Dyspepsia

Question 1

Dyspepsia describes a range of upper gastro-intestinal symptoms, which are typically present for _______ or more weeks.

Answer 1

4

Question 2

What are the symptoms of dyspepsia? (6)

Answer 2

1. Upper abdominal pain and discomfort
2. Heartburn
3. Gastric reflux
4. Bloating
5. Nausea and or vomiting
6. Early satiety

Question 3

What are the causes of dyspepsia? (5)

Answer 3

1. GERD
2. PUD
3. Gastro-esophageal malignancy
4. Side effects of medication
5. Functional dyspepsia (majority of patients)

Question 4

Uninvestigated dyspepsia describes symptoms in patients who have not had ______________

Answer 4

an endoscopy

Question 5

The majority of patients with dyspepsia are likely to have __________ dyspepsia

Answer 5

functional; an underlying cause cannot be identified and endoscopy findings are normal

Question 6

Dyspepsia symptoms in pregnancy are commonly due to ____________

Answer 6

GERD

Question 7

Patients with dyspepsia should be advised regarding which lifestyle measures? (9)

Answer 7

1. Healthy eating
2. Weight loss (if obese)
3. Avoid triggering foods
4. Eating smaller meals
5. Eating the evening meal 3-4 hours before bed
6. Raising the head of the bed
7. Smoking cessation
8. Reducing alcohol intake
9. Manage stress, anxiety, and depression if present

Question 8

Urgent endoscopic investigation is required in which patients with symptoms of upper abdominal pain, reflux, or dyspepsia? (3)

Answer 8

Patients with…

1. Dysphagia
2. Significant acute GI bleeding
3. Age 55 and over with unexplained weight loss

Question 9

__________________ is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia

Answer 9

Urgent endoscopic investigation

Question 10

Which drugs are associated with dyspepsia? (12)

Answer 10

1. Alpha-blockers
2. Anti-muscarinics
3. Aspirin
4. Benzos
5. Beta-blockers
6. Bisphosphonates
7. CCBs
8. Corticosteroids
9. Nitrates
10. NSAIDs
11. Theophyllines
12. TCAs

Question 11

_____________ and/or ____________ may be used for short-term symptom control of dyspepsia, but long-term, continuous use is not recommended.

Answer 11

Antacids

alginates

Question 12

In patients with uninvestigated dyspepsia, a _______________ should be taken for 4 weeks

Answer 12

PPI

Question 13

In patients with uninvestigated dyspepsia, a PPI should be taken for _____________

Answer 13

4 weeks

Question 14

Patients with dyspepsia should be tested for _______________

Answer 14

Helicobacter pylori (H. pylori) infection, and treated if positive

Question 15

Public Health England recommends that patients who are at high risk for H. pylori infection should be tested for H. pylori ______________ (before/in parallel with/after) a course of proton pump inhibitor

Answer 15

first, or in parallel with

Question 16

Public Health England recommends that patients who are _______________ should be tested for H. pylori first, or in parallel with a course of proton pump inhibitor

Answer 16

at high risk for H. pylori infection

Question 17

For patients with functional dyspepsia, patients should be tested for ____________

Answer 17

H.pylori and treated if positive

Question 18

In patients with functional dyspepsia who are not infected with H. pylori, a _____________ or a _____________ should be taken for 4 weeks

Answer 18

proton pump inhibitor

histamine2-receptor antagonist (H2-receptor antagonist)

Question 19

How should patients with refractory dyspepsia symptoms be managed? (4)

Answer 19

1. New alarm symptoms should be assessed
2. Alternative diagnoses should be considered
3. Patients adherence to initial management should be checked
4. Lifestyle advice should be reinforced

Question 20

In patients with uninvestigated dyspepsia taking an NSAID and unable to stop the drug, consider _________________, or _______________

Answer 20

reducing the NSAID dose and using long-term gastro-protection with acid suppression therapy

switching to an alternative to the NSAID, such as paracetamol or a selective cyclo-oxygenase (COX)-2 inhibitor

Question 21

In patients with uninvestigated dyspepsia taking aspirin and unable to stop the drug, consider ________________

Answer 21

switching from aspirin to an alternative antiplatelet drug

Question 22

Do patients treated with H.pylori eradication therapy require routine retesting?

Answer 22

No; although there are specific situations in high retesting may be appropriate and if positive, second-line eradication therapy should be prescribed

Question 23

How often should patients with dyspepsia be reviewed to assess their symptoms and treatment?

Answer 23

Annually; a ‘step down’ approach, or stopping treatment, should be encouraged if possible and clinically appropriate. A return to self-treatment with antacid and/or alginate therapy may be appropriate

Question 24

A __________ approach, or __________ treatment, should be encouraged in patients with uninvestigated or functional dyspepsia if possible and clinically appropriate. A return to self-treatment with __________ and/or ___________ therapy may be appropriate

Answer 24

‘step down’

stopping

antacid

alginate

Question 25

Referral to a specialist for further investigation of dyspepsia should occur in patients of any age with _____________ symptoms that are unexplained or non-responsive to treatment, or in patients with _____________ that has not responded to second-line eradication therapy

Answer 25

gastro-oesophageal

H. pylori infection