usual lifestyle?"

5) Disease-Specific Example Questions

• "How much will Helicobacter pylori eradication therapy help improve my symptoms, and when should I be retested after treatment?"
• "Could the medications I am taking (e.g., NSAIDs/anticoagulants) affect my dyspepsia? Should I stop taking them or switch to alternative medications?"

Additional note: If severe chest pain, difficulty breathing, fainting, persistent vomiting, bleeding, or similar symptoms occur, use emergency medical services immediately.