Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic epigastric pain of at least 6 months duration, meeting Rome IV criteria for Epigastric Pain Syndrome (EPS). Symptoms include bothersome epigastric pain or burning occurring at least 1 day per week, severe enough to interfere with usual activities. Patient denies postprandial fullness or early satiation. No alarm features (weight loss, dysphagia, anemia, or persistent vomiting). Symptoms are not relieved by defecation or associated with change in bowel habits.
Clinical Examination Findings
General: Patient appears in no acute distress. Abdomen: Soft, non-distended, bowel sounds normoactive. Palpation: Localized tenderness to deep palpation in the epigastric region; no rebound tenderness, guarding, or rigidity. Organomegaly: No hepatosplenomegaly or palpable masses. Rectal exam: Deferred/Normal, no evidence of melena or occult blood.
Treatment Protocol
Initiate trial of Proton Pump Inhibitor (PPI) once daily for 8 weeks. If symptoms persist, consider neuromodulator therapy (e.g., low-dose tricyclic antidepressant). Advise avoidance of known dietary triggers (caffeine, alcohol, spicy foods). Lifestyle modification: Smoking cessation and stress management. Follow-up in 8 weeks to assess response to therapy.