1. DR SHARAD MALHOTRA CONSULTANT GASTROENTEROLOGIST, HEPATOLOGIST AND THERAPEUTIC ENDOSCOPIST BATRA HOSPITAL, NEW DELHI

5. FUNCTIONAL DYSPEPSIA

6. Definition Characteristics: Central abdomen Pain or discomfort Not associated with bowel movements No structural or biochemical abnormalty Part of Gastroduodenal disorders (Rome II)

7. Classification Organic dyspepsia PUD, GERD, Pancreatico-billiry disease Functional dyspepsia Ulcer-like dyspepsiea Pain Dysmotility-like dyspepsia Discomort; nausea, vomiting, postprandial fullness and upper abdominal bloating Reflux-like dyspepsia Heartburn but not the predominant symptom

8. It occurs in approximately 25 percent of the population each year, Most affected people do not seek medical care

9. Alarm symptoms Unintended weight loss Persistent vomiting Progressive dysphagia Odynophagia unexplained anemia or iron deficiency Hematemesis Palpable abdominal mass or lymphadenopathy Family history of upper gastrointestinal cancer Previous gastric surgery Jaundice NPV=99%

10. Endoscopy  Advantage:  Gold standard test to exclude gastroduodenal ulcers, reflux esophagitis, and upper gastrointestinal cancers.  Beneficial because up to 40 percent of patients have an organic cause of dyspepsia.  It also provides reassurance to patients

12. CANCER- OFTEN DIAGNOSED LATE

13. GASTRO ESOPHAGEAL REFLUX DISORDER MYTH 1: WRONG FOOD IS THE SOLE CAUSE OF GERD MYTH 2: GERD PATIENTS SHOULD KEEP THE BED RAISED

14. MYTH 3: BODY WEIGHT DOES NOT MAKE A DIFFERENCE MYTH 4: EXCESS ACID PRODUCTION CAUSES GERD

15. MYTH 5: GERD CAUSES ONLY COMPLICATIONS IN ESOPHAGUS MYTH 6: TOO MUCH STRESS CAUSES GERD

16. MYTH 7 :GERD IS BEYOND TREATMENT MYTH 8: ACID SUPPRESSING MEDICATIONS WILL IN RETURN CAUSE INDIGESTION

17. MYTH 9: GERD IS NOT A SERIOUS DISEASE MYTH 10 : IF MEDICATIONS FAIL, NOTHING CAN BE DONE

18. Alcohol Use

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20. Alcohol: Our Most Primitive Intoxicant Egypt (el-Guebaly N, el-Guebaly A, 1981, Int J Addict., 16:1207- 21) barley beer is probably the oldest drink in the world with its origin in Egypt prior to 4200 BC China (McGovern et al., 2004, PNAS, 101:17593-17598) 7000 BC - the production of a prehistoric mixed fermented beverage of rice, honey and fruit (neolithic village of Jiahu in Henan province) 2000 BC- unique cereal beverages (Shang and Western Zhou Dynasties)

21. Drinking Patterns: Rates and Risks Moderate Drinking Most people abstain or drink moderately placing them at low risk for alcohol use disorders. In general, Moderate Drinking is up to 2 drinks/day for men; up to 1 drink/day for women (USDA/HHS Dietary Guidelines, 2005) One drink: one12-ounce can or bottle of beer orwine cooler, one5-ounce glass of wine, or1.5 ounces of 80-proof distilled spirits.

22. Nearly 3 in 10 U.S. adults engage in these high-risk drinking patterns 1 Men:more than 14 drinks in a typical week more than 4 drinks on any day Women:more than 7 drinks in a typical week more than 3 drinks on any day 1 Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003 Drinking Patterns: Rates and Risks High-Risk Drinking

23. Ancient Warnings About Alcohol and Harmful Use Through the Ages 1600-1050 BC - Downfall of Egyptian and Chinese Empires and Dynasties attributed to excessive alcohol use 460-320 BC- Grecian Scholars issued advisories on drunkenness and moderate drinking Plato – No use under age 18, between 18-30 use in moderation, no restrictions for use by those older than 40 Aristotle and Hippocrates were both critical of drunkenness 11 th Century AD - Simeon Seth, a physician in the Byzantine Court, wrote that drinking wine to excess caused inflammation of the liver, a condition he treated with pomegranate syrup

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