Dyspepsia surgery
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Dyspepsia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Dyspepsia surgery On the Web |
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American Roentgen Ray Society Images of Dyspepsia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahad Hasan, M.D.[2] Ajay Gade MD[3]]
Overview
Surgery for dyspepsia is reserved for a small but important subset of patients with well-defined structural disease — principally peptic ulcer disease complicated by perforation, haemorrhage, obstruction, or medical intractability — and, in highly selected cases, for medically refractory symptoms attributable to disordered gastric neuromuscular function. Critically, contemporary guidelines from the British Society of Gastroenterology (BSG) explicitly state that surgery should be avoided in patients with severe or refractory FD, in order to minimise iatrogenic harm, given the absence of high-quality evidence for benefit and the recognized risk of worsening symptoms post-operatively.[1] The substantial reduction in elective peptic ulcer surgery over recent decades is directly attributable to the discovery of Helicobacter pylori and the development of effective proton pump inhibitor (PPI) and eradication therapies.
Surgery
Indications for Surgery in Dyspepsia-Related Conditions
Surgical intervention in dyspepsia is predominantly indicated for organic complications of peptic ulcer disease rather than for FD per se. Recognised indications include:
| Indication | Clinical Scenario | Preferred Approach |
|---|---|---|
| Perforated peptic ulcer | Pneumoperitoneum, peritonitis, haemodynamic instability | Laparoscopic or open repair; omental patch closure |
| Upper gastrointestinal bleeding refractory to endoscopy | Failure of repeated endoscopic haemostasis | Open or laparoscopic gastric surgery; angiographic embolization if available |
| Gastric outlet obstruction | Pyloric stenosis secondary to chronic PUD; vomiting, succussion splash | Gastrojejunostomy, vagotomy and drainage, or endoscopic dilatation where feasible |
| Intractable peptic ulceration | Failure of maximal medical therapy including PPI and H. pylori eradication, confirmed absence of NSAID use | Highly selective vagotomy (preferred elective procedure), or vagotomy and drainage |
| Suspected or confirmed gastric cancer | Ulcer with malignant features on endoscopy/histology | Gastrectomy with curative or palliative intent |
| Medically refractory gastroparesis with dyspeptic symptoms | Objective delayed gastric emptying (>10% retention at 4 h), failure of dietary and pharmacological management | Gastric electrical stimulation (GES), laparoscopic pyloroplasty, or G-POEM |
References
- ↑ Black CJ, Paine PA, Agrawal A, Aziz I, Eugenicos MP, Houghton LA, Hungin P, Overshott R, Vasant DH, Rudd S, Winning RC, Corsetti M, Ford AC. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut. 2022 Sep;71(9):1697-1723. doi: 10.1136/gutjnl-2022-327737. Epub 2022 Jul 7. PMID: 35798375; PMCID: PMC9380508.