CASES (II)

Question 1

According to NICE, what are indications for urgent upper Oesophago-Gastro-Duodenoscopy (OGD)

Answer 1

1. New-onset dysphagia
2. Aged >55 years with weight loss and either upper abdominal pain, reflux, or dyspepsia
3. New onset dyspepsia not responding to PPI treatment

all in relation to symptomatic presentation of peptic ulcer disease. peptic ulcers can present with epigastric or retrosternal pain*, nausea, bloating, post-prandial discomfort, or early satiety.

Question 2

Differentiating between gastric ulcer and duodenal ulcer

Answer 2

epigastric pain is the most classical symptom associated with peptic ulceration

any pain from a gastric ulcer is exacerbated by eating, whilst duodenal ulcers are worse 2-4 hours after eating or even alleviated by eating