Dyspepsia

Question 1

How long should PPI/H2 receptor antagonists be stopped for prior to endoscopy?

Answer 1

2 weeks

Question 2

Management of dyspepsia without alarm symptoms? (3)

Answer 2

Trial lifestyle advice
Test + treat for H pylori
Trial PPI e.g. omeprazole 20mg for one month

Question 3

Alternative options to PPI?

Answer 3

H2RA e.g. ranitidine

Prokinetic e.g. domperidone

Question 4

Options for H pylori testing? (3)

Answer 4

Breath test
Serology
Faecal antigen test

Question 5

First-line eradication regimes for H pylori?

Answer 5

1 week of:

PAC500- omeprazole 20mg bd + amoxicillin 500mg bd + clarithromycin 500mg bd

PMC250- omeprazole 20mg bd + metronidazole 400mg bd + clarithromycin 250mg bd

Question 6

Management of endoscopic-proven GORD?

Answer 6

Full-dose PPI for 1-2 months

If remain symptomatic, double dose PPI; if no response, try H2 receptor antagonist and/or prokinetic

Question 7

Metaplastic transformation of squamous mucosa of the oesophagus

Answer 7

Barrett’s oesophagus

Question 8

Iron-deficiency anaemia + dysphagia due to post-cricoid oesophageal web

Answer 8

Plummer-Vinson syndrome

Question 9

Presents with dysphagia + regurgitation + halitosis + 2/3rds have a palpable neck swelling

Answer 9

Pharyngeal pouch

Question 10

Epigastric pain worsened by eating

Answer 10

Gastric ulcer

Question 11

Epigastric pain improved by eating

Answer 11

Duodenal ulcer

Question 12

Peptic ulceration caused by a gastrin-secreting pancreatic/duodenal tumour

Answer 12

Zollinger-Ellison syndrome

Question 13

Virchow’s node

Answer 13

Enlarged supraclavicular lymph node, associated with gastric cancer

Question 14

Management of peptic ulcers? (3)

Answer 14

Eradicate H pylori if present; PPI for 2 months; re-endoscope to ensure healing

Question 15

Abdominal distension + colic + vasomotor symptoms after eating

Answer 15

Dumping syndrome- post-gastrectomy complication due to rapid emptying of the stomach