A 59-YEAR-OLD PROFESSOR HAD DYSPEPSIA AND SUBJECTIVE WEIGHT LOSS. HE WAS TREATED PREVIOUSLY FOR H PYLORI INFECTION. EGD AND BIOPSIES SHOWED CHRONIC INFLAMMATION WITH INTESTINAL METAPLASIA AND ONE FOCAL AREA OF LOW-GRADE DYSPLASIA. WHAT DO I DO?

Dyspepsia is a nonspecific complaint that may be related to a number of underlying gastrointestinal problems. It consists of a variety of upper abdominal symptoms, including fullness and dull aching in the epigastrium and early satiety. Some patients also notice abdominal bloating associated with frequent belching, whereas others complain of heartburn symptoms. In rare cases, patients may have nausea and vomiting. It is estimated that 20% to 25% of the general population has dyspepsia, which could be related to either functional or organic causes. Functional dyspepsia (FD) can be caused by delayed gastric emptying, complicated longstanding diabetes mellitus, impaired gastric motility, and hyperalgesia to gastric distension. Organic causes include most commonly peptic ulcer diseases, gastroesophageal reflux disease (GERD), and intake of gastric irritants such as nonsteriodal anti-inflammatory drugs (NSAIDs) or other medications. Rarely, it may be related to underlying gastric malignancy or pancreaticobiliary disorders. ¹.