From the Guidelines
Whole abdominal ultrasound is not generally recommended as a first-line investigation for uninvestigated dyspepsia in most patients, except in cases with specific alarm features or suspected biliary and pancreatic disease, as indicated by recent guidelines 1. The primary indications for abdominal ultrasound in dyspepsia include the presence of alarm features such as unexplained weight loss, persistent vomiting, progressive dysphagia, gastrointestinal bleeding, iron deficiency anemia, palpable mass, or lymphadenopathy. Key considerations for the use of ultrasound in dyspepsic patients include:
- Patients over 55 years with new-onset dyspepsia
- Those with a family history of upper gastrointestinal cancer
- Patients with suspected biliary disease, particularly if pain is localized to the right upper quadrant or associated with fatty food intake
- Patients with abnormal liver function tests or suspected pancreatic disease For most patients with uncomplicated dyspepsia, especially those under 55 without alarm features, initial management typically involves either empiric acid suppression therapy with proton pump inhibitors or testing for Helicobacter pylori with either a urea breath test or stool antigen test, followed by appropriate eradication therapy if positive, as recommended by the British Society of Gastroenterology guidelines 1. Ultrasound is valuable when biliary or pancreatic pathology is suspected as it can effectively visualize gallstones, biliary obstruction, and pancreatic abnormalities that may present with dyspeptic symptoms, while avoiding radiation exposure, as discussed in the guidelines 1. In patients aged ≥60 years with abdominal pain and weight loss, urgent CT scanning should be considered to exclude pancreatic cancer, according to the guidelines 1. Overall, the decision to use abdominal ultrasound in patients with dyspepsilo should be based on the presence of specific alarm features, suspected biliary and pancreatic disease, and in accordance with recent guidelines 1.
From the Research
Indications for Whole Abdominal Ultrasound in Uninvestigated Dyspepsia
- The use of abdominal ultrasound as a diagnostic tool in uninvestigated dyspepsia is recommended as a first-line obligatory routine method, along with the exact estimation of nutritional condition 2.
- Abdominal ultrasound, physical examination, and BMI control have significant value in the diagnostic evaluation of dyspepsia 2.
- However, other studies do not specifically mention the use of whole abdominal ultrasound as a primary diagnostic tool for uninvestigated dyspepsia, instead focusing on empiric treatment, H. pylori testing, and endoscopy for patients with alarm symptoms or those over 60 years old 3, 4, 5.
- The majority of the studies focus on the management of dyspepsia through medication, lifestyle modifications, and endoscopy, rather than the use of abdominal ultrasound as a primary diagnostic tool 3, 4, 5, 6.
- One study suggests that upper GI endoscopy is justified in patients under 60 with alarm symptoms to exclude upper GI neoplasia, but does not mention the use of abdominal ultrasound 6.