DYSPEPSIA IN AFRICAN-AMERICAN AND HISPANIC PATIENTS
Dyspepsia, derived from the Greek “dys” (bad, difficult) and “pepsis” (digestion), is defined as pain or discomfort in the upper abdomen. Dyspepsia is a common symptom with a prevalence of up to 40% in the general population. Dyspepsia is responsible for more than 11 million physician office visits annually. More than half of these patients presenting with dyspepsia have no detectable cause for their symptoms. The common organic causes of dyspepsia include peptic ulcer and esophagitis. The upper gastrointestinal (UGI) tract, as an organic cause of dyspepsia, accounts for 1-2% and less in patients under age 50 years. The presence of one or more alarm features may help identify patients with a higher risk for underlying lesions. The common alarm features include age older than 50 years, anemia, weight loss, gastrointestinal bleeding, loss of appetite, early satiety, abdominal mass, and dysphagia.
Options for evaluating dyspeptic patients include therapeutic trials, testing for Helicobacter pylori, UGI radiography, and endoscopy. Once the decision has been made to investigate, the diagnostic test of choice is endoscopy. A clinical diagnosis of dyspepsia may be unreliable and misleading. Patients in whom investigations have revealed no organic cause are considered to have functional dyspepsia or “nonulcer dyspepsia.” There may be considerable overlap of nonulcer dyspepsia with other functional gastrointestinal disorders—in particular, irritable bowel syndrome, aerophagia, and some cases of gastroesophageal reflux and rumination syndrome. canadian discount drugs
Our estimates of a population’s attributable risk of higher mortality from upper- and lower gastrointestinal hemorrhage in African-American and Hispanic patients suggest a need for further investigations in other gastrointestinal disorders as well. H. pylori infects approximately half of the world population. Previous studies have reported an overall prevalence of H. pylori of approximately 32-35%. This prevalence increases with age to 41-57% for those persons aged 70-85 years. African-American and Hispanic populations have a higher prevalence of H. pylori infection than do Caucasian Americans. Although H. pylori infection affects the majority of patients with duodenal and/or gastric ulcers, the association of H. pylori and nonulcer dyspepsia is not very clear.
Although there is ample data in the literature about dyspepsia in the population at large, this problem is not well studied in African-American and/or Hispanic patients. Our study focused on these two ethnic groups, as they constitute the majority of our patients. The aim of this study was to determine the etiology of dyspepsia in African-American and Hispanic patients in relation to age and the presence or absence of alarm features.