Abstract

Dyspepsia describes a constellation of symptoms centred in the upper abdomen. In functional dyspepsia, no discernible organic pathology is found. Diagnosis and management of these patients are challenging but centred on individual symptom management. In organic dyspepsia, patients are found to have a number of disorders to account for their symptoms. These include gastritis and peptic ulceration. Gastritis refers to a group of diseases characterized by inflammation of the gastric mucosa. It can be acute or chronic in nature and may involve part or all the stomach. H. pylori infection gives rise to Type B atrophic gastritis where the inflammatory changes are accompanied by atrophy and intestinal metaplasia. There is an increased risk of intestinal type gastric cancer. Other types of gastritis are less common. Peptic ulcer disease and its complications remain a significant cause of morbidity and mortality. It is most commonly caused by H. pylori infection or the use of non-steroidal antiinflammatory drugs. Management involves the use of PPIs together with eradication therapy of H. pylori. The management of perforation and gastric outlet obstruction is mainly surgical. The management of upper gastro-intestinal bleeding consists of resuscitation and haemostasis mainly by endoscopic therapy. In-hospital mortality from bleeding peptic ulcers remains high. Acute gastric dilatation and gastric volvulus are surgical emergencies. The management must commence early by resuscitation followed by prompt surgical management. Mortality remains high in vulnerable and compromised patients.